Sometimes, interacting with clients feels a little like speed-dating. We meet, we chat for a bit, and suddenly I find myself wondering and worrying about whether or not they’ll call me again. Did they find our session helpful enough for round two? Am I the type of counselor they can see themselves with?
After a first meeting or particularly difficult session, a client cancellation or no-show prompts me to rewind back through the session in slow motion, searching for clues that might answer that persistent nagging question: “Was it something I said?”
I’m embarrassed that a missed session can so quickly bring down my carefully constructed fort of self-confidence. The cancellation/ no-show kicks up those still too-fresh grad school feelings of self-doubt and uncertainty. At best, I feel a little rejected. At worst, I fear I’ve scared them away from counseling altogether.
I had to face this recently when Calm Client missed not one, but two sessions in a row. Complete no-shows. No call, no text, no pigeon carrying a calligraphic notice. So, I did the normal thing and placed a phone call. No answering machine and no client. Then I did the abnormal thing and conjured up the last session (and the one before that) for a mental re-run. By the time I was done – none of it yielding any clues – the second week had come and again, a no-show. Well, I thought, I’ve really done it now. I called again but this time the number was no longer in service. I must have scared Calm Client right out of the state!
The following week, I was shocked to see Calm Client was waiting for me, a full 15 min before the scheduled session. The wave of relief that Calm Client was a) physically fine and b) present was overwhelming. I felt greedy to know what had caused the no-shows and I prayed it had nothing to do with me. The explanation was one of the best I could have ever hoped to hear. Calm Client had landed a new job and the change in schedule caused the missed sessions. Calm Client meant to call, but had not. And my second call attempt failed due to a change in phone service. The words from Carly’s song came to mind, “You’re so vain…” and yes, I did think that the no-show was about me. It wasn’t.
My take home lessons:
1. The cancellation/ no-show might not be about you.
2. Self-confidence is still a weak spot. As a new professional, it’s easy to fall into the mindset that perhaps you did something wrong or that you’re not very good. Keep building that brick house of self-confidence.
3. The cancellation might indeed be because of you…and now how do you prevent those negative feelings from causing you to run screaming from the profession?
While I work on the internal aspect of cancellations, I’m trying to take a proactive approach to managing cancellations.
Client Responsibility – When I meet with clients for the first time I stress the importance of calling in at least 24 hrs before the session if they cannot make it. Not only does it put some of the responsibility on the client but it serves as a way for me to check in on the client. I’m far less likely to feel anxious and get lost in the world of self-doubt if I can hear the client’s voice (their tone can tell you quite a bit) and provide a positive statement like: “I’m sorry we will not meet today but I look forward to seeing you next week.”
Assigning Homework – I don’t do this in every session, but sometimes a well-timed homework assignment can give clients that extra push to make it next week. Sometimes something as simple as, “You mentioned XX during the session and perhaps next week you can tell me more about it,” can provide the impetus for a client to return.
Charge a Fee – I’m not in private practice so I can’t implement this for my clients but some private practitioners and agencies will charge a fee for a no-show or cancellation less than 24-48 hours before the session. It’s not about beating the client over the head with fees but rather making it very clear that counseling services are indeed a service and a missed session without prior notification may cause a counselor to miss providing that service to another paying client. Charging a no-show or late cancellation fee certainly makes one reconsider blowing off the counselor for that re-run of any-old reality show.
End it with Positivity – Therapy can be tough. Anyone who has ever been a client can tell you there are days that you want to just melt into the couch and be done with the whole thing. I make it a point to leave some time at the end of a hard session to summarize and pull together pieces for the client, to acknowledge the difficulties faced during the session, and to appreciate the courage it took to engage fully. It instills a sense of accomplishment for sifting through the issues and as a reminder that therapy is a process and it’s not always easy but sticking with it can yield life changing results.
How do others proactively (or retroactively) deal with clients that cancel, don’t show, or simply never return?