The missed appointment fee is meant to cover the cost to the therapist when someone no-shows or cancels so late that the therapist can’t fill their spot. To me it makes sense to charge a client who misses appointments somewhat often with no notice. Some clients are habitually disrespectful of the therapist’s time. Without billing them for it the only options would be to tolerate the income loss (and loss of availability to would-be clients) or to terminate the client. So I think in principle the fee is okay.

It is completely unfair when a generally conscientious client is ill or has a similar emergency, or you know, your area is in the throes of a natural disaster. Every therapist I’ve ever been to has a no-show fee policy but none has charged it when I’ve had to cancel for illness, major family issue or even for the occasional (frontline HCW) work emergency.