Episode 7 Transcript: Navigating Late Cancels and Frequent Reschedules

The Unmasked Therapist Podcast | Kim Rippy, LPC, and Kaitlyn Steel, LMFT

Edited for readability: subtitle numbers and timestamps removed, punctuation and obvious speech-to-text errors corrected, and topic headings added. Dialogue is preserved in sequence. Speaker labels are omitted because the caption file does not reliably identify speakers.

Opening Reflection

When they let you down and they change, that does feel like, you know, it’s not about you, right? It does feel like they let you down or you’re coming up for them and they’re not holding their end up. Again, it’s not about you. It’s about are they showing up for themselves? But it’s really hard to continue to show up for someone who’s not showing up for themselves. Welcome to the Unmasked

Welcome to The Unmasked Therapist

Therapist Podcast, the show where we explore the heart of therapy, authenticity, and connection. We are therapists from Keystone Therapy Group, located in Northern Virginia. In each episode, we’ll share stories, insights, and conversations about what it means to show up authentically for our clients, for each other, and for ourselves. Whether you’re a new therapist or a seasoned therapist, we’re glad you’re here. Hi, welcome back to the Unmasked Therapist podcast.

Part Two: Scheduling Boundaries and Inconsistent Attendance

We’re so excited you guys are here again today. Today is Part 2 of our two-part series talking about what it is like as the therapist to hold scheduling boundaries with our clients. This can be a really uncomfortable space to be for therapists. Often in our practice and when we’ve talked with other therapists and other forums that we’re part of, this is a common conversation about that discomfort of wanting to recognize your clients are human, wanting to help them, wanting to show up for them, but also trying to hold to this need that we have as therapists to make sure that we are holding our sessions. Sometimes boundaries are helpful for clients just completely unrelated to scheduling, but because it’s important for them to experience a healthy boundary, things like that. So last week we talked about why we hold these boundaries, what’s important about them, how we use them. And then we also touched on when a client just straight up no shows how we approach those situations. Today we’re going to talk about what you do with clients who have frequent late cancels, frequent no shows or reschedule requests.

We’re going to talk about how to handle or how we would recommend handling late cancels. And then we’re going to spend some time talking about how we think it’s most helpful to talk to clients about these boundaries to set yourself and your clients up, set the expectations at the beginning kind of situation. So what we’re getting into today, we again appreciate you guys being here, appreciate you listening to this. And we hope today’s conversation is one that really helps you walk away feeling empowered and authentic and your increased your ability to just feel like you can really show up for your clients in a way that doesn’t just respect and serve them, but also respects and serve yourself. Absolutely beautiful summary, Kaitlyn. Yes.

So if you missed the first part, go ahead and dive into that. Pause this one. Go back and listen to kind of how we set up the structure. How do we define a no show? How do we define a late cancellation? And kind of those 3 pillars that we’re looking at here is the difference between no show, late cancellation and that frequent reschedules or cancellations that are quote, UN quote on time, they give you enough notice outside of your policy. So we kind of go into defining those. And again, that no show is a big one on how to handle that. So go back and listen to that one. So for this episode, we’re kind of diving right back in and we’re talking about how to show up as an authentic person, leaning into your humanness and the empathy that we naturally have for our clients while still respecting ourselves, just like you said, Kaitlyn, and respecting the empathy for the job that we have and the work that we do with our clients. So let’s talk about late cancellations. So as we talked about last

Late Cancellations and the 24-Hour Policy

episode, most therapists or most practices have a 24 hour cancellation policy where if a client needs to, you know, cancel or reschedule a session, we ask for 24 hours notice so that we have some more wiggle room on. Perhaps we have another client who’s waiting for an opening. Perhaps we have somebody who had to, you know, they had meetings moved around at work and they still really want to make it, but it was out of their control. And this would help them, you know, still get the care that they need with some flexibility.

So with less than 24 hours notice, it’s difficult to offer that spot to another client, especially even if they are waiting for it. You know, getting an e-mail at 8:00 AM for a 2:00 PM session, that still might be OK. Your day is already set. So it’s highly unlikely we’re going to be able to fill that spot if we get less than 24 hours notice. And so with late cancellations we do, there’s a lot more to kind of to consider or to balance versus a no show. A no show is, you know, again, unless there was an emergency, like we’re still going to hold accountable for that spot because we were still sitting there waiting for that client. We were still, you know, we were worried most of the time. Like we’re, we’re concerned about the client’s well-being too.

So it’s not only an investment of our time, but it’s an investment of our energy. And it’s reminding that clients of this process is very important. You still need to invest in the process and the time of therapy and it communicates the value of a therapeutic process. So those same things still apply with a late cancellation, but we do have to take more variables into account. Yes, that I love that you, that you’re highlighting that last

Using Clinical Judgment and Considering Individual Circumstances

piece that we have to take more variables into account. One of the things that I think really introduces opportunity for clinicians to get into sticky situations is that these variable variables, excuse me, are even in and of themselves not static. It’s not just like, oh, this variable, this variable and this variable and these are the rules for how I approach this. It’s these variables also are very client specific and yet have to be generalizable enough to where you’re not showing favoritism to a client, right? So there’s, it’s, well, like therapists, we love to do this.

There’s variables within variables within variables. It’s case by case, Yeah. What do I do with this client? Well, it depends on the client. That’s the standard. It depends on the client. And it’s unfortunately that is true here, right? And fortunately, because every client is different, every client has different situations, different schedules, different needs, different responsibilities. So we want to take those into account and we have to. So my role is, was this an unavoidable late cancellation? So I follow the same rule with a no show where if you or someone you care for is kind of my, you know, emergency or like, quote-unquote, bleeding, dying, or dead, then like that’s something that obviously we’re not going to charge for that. We’re going to have a conversation with a client. Their well-being is the most important factor here. So let’s make sure they’re OK.

You know, if somebody is coughing up a lung and they’re not able to, you know, they’re not able to eat or, you know, they don’t have a confidential location, but they didn’t find out that their spouse was going to be home in the one bedroom apartment until 30 minutes before the session. Like that’s, that’s those are things that we definitely need to take into account. And that’s my rule is, was this unavoidable or unpredictable? I like that. And then that’s when I have to use my judgement, right? And somebody says, hey, you know, I had a work meeting come up. I can’t push it, you know, I can’t, I have to go to it. OK, So what do we do?

Right. And so I’ll share my kind of rule, which I think it’s really interesting because I’m hoping that as we have this discussion, clinicians recognize and realize it’s not a one-size-fits-all. You can have two really solid therapists who handle this differently. There’s a lot of I used to hear at my where I very first started working, people would throw around the words best practice. I was having a traumatic response to that. Girl, we could go, but I think I’m going to make a note. We need to Go went to a whole episode on what it means to be best.

Practice, yes, got it. Anyways, So but the reason I’m verbalizing this is because I think that it took me a very long time to realize that just because a different therapist handles a different situation a little bit differently doesn’t mean that the way that you handle it is wrong or not OK. And. We can learn from each other. I just learned from you When you said that, I was like, oh, that’s such a great like way to do that. And it’s that golden thread, right? So love that for me, I like to consider myself a pretty lenient

Balancing Flexibility With Attendance Patterns

therapist in the sense of if you as a client e-mail me at any point before the session and you say, hey, I am so sorry this happened. Can we reschedule? Do you have any other openings? Like you know, whatever and you’re trying to communicate with me. I will do my best to be as flexible with you as. Yes, that’s my. If I have another opening, I will always. Offer it. Yes, if. I have another. Opening I’ll I’ll offer it. And I also take into consideration the tendency, the patterns of this client.

If this is a client who is always at therapy, always showing up, always communicative, really invested in their work, that I can tell that this matters to them and they’re trying to be respectful of my time and our work together. I am going to, I’m going to honor that. I don’t want to punish clients by any means who are not doing that. But at the same time, if a client has for six months never missed a session and then 10 minutes before is like Kaitlyn, I’m so sorry, totally spaced that we had our session today. I’ve had these things going on that we’ve been talking about in therapy.

Please forgive me. I’m going to be pretty lenient with that client. Absolutely. Whereas if I have a client who it seems like we’re supposed to meet every week or biweekly and it’s every session I’m going. So what’s been happening for the past month, I might have to, I might make the decision to hold that boundary a little bit more for me that’s a clinical decision, not necessarily a personal you have to what is that phrase? You have to follow my rules. It is again like what? Let me take into consideration what is happening.

If you’re a resident therapist or early career clinician who’s

A Word About Clinical Supervision

craving A supervision space that feels real, not performative, this is for you. The Unmasked Therapist Clinical Supervision Group is where authenticity meets growth. Led by Kaitlyn Steel, LMFT, and Kim Rippy, LPC, therapist at Keystone Therapy Group, this 12 week virtual group invites residents to drop the I Have It All together mask and explore the person behind the therapist. You’ll get to present real cases, receive honest feedback, and learn how to integrate your authentic self into your clinical work, all while meeting your Virginia Board of Counseling supervision hours. Groups are small, safe, and supportive.

Learn more or join the wait list at keystonetherapygroup.com/supervision. Because the best therapy you give starts with the therapist you are. Right. And I appreciate that your

Cancellation Fees Are Not Punishment

response to let’s say a frequent counselor is not punish them, right. You use the word punish, like I think that’s so important is that like charging a client is not punishing them. We are not their parents, right? It is a natural consequence of their actions and their choices. So it is accountable, right? They had the choice to attend, to let us know in advance or to let us know not in advance. And again, because of the informed consent and the way that we talked to them in the first session with this expectation of scheduling, as uncomfortable as that may seem, they know the rule. They know the expectation.

And so when they late cancel or no show and it is something that’s a pattern, then this is not a punishment. This is a natural consequence of what happens. And again, they fully knew that. So they made the choice knowing that was a consequence of what would happen. Something else that really stuck out to me is like you said, like

Exploring What Is Behind Repeated Cancellations

it’s if somebody is if somebody has a pattern of this, Nope, charge them. Your response is this is clinically significant. Let’s have a conversation about it, right. This is something that there’s a plethora of things that could be going on. Is client valuing therapy? Is their life truly at a point that they can commit to this time or day? Do we just need to talk about shifting to a different day or time? Do they need a different approach? Do they need a different specialist? Are we hitting on something that is really important, but they’re not ready for it, so they’re starting to cancel or flee. There’s is it a financial issue?

Is it right? Currently we’re still experiencing so many of our clients and the people in our communities are experiencing the furlough and the shutdown. It’s still going on. So at the time that we’re recording this. So that is a factor as well. So, you know, or maybe you’ve you and the client have hit treatment goals and the client feels like, OK, then why am I still coming in but doesn’t know how to say that to you. So it’s, you know, they get to the time that they’re supposed to meet and they’re like, I don’t really have anything that they’re to now me personally, when my clients come in and say I don’t have anything to talk about, usually those end up being our best sessions because, you know, they’re not in crisis state, which that’s going to be a whole conversation for us too.

What to do when a client says that and the pattern is so important. So Kaitlyn, you said we address the pattern. We’re not just immediately charging them, right? Those might happen concurrently. And as a practice owner, my expectation and my hope would be that it does that. Yes, if they are frequent cancellers or frequent reschedulers and again, we’re all saying that this is late within the 24 hour expectation, then they are charged for that. And there is a conversation that happens with the therapist and that conversation should be what’s coming up for you? What’s getting in the way of you attending? Is it a scheduling issue?

Is it a therapy processing issue? Is it a clinical issue, finance? Like what’s actually coming up and what can we do? Because I don’t want to charge you for this, right? I don’t want you to have these experiences. I want you to come to therapy where we can continue to do really good work together consistently, right? Our motivation is not to sit on our butts for a free hour and in charge. That’s right, We are not typically, most therapists really struggle with charging because that’s not what we want. So it’s so important that I think that you communicate that using your humanness. You can say to your client, I don’t want to charge you for this or I would prefer to meet with you and have these sessions, right?

Saying let’s say something negative about the unwanted

Communicating With Clients About Attendance

behavior. Let’s say something positive about the desired behavior. Whereas, hey, I would love to meet with you every week. I think we do some great work together. How do we shift this so that you can show up more consistently and more fully? Right. And I love that. Well, not. And I guess in addition, I love that you’re talking about shifting, how you’re communicating it to your client, but that shift also starts internally, yes, if you are the type of person. So I’m going to call myself out here.

Recognizing Our Own Reactions and Frustration

I really value being on time. So me being on time is almost late, although having children has changed. However, you know, when I’m sitting here and let’s say, you know, we, I start my sessions on the hour that just works for my brain. It works for scheduling. It works because I live in a different time zone than I work. So it decreases opportunities for me to mix all those things up. And so to me, it is very important because I also stack my clients back-to-back just because that’s what works best for my life and for my brain and for therapy for my, for how I provide therapy.

But what that means is, you know, there are times or maybe the next session or the next time slot I don’t have anyone scheduled. So if a client shows up a little late, I can bump over. But if not, you know, it creates this whole thing of I can’t do a full session and things like that. For me as a therapist, if I’m getting annoyed with my client because on a personal level I do not like what they are doing, that’s something I need to really process through first kind of take a look at.

It doesn’t have to be resolved, but I do have to make sure that when and I’m having these difficult conversations with my clients about, hey, what’s happening where you’re canceling a lot late, canceling a lot, rescheduling or no showing, right? Like I need to make sure that my own personal opinions and bias and feelings are really well understood. If we’re talking about authenticity, I am the kind of person and I think this is true for all people. You can’t be truly authentic if you’re pretending to be compatible, passionate with your client, but in your heart you’re like really annoyed with them.

Absolutely right. So. I think that’s a really important part here is at least

Supervision, Consultation, and Therapist Self-Awareness

from my experience with our practice, with a lot of our, I mean this is a thing that our residents, I mean we even as licensed clinicians, we talk about this frequently in our consultation meetings. This client doing this, how do I handle it? We process it with each other and we really encourage each other. We challenge each other. We talk through it a lot, whether it is in supervision or if it is in our consultation group before we have a difficult conversation. Eventually we get more comfortable with that. We don’t necessarily need to process every single time, but it’s important to take that step when you’re going to have a conversation, I think, with these clients where you recognize this is getting under my skin.

Absolutely. And I love that you said you need to understand your experience rather than work through it, compartmentalize it, put it away like no, like your experience is valid. And I think that’s what’s so important is how you check in with yourself and your own experiences gives you a road map to what’s going on with your clients, right? We know that with how are you feeling in the room? If you’re feeling activated, your clients activated, you know, how do you Co regulate together? But it is also, if you’re annoyed with your clients, there’s something going on there that is different than against, you know, conflicting with the expectations that you have for them or the expectations that they set that they would attend. When you say you next week, same time they say, Yep, you go, OK, great.

That is an agreement. I will show up for you.

When Therapists Feel Let Down

You will show up for me. So when they let you down and they change, that does feel like even though it’s not about you, right? It does feel like they let you down or you’re coming up for them and they’re not holding their ends up. Again, it’s not about you. It’s about are they showing up for themselves? But it’s really hard to continue to show up for someone who’s not showing up for themselves. So that annoyance, it might be this person keeps canceling on me. Check in with that very human response.

And as a supervisor, I also want to help you kind of reconsider that idea that they’re not showing up or they’re letting you down because it’s not about you, but it is about them not showing up for themselves. And when you’re showing up for them, it can be really hard. And that puts you in the space where again, you’re doing more work than the client. So when we don’t hold the accountability, we don’t charge or especially if we avoid having those conversations with the frequent cancellers or frequent reschedulers at accountability or the lack of accountability enables them to be in a position where you’re showing up more than they’re showing up for themselves. And it builds frustration, resentment, annoyance with them. So charging them that fee or even having the conversation. And that’s the same conversation you have with people who you’re not charging, who are canceling often, but they’re, you know, days in advance is the same

Making Attendance a Clinical Conversation

conversation. Hey, clinically, what’s going on here? Yeah. Let’s then is this just too much right now? Do we need to change our approach, change our schedule? Because again, that’s not authenticity. And it might be easier for you to have that conversation with those clients who are giving you quote-unquote like enough notice because you’re not frustrated with them as much. It doesn’t feel as maybe disrespectful, but it still is part of their clinical process in their experience. So it’s still so important to have that conversation with them. Yeah. And so speaking about let’s transition for our last couple minutes to that, how to have these conversations.

We’ve talked a lot about why it’s important. We’ve talked about the different situations that you might see or that you might experience. But now I think this is really

Set Expectations During Informed Consent

important of how do we approach this, how do we talk to them. So my biggest thing that has helped me to maybe calm my nervous system in this whole process is being very explicit in the first session. You are, you know, the way that I do my intake sessions, right? So our practice, we send intake paperwork ahead of time, Clients fill it out. This is part of the intake paperwork. But let’s be honest, who really reads in detail every little piece of that contract, right? Hopefully they do. But the reality is that we’re humans.

They’re humans, so I have very specific things. This is one of them that I verbalize and I confirm and I express. I provide maybe sometimes examples and I’m very clear with my clients, this is how I will handle these situations that just that one shift has helped. Like I said earlier, my nervous system feel a lot more comfortable holding this boundary and so I will go with them. I’ll go through with them No shows, late cancels and frequent no shows, late cancels, schedule requests and I everything we talked about today.

I essentially will say I’ll let them know. This is how I will approach it. This is what you’ll see from me when these things are happening. This is my promise to you in those situations. Yeah, it’s so important to have that conversation ahead of time because it gives you something to fall back on if the client does push back or challenge it. And make sure that those, if you’re working for a practice, make sure that your own charging or patterns are aligned with your practice. Because chances are if you’re working looking for a practice, whether it’s a private practice or an agency, they might have a billing team or somebody else is

Consistency Across the Practice

doing billing. And the client might reach out to the billing team and say, hey, why was I charged this fee? So they need to have consistent policies. You need to be aligned with their policies. And truly, the client shouldn’t ever get in the position where they ask somebody else, why was I charged this fee? Because you have told them what your expectations are from the beginning, from session #1 and then any time that they do no show or late cancel, you’re sending them an e-mail to check in. First of all, are you OK?

Second of all, you let them know, as awkward as that may feel, I have to charge for this or there is a fee for this no show cancellation. And you let them know exactly why. And if they question it, send them back to the intake paperwork. If it’s not in your intake paperwork, it needs to be in there now. That needs to be in there now. Not on your website. Like you can put it on your website, you can put it wherever you want, but minimum it needs

Discussing Exceptions Without Abandoning Boundaries

to be in your informed consent. So you can point them back to that and then have a conversation with it, right? If they come in asking questions, be open to having that conversation and you know, be human. Every now and then somebody will bring something in and it really isn’t OK. You really didn’t have the control over the situation that I thought you did. Sure, let’s waive it or but in the future, I’m going to hold this like this is still a boundary, like I still need more communication or OK, I understand you had to like cancel here, Let’s reschedule to a different day and then I’ll waive it if they’re able to reschedule within the same week.

Somebody who cancels often more than 24 hours. So it’s not technically within that window, but it’s still frequent, you know, a frequent occurrence. OK, maybe now we have a conversation. I need you to give me 48 hours notice or we’re going to have to go to a different spot. But again, keep having that conversation and check in with your humanness to see what is coming up now as your own authentic reaction. Tap into your empathy for your client about what is going on here. And you know, really remember that this is, I mean, it is a business, but it’s the business of helping people. So you do what you can to help

Closing Thoughts

people. And sometimes maintaining those expectations and boundaries and implementing the consequences is what’s healthy for them, right? And it’s sure as. For you, Absolutely. Absolutely. Thank you guys so much for joining us today. We hope that this series has been really helpful. As usual, send us emails, let us know, communicate with us on what your experience of listening to this podcast is. If you have any thoughts or further questions, we’d love to hear from you. Thanks. Thanks. Bye. We hope today’s conversation allowed you to reflect and gain new ideas for becoming an authentic therapist.

We would love to hear how this podcast is impacting you. To learn more about us, visit keystonetherapygroup.com, where you can find information about our services for clients as well as our supervision program. Remember to subscribe for new episodes and please rate us five stars. This helps us reach new therapists like you who are learning to step into their authenticity. We’ll see you next time.