T wants me to pay a deposit or else month up front

I keep my credit card on file with my T bc I never want there to be a problem with paying. My T is busy, and I don't want anything to go wrong that would make him irritated with me as a client on that level, bc I am a lot of work compared to some others.

I put a deposit on file for I assume missed appointments or payments. I've also cancelled under 24hr notice and been charged, which is fine with me. I'm aware of the rules and understand the business practice.

Mine doesn’t charge for cancelled sessions even if last minute. None of the doctors/dentists/therapists ever charged me regardless how close to the appt time I cancelled.

Reasons were snow storm started, got stuck at work, car broke, got sick, family member got sick Etc not often but it happened, alwars fir legitimate reason (but how do they know?) they had no issue with cancellations, just rescheduled.

I’d not see therapists or doctors who charge for cancelled appts (unless of course there was my only option).

Mine have technically charged for missed sessions (without 24 hours notice), but when I've had to cancel for something like being sick, my D being sick, weather, etc. they've never charged me. Current T even said recently that I'd probably get a free skip day because I've been so reliable.

When I worked in an agency serving Medicaid clients, charging for missed sessions was not an option, let alone asking for a deposit. Our clients were destitute. The tricky thing is that this population also has a higher no-show rate due to several factors. One is that many of our clients were on disability due to their mental illnesses and that's why they qualified for Medicaid. So they had pretty severe symptoms. Another factor was that because they were living in poverty, access to transportation was often an issue.

It was definitely a difficult problem to address, especially since Medicaid reimbursement rates are so low. From what I can recall, what we ended up doing was purchasing a fleet of vehicles and hiring transporters to assist clients with transportation barriers. We did reminder calls and if someone said they weren't coming, there was almost always someone else we could fill that slot with. We also hired a lot of therapists who were community based, so they met clients in the clients' homes. For med management, we actually double or triple booked appointments. That wasn't ideal, but it seemed to be the only way we didn't LOSE money. We obviously couldn't do that for therapy appointments since they were much longer. I think there was a limit of three cancellations or no-shows because we had a long waiting list.

Back to your original post: Is this T the only option you have? If you have other therapist options, why not check a few out? You have a history with this therapist, and it sounds like it was a bit contentious; additionally, this therapist has some preconceived ideas of you because of your past therapy with her. Would it not be a better idea to start fresh with someone who . . . A. Won’t require that kind of payment up front if that is something that doesn’t work for you . . . B. Will allow the biweekly schedule you were planning on . . . And C. Doesn’t have any preconceived ideas of who you are? It just seems like you haven’t even really started and there are several problems on the table already. To me, that screams “RUN!” Find someone better suited for your needs. Don’t settle.

I can see both sides to this issue. On the therapist's side, I can see asking for a deposit to cover missed sessions. My T's have all had cancellation policies that required a payment if the session wasn't cancelled within a certain amount of time (although former T never charged me. I was very consistent but had to cancel a few times in the 10 years for things like being in a car accident a couple of hours before the appointment etc). But I can see on the client's side that this feels punitive. Or at least it would feel punitive to me. But I think if I worked well with the T then I would pay the deposit and maybe discuss it a bit more with the T. But I think ultimately I would pay the deposit and move forward. HUGS Kit

I think that's completely unethical to ask for a deposit. Clients are not supposed to pay in advance for therapy sessions. I would never agree to any of this anyway. This therapist is treating you like a child. You're not a child. Having a 24-hour-cancellation policy is fine, I would never see someone who had requested more than 24-hour notice. I once saw a therapist who requested a 5-day-notice and I was like "lol bye".

But that’s the issue - OP has said she has a history of cancelling on short notice, so in this situation the T has every right to recoup her lost wages and/or terminate the client. (My T would let it happen once maybe twice and then he would end the relationship).

I don't agree that a therapist has a right to demand a deposit from a client no matter what. Other professions, who also depend upon clients paying for time, do not operate in this fashion. It is just a part of the business.

I think I would be willing to pay one session ahead, if I liked the T and so on, given the history. A month ahead seems excessive, especially when she wants to see you more than twice a month! Whatever you do, make sure you get a receipt!

That all said, I will not allow a T to keep a credit card on file and bill me as they wish. I did that with one I saw 4 times while my regular T was gone for 6 weeks. The substitute T charged me for 5 sessions and charged more than my copay ($40/session instead of $20). Since I wasn’t authorizing each charge and she never provided a receipt/invoice/statement I didn’t catch it until much later.

I pay my current T by check every week. I don’t need a receipt because I get the check image when she deposits them. I have paid her by credit card when I was on short-term disability (so cash flow was an issue), but I always got a receipt right away (emailed - and didn’t leave until it showed up on my phone). I pay by check so she doesn’t have to pay the transaction fee for running a card, though we haven’t discussed that.

But OP didn't say she had any history of non-payment, late payment, reluctance around paying for missed sessions, or anything else that would justify payment upfront. Having and enforcing a cancellation fee doesn't have anything to do with also requiring payment upfront.

This therapist is treating the OP based on experience. If this seems childlike then that is what it has come down to. Do not blame the therapist for acting in response to a pattern of behaviour. This very much IS maintaining professionalism.

Are there things the therapist can do to prevent this from continuing? Yes. They can have the office make reminder calls and have them determine if there is an outside factor or influence that would necessitate difficulty in making the appointment. That would give the office time then to book that slot with another client.

However, ultimately the responsibility lies with the client. If you are going to behave irresponsibly you need to expect such actions that would encourage you to step up accordingly. I see no blame on the part of the therapist and office at all here.

Perhaps standards are different in Canada. But in the US, APA issues cautions in related financial matters, such as financial inducements to research participants, fees from/to 3rd parties for consultations, obeying all jurisdictional laws regarding financial record keeping, and not behaving in a punitive manner, financially or otherwise. It would not be irrelevant to consider how such funds are categorized for tax purposes. Such funds would be held in the event of non-payment for services not rendered. This is not the same as a "retainer" payment. Not sure that would fly with the IRS.

More importantly for me, the notion that it is somehow justifiable psychologically simply because it is practically convenient and advantageous to the provider strikes me as intellectually and ethically bankrupt, as suggested by starfishing's post #20.

Why are we so quick to judge the service provider? The OP clearly stated a history of not showing up to appointments. It only makes sense then that there be repercussions for this behavior. The therapist could have terminated them altogether. The fact she is trying to make suitable arrangements that would allow the OP to have a continuous cycle of care is actually commendable.

Maybe because it is manipulative in some ways?

But if the cancellations of 1 client (are we talking a once a month cancellation here?) will threaten the therapists business and livelihood, maybe she has bigger issues we are unaware of.

Because it's gross to set up things so that they are to your own benefit and then turn around and try to convince the other party that they are the actual beneficiaries.

Edit: And to be clear, it's not that I think it is wrong to set things up to your own benefit, but don't act like it's some sort of therapeutic intervention, ffs.

I don't see a continuous cycle of care that rests on a punitive tactic as being of benefit to the client. I would say it's incumbent upon the therapist to approach the behavior psychologically (while also imposing whatever missed session fees are usual and customary). And if, upon reflection, the therapist cannot do so, ethics would require the therapist to refer out. The only beneficiary otherwise is the therapist's financial security.

There seems to be this assumption that such a financial imposition is psychologically neutral--or pushed to the extreme, positive for the client. I think that's a naive assumption. It seems more akin to me to physical punishment of a child. Some believe it teaches the child about the consequences of bad actions; others believe it teaches the child that people bigger than you will hurt you.

Both of these behaviors involve coercion.

How on earth is this being manipulative. It is she who is responding to the actions of the OP. Are you suggesting she ignore them? Is her business to be held hostage while she waits for the client to show up or not? And, to stir the pot here, are you all also suggesting the OP's irresponsibility and actions are permissible without repercussions?

No one has suggested not to charge for a cancellation without sufficient (24 hours) notice.

Reading through the lines, it has been indicated this was problematic. Clearly, the therapist has been unable to guarantee this will infact happen. That is the very reason why payment up front is now required. Reliability is the issue here.

I would not see a punitive therapist. If others would, that is up to them.
I do not read it that the client did not pay. If a client does not pay then perhaps an exploration of why would be in order.
(and as a solo practitioner - I have had clients not show up and not pay me for my services - I do not demand up front payments or retainers for my work and certainly not for missed appointments)

Valid point, but I am willing to assume - it would be the most reasonable, logical, and professional thing to have done so - that the therapist did entertain this. Ultimately though, we have to acknowledge that the therapist's choice in how to manage the situation has come as a direct result of the history she has with the client. We also need to acknowledge such decision is hers to make and I point out a recognised method of professionalism. Were the client to have been more reliable and consistent then we wouldn't even be discussing this.

I would suggest that it is manipulative because the therapist is not responding: she is reacting. Professionalism requires a therapist to be reflective, not reactive. There seems to be no reflection psychologically, but simply a reactive action (which can easily be seen as punitive) which only focuses on the therapist securing payment. Even if the OP has a history of non payment--which I see no indication of in her post--the therapist's job rests on addressing the issue psychologically; it is this which distinguishes the therapist from most other professionals offering a service for a fee. If she is unable or unwilling to do so, she shouldn't work with the client. And I would repeat that APA speaks to these sorts of issues and always keeps the ethical duty to reflect, not react, as a central tenet.

This T is being very manipulative. The T is a separate person-her behavior is irrespective of what the client does. This T's behavior/reaction is not the client's responsibility or fault.

In addition to what feralkittymom said, the therapist is taking an action to try to influence/get the client to do something. It's controlling. And engaging in the client's pattern is acting out--this is the very type of thing that leads to enmeshment with a T and client.

Feeling like being held hostage would come from the T, not the client. And yes, the client does deal with the consequences-the missed session, lack of support, missed session fee, whatever else. Engaging in the pattern-enmeshment-leads to more problems. Letting the client have autonomy to work the issue out will likely result in the issue running it's course on its own.