So, you have done everything right to build your private practice, you have your website in place, you have an awesome marketing, and then the phone starts ringing! You finally get people to make an appointment with you and it is so exciting!
Then you go to your beautifully arranged office that is decorated just perfectly. You patiently wait for your 4:00 appointment to arrive…then its 4:05, 4:10, 4:15…
So you call your client…it goes to voicemail…you text them…crickets…
It’s the dreaded NO SHOW!
By far, this is one of the most frustrating things about being in private practice. No shows and cancellations are absolutely a waste of your time. They also cost you money. It is so frustrating!
So what can be done to minimize and drastically reduce the loss of time and money with no shows and cancellation? Actually there is a lot you can do.
How to “fix” the No Show
What I have found over the years is that people coming to their first appointment are the most likely to no show. So here are a few “fixes” for preventing first appointment no shows:
When people make an appointment, tell them your no show policy on the phone. This might seem obvious but so many times it is just not said because we are generally nice people. But do reiterate it when you set the appointment up.
Send people the paperwork ahead of time. What this does is not only save time in the first session, it is a reminder to people that they are entering into a therapeutic relationship. It also gives an additional reminder of the appointment.
Have a clear no show policy in your consent for treatment forms. Again, this might seem obvious, but I also have them initial that part of the consent form.
Communicate your policy
In the first session, I think it is a good idea, not only clinically, but from a business standpoint to go over some “housekeeping things” with new clients. You mention confidentiality, where the restrooms are, a little bit about yourself, AND your no show/late cancellation policy.
Another thing to look into is getting some sort of automated appointment reminder system in place. Many of the practice management systems have this feature available and can send voice messages, texts or emails as a reminder. Or if you are just starting out, do it yourself or have an assistant send out those reminders.
Unfortunately though, even with doing all of these things on the front end, you can still have people will not show up. And, again, its frustrating!
One strategy that many therapists are having success with is keeping client credit card numbers on file to charge if they no show. There are some pros and cons with doing this and you will need to make sure you have measures in place to protect that credit card information. It will at least help in recouping any money lost by a no show. And it is something that needs to be done with every client and done equitably.
Another problem that is just as bad as a no show are people that call, text or email right before the appointment to cancel. Technically, they are not a no show because they cancelled before the appointment, but the effect for you is just the same. Again, having a late cancellation policy is just as important as the no show policy. It is only fair to require 24 to 48 hour notice so that you can fill that slot with someone else.
You can also charge for these late cancellations as well. With clients where this a chronic problem, you can require them to pre-pay before you set the next appointment. And if it continues, I think it would make sense to refer them to another therapist; aka drop them as a client. (But do keep within your ethical guidelines on this.) Then document, document, document!
It’s a clinical issue
In graduate school, I remember talking about this in a class and the fact that this is sometimes a problem with a lot of clients. Either them cancelling at the last minute or simply having a no show. I remember the professor saying that this is a clinical issue. I do believe this is very true. And many times, it comes from them avoiding the issues they are working on in therapy. So when you do get that client that no shows or chronically cancels at the last minute, it does need to be addressed in the session. Clinically it helps hold them accountable for themselves and their growth.
Besides no shows and late cancellations, there are the clients that consistently show up for sessions late. That is why it is also important to have in your consents, not only a no show/late cancellation policy, but also a “late for the appointment” policy.
Protect your time
With this I think you have to judge what you feel is best for your therapeutic style. For example, it they are late, the appointment just gets cut short by that amount of time. Or if they are over 20 minutes late it is considered a no show and they will have to reschedule. Neither one of these is wrong, but you definitely DO NOT want to go over in your sessions and into another client’s time. It’s just bad customer service and a bad business practice. Not to mention a bad idea clinically.
With all of these strategies, you can absolutely reduce your no show rate. You might not stop them all but they can be reduced. And if these strategies are not working for you, it might be worth it to look at your clinical skills and see if it is something you are doing that is keeping people from showing up. Getting some supervision and feedback from other professionals can be invaluable.
Finally, once you have your no show, late cancellation and late for appointment policies in place, stick to it! Certainly people will have legitimate emergencies and things to come up. And by all means, have compassion and leniency with those. Remember that you time is important. You time is what brings you your income. So give yourself permission to protect your time and income!
All the best!
By L. Gordon Brewer, Jr., MEd. LMFT – Gordon is the President and Founder of Kingsport Counseling Associates, PLLC. He is also a consultant and business mentor at The Practice of Therapy. Follow us on Twitter @therapistlearn and Pinterest “Like” us on Facebook.