Last-Minute Cancellations

Last-minute cancellations: They’re inconvenient, frustrating and potentially costly. How many times have you turned a client away because a time slot was filled, only for the scheduled person not to show up? How many times has someone cancelled at the last minute, before you have a chance to reschedule the appointment? It can be a real nuisance.

One of the frustrations of these last-minute cancellations is that someone who really needed the appointment has missed out because the scheduled client wasn’t able to give adequate notice. On top of this, the therapist has lost the income they were expecting for that time slot.

Some people who cancel at the last minute do so for legitimate reasons: their child was ill and they had to stay home with them; they got sick at the last minute; they had a death in the family. Often, however, people make last minute cancellations for therapy-related reasons.

Sometimes, a client is dealing with an issue that’s challenging and they cancel at the last minute because they’re reluctant to look at this issue. Sometimes, they’re acting out their negative transference toward the therapist instead of addressing it in the therapy.

Sometimes, the client is demonstrating their resistance to the entire therapeutic process, and sometimes they’re manifesting a defense mechanism called “reaction formation,” whereby they unconsciously anticipate rejection so they’re driven to behave in ways that could provoke it.

These are all fairly common reasons for therapy clients to cancel at the last minute, but that doesn’t mean the therapist should be expected to take the hit.

The financial aspect of these missed sessions is not insignificant. If a therapist sees twenty people per week and five of them cancel at the last minute, the therapist has lost 25% of their income for the week. If this pattern persists, it can render their business no longer viable.

Many clients don’t associate therapy with the fact that this is how their therapist earns a living. This is especially the case when the therapy is covered by a health plan or by insurance. When no money is being exchanged, it’s easy for the client to forget that a missed appointment means a loss of income for the therapist; something any other employed individual wouldn’t willingly forego.

We therapists have significant responsibilities when it comes to protecting our clients. We must have impeccable boundaries and be fully cognizant of the power dynamics in the therapeutic relationship. Still, I don’t believe that patient care should extend to allowing clients to violate the therapeutic contract. In fact, this is neither therapeutic to the client nor conducive to the therapeutic alliance.

One of the essential aspects of successful psychotherapy is the therapeutic alliance. This entails mutual trust as well as mutual respect. The therapist respects the client by treating them with courtesy and consideration and by maintaining confidentiality and good boundaries. The client demonstrates respect for the therapist by being courteous and honest and by complying with the expectations around such things as appointment times. Without respect, one cannot expect a good therapeutic alliance.


The views expressed in these blogs are the author’s own and not necessarily reflective of those of Psychotherapy Matters.  Information provided here and anywhere else on is for learning purposes only and should not be used to guide treatment of clients/patients. Copyright © 2018

Marcia Sirota
Marcia Sirota

Dr. Marcia Sirota, MD, FRCPC, is a psychiatrist, coach, author, speaker, and prolific Huffpost contributor. She completed her residency at Maimonides Medical Centre and has over 25 years of experience in health and wellness focusing on long-term results. Dr. Sirota enables people to overcome adversity, obstacles, mental blocks, to improve effectiveness, performance, and leadership. Her achievements include 5 books and hundreds of published articles on personal and organizational development. In 2016, Dr. Sirota was named one of the Top 50 most influential bloggers and communicators in Canada.

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4 responses to Last-Minute Cancellations

  1. You defined a range of problems associated with client cancellations — this was clear and concise. Your guidance would have been even more helpful if it had presented practical options aimed at reducing the frequency of such cancellations. Perhaps a follow-up post?

    • Hi Rian,
      Thanks for the comment. I am planning to write a follow-up to this article with some tips on handling last-minute cancellations and missed appointments.

  2. Shay says:

    Hello we are looking for a couples counsellor. The only thing is, we run an on-call business (vehicle towing and recovery) so it’s hard to make appointments as we cannot 100% commit and would be charged. Can you help ? Thank you.

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