A reader asked me how he could engage with people who regularly cancel their sessions.

Cancellations can be a pain in the neck. You need your income and also want to work in a satisfactory way with clients. Cancellations can interrupt both. I won’t go into all the issues that could be giving rise to the client cancelling. Sometimes the cancellation is a sign of an underlying issue that can be explored between you, but bear in mind that it may not always be an avoidance or a sign of lack of commitment. It is possible that it is genuinely not a good time for the client to do the work, because of other issues that are going on in their life. Perhaps, it might be as well to acknowledge this, and give the client the option of re-engaging when the time suits better.

Relationships are co-created, and as therapist you have your part to play too. I would start by spending some time asking yourself what you really want in the situation. The answer might surprise you!

Bringing up the issue of cancellations with a client can be tricky, especially if the client is avoiding something. When I encounter this problem, I like to refrain from raising it with the client until my own energy has cleared. So if I’m annoyed, I deal with that first. That way I can bring it into the session as a “clean challenge.”

I find the following questions help:

• I notice we’ve missed some sessions lately and I’m wondering if you’re finding it hard to be here?
• If it weren’t about (your mother being sick, overtime at work…) what might it be about?
• How do you feel the therapy is working for you at the moment? How is it to come here?
• And in relation to the cancellation fee, How do you feel about paying for something you’re not getting?

However, by the time you get to the frustration of having to deal with it, it is already an issue. So lay the ground for the future by being absolutely clear about where you stand. Here are some tips:

1. Start with an intention for what you want, for example, “I want to work with clients who respect my time and my need to earn an income.” Don’t underestimate the power of this step. It can bring up spectres of wanting to be liked, fear of rejection, worthiness and deserving.
2. At the outset, when you first speak to a client, underline that your time is important. So when you make the first appointment, ask the client to call you in advance if they are not able to make it, and specify a time limit (eg 24 hours.)
3. If you have credit card facilities, you could ask the client to pay a deposit.
4. At the first session, state your cancellation policy clearly and firmly. For example, “If you aren’t able to make an appointment, for whatever reason, please give me x hours / days notice. My preference is to rearrange the appointment within the same week, but if you don’t give me the notice, and we can’t find another time in that week, I will charge you for the session.” I usually add that I don’t want to do that, because I’d prefer the client to get what they paid for, but that I hold the time for them and can’t fill it with another appointment at short notice.
5. Get the client’s buy-in verbally. “How do you feel about that?” “Is that okay with you?”
6. You may wish to follow up with a written contract or a simple page outlining your terms. Bringing this in in the second session helps to reinforce the message.

When a client rings or texts to say they’re not able to make the appointment, consider reminding them of your cancellation policy at that stage. This feels like a bold step, and you don’t get the opportunity to process it with them there and then, but it may actually flush out that there is an underlying issue.

Finally, I find that not forcing myself to do or say things I don’t feel ready to say gets me further. When I allowed myself to let go of the “I should be dealing with this…” I experienced far fewer cancellations. These days it’s a rare occurrence that a client cancels, and when they do, there’s rarely an issue about them paying for it, probably because I’m far more relaxed about it.