Ah, money. Despite being a concern for most of us, money is hard to talk about. (So much so that I had to make that silly joke about having a CFO.) But it’s nothing compared to some of the conversations we get into in therapy about trauma, depression, drugs & alcohol, sex & relationships, even religion & politics… So, we can do this.
Why does my therapist charge for a missed session?
Private therapists get paid by the hour (by you –so, in essence, you are their boss), but they are responsible for their own overhead, and as such they get to keep only cents on the dollar. Your therapist must cover the cost for confidential communication platforms, fees for accepting credit card payments, electronic health records, licensing costs, malpractice insurance, utilities, supplies, etc. Your therapist has to pay for all these, whether or not the client makes it to their session, and regardless of reason. So, even if you get sick, or your kid does, or it rained or snowed, your therapist still has to pay all their bills, in full. While this type of things are out of your control; they are certainly outside of the therapist’s.
We accept when airlines and concert venues do not refund our unused tickets –even though they could likely afford to, and we continue to give them our business. These are big powerful corporations. Your therapist is one person. And likely not a rich and powerful one.
And what when your therapist’s own child gets sick? When you or your child get sick, your therapist is out that session fee. When they or their child gets sick, they’re out that money, too. Does that seem fair? And is that the boss you want to be?
With all these considerations in mind, your psychotherapist carefully budgets for each week in terms of both time and financial resources.
Many offices send appointment reminders as a courtesy; this is the time to let them know if you’ll be unable to keep the appointment. Most mental health providers work to be as accommodating as possible and will do their best to move things around to find an alternate day or time that week that will fit in better with your schedule.
Your therapist may at times feel able to offer you a courtesy waive. This should be weighed against the potential implication, message, or meaning this may have for you, the client. If your therapist sees you as an autonomous and competent adult, they should not assume that you want the fee waived. It may be that you appreciate clear rules and prefer consistency, or that the unsolicited “gift” may actually feel like a debt, a burden, or an insult. It may be that it brings up insecurity or fear of resentment. It even could be that you are more comfortable financially than your therapist, and the charged fee impacts you less than it would them.
As you can see, it’s complicated. So, when your therapist’s practice enforces -or doesn’t- their cancellation policy, it’s not because they don’t care about you; it’s because they care so much that they want to keep their doors open, so they can continue working for you.
Thank you for your understanding and as always, please reach out with any questions, concerns, insults, or jokes. We will have a difficult talk, and then (perhaps virtually) high-five each other.
