[alcira]

I have been looking for a new T as I moved to a different town. I met with one recently but she had what seemed unreasonable cancellation policy. She said if you work with her you will have the same day/time appointment(s) (maybe more than one) every week but you can never cancel them (not even with 24, 48 or 72 hour notice) - it doesn't matter if you are sick, out of town, on vacation, emergency, etc. If you miss the appointment for any reason you owe her the fee for that appointment as she has a business to run. I've never heard of someone running a practice like that. Does anyone here have a T or have worked with a T with a similar policy?

Also, if you have advice on finding a competent, caring and honest T, I would greatly appreciate it.

[Amazonmom]

I don't think I would sign up with that T. I work in healthcare and have never seen anything other than a 24 hour cancellation policy in 10 years! She sure sounds like she is lining her pockets charging clients for appointments like this!

[stopdog]

I have heard of it, read books by guys who do it, and there is a blog by a guy who runs his practice like this. but I would personally never work with a therapist who had such a policy. I think it is often more of a hold over from traditional psychoanalysis. It seems to me like renting a space in the guy's appointment book.

I have interviewed over 12 therapists in the last two years. I found them through referrals and sites like psychology today (where there is often a little blurb about how they practice) - call them up and talk on the phone, make an appointment and interviewed them.

[ECHOES]

The good part for the patient is that it is a constant expense for the budget.
The good part for the therapist is that it is a constant income for the budget.
It just works well for some and is the preference of some. It's something to decide if it would work for you in the long run.

I just count on $400 a month as a constant therapy expense. My therapist doesn't have as strict a policy, although it is posted that patients are responsible for a cancellation without at least a 24 hour notice. She hasn't held me to that, and once I insisted on paying for the cancellation because I cancelled as I was driving there and knew it was avoidance. She set aside that time for me and I ditched her. She tried to give it back but I insisted and it was included on the check for 2 weeks of therapy, so she was stuck with it

[BashfulBear]

Yes, one of the Ts I recently met with has this policy too. I understand it's income for her, but like you, I find it unreasonable.. particularly given how much disaster strikes my family lately. I know it ensures people don't mess around and deliberately avoid sessions, but I'm not like that, so perhaps that's why I view it as odd and unfair?!

It's a shame because I think she could be really good if it wasn't for this policy and a couple of other odd ones!

Have you crossed that T off your list because of this? I hope you manage to find someone suitable!

I wouldn't be able to work with this particularly T because my life is much to variable and unpredictable to have a set appointment day and time. So yes, I would have to choose against some T's due to their policies on scheduling, etc. It is a factor we just have to consider -- the whole package so to speak.

not a choice we would make but you have to do whats best for you. seems a bit rigid-what if there was an unavoidable situation and you would still have to pay♥

[SoupDragon]

I can to some extent understand the need for financial commitment, but to balance this there should be flexibility in session times, just in case something crops up and an appointment can't be made.

This T seems very rigid and I wonder how that translates into her therapy?

what would happen if this t got sick?
does she NEVER take vacations?
had a car accident?
seriously, life happens.
would you still have to being paying her?

i couldn't work with this type of t either.

[googley]

I have seen Ts with these policies. I have also seen Ts with the policy that you are responsible for paying if they can't fill the hour with another client. IE the closer you cancel the appointment the less likely they are able to schedule another client in the slot. I can see both sides of it. I don't think I would be able to work with a T like that.

For me, therapy contains enough stressors (the tough work that goes along with doing deep work, concerns over the relationship itself, sometimes difficulty returning to what I need to accomplish afterward) that I wouldn't want to add another one. Insurance doesn't cover missed appointments, which would make me so nervous to have to pay the whole thing out of pocket. With my T, though I do need to cancel 24 hours in advance, she usually has a waiting list of people wanting to get an appt--she has called me at times when other clients have cancelled. Could this mean that this T doesn't have enough clients? This would worry me some. And as jbmomg points out, what if she misses? Is the next appointment on her? I get that this is a business, but such rigidness makes me wonder if her therapeutic approach is rigid? Flexibility within healthy boundaries is an important component of therapy, in my opinion.

[Eliza Jane]

I haven't had any T's with this policy, but I have a lot of friends who are in the music business who have policies like this for their private lessons.

My other thought is that maybe this T is go "good" or sought-after she can afford to be picky and demanding. I once had a pdoc like this. He was known to be the best in town, so he charged a lot, didn't accept insurance, and felt pretty comfortable firing people if they wouldn't do what he wanted.

IDK what I'd do. In my case, I did benefit from treatment with pdoc for a few years, but ultimately, his rigid independence caused us to part ways.

Good luck in whatever you decide,

EJ

[healed84]

Wow, that seems like a harsh policy.. I for sure could not work with somebody who was so strict like that. I guess it may work for some people though.

[alcira]

Thank you all for the replies! I am very grateful. I decided I could not work with someone like that. As many of you pointed out, it feels too rigid and life does happen. I think giving an advance notice for not being able to make an appointment is reasonable but not being able to do that is certainly not. I would not have even met with her, had I known about her policy. In a way, I feel she purposefully did not mention that until I made it to her office which is even more bothersome (at least now I know to explicitly inquire about this before I meet another T). She does come from psychoanalytic background and that was in part her justification for the policy. I have called a few Ts around here and it seems that the good ones are all booked weeks in advance and/or have waiting lists. So the fact the she did have a few available times (not a lot) despite her rigid policy, perhaps speaks for itself about her ability to retain clients and ultimately the quality of her work.

I asked the question here because I was uncertain whether this is a common practice as she implied it was. As far as I could tell that doesn't seem to be the case.

[kirbydog156]

I think that's really inflexible and unreasonable, and I wonder what other areas that T is not flexible in her practice. I know it's really difficult if clients are habitual no-shows, but people get sick, kids get sick, and as long as you give enough notice, that should just be factored into the business plan.

[Crescent Moon]

I've heard of it, but I think it's really unreasonable. With proper notice (24 - 48 - 72), most therapists in 'business' can fill that spot with a client who is trying to get in for an extra apt., or a new client, or even to conduct the paperwork, returning phone calls, etc. that they have to do.

I can understand that it would be a problem if a therapist has a client or two who abuses it and frequently cancels, but I'd be more in favor of a policy that allows cancellation with proper notice, alongside another policy that 'x' number of non-emergent cancellations within a certain period of time puts the client in jeopardy of termination.

He does it because he has to run a business? I'll be that policy turns away a good amount of business.

[critterlady]

I agree that this T's policy is too inflexible to be workable for most people.

My T's official policy is to charge for a full session with less than 24 hours' notice and he reviewed that with me in my first session. Since then, though, he's told me that it really is flexible and that if I wake up sick as a dog or some other emergency arises, I can cancel without charge. If it becomes a pattern, then it becomes chargeable and a topic for discussion in therapy. We make appointments week to week, but unless one of us has something unusual arise, we meet at the same time.

[Towanda]

This policy would really bother me, and like Soup, I would wonder if this attitude would run over into the therapy hour. I would not be able to work with this person from the outset. I would look for someone else.

[Nightlight]

The thing that would most annoy me about that is that it would presumably be okay for the therapist to cancel because they are sick, away, had a family emergency etc.

I think I've only once cancelled at the last minute. My T has a 24 hour policy as far as I can remember. Once she was expecting me and I didn't turn up because she'd told me a different day than what she had written down. However she has on occassions double booked accidentally, or booked me in for an incorrect time and by the time she realised had no spaces left when I could see her. So honestly, if I'd messed up our times more than she had, no problem paying for the cancellation fee. I haven't had to, and as I've often accommodated last minute changes for her, it would bother me, if it was for a genuine reason that I had to cancel. So I definitely wouldn't consider seeing someone who would not let me cancel for any reason, but surely would have to cancel at times themselves. Even if they didn't cancel, I wouldn't particularly want them to see me when they were really sick, or in the middle of family crisis.

[scorpiosis37]

alcira, it sounds like you've made your decision-- and a good one! I just wanted to chime in since reading about your prospective T's policy really rubbed me the wrong way. Usually, policies are created to protect BOTH parties-- but this policy seems to be for the benefit of the T, at the expense of the client. That just doesn't seem right.

It's completely unreasonable to say that a client has a weekly slot and must pay for that slot NO MATTER WHAT. For instance, if your time slot happens to falls on Christams Day, are you expected to either show up or pay for missing that appointment? If you plan a vacation 6 months in advance, and give T 6 months notice, is that really insufficent? Is 6 months really not enough time to work on filling that slot? Or what if you are in a car accident, are hospitalized for several weeks, and inform your T immediately? Are you really expected to pay for the series of sessions you miss while you are in the hospital?

What if T encounters these same situations? Does she pay YOU when she misses a session? Or give you a free session to make up for her absence? Policies are really only fair if BOTH parties benefit from that policy. And, as others have already pointed out, that kind of rigidity is probably a "red flag" for an overly rigid approach to therapy AND that is probably the reason she has this kind of a policy-- because she can't fill her schedule!

Even a T who has a fairly strict attendance policy should have some caveats for extreme circumstances. For instance, I don't think it would be unreasonable to say that you must pay for your session IF she is unable to book another client in your slot. If you give her days (weeks, months) notice, she should have no problem booking that slot. If you give her 12 hours notice-- you're probably going to have to pay. Alternatively, it would not be unreaonable to say (as us instructors do in our attendance policies) that you get "3 free misses" per semester (or 6 months). That way, if you are sick once, you go on vacation once, and your car breaks down once, you don't have to pay for missing those sessions. However, if you miss more than 3 times, then you have to pay for any additional missed sessions. Those kinds of policies help differentiate a responsible client with a legitimate circumstance from an irresponsible client who simply misses appointments.

In terms of what policies are common/fair, I think my T's policy is both typical and reaonable. I have a set day/time each week (hence, she can depend on my having income from my session). However, I have the right to cancel/reschedule my appointment with appropriate notice. The more notice the better-- for instance, if I know I'm planning a vacation, I tell her as soon as I know. However, if I get sick at the last minute, I will not be charged for my session as long as I give her 24 hours notice. Since my T is *fabulous* and is in high demand, she can almost always fill her cancellations. That way, she doesn't lose income when I'm not there. It also works both ways. There have been times T has been sick-- or one of her kids has been sick-- or she's had a conference to go to--and she has had to cancel/reschedule my appointment. She is understanding when I have to reschedule, so I am understanding when she has to reschedule. I'm also a PhD student/instructor and my class schedule changes every semester. As a result, I sometimes have to change my time slot at the beginning of a new semester. T always accomodates this so, in exchange, I've been willing to move my time on a couple of occassions in order to accomodate another client who would otherwise not be able to get an appointment that week. (For instance, if my slot is usually Tuesday at 1, I've let her push me to Tuesday at 2 that week, so the other client could have Tuesday at 1). As long as I'm going to get seen and I don't have another commitment at that time, it doesn't matter to me whether my slot is at 1pm or 2pm. I think the ability to be "human"-- to be flexible within reason-- is important in a T relationship. As is a little give and take!

Sure, being a T is a job, and Ts are highly edicated professionals, which means that they have to make sure that they get paid. But I agree completely with scorpiosis' points, and would add that the kind of policy you describe, alcira, sounds a bit infantilising. I fully understand it for music teachers who deal with children who may or may not be thrilled about coming to their weekly lessons (and who aren't paying for the lessons themselves) but even then there surely has to be a cancellation policy where you don't have to pay if you cancel more than, say, a week ahead of time.

My ex-T worked at a place where the centrally-decided cancellation policy was one week's notice, unless you were able to reschedule rather than cancel the time. Since my T, at least, was always fully-booked it was never possible to actually reschedule, at least not for me (on those three occasions when I had to cancel), so I did feel that the policy was a bit strict since it was obviously quite easy for them to fill any empty slots - but it wasn't T's own policy. On the other hand, at least once I know that I wasn't billed for a Wednesday appointment I'd cancelled on the previous Thursday, which meant that T must have just removed me from her calendar without reporting to the central administration that I had cancelled, which I thought was decent of her.

[dizgirl2011]

That sounds ridiculous and extreme. I would love to know what the policy is if she cancels! As a caring therapist (and human being) you would think she would appreciate that life happens and sometimes cancellations are nesscary or can't be helped. I would definately be put off this therapist from this policy alone.

[minneymouse]

The whole thing sounds pretty ridiculous, but the worst aspect is that it keeps the client tethered to the therapist rather than encouraging them to engage with the world (which is the ultimate purpose of therapy). I find it hard to miss seeing T as it is, but if I do cancel so I can go on holiday or do a new piece of work or to try to see if I can manage on my own, then off I go with her excitement and blessing for my endevours, not a £120 penalty for not showing up at her office that week...

[splitimage]

I wouldn't be able to work with a T who had that kind of policy. My T does charge for missed appointments if you don't cancel 24 hours in advance, which I think is reasonable. She also doesn't charge if you cancel because you're sick. But my T is also really busy and goes out of town to train other T's or to get more advanced training herself, so the same time every week thing wouldn't work.

My music teacher's policy is like that of the T in question. You pay for the lessons in advance and if you miss one you forfeit your fee with no make up lessons. If she cancels a lesson (rare) she does make it up. For some reason that seems fair to me, in a music teacher, but not in a T. Will have to think about why that is.

splitimage

[unaluna]

*** TRIGGER ***

is no one going to mention Woody Allen's joke in Annie Hall, where he says his analyst is a very strict Freudian, if you sui, you still have to pay for the sessions you miss...