What is your cancellation policy, and do you have any pointers you have for navigating difficult and awkward scenarios around cancellation? How flexible/strict are you with your policies? Do you offer freebies? And, do you accept any forms of payment besides cash and check?
Forms of payment I accept: After an evolution through PayPal and Venmo and credit cards and cash and check, I’ve pretty much settled down to accept (except in a couple of grandfathered cases) cash, check, bank transfer, and Zelle. I can go into elaborate answers as to why, but they boil down to two primary concerns: first, they’re the ones that are easiest and work best for me. And second, they all represent an instantaneous transfer of money from my patient to me – and they do so in ways that are in compliance with the terms of my agreements with the various vendors.
Cancellation policies: Here, too, I’ve evolved. When I started practicing, my policy was 24 hours. That created all sorts of problems for me, ranging from patients who cancelled as many as half of their (prime time) appointments 25 hours in advance to those who canceled at 24:01 (or 23:59), and thus, put me in a position of having either to abide by or clash with their acting out to those who were studiously compliant and considerate, and who were unable to reschedule long-planned conflicts with me because of the behavior of other of my patients (see above, taking up prime-time slots that they didn’t ultimately use).
I’ve come to a different policy, one that I feel reflects my reality and that I’ve found is a really helpful communicative tool with my patients – both about my reality, and about how I think about therapy. With my newer patients (in the last two years or so), I’ve moved to a no cancellation policy. When we start work together, I tell them that, to the extent we are scheduling on a one-off basis – a session here, a session there – my policy is 24 hours. But when they want to reserve a recurring time in my calendar? That then becomes an obligation for both of us. My obligation is to hold the time for them. Their obligation is to pay for that time. (They may use it however they choose, within reason.) I tell them that if their circumstances require them to reschedule a session, I’ll do my best to make something work within 7 days on either side of the regularly scheduled appointment, but that on the off chance we can’t make something work, they’ll still be obligated to pay me. (That has not happened yet.) Finally, I tell them that, to the extent they plan vacations in advance – and do so with me – I will not charge them for sessions that pass during their vacations. That’s a lot of words, but it boils down to, it costs me money to hold a session for you; if you want me to hold it, you have to pay for it. And/but, I understand vacations.
I pay my analyst in a way that reflects this, and I feel like, honestly, it’s really the best way I can imagine: we took a per-session fee. We multiplied it by 44 weeks in the year (figuring she gets 4 weeks vacation, and I do too, so 52-8=44). Then, we multipled my weekly cost of sessions * 44. And divided that by 12 months in the year. I set my bank to auto-pay her an even monthly fee, 12 months a year. Regardless of how many actual sessions there are. This works really well for her, and equally well for me. And, it has the bonus of reflecting how I conceive of therapy: not doled out in 45-minute increments, but rather, representing a sort of space our patients occupy in our minds. More like rent; less like a fee for a service.
You ask about flexibility: there are, always, patients who test the limits of any policy. (Right now I’m in the middle of an elaborate, multi-month enactment on this issue with one patient.) In general, I find that my patients really appreciate my policy – and my adhering to it, except in extreme circumstances or, most often, cases of genuine miscommunication.
All that said: I’ve definitely lost a few prospective or ongoing patients over this policy – patients who simply couldn’t or wouldn’t tolerate my assertion of my own needs. I think I’m getting better at communicating my rationale, and the impact, and haven’t lost any over it in a while. But when I started? It was a bit messy, and it definitely tried my conviction that it was what was right for me. But, increasingly, I’m certain that it is what’s right for me.
Finally, re: freebies. I think you’re asking about a sort of “freebie” for a missed session. I don’t offer that. Ever. Unless there’s been a complete failure of communication.I do, though, occasionally offer new patients one or two initial consultations at no cost, so we can both get a sense of whether we think it might be productive to work together. I go back and forth on how I feel about it. On the one hand, it feels both a bit seductive and a bit masochistic; on the other, it actually feels quite fair to me to the patient. So I’m unresolved on that.
