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Monday, 16 April 2018

What to do when clients don't turn up


This is a topic that comes up regularly on social media and in discussion with other therapists, so I thought I would look this month at the issue of 'no shows' - clients who fail to turn up for their appointments, without giving you any notice.

GoodTherapy.org[1] cites studies which say that 20 to 57 percent of people in therapy do not return after the initial session (Lambert). Another 37 to 45 percent only attend therapy a total of two times (Schwartz), so if your stats are lower than this you may be doing better than you think.

But even so you might want to think about how you want to deal with this problem, to helps things stay on a professional level, and prevent your annoyance at being 'stood up' from getting in the way of your rapport with the client.

Why do clients fail to turn up?

 
There are probably as many answers to this as there are clients who don’t show, but we can make a guess at the most likely answers. For example
  • there is a miscommunication between you - somehow you and the client have different times or days in your diaries, or your cancellation policy hasn’t been made clear
  • they genuinely forget - especially likely if there is a long time between appointments, or the appointment is a different time or day from usual
  • there's a last minute emergency or logistical issue - children get poorly, work turns manic so they can’t get away, traffic hold-ups cause delays
  • the client feels better and doesn’t want to continue therapy
  • the client doesn’t feel therapy is helping - and they may be wary of contacting you in case you try to persuade them otherwise
Some clients will get in touch even if it’s at the last minute, but others don't. Especially in the case of emergencies they are probably too caught up in their situation to think of contacting you.
 

How should you respond?

 
How you deal with this situation probably depends on a number of factors, such as
  • if you pay for your room by the hour, whether or not the client turns up
  • if you have a waiting list, made longer by frequent no-shows
  • how often you get clients who don’t turn up
  • how much it bothers you
  • why the client didn’t show up
But here are some ideas.
 
Communicate clearly
  • Make sure your terms and conditions clearly state how much notice you need for cancelled appointments, and what payment is due if you don’t get it. Ask every client to sign a copy for your records, and give them a copy to take copy home.
  • Remind them verbally as well when you book the next appointment.
  • Make regular checks on how well the client feels things are going, and how happy they are with the therapy.
Prevention can be better than cure
  • Write everything down - don’t rely on your client's memory, or your own.
  • Consider a routine text, call or email to remind the client they are coming, and asking them to contact you if they are unable to attend. One study showed a 25-28% reduction in missed appointments by simply using text-message reminders! [2]
  • Consider taking a deposit or full payment when you book an appointment, so at least the cost of your room is covered.
Have a system to follow if people don’t show up
          For example,
  • If the client is ten minutes late, send a text  along the lines of  'I have you down for an appointment at [time] today - are you on your way?' As this is friendly and non-confrontational, in genuine cases of misunderstandings, forgetfulness, or emergency they'll get back to you and you can go from there.
  • If you don't hear from them after 24 hours invoice them for the missed appointment, referring back to your terms and conditions. (A short delay allows the client time to get in touch with you if they're going to, even in a genuine emergency.)
  • If this isn't paid, send a reminder which tells them you will consider legal action if they fail to pay this time. Whether you actually do this is entirely up to you - sometimes it’s easier to just write it off - but it's simple and all done on line now if you want to follow through.
Yes, this is tough, but it's fair and professional. It’s likely the client will not want to work with you again if you threaten legal action, but as they have already ignored two reminders that's on the cards anyway.
I sometimes waive non-attendance fees in cases where the client has genuinely forgotten or had a problem on the day, but many clients offer because they are aware of my cancellation policy.
 
Persistent non-attenders
  • Think about why the client has recurring problems getting to appointments. Is it linked to the reason you are working with them? Do they have motivation issues, emotional or physical difficulties leaving the home etc? If so, you may need to address those issues before things improve.
  • It might help to offer appointments at a different time or on a different day of the week, or to ask them if they can set up a 'buddy system' with a friend who can help them arrive on time.  
  • If you feel the client isn’t able to prioritise or value the therapy enough, it may be best for you to part ways. Discuss this with them directly, and perhaps offer a referral. If the two of you decide to continue, ask them to pay for sessions in advance, even if this isn't your usual policy.
  • Use reflective practice and/or supervision to  decide if you could change any of your routines to help prevent this happening again.

And a final tip, always have something with you that you can do if a client doesn’t show. Brainstorm blog titles, answer some emails, or even just play scrabble on your phone. It will do wonders for your stress levels if you don’t feel the time was 'wasted', and you'll be calm and collected when the next client arrives.

Please do post below if you can suggest other ways of dealing with this issue - I’d love to hear them.





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[1] https://www.goodtherapy.org/blog/why-do-clients-leave-therapy-prematurely-0627137
[2] http://ps.psychiatryonline.org/doi/abs/10.1176/appi.ps.201100211

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Author: is an experienced hypnotherapist and hypnotherapy trainer. She is the author of Their Worlds, Your Words and has co-written the Hypnotherapy Handbook, both of which are available from Amazon.
Find out more about Debbie's services on
Yorkshire Hypnotherapy Training - multi accredited hypnotherapy practitioner training, taster days and foundation levels.
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4 comments:

  1. Some great points and tips in this article Debbie. Thank you.

    ReplyDelete
  2. I always have some 'study' material to hand. This helps me to progress and ensure that I don't feel the time has been wasted.

    ReplyDelete