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

I've recently started therapy again with an old T. I had to cancel my appt last minute due to a panic attack I had that morning but attended the next day instead.

At the end of the session she told me she won't work with me on a fortnightly basis as I had requested as I would not get the benefit. She then said she wants me to pay a month up front every month as she feels this needs to be in place for me to attend as I have a history of being inconsistent.

When I said that felt like a lot she asked for me to pay double on my next appt and said that the extra money will be there in case I miss an appointment and this will then cover it. When I asked when will I get that money back? She told me, on my final session.

I do understand that it would be frustrating to have a client cancel last minute, but I've never heard of a T doing this and was taken aback by it. I asked if I can think about it and she said yes and we'd come up with a plan on our next session.

I just wondered what people thought of this?

I had one therapist who requested a $100 deposit at the start of treatment to cover the cost of any missed sessions. In her case that was because she took insurance and couldn’t charge insurance if a client missed a session.

Didn’t encounter that with any others, though. They just had cancellation policies.

My last T unless you cancel 24 hours in advance you pay for missed session the same amount as if you attended. I think that's pretty routine now days. For my T if I missed it was a bill but if you've a history of not showing up I can see why they insist on money up front.

I act out a lot by missing sessions. But I noticed that I actually never did this whenever I used to pay him for the whole month up front. He never asked me to do this though and actually prefers weekly payment. For me it was an incentive not to skip. Now that i've been seeing him for a while I usually send payment after both sessions eg for a thursday and friday session I'll pay on saturday or sunday,

He's also never charged me for a skipped session. If he did it would probably add up £££.

I don't think it's an unreasonable request. I would do it if my T requested it and not worry about it, because I'm not paying for anything I won't receive. Car rentals, airplane reservations, hotels, I pay for lots of things up front and don't feel like I'm being scammed for things I won't use.

I have to pay for missed sessions and my T has a 14 day cancellation policy. We’ve talked about it and I’m ok with his reasons for this. When I want to cancel (mostly in order to avoid things in therapy) it has made me think about my decision a bit more.

Seems like a reasonable request since there is a history of cancellations. It's amazing how people will commit more to things when they are already financially invested.

My husband wasn't a last minute cancel kind of person, but he had a tendency to forget and miss sessions. Just carelessness. Our therapist had him start paying full cost for his missed sessions, and funny how he started being more attentive to his schedule (particularly after I fussed at him about the financial end of things).

Is this going through insurance?

I wouldn't hire one who required a deposit of any sort. They get paid for the time I use and they can bill me. I always cancelled at least 48 hours ahead of time and would not work with one who required more than 24 hours cancellation notice.
I would absolutely never give one of those guys a credit card. As much as they do not trust clients, those guys are not immune to the lure of using a credit card that is not theirs.

I don't believe in paying for services up front. What if she gets called out of state for a family emergency and misses 2 weeks? Then your money would be tied up.

Maybe holding a credit card number is more reasonable.

If you think it's helpful, why not do it.

I don't know, seems odd and yet reasonable. I pay my personal trainer for 20 sessions at a time. I buy bulk sessions with my massage person as well. I had thought about this type of arrangement with my T in the past and thought it would be easier to pay her my full annual out of pocket max up front as I'll end up using it all anyway.

Some of it I guess would depend on where you are financially, can you afford to have her hold a deposit? Could you negotiate that after a period of time (like a year) of no missed appointments outside of pre-scheduled or greater than her cancellation policy, that you could have it back.

A lot of therapists require a credit card number on file that they can charge in case you no show or cancel last minute. I’ve never heard of asking to have a month paid up front - that could be a serious hardship if you didn’t have the money. I always pay my therapist a month in advance tho because I don’t want to worry about payment each week. And if I cancelled last minute I would not expect that money back or credited.

My new T charges $35 for a missed session, but his hourly rate is $200. I find it strange that the fee is significantly reduced if you no show.

At the end the of day, they are running a business and have bills to pay as well, so i fully support some kind of system in place to protect them from no shows and last minute cancellations.

Is this OP's therapist offering a bulk discount for buying 20 appointments in advance?

This is not the norm from what I have experienced with other professions who are also running businesses and have bills to pay etc.

I'm confused about what exactly the plan is. First you said she wants you to pay for a whole month in advance. Then you said that she has asked you to pay a double fee for your next appointment. The latter makes it sound like you won't have to pay a whole month in advance after all, but pay a deposit that will be used as a missed session fee instead. Is that correct? It doesn't make sense for you to have to do both. If you have a history of cancelling appointments at the last minute, it is probably fair to compensate your therapist because this sort of chronic behavior results in a significant loss of revenue for her. I know that's not your intention and it sounds like it's a result of whatever you're struggling with. However, like most people, therapists need a steady source of income and they can't get that by booking clients who don't show up. If the problem is often that you have a panic attack and are unable to leave to go to your appointment, perhaps you could find a therapist who offers video appointments as well as face to face sessions. That way, you could contact the therapist at short notice and let them know you need to meet with them remotely and it won't matter. Just an idea.

I'm not a fan of therapists deciding how often a client has to come to therapy. They can make recommendations all day, but I think it should ultimately be up to the client.

I wouldn't prepay for appointments and I wouldn't give a deposit. Not to be morbid, but what if she died? I would feel like a complete asshole to then call up asking about my money. I do have a credit card on file with the therapist. Cards come with protections for fraudulent charges, so I don't have an issue keeping one on file. It is certainly preferable to prepaying for appointments or paying a deposit because then you would have to go to a lot of hassle to get your money back, and it might not be possible. You might even have to file in small claims court or something ridiculous like that - and that would only be worth it if the money owed you was significantly more than the court filing fee. With cards, you can just initiate a charge back.

That's exactly what I was thinking.

This therapist isn't offering a discount, she's supposedly doing it because she thinks OP is just being a flake and needs motivation. I support missed session fees to an extent, but I would be unimpressed if they were framed as motivation for me to come to session. That's not what they are about and I think it's disingenuous for this therapist to pretend otherwise.

I have not heard about a T asking for payment upfront. T charged $35 for last minute cancellations. This happened for me 2x. The first was I totally numbed it though it was at a later time. The second time I was really sick and couldn't get out of bed. I offered to pay both times she refused. She said the fee is for clients who make a habit of making last minute cancellations.

Not sure about EMDR T but I believe plshe feels the same way T did.

I

Yeah, I would not agree to any of these arrangements. I'm not a fan of Ts who use finances punitively, or as a tool for behavioral change. If a T can't figure out a more straightforward adult way of addressing the inconsistency issue, then they should be honest and just suck it up or choose to not work with the client.

I hate to say it but you indicated yourself you have a regular problem attending appointments. I am not sure of just how bad this situation is but the behaviour of your therapist you are describing suggests this was frequent. Don't forget they are operating a business. When someone doesn't show up and misses an appointment it is not like they can fill it. That is lost income - which they have every right to recoup. When they foresee this happening on account of past experience then they are perfectly within their right to ask for payment up front. I am sorry to hear this situation has come to this but I am inclined to agree with the therapist in this case.

This seems odd to me, particularly the fact that she's blurring the line between things done for your therapeutic benefit and things done for the benefit of her business. She's entitled to make recommendations of how best to arrange things to meet your needs effectively, and she's allowed to have rules around missed appointments and cancellations in order to protect her income, but mixing the two and pretending her business interests are for your benefit is really questionable.

Maybe it is a canadian/european thing.

Maybe the important thing is what this means to you? You could be viewing it as: ‘my T knows me, she wants to help me to come every week, and that feels good’, or it could have a negative meaning for you? I don’t want to make suggestions of the negative meaning it could have for you, but if it does have negative meaning then maybe it’s not so helpful of your T to do this. Do you want to tell us what it means to you, and would it be helpful to you to tell your T?

I’m uk based- I note some posters saying they would not agree to their t holding some money on account -credit card/cash in case of repeat/late cancellation
-what would they suggest instead to secure income /best utilisation of therapists time eg other/ urgent clients
I have no vested interest either way -as a veterinary surgeon the practice gets many “failed to attends” but there is always something else to do in a hospital practice eg contacting clients with results assisting with other cases etc -major surgery fails take several Hundred £ out of the till but we NEVER ask for deposits/credit card details in advance- that’s life - in business there is always something else you can be doing
I guess a therapist could set a limit of last minute cancellations before referring a client out which is clearly defined (endless vague illnesses/ excuses like a school child would require common sense to sort through)

Under those circumstances, it seems only fair. Why should Ts be penalised with clients who tend to miss sessions and hence compromise any money owed them.

If clients don't want to come, fair enough but if not enough notice is given, why should Ts be left dangling when they could have booked another client. After all, Ts also need to survive and earn a living.

You raise a very good point here. Is it possible then that the therapist is doing this for ulterior motives? By arranging things as you say for the OP, is she not ensuring she still has a client?