Commitment Policy: How I Handle Cancellations in my Private Practice
My private practice has a commitment policy, which is just a cancellation policy with a different name. I call it a “commitment” policy because clients commit to coming to therapy every single week at their designated time. There are no cancellations.
The first time I heard another therapist talk about her no cancellation policy I thought, “That’s nuts.” At the time, I had a caseload of 40+ clients that I saw anywhere from weekly to bi-weekly to monthly. People canceled or rescheduled frequently. I was so full that I often breathed a sigh of relief when someone canceled.
I was proud of myself for having a 24 hr cancellation policy at the time - meaning my clients had to provide me with 24 hrs notice to cancel or reschedule a session. If not, they would be charged. I know many therapists who don’t require 24 hrs, or who don’t reinforce their cancellation policy. So I thought I was doing well.
I had so many clients that I had a waiting list for appointments. Thus, if someone canceled, I could usually get the spot filled and it wasn’t a big deal - other than the amount of time spent emailing back and forth.
It was like I was so busy that I didn’t even notice the impact of another thing. That’s a problem.
It was a problem that I finally addressed in May of 2021. I decided I was too emotionally and mentally tired and that I needed to have my business take better care of me.
Over the next three months, I examined every aspect of my business and how I could have it work for me. I reduced my caseload, narrowed my population and niche, changed my schedule to my ideal hours, and much more.
As I made these changes, I also looked at what kind of work I most enjoyed doing with clients. I realized that I most enjoyed working with women with overwhelming emotions and thoughts. Often, these patterns are present for a lifetime.
From my experience in therapy, it takes weekly sessions to change these lifetime patterns. When working with people with lots of ups and downs, they need a consistent weekly check in to stay the course. Furthermore, they need firm structure and boundaries. They come to me ruled by their emotions and thoughts - which can sometimes tell them to just skip that therapy appointment.
It is up to me to provide the container I know they need for growth. It was at this point that I saw the value of a commitment policy. What I once thought was a ridiculous idea made lots of sense.
My clients commit to coming weekly for the duration of therapy. If there’s a conflict, they can reschedule if they provide me with 48 hrs notice. There is no canceling the appointment. That rescheduled appointment can happen the week prior, the same week, or the week after. It means that sometimes they have two appointments in one week.
Every client also gets one “freebie” cancellation per calendar year where they can cancel for whatever reason and not be charged.
It’s a wonderful back-up for when someone emails the same day and says, “I cannot make it today, I’m sick. Can we reschedule?” I tell them, “I need 48 hours notice to reschedule. But you do have three options: use your freebie cancellation, meet by phone/video, or skip the meeting and be charged.: Choices provide the client with power.
The most important part of a commitment policy or cancellation policy is that I enforce it. Even though my policy is in my paperwork and I verbally explain it during our first meeting, I’ve had to remind and enforce the cancellation with every single client I’ve ever had. I think this is natural - a new client is inundated with information and it can be hard to remember the details. It is up to me to hold the safe container.
If I don’t, they’ll know it’s a porous container they cannot rely on.
I want to provide consistent, supportive care, and a commitment policy ensures I can do that.
Thank you for reading. If you would like more support creating policies that honor your practice, I provide business consultation.