A new therapist with a strict timetable

September 17, 2019 7:22 AM

I'm looking for a new therapist. I've found one that I like, but at our introductory session, she told me that I can't cancel my regular slot if I can't make it - so if I'm on holiday or out of the city, I would need to pay for a slot that I can't use. Is that normal? Or are therapists normally a bit more forgiving with their schedules? I'm in the UK, if that makes a difference.
posted by anonymous to Human Relations (29 answers total)

This is pretty normal in my experience in the US (it's the same with music lessons and childcare also), I guess the thinking is that you have agreed to a service on a pre-set contract. But I will also say that most people I have worked with will help to reschedule a missed session-if this provider isn't, that seems very inflexible to me.
posted by epanalepsis at 7:33 AM on September 17, 2019 [2 favorites]

Seems unusual to me. My experience (personally and observing other people's scheduling with therapists) is that they have policies about "must cancel within NN hours or pay for session" but not "must always pay for slot whether or not one uses it."

I would expect if I had a recurring slot and canceled a lot that the therapist would balk at keeping me in that time slot. But in my experience (again, direct and observed) therapists have been happy to keep, say, a bi-weekly schedule where occasionally they're notified "hey, I need to move October 15 because I'll be out of town" or whatever.
posted by jzb at 7:40 AM on September 17, 2019 [18 favorites]

This is not normal - in fact is is cruel and doesn't take into account how normal people's schedules work.

... You should pay if you cancel with little notice, but not otherwise. If your therapist can't relate to other humans enough to know how normal peoples' schedules work, then I doubt the therapists ability to relate enough to perform therapy.
posted by jazh at 7:55 AM on September 17, 2019 [22 favorites]

It's common for therapists to have a cancellation policy (either you can only miss X number of appointments within a given period OR "if you miss an appointment within X hours that is not due to act of God emergency, you will have to pay 50%-100% of the fee/copay/etc")... however, missing appointments with reasonable notice is typically totally fine, at least in the United States. I am in the therapy world and do not know any therapists at all who do not let standard outpatients cancel without penalty/fee within some time frame.
posted by Keter at 8:00 AM on September 17, 2019 [7 favorites]

I have relatives who are therapists in the UK, and are heavily involved in therapy organisations, and this is absolutely not what they do, except for last minute cancellations.
posted by tavegyl at 8:09 AM on September 17, 2019 [2 favorites]

That does not sound normal to me for THERAPY (music lessons and childcare are not the same thing). I've been made to pay for a therapy session when I straight-up forgot to show up at the appointed time, but I've had a handful of different therapists over the years and ALL of them have been flexible about moving a session when notified well in advance that I needed to reschedule for work travel or vacation.
posted by anderjen at 8:15 AM on September 17, 2019

USA here, California. Cancellation 24 hours in advance or you pay. Decide on next session date and time at the end of each session. This works well for less frequent, but for me was the same when I was going weekly.
posted by artlung at 8:21 AM on September 17, 2019 [2 favorites]

Every therapist I've had was using the policy of "You must cancel within X hours." usually 24 or 48 hours. I have never heard of you having to basically buy the slots because that's what this arrangement is. You're on the hook no matter what.

US, Midwest and Texas. Been the same for doctors too.
posted by OnTheLastCastle at 8:24 AM on September 17, 2019

It sounds rigid if she was saying you can't reschedule *ahead of time with notice* if you're going to be "on holiday or out of the city."

But consider if she meant you can't cancel at the last minute and expect her to have to lose that session time and see you during another session with no fee. That happens a lot with some patients and many health care providers (not just mental health) have no-cancellation or 24-hour-notice policies to see as many patients as possible and keep from having idle/non-billable time.
posted by headnsouth at 8:25 AM on September 17, 2019 [2 favorites]

I’m in the UK; no that’s not usual. You would usually only be expected to pay if you cancelled at short notice. Certainly not where you’ve set up the schedule in advance and told them that you’re not available on a particular day.
posted by JJZByBffqU at 8:26 AM on September 17, 2019 [1 favorite]

I've encountered this in therapy groups, where the goal is to have the same set of people present every week as much as possible, and where rescheduling isn't an option because everyone would need to reschedule.

I'd find it very odd in individual therapy.
posted by nebulawindphone at 8:29 AM on September 17, 2019 [3 favorites]

That is absolutely absurd. Never heard of such a thing, and I would never trust such a person to be an empathetic human who I would want to share intimate information with. I don't care that a regular income stream is preferable. Cancellations are PART of the business model, and it is absurd to transfer ALL that risk to the patient. It is totally unconscionable. Cancellation policy: yes. This? Absolutely not. No way, no how.
posted by thegreatfleecircus at 8:30 AM on September 17, 2019 [3 favorites]

I think this isn't common in my experience in the midwest US, but also I have never been to a place where I had a standing "slot". I would schedule every appointment after the last appointment--I didn't just, say, own Thursdays at 4pm, even if I virtually always wound up with Thursday afternoons sometime. I can see how, if they're offering you that, what they're charging you for is not, strictly speaking, that you're missing the appointment. If they have everybody on fixed schedules, that they'd have almost no chance of being able to fill a slot even if you cancelled with 24-48 hours notice, unless someone else just happened to need to reschedule around the same time. I don't love the idea of it, but I might have been willing to pay for it to know that I could schedule my life around my appointments always being at the same time.
posted by Sequence at 8:45 AM on September 17, 2019 [1 favorite]

I am totally not getting charged for going on vacation. I can't speak for the UK but that isn't normal. Just give enough notice if you're gone is what seems to work here.
posted by jenfullmoon at 9:29 AM on September 17, 2019 [1 favorite]

I have to give 48 hours notice.
posted by jeszac at 9:52 AM on September 17, 2019

I'm on Team Not Normal, too. That's an absurd policy, and it puts a heck of a burden on the shoulders of the very people who don't need more burdens. Cancel within x-hours, sure. That's normal. This isn't.
posted by Thorzdad at 9:59 AM on September 17, 2019

I think it's rigid and unreasonable. In my experience, re-scheduling is a thing, because work/ life/ family/ illness. If you cancel with notice, the therapist has a slot open for someone who is in crisis or can't make their regular slot. This should have come up before the intro appointment.
posted by theora55 at 10:01 AM on September 17, 2019

In the US, I have heard a few therapists who that policy. Some of it may be that they in sufficient demand that they can afford to not take patients who don't agree. I also think that therapist with a more psychoanalytic approach are more likely to do that - has to do with their perspective on the entire process of how therapy works.

So, not normal in the sense that it isn't the most common but not unheard of it.

If you thinking of working with them, definitely ask about the possibility of rescheduling if space is available although be aware that there might not be much available since it would rely on someone else having to cancel first.
posted by metahawk at 10:12 AM on September 17, 2019 [1 favorite]

It’s pretty unusual but the therapist that I chose works this way (I’m in the US). She was upfront that it might not be a great fit if I traveled a lot. I think she only does therapy a couple days a week so there are limited slots, and cancellations would make it unsustainable. She offers to reschedule to another day that week (in advance), but if I completely canceled it, I’d have to pay for it. I liked her a lot, had tried a few others that didn’t work out, and this logistical piece didn’t feel that important to me since I wanted to prioritize this — but these factors may be different for you.
posted by sincerely yours at 10:15 AM on September 17, 2019 [2 favorites]

What sort of therapist is she? I could imagine this being a thing if she was psychoanalytic and she was holding the space for you whether you attend or not. But normally as long as you give notice - 24-48 hours as a standard - then you don’t pay. But I will say this considering she’s being called cruel etc: she is a working professional and perfectly entitled to set her own rules. If you’re not there she doesn’t get paid, and she can’t book someone else in if she has specific slots for each person. The whole point of explaining the contract and working conditions for your relationship is that you are perfectly entitled to say “no that doesn't work for me” without offence on any side. It is 100% your decision to choose not to work with her because her rules are too strict for you, but it’s not to say that her rules are somehow unethical - it obviously works for her for a variety of reasons. (I am in the UK and IAAT, IANYT)
posted by billiebee at 10:51 AM on September 17, 2019 [2 favorites]

I've heard of it, but it is not common. What happens if the therapist has to cancel for any reason? I would find it very difficult if they could cancel with no problems but I could never reschedule, ever.
posted by jeather at 11:38 AM on September 17, 2019 [1 favorite]

I don't know if it's common, but I would certainly be taken aback by it. For another data point, I'm in the UK too and my counsellor's policy is that you only need to pay if you cancel with less than 48 hours notice. And in practice, that is the organisation's policy but my individual counsellor has some leeway and can make exceptions, which she did for me when I once had to cancel at short notice due to a family emergency.
posted by maybeandroid at 11:43 AM on September 17, 2019

I've only been to one counselor (in California, USA) so no idea how universal this is, but they've been very flexible about schedule changes. I think technically I'm supposed to let them know 24 hours in advance, but at this point they've requested more schedule changes from me than I have from them.
posted by Aleyn at 12:16 PM on September 17, 2019

US: I've definately been billed for late cancellations, but never for planned vacations or other things like holidays. Does that person never take vacation, attend conferences, take case consultations, have family emergencies?

I would be concerned about the inflexibility especially if you have therapy on a Monday or Friday where lots of holidays tend to fall anyway.

Are you contracting to a specific number of Sessions as well? What happens if you want to quit, does the therapist want notice or something? That would be a huuuuge red flag (not one that you mentioned though).

My therapist was open to phone sessions, and I did get billed for time I utilized while I was out of town. I did find this very useful as at the time I find vacations rather stressful and the routine was really helpful.
posted by AlexiaSky at 1:20 PM on September 17, 2019 [1 favorite]

I'm in the UK and my notice period for rescheduling a session with my therapist is 4 weeks. It was put across as something mutual, and an expectation that I'll be there every week.

I've no idea whether it would be OK for me to cancel at a week's notice or not, but I feel pretty safe saying 2 weeks works fine. I've only been going a little over 6 months, and I can't remember whether I've done that or not.
posted by ambrosen at 1:57 PM on September 17, 2019

NYC here and my therapist is very flexible and understanding.

But some years ago, I had a NYC therapist (LCSW) who charged me for a session while I was having emergency abdominal surgery -- I even called her from the ER day before to cancel. She said she had bills to pay, and it was a longstanding appointment so... send the check.

I had to pay for all my scheduled appointments while I was recovering too, but was able to do some phone sessions. Truly, I never entirely felt the same about the therapist. Eventually moved on.
posted by alwayson_slightlyoff at 9:32 PM on September 17, 2019 [2 favorites]

I could imagine agreeing to this if the price per session were relatively lower so that even if I missed a bunch of sessions, it would still be reasonably priced. But this doesn't really benefit the therapist, unless they really hated scheduling and wanted the same sequence (modulo absences) each week.
posted by batter_my_heart at 10:27 PM on September 17, 2019 [1 favorite]

That sounds absurd. Therapists typically have cancellation policies where you may have to pay a fee if you cancel with less than 24 hours' notice, but I have never heard of anyone who says you can't cancel your standing weekly appointment at any time for any reason and will make you pay if you can't go. That seems far beyond what is reasonable; everybody gets sick or goes out of town occasionally, and I bet she does, too.
posted by kite at 9:52 AM on September 18, 2019

I had this with a therapist in the UK. I think it was a psychodynamic one, it was a relatively low cost service but that wasn't the reason it was done... it was what she did. My current therapist doesn't do this. I did mention it to my current therapist and she shrugged and said some therapists do it . I don't really agree with it perhaps it's because they want to hold slots for you.
posted by blue_eyes at 4:15 PM on September 21, 2019