For not wanting to pay my therapist when I was sick!!

[Anonymous2566]

So, I’ve been seeing my therapist for about a year and things are going well. I’ve been very dedicated and always attend my sessions and pay upfront. My issue is, the cancellation policy. The agreement stipulates that I must give 72 hours notice for cancellation, otherwise the full payment is due. I was sick a few weeks back and let my therapist know on the day, she wished me better, advised me to relax and then put something about the cancellation policy, but that she didn’t wish to charge me on this occasion. Again, I have been sick and had to cancel my session on the day. She sent a similar message, wishing me better etc, but this time included something like “I’m afraid this is very short notice to cancel
without charge” and then offered a reschedule, which was online and didn’t suit as I was still feeling poorly.

AIBU to not want to pay this? How could I possibly give 72 hours notice when I woke up sick?!! It’s seem a little inflexible.

I do private work and I'm contracted to a couple of EAPs on a self employed basis.

When I first qualified I was only able to offer evenings as I had to work full time in another job.

I'm now in a different financial position and was able to become fully self employed. Many therapists are not that fortunate and recent surveys indicate that on average most earn less than 35K. The outgoings are also not inconsiderable.

So please don't refer to specialist healthcare professionals as a 'lifestyle business '. It's insulting and just serves to further stigmatise mental health and people seeking healthcare for mental health issues. As someone who apparently works with a demographic who themselves experience high levels of stigma and mental health difficulties, hopefully you can see that.

Part of my private practice involves direct client payments. It's a fairly normal payment model.

@Woodenwonder

The phrase "lifestyle business" suggests you think the therapy that the OP is receiving is just some chit-chat, just something to go to and have a bit of a moan because it's trendy to say "I see a therapist".

99% of 2214 people think you're being unreasonable OP so I think you can conclude that you are being unreasonable. If you can't make it and can't give the notice then of course you pay. I think it was very generous of her not to charge you the first time.

The poster has already showed that they don't understand either 'therapy' or 'empathy'. "if you have no wiggle room as a therapist for empathy because of money then maybe taking mental load off people isn't the calling, money is"

Those people saying this isn't fair because they get no compensation if it's the service provider who cancels, are missing the crucial point that for the service provider, this may happen several times in a day or week. For you as the client, it's more likely a one-off. So whilst it's annoying and does have some effect, it's not likely to make a substantial dent in your earnings. This is particularly the case if the service provider doesn't have a cancellation policy, because then they're more likely to have inconsequential cancellations.

This may be how it's done with other more ad hoc or less in-depth/behavioural forms of therapy, but the commitment between a (for example) psychodynamic psychotherapist or psychoanalyst and the patient is that the psychotherapist will be present for the patient, and vice versa, at the same every week. It is a big commitment, because what is being done is 'big' ie important.

A huge amount of the work is begun and embedded through the experience of the relationship with the therapist - it's not a service, and treating it as such almost guarantees that it can only offer a very superficial impact.

If the patient doesn't value the relationship enough to see that the therapist has committed time to them which must be paid for whether or not the patient is able to make use of it, then they don't value the relationship enough for it to have any real or lasting impact on them.

Often, patients will unconsciously find reasons not to attend, as a way of 'speaking' to the therapist. It's part of the process. You have to commit to your own healing, and value both your therapist and yourself. You might suffer inconvenience or be 'out of pocket' because it's worth it for what you will gain.

You do understand that contracts are legally binding, don’t you? If you don’t like the terms, don’t sign up. It’s very simple. Seems a bit churlish to enter into a contract with someone (I assume you weren’t coerced into it), not like the agreed terms of it being enforced, then complaining about it on a website.

@WinterDeWinter no psychodynamic therapist who works to an ethical framework is going to insist on a client who is too sick for therapy attending.

You are plainly wrong.

Unless you're talking about therapists who aren't registered with a membership body, in which case people should steer clear.

I think it's a really poor example of boundaries/being assertive/knowing your worth to be honest - all skills I want my therapist to model.

It really isn’t true that if someone cancels the day before you have time to fill the slot. I am a children’s therapist - I have children waiting to be seen but I can’t just randomly slot a child into an empty slot - to take on a new client I need to do a full assessment, which requires a longer slot and then the capacity to offer them regular input. A single one off cancellation slot is very difficult to fill for certain industries.

I don't think I said they would insist on the patient attending, did I? I said they would expect the patient to pay for their weekly session, even though they were sick, though they would probably offer an alternative time if they had one available.

You think it's reasonable for me to keep the money for a session the client hasn't been able to attend due to my illness? I have explained above that the payment rolls over and I'm not offering a free session on top.

As a therapy client, I like having these boundaries in place. I don't expect favours from my therapist, and he doesn't offer them to me.

It's a relationship built on mutual respect within a clear framework which was set out when we started working together.

If I got to the point where I was bitching about him on mumsnet for not letting me off paying for a week, my real concern would be that we no longer had the relationship needed to work together.

Nrtft, but She offered to reschedule an online session, which you turned down. Unless you had violent d&v, you should have taken it.

I’m a therapist and I have a mortgage to pay. We still have to pay for room hire etc if a client doesn’t come so we end up out of pocket if clients cancel, as it’s usually not possible to fill the slot with less than 72 hrs notice. Like your therapist, I try not to charge the first time as a goodwill gesture, but it’s not financially viable to do this ongoing. If your therapist has a few cancellations in a month and doesn’t charge then she may well not be able to pay her bills.

I am a therapist and I have a 48 hours cancellation policy. Mainly because I have to pay room hire if I cancel that in less than 24 hours, so would be out of pocket as well as losing the fee earned from the session.

There are also fees for insurance, supervision, ongoing training that form part of our registration requirements (and registration itself) that all need to be covered before you make any income. I have a small client list and limited sessions available, it starts to cost me more money than I make if people cancel without payment, which means from a very pragmatic point of view I would need to stop working.

Its good to take you’re reaction back into therapy though, money in the relationship does have meaning beyond mere payment for time so it’s good food for the therapeutic relationship.

YAB totally Unreasonable to expect not to have to pay for a session that you've cancelled at short notice!

The 72 hours notice period is for planned absences. If you're taken ill suddenly it will mean having to cancel on the day and thus not giving at least 72 hours notice. That means, of course, that you will still need to pay for the session that you can't attend.

I don't understand why you are so up in arms about this. It's pretty obvious to me (and almost everyone else) and seems to me to be a fair and reasonable policy.

Suppose, for example, that you make cakes for a living. Somebody orders a birthday cake, to be collected on Saturday. You buy the ingredients and make the cake on the Thursday and decorate it on the Friday. On Saturday morning your customer phones to cancel the order because the child is ill. So, do they still have to pay for the cake? Of course they do!

I'd take this to your therapist. There is nothing that happens with a therapy session that lies outside the parameters of 'therapy', and this is no exception. All grist for the mill, as we were told many times in therapy training.

So, you should not have to lose £75 but she should. Is that your argument?

Does that sound fair to you?

If you bought tickets to the theatre, or cinema or anything else, you would pay whether or not you used them. This is the same.

As a therapy client, I like having these boundaries in place. I don't expect favours from my therapist, and he doesn't offer them to me. It's a relationship built on mutual respect within a clear framework which was set out when we started working together

I agree with this.

Just to add - as well as the need for the therapist to model good boundaries so that the patient can learn them at a behavioural level, there is also the possibility that the foundation of this critical relationship will be undermined by a failure to hold them. They might experience it as care and feel gratitude - or they might, consciously or unconsciously, wonder why they have been given special treatment, and what might be asked of them in return. Do they 'owe' the therapist now? Or they might experience it as the therapist infantilising them, like a parent previously did, or as an indication that they are so damaged that they must be treated with kid gloves. Or that they are the centre of the universe around which everything else must be arranged - which can be quite a terrifying message. The therapist may sometimes make an exception, but there will be real thought behind their decision to do so that will be specific to that patient.

Sometimes they might let the patient know that they will be giving attention to them anyway, even if the patient isn't in the room, during that time. This can sometimes be a very powerful experience for the patient.

So there's a lot going on behind this idea - one reason that it's called a depth psychotherapy.

I think it’s unreasonable of me not to have understood your post properly before commenting!

In therapy, therapists are often taught that what happens in the room happens outside it. A client that just cannot stop talking for the therapist to get a word in edgeways is likely to do the same to their friends and family in their day to day life. Someone who is really closed off and finds it hard to share their emotions in therapy, likely to be the same with their family. So this would be really useful and valid to bring up in the session OP. A client who feels aggrieved at paying a fee that was explicitly laid out in the T&Cs they agreed to when starting therapy may well display or at least feel that sense of entitlement and being hard-done-by in the rest of their life when situations crop up that are very fair and predictable but unpalatable. Definitely bring it up to discuss.