I think many of us here are self employed at an hourly rate and only get paid for appointments if the client actually shows up. I think it is a part of being self employed that people sometimes cancel. I only see it as a problem for me when a client cancels on me at the last minute (and I still don't charge them anything if they do) - I give the therapist enough time to fill in the slot with another client if they want. I also have been cancelled on by the therapist the morning of my appointment due to illness, change of schedule, her dog needing to be there for some reason, and so forth - and I do not give the therapist grief about it. I can handle that sometimes things arise. That is the equal courtesy that I find necessary.