Therapists’ cancellation policies/Ts&Cs…

barefoot

Sponsor
Posting this for two reasons really…

1) I’m curious about what cancellation policy your T has and how/when they have communicated their T&Cs to you.

2) I’d appreciate any thoughts about a situation I find myself in with my T currently. More info on that below!

We’ve worked together almost 8 years. I had to cancel my last session as I was unwell. Unfortunately, it was a very short notice cancellation (90 mins before we were due to meet online) as it was a sudden onset thing…I was actually throwing up, sick as a dog by the time we were supposed to be in session. I felt awful about cancelling at such short notice - I hate messing people (including her) around and completely understand the inconvenience it can cause. As soon as I started feeling unwell, I messaged her to let her know, apologised profusely, told her what was happening. I didn’t get a reply but figured she must have seen my text otherwise she would have texted me when she discovered I wasn’t on our session call.

Next day, I got an email from her, invoicing me for the previous day’s session because it was short notice and she was unable to fill the slot with another client.

As I say, I totally get that it’s very inconvenient to cancel last minute, especially as you miss out on money as you can’t take on another client instead at short notice. This happens with me in my work, so I know it’s inconvenient and sometimes very frustrating and annoying!

I also get that it’s very common to charge half or full fee for no shows/late cancellations. I have Ts&Cs/a cancellation policy in place for this with my own business, and I enforce it in particular with repeat offenders who regularly don’t turn up/cancel last minute.

The thing is, in eight years, my T has never shared any Ts & Cs with me. She’s never told me what her cancellation policy is. I don’t cancel very often (she had told me before that I’m one of her most reliable clients) but, if I do, it’s always for a good reason (illness etc), I always give her as much notice as possible, and I always sincerely apologise and acknowledge the inconvenience. She has always been fine and flexible with these things and has never once let me know that there is even a possibility that I might be charged if I cancel a session.

So, her way of letting me know that is to send me an invoice for the full session amount the day after I cancelled because I was throwing up.

To be clear: I’m fine with her having whatever cancellation policy she wants to run her business with. And if she’s decided suddenly to change her approach and adopt this new policy, that’s fine too. Totally her right.

But the thing I am feeling rattled by and am having a hard time getting to feeling ok about is that I really believe Ts&Cs, including cancellation policies, should be shared upfront before you want to enforce them. Letting me know after the event by just hitting me with a email with a bill attached the day after, when it hasn’t come up at all - even as something that could be a possibility - in eight years just feels very…well…it has landed very badly. I feel upset and angry about how she’s gone about it.

I’ve emailed her to let her know how taken aback I am and how I wish she’d have let me know this was now her policy in advance rather than letting me know by invoicing me. She hasn’t replied. Based on previous ruptures, I doubt she will. We’ll both play the waiting game and, ultimately, I will have to be the one who ‘cracks’ and contacts her to book another appointment.

I haven’t yet paid the invoice and didn’t make reference to whether I would pay it or not in my email. I guess I am hoping that she might decide to waive it this time. But I don’t know. Any thoughts? Would you pay it now?
Or have no intention of paying it? Or want to talk to her about first? Or…???

I don’t really know what to do at this point. We have been going well relationship-wise and have been digging in to difficult work that I find incredibly painful and excruciating, so we’ve sort of been hanging in there together on that as I make some tediously slow progress processing some old stuff.

But this happening out of the blue has just really blindsided me. And whether she says she’ll waive the fee or not (I’m not expecting her to) I’m not really sure where we go from here and how we pick that work back up. I feel that trust has been damaged a bit as her invoicing for a cancelled session when she had never once mentioned that that could be a possibility just feels like she’s not been transparent and straightforward. And that doesn’t sit well with me. And has surprised me. And makes her less trustworthy.

What would you do in my situation? About next step? About whether/when to pay this invoice?

And, as mentioned at the start, I’d be interested to know if your Ts have been clear about this stuff with you and, if so, how did they share it with you? Did any of you sign contracts? Have to fill in intake forms? Have to informerly or formerly accept their Ts&Cs before starting work together.

I guess I am also quite hoping for some reassurance that this is a weird, not ideal thing for her to have done this way and that it’s ok that I feel bothered by it! But, if you think the situation’s very ok and don’t see why I would be bothered at all, I guess that could be useful for me to know too!
 

whiteraven

MyPTSD Pro
if she’s decided suddenly to change her approach and adopt this new policy, that’s fine too. Totally her right.
Her right but very unprofessional not to communicate it.
I feel upset and angry about how she’s gone about it.
Oh yeah. I would, too! I'm sorry she put you in this position.
We’ll both play the waiting game and, ultimately, I will have to be the one who ‘cracks’ and contacts her to book another appointment.
This feels manipulative on her part to me. And dishonest. I understand from you end; I've been there with other things. But I don't think this is professional on her part.
Any thoughts? Would you pay it now?
This would likely damage my trust completely, so I'd likely not go back. That's me. I quit after almost 10 years for a similar, although not the same, issue.
I don’t really know what to do at this point. We have been going well relationship-wise and have been digging in to difficult work that I find incredibly painful and excruciating, so we’ve sort of been hanging in there together on that as I make some tediously slow progress processing some old stuff.
Personally, I would not be willing to go back and pay for another session until she responded to my inquiry about why she was charging a cancellation fee when she failed to communicate that was her policy. Is she in the office by herself, or is she with a group? I would push her for an answer, and if she's with an office practice, I'd request the policies from them.
I’m not really sure where we go from here and how we pick that work back up. I feel that trust has been damaged a bit as her invoicing for a cancelled session when she had never once mentioned that that could be a possibility just feels like she’s not been transparent and straightforward. And that doesn’t sit well with me. And has surprised me. And makes her less trustworthy.
Yeah, I get this. It would damage my trust, as well. Worse, though, would be her lack of response to your email.
What would you do in my situation? About next step? About whether/when to pay this invoice?
I think maybe I covered this above.
I’d be interested to know if your Ts have been clear about this stuff with you
Well, I recently cancelled all of my future appointments. He said he'd be available if needed in the future and has not responded to my email of a week ago. We never had any sort of contract in place, and there was no additional fee for cancellation, no matter when I cancelled.
 

Sideways

Moderator
What would you do in my situation? About next step? About whether/when to pay this invoice?
I'd personally pay it and keep going back.

A couple of my past psychiatrists have advised me in writing when they first took me on as a patient about their cancellation policy. They were both expensive though.

My other psychiatrists and therapists have never actually given me written notice about cancellation policies - which probably reflects (1) the fact that they aren't working as part of a bigger practice, so they don't have the same amount of resources; and (2) being charged the full amount if you cancel with less than 24-48 hours is (in the country where I live) pretty standard for all private health and allied health services (so, everything from my therapist to my physio).
 

Friday

Moderator
What would you do in my situation?
Pull out my paperwork from 8 years ago and see if the cancellation policy is something I’ve just forgotten about, as I’ve been being given a pass for years.

^^^ Not being passive aggressive here, I know that’s actually what I would do, as I’ve had to do exactly that after my TBI (and I had to go over everything involving numbers to make sure I was correct). It was a little alarming to me how often I was incorrect & our usual way of doing things was special treatment rather than clinic policy.

About whether/when to pay this invoice?
100% I’d pay it, and continue attending sessions, even if the policy had changed from what I had originally signed and had come to expect.

Why?

1. It’s standard & reasonable.

2. Avoidance (as a symptom) means I’m infinitely more likely to use any excuse* to interrupt painful/difficult work to either focus on the shiny & distracting thing (let’s not talk -or even think- about me, let’s talk about US / that’s nice and complicated and likely to drag on as I can continue to tie all kinds of stuff into it, or failing you falling for “let’s spend a few months doing something else? Lets talk about you, so I can reinvigorate my rage at home in how I should have said something, will say something next time, will wallow in self doubt, & -bonus!- may even work myself up to a state to quit entirely).

When I say “any excuse”? I’m reeeeeeally talking about the symptom here, not a conscious decision. If it were a conscious decision I wouldn’t be so emotionally invested (real feelings of anger, hurt, insult, fracture, distance, etc.) in the shiny distracting thing, nor would it even remotely sound like a good idea, much less be something I want.
 

Teamwork

MyPTSD Pro
In a way, since you are very familiar with cancellation policies, I would expect that you would realize , sick or not at 90 minutes before the session you would have to pay. Most places have posted policies. I can’t think of any therapy office that doesn’t have a policy. As well after 8 years, it would make sense that somewhere this was gone over. Mine has never outright said it, but the signage at the check in desk is visible as well it is on his website alongside social media policies. I don’t think this constitutes a rupture, as from what you describe most of your other cancellations have given ample notice. I’ve been seeing mine for over ten years and have never missed a session. What I did pick up in this was an area where it seemed unhealthy that you have times where neither of you address situations but wait it out, until you crack. In this case, I’d pay the bill as you do owe it in my opinion. I’d be asking, what is the best way to reach you if in the future I wake up sick on therapy day and need to cancel? My guy, checks email every day around 7-7:30 so if I wasn’t coming in, I’d have to call his secretary for sure. Compared to everyone else on here I feel like I’m being harsh, however there is something here that is amiss and I feel like it is more the contacting her measure than a random new policy. Those policies are so standard, that unless she shows you special favor due to how long you’ve been going and reliability, that bit ought to be made clear between you both.
 

whiteraven

MyPTSD Pro
being charged the full amount if you cancel with less than 24-48 hours is (in the country where I live) pretty standard for all private health and allied health services (so, everything from my therapist to my physio).
Perhaps it's become standard, but that doesn't mean it's ok or acceptable. It's been pounded into people's heads that this is perfectly reasonable, so very few people question it.
I can’t think of any therapy office that doesn’t have a policy
My T did not, and the T I saw before him did not, either.
 

Movingforward10

MyPTSD Pro
I'm sorry @barefoot . I can understand your response. It does seem uncaring from her to send the invoice without acknowledging that you were unwell and asking about you. I think that was her mistake and I hope she apologised to you.

I would pay. It is reasonable for her to invoice you (how and when, for me that is the issue given your 8 year relationship).

I also don't think my T has said the cancellation policy. Or I have forgotten it. But I am assuming it's a 48 or 72 hour one. As that is semi standard here. I cancelled one session on the day before and paid the session.

So I think paying it needs to happen.
But maybe a discussion to understand why she sent the invoice how she did, and her explaining why she didn't ask after you and your health? As I wonder if that is the underlying hurt? The quite brutal financial exchange by the sending of the invoice, rather than the empathetic connection.

Hope you overcome the rupture quickly.
 

ninja

MyPTSD Pro
My current T is and has always been transparent about her cancellation policy: 72 hrs notice. My previous T did not have one. At least where I live, cancellation policies within and across different professions vary quite a bit, so if my T didn't make it explicit I wouldn't know what to assume. I think most common is 24 hrs notice, but even then there are differences in terms of amount charged, whether they're willing to waive the first x times, whether they waive in case of illness, etc.

Because there isn't really a standard where I live, I personally think it's unprofessional not to make your cancellation policy abundantly clear. Similarly, if I decide to update my cancellation policy (especially if in significant ways like deciding to charge last minute cancellations), it is my responsibility to make this information available to my clients in one way or another (could be on website, integrated into email reminders, in the signature of the email used for scheduling, ..).

If I were in your shoes, I'd pay the invoice, likely setup another appointment, and would definitely be looking through all the paperwork, consent to treat, online docs, online scheduler, emails, etc. etc. to make sure I hadn't missed/forgotten anything (it would be a real possibility for me). I think I'd tell myself that it would be a good idea to discuss the rupture, but I personally have a really difficult time talking about that kind of thing, so it would probably take me several sessions before I'd bring it up!

Wondering though, are you interested in continuing to work with her? If mixed, what parts of you do, what parts of you don't? (No pressure to answer.)
 

Sideways

Moderator
Perhaps it's become standard, but that doesn't mean it's ok or acceptable.
It's really a norm for services where you require the service provider to be available to you (and only you) for a specified time. In making the appointment, you're agreeing to pay them for providing that time to you. If a person doesn't give enough cancellation notice for the appointment to be rebooked with someone else, they can't make any money for the time they set aside for you.

Legally, that's all perfectly normal. Engaging someone to provide services (like when we make a medical appointment) is setting an agreement into motion where a lot of the terms don't need to be in writing to be enforceable.

If I was to not pay a cancellation fee that had been issued reasonably, then I'd be anticipating a call from a debt collector in due course (the medical provider could take me to court, but it would be more cost effective for them to sell the debt to a collector).

Certainly here in Australia, there are laws protecting consumers from unreasonable cancellation policies. But in and of themselves? Cancellation fees that are reasonable (in the legal meaning of the word) are par for the course, part of normal business practices and enforceable as any other debt.
 

barefoot

Sponsor
This feels manipulative on her part to me. And dishonest.
From previous experiences, I suspect she would say she is giving me space because I’m upset. I also suspect (again, based on previous experiences) that these things make her uncomfortable. I think she actually goes into avoidant mode!

Personally, I would not be willing to go back and pay for another session until she responded to my inquiry about why she was charging a cancellation fee when she failed to communicate that was her policy.
Yeah, that’s where I’m at…but if she doesn’t respond to my email and this is only going to move forward by me getting in touch with her to book a session, I guess I don’t know if she would see me for another session before I’d paid the invoice.

Is she in the office by herself, or is she with a group?
She is in private practice, so it’s just her. She used to rent a room in a building when we met face-to-face pre-Covid. Since Covid, she is still working remotely from home so we just meet virtually on Zoom.


He said he'd be available if needed in the future and has not responded to my email of a week ago.

Ah, sorry to hear that. Do you think he will respond? I hope he does.

Pull out my paperwork from 8 years ago and see if the cancellation policy is something I’ve just forgotten about
There is honestly no paperwork. She sent me one initial brief email before my first appointment. It was really just a ‘looking forward to meeting you’ email giving me details of the address, how to get into the building (which button to press to buzz her room), and which floors the waiting room and loo were on. After that, she gave me her phone number in the session so that she could text me to tell me to come up from the waiting room to save her keep walking down to collect me when she was ready. And she said I was welcome to email or text her between sessions, including for things like scheduling.

I’ve been being given a pass for years

our usual way of doing things was special treatment rather than clinic policy.
It’s possible that, without knowing it, she has been giving me a pass/special treatment. If that’s the case, it’s been her choice as I’ve certainly never asked for it. She is in private practice so can do things however she wants (within reason/ethics!) so ‘clinic policy’ is just her policy and whatever way she wants to run her business. It’s interesting though because, if she has being given me special treatment, I guess that makes me wonder why the special treatment has now stopped?! And why she can’t just say, ‘look, my cancellation policy is actually X but I’ve never enforced that from you. But just to let you know that, from now on, I will be applying it with you as well, so that will mean X’ I wouldn’t have a problem with that at all - it’s the just not communicating it but that really gets my goat.

It’s standard & reasonable.
I don’t disagree that it’s reasonable to charge for no shows and last minute cancellations. That’s not the issue.

As for it being standard…I’d say yes and no. Yes, it’s quite common for all sorts of practitioners to charge. Also quite common for them to not charge. Or to perhaps charge after the first time. Or to charge if it’s a regular occurrence. Also lots of variety with the time frame of when you need to cancel before you get charged. And how much of the fee you pay (full session/50% of session cost/an admin fee etc) Also, plenty of people don’t charge for a one-off if they think there are genuine unavoidable reasons - which also brings a bit of subjectivity and flexibility into whatever standard policy they have.

So, considering all the variables, there isn’t really one standard that I (and all her other clients are expected to know)
Avoidance (as a symptom) means I’m infinitely more likely to use any excuse* to interrupt painful/difficult work to either focus on the shiny & distracting thing (let’s not talk -or even think- about me, let’s talk about US / that’s nice and complicated and likely to drag on as I can continue to tie all kinds of stuff into it, or failing you falling for “let’s spend a few months doing something else? Lets talk about you, so I can reinvigorate my rage at home in how I should have said something, will say something next time, will wallow in self doubt, & -bonus!- may even work myself up to a state to quit entirely).
Ha! I’m sure you can remember other things I’ve posted here about ruptures with my T and times when I get worked up about firing her! Avoidance certainly comes up for me a lot. But I have been really pleased with what we’ve been doing lately because we’ve been building some momentum around a key topic, which is something we used to struggle with before. We used to be quite stop start and go off on tangents a lot, which made it difficult to get a strong thread going from session to session, and would feel like we’d left important things hanging.

I don’t actually want to lose the current momentum, so I’m frustrated about this. And I actually hate talking with her about ruptured/our therapeutic relationship! I don’t want to draw this out because that’s really stressful and exhausting and I actively want to be picking up where we left off. Hence asking for advice here about next steps,

since you are very familiar with cancellation policies, I would expect that you would realize , sick or not at 90 minutes before the session you would have to pay
Business Ts&Cs including Cancellation policies vary hugely, so I wouldn’t try to assume what any business’ or someone’s personal one was. I know what my cancellation policy is. And I know what my physiotherapist’s is. And other people I’ve engaged over the years. And I know them because they have shared that information - it’s on the booking email or the intake paperwork or their website etc. If I HAD to hazard a guess around someone’s policy, I would think they may charge a fee or for the full session if I cancel with less than 24 hrs. But that’s me forcing myself to make an assumption, which may or not be true. And, even then, plenty of practitioners (I’m talking about those in private practice, really, not so much those who are operating under a larger clinic set up, where it is the clinic’s policy that’s enforced, rather than individual practitioners being allowed to come up with their own individual ones) also use discretion around whether they will enforce it - so if someone cancels because they are ill, their kid is home unwell, they have a plumbing emergency or a family emergency etc - they may not charge it. Especially if it is unusual for the client to cancel at such short notice.

‘Most places have posted policies. I can’t think of any therapy office that doesn’t have a policy.’

Sorry, don’t know what happened to my quote formatting above! Ah, and now my response is in odd formatting too! I’m keeping going as don’t want to do something and then have to start again!

As I’ve mentioned, it’s just my T by herself. She’s not part of a larger practice. When we worked face to face before Covid, she was in a building where she rented a room a couple of days a week and there were all sorts of practitioners using other rooms, none of whom had anything to do with each other. They were all just doing their own thing. So, no…nothing was visibly posted anywhere as it’s not that sort of set up. And my T doesn’t have anything on her website either.


As well after 8 years, it would make sense that somewhere this was gone over.

Aargh, I’ve just done whatever I’ve done with the quote formatting again! Grr. Sorry!

Yes, this is the thing that is striking me as do odd and that’s got my back up. Of course it’s reasonable for someone to have a cancellation policy, including a policy where you may charge for short notice cancellations. But you have to let your clients know! You can’t just expect them to know or hope that they will assume. Especially when there is no one standard approach here that’s widely accepted as the one way of doing things.
the signage at the check in desk is visible as well it is on his website alongside social media policies.
See above - none of these things apply. When face to face, the set up meant no check-in desk. And we’ve been working on Zoom for 2 years. Nothing on her website.
I don’t think this constitutes a rupture
For you, maybe not. For me, her lack of transparency and communication over this and then suddenly charging for a cancelled session without any kind of heads up at any point and when she’s never done it before anytime in 8 years, has damaged the level of trust I feel right now. Not saying it’s irrepairable.
what you describe most of your other cancellations have given ample notice.
Yes, that’s true. But there have been a few same day cancellations, which I’ve been very apologetic about. And when we’ve next spoken, I’ve apologised for it again…and she has literally waved her hand and pulled a face to dismiss it and she’s told me it’s no problem.

As I’ve said, she can change her policy whenever she likes. Or if, as @Friday suggests, she has been giving me a pass as a form of special treatment, and she now wants to start enforcing it with me too - that’s ok! What doesn’t feel ok is the incongruence and the lack of transparency and communication. She’s been explicitly fine (ie actually saying it’s fine) about cancellations whenever for 8 years…so I’m not sure how I was meant to realise that I was about to be invoiced for £100 last week?
What I did pick up in this was an area where it seemed unhealthy that you have times where neither of you address situations but wait it out, until you crack.
I think in the past when there have been ruptured…when we met in-person before Covid, I generally had the same regular time slot, so it was a given that that was my slot booked in the diary unless either of us said otherwise and needed to change it. So, a rupture then meant just waiting til next session, by which time either I was over it or we talked about it.

Since Covid we’ve been meeting over Zoom only. And we’ve been working more flexibly and generally booking the next session at the end of the current session. If there’s then s rupture and we have nothing booked in…that’s where this waiting for each other thing started to occur. That’s when I brought it up last time - a session had ended very badly, I said I was upset about something….we didn’t book another date in…and after three weeks I hadn’t heard anything from her and I couldn’t cope with the stress of it anymore, so even though I was still annoyed, I just emailed to book a session. We then spent the session talking about what had happened. And I then said about the three weeks since the session feeling like a very long, stressful, limbo period and that I assumed that I had to be the one to get in touch. She said she would have got in touch with me ‘at some point’ to check in but that she felt like I needed space.

I did actually ask if she was available on a specific day this week when I texted her to cancel last week, but she hasn’t responded to that either. Not sure why she didn’t mention that in the email she sent the next day, which included the invoice.

So, it’s this uncomfortable time when there’s no next session date in the diary and there is tension between us…that’s when we seem to struggle and get into a bit of a stand off. It always feels like we’re both waiting for the other one to make a move. And, it is always me who does it at some point. Which is quite difficult to do when I’m the one feeling upset and I’m just getting radio silence from her.

Who knows - maybe she will prove me wrong and respond sometime next week?!
I’d be asking, what is the best way to reach you if in the future I wake up sick on therapy day and need to cancel?
Well, for sure I’ll be asking what her cancellation policy is. Because I’m still unclear about that. Especially because, in her email, she said she tried to fill the time with another client and couldn’t. Hence she was invoicing me? So was I charged because it was 90 mins notice? Earlier on the same day cancellations have been fine - so when’s the cut off point? Or is it now that any time on the day are not ok? And, however short notice it is, if she does manage to have another client take that slot, so I then not have to pay?! It’s still all very unclear to me.

Having worked with her for 8 years and getting to know her s bit in the process - including how she works - I actually would not be surprised if she won’t be able to clearly articulate her cancellation policy. Because I would not be surprised if she hasn’t actually got one written down anyway and just sort of goes with the flow and does what she feels is the right thing to do at the time.
I’d have to call his secretary for sure.
She doesn’t have a secretary. I can text her or email her. Or call her, but I don’t ever call her.
Those policies are so standard, that unless she shows you special favor due to how long you’ve been going and reliability, that bit ought to be made clear between you both.
Again, lots of variables in the so called ‘standard’. So, yes, I agree, that these things should be made clear. The fact that they have never been is what my issue is here. That the first time she has made it clear after never doing this in the past, is by sending me an invoice.

Obviously, I can look back on when we started 8 years ago and think, perhaps I should have asked her about these kinds of things then. But she is the only therapist I’ve ever had, so I didn’t have any other example to compare to. I also wasn’t running my own business at that time, so T&Cs weren’t on my own radar in the same way then. Plus, I was in the middle of s pretty major breakdown. So I didn’t really think to ask what her cancellation policy was! And all those things aside…I strongly feel it’s her responsibility to let me know, rather than my responsibility to ask. Just as I feel it’s my responsibility to let my clients know my T&Cs - I don’t expect them to just magically know, I don’t want them to assume they know when their assumption may be wrong, and it’s just not on them, it’s on me to clarify and communicate this stuff.
It does seem uncaring from her to send the invoice without acknowledging that you were unwell and asking about you.
She started the email saying she hoped I was feeling better.
‘I would pay. It is reasonable for her to invoice you (how and when, for me that is the issue given your 8 year relationship).’

Sorry, have messed up my quoting again! 🤦🏻‍♀️ Yes, I agree it’s not unreasonable to charge for late cancellations. The fact that she has never mentioned this, had never done it, and has explicitly said ‘you’re a king term, reliable client - you can do what you like really!’ when it comes to scheduling/moving things around/having to cancel because I’m not well (said to me in the last 12 months)…and then, with no heads up that anything is different, sending me an invoice the next day…that is the thing that has taken me aback.

But I am assuming it's a 48 or 72 hour one. As that is semi standard here.
I know we’re both in the UK. I have honestly never come across anyone (therapist, coach, physio, dentist, massage therapist) who operated a 72 hour cancellation policy. Hotel or venue bookings, Yes. But not personal/medical appointments. So, if that’s pretty standard where you are, I guess that just emphasises how there is no clear one accepted/expected standard here - there are so many variables. In my experience with other things, 24 hrs notice is much more common though I’ve seen 48 hours occasionally too.
I cancelled one session on the day before and paid the session.
I think if it was the first time, even if she hadn’t communicated the policy, I would at least think, oh, ok…that’s your policy then! Now I know what to expect. It’s just springing it on me after 8 years of nothing like this…I’m finding it very odd!

But maybe a discussion to understand why she sent the invoice how she did,
Yeah, this is what I feel would be useful. At the same time, I’m sure I’m going to end up paying this invoice for the session we didn’t have (£100) I then feel pretty loathe to have a session (another £100) to try to find out why she went about it as she did, what was different (and not acceptable) this time and on what basis are we moving forward re cancellations.

Hope you overcome the rupture quickly.
Thanks. It’s never fun, is it?! I’m not losing my shit about it and not feeling completely devastated by it as I sometimes have in the past. But I certainly feel some anxiety about it - and especially around how we reconnect and what that will look like. I so wish me already had a date in the diary!
My current T is and has always been transparent about her cancellation policy: 72 hrs notice. My previous T did not have one. At least where I live, cancellation policies within and across different professions vary quite a bit, so if my T didn't make it explicit I wouldn't know what to assume. I think most common is 24 hrs notice, but even then there are differences in terms of amount charged, whether they're willing to waive the first x times, whether they waive in case of illness, etc.
Yes, my experience of these things varying wildly is similar, @ninja.
Similarly, if I decide to update my cancellation policy (especially if in significant ways like deciding to charge last minute cancellations), it is my responsibility to make this information available to my clients in one way or another
Exactly how I feel about mine too.
would definitely be looking through all the paperwork, consent to treat, online docs, online scheduler,
None of these things exist. There’s been no paperwork ever - just the initial email I mentioned earlier in response to Friday’s post, which basically just outlined where her building was, which button to press to get in and where the waiting room and loo was. Her website just has a privacy policy on it.
I think I'd tell myself that it would be a good idea to discuss the rupture, but I personally have a really difficult time talking about that kind of thing, so it would probably take me several sessions before I'd bring it up!
Yes, it can be really difficult, can’t it? We have both got better at discussing our ruptures, I think. But, as I just said to @Movingforward10 the thought of paying for another session so that she can clarify her cancellation policy now…I just think, just reply to my email! Or let’s just have a very quick phone call outside of a formal paid for session to sort this out and clarify expectations. I’ve paid for plenty of sessions in the past where we’ve discussed ruptures…sometimes a number of sessions about the same thing! But they have mostly been where working on the rupture has felt part of the wider ‘work.’ Not paying someone to clarify what policy we’re operating with now.

‘Wondering though, are you interested in continuing to work with her?’

Sorry again for formatting issue! We’ve got over a lot of ruptures and I’m sure we will again. It just feels exhausting that we’re back in a tricky place again and I’m not sure what to do next to get back on track as, again, it feels like it’s likely going to be on me to be the one to try to reconnect. We were in the middle of doing good work. It was difficult work, emotionally, but I felt like we were really getting somewhere. So, yes, after 8 years, I don’t intend to finish our therapeutic relationship over this. I just wish we could both (and I say both because I think she contributes to what happens and how we resolve things and repair ruptures as much as I do) find a way to deal better with things like this do that we don’t end up in stand-offs where I’m hoping for some kind of response from her and she gives radio silence and seems to just be waiting for me to get in touch whenever I’m ready to book another appointment. I just want her to be straightforward with me. Including being straightforward about what I can expect about how she works and what policies she has. She knows straightforwardness is huge for me. And I know that’s partly my particular bug bear. But it’s also about general professionalism.
 

scout86

MyPTSD Pro
I can totally understand how this feels unsettling and probably, somehow, unsafe! Instead of thinking of it as "a rupture", would it be more useful to think of it as "a communication issue"? I suspect it feels totally different on her end.

I've been thinking about what I'd do in your situation. I think I'd pay the invoice but include something like, "Would you fill me in on what your cancellation policy is? I don't remember discussing it and, since this is the first time I've gotten a bill for cancelling a session, I'd like to be clear on what the rules are in the future."

Chances are this isn't anything more than her thinking you knew the policy. Could even be that it's a new policy and she thought she'd mentioned it but she didn't. (My T did that with start times. Appointments used to start at the start of an hour. Now they officiallyu start at 10 after. I have no idea when he did that. He mentioned it one day, I asked, "When did that start?" He couldn't remember. LOL Doesn't really matter because he's usually not on schedule anyway.)
 

Movingforward10

MyPTSD Pro
Sorry I didn't realise this is the first time she has invoiced you in 8 years at a short notice calculation. That does add a very confusing spin on it.
Do you think there was some sort of mistake? But without her responding to you, it's hard to know.

Or let’s just have a very quick phone call outside of a formal paid for session to sort this out and clarify expectation
Do you feel able to ask for this? Sounds a reasonable thing to ask, a quick call to under the cancellation policy, and why this time has differed from other times, and what the expectation is moving forward.


I understand the feeling of paying £100 for a session you didn't have, to then paying £100 (or more if the rupture continues beyond the next session ....) to talk about it. It adds a financial 'ouch' to the emotional one.

I'm sorry you're in this situation @barefoot. I remember your previous ruptures and how at certain points it feels like she brings her own stuff into it which doesn't help to make the repairing of ruptures easy.
 
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