Early thoughts on cancellation

I'm thinking of changing my 24-hour cancellation policy. What do you do?

I have different cancellation policies for different patients, for different treatments. I'm often struck by the doctrinaire way in which some clinicians advocate for their particular position (whether it's a 24-hour policy, a 48-hour policy, or a pay-for-all-scheduled-sessions policy).

Intuitively, my preference is to charge for all scheduled sessions. This preference is borne of two different, but related, perspectives:

1) Scheduling a session has a cost for me. It means I'm holding a time for a patient, agreeing not to see another patient in that time, and so, foregoing potential income from another source. That is the case regardless of whether a patient attends or misses a session. (Yes, it's possible, sometimes, to fill a "slot" that has been canceled, but this seems a mostly spurious objection to me, as it's generally not the case, for me, in my practice.) The analogy is to an airline seat, or a movie ticket: if I buy a movie ticket and then don't see the movie, I still have to pay for it.

2) More compellingly, to me: I don't actually think of the service I provide as being the provision of sessions, but rather, the provision of a relationship. That relationship takes place primarily, but not exclusively, in 45-minute sessions. I also think about my patients when we're not together; they think about me when we're not together. A missed session has meaning for both of us. CPT codes and conventions encourage us all to understand what we do as being sessions, but this feels profoundly wrong to me. If I had my druthers, I would charge a monthly fee....

That's all about how I think of these questions. But as do many others, I have a 24-hour policy with most of my patients because, at least so far, I haven't had the courage of my convictions with most of my patients. I will say that, when I have implemented the policy I said is my "druthers," it has worked well, reassuring my patient and establishing an opportunity to deepen the treatment. But I'm not brave enough to do that very often....