A major problem of most private practices are clients who don’t show for appointments. No shows cost a therapist time and money. When you are first starting out, you may drive to your office just to meet one or two clients. If they no-show, you wasted travel time and gas. Even if you have a full schedule, a no-show means wasted time. Learn how to cut down on no-show clients who cost you time and money.

Be Prepared

A good tip is to always prepare for clients who may miss their appointment. This way at least your time is not wasted. Use this time to do paperwork, billing, read about new therapy techniques or other valuable tasks that are a part of running a private practice. If you are going to your office just to meet a client, make sure you have other work with you that you can complete if they don’t show.

No Show Policy

You can have a no-show policy that states clients have to pay a certain amount for any missed appointment. Be careful that this does not go against any contracts you have with insurances or EAPs. Your regular clients will know that missing an appointment means they will have to pay for the appointment if you had them sign an informed consent agreeing to pay for missed appointments.

Build Relationships

In my experience, most no shows happen on the first appointment. Clients who have a relationship with you are less likely to not show for an appointment without calling. These clients value your time. They are aware that you are a small practice and not a large office that can absorb the loss of money and time from lost appointments.

They respect you and don’t want to damage the counselor-client relationship that has developed. If you are doing a good job, they like you and don’t want to disappoint you or create tension in the relationship. Clients are usually unaware that a part of being a therapist is keeping your personal feelings separate from the therapist-client relationship. They are also aware of your no-show policy and they may not want to pay for a missed appointment.

Behavioral Contract

Even though you may have a relationship with your regular clients, some of them may still no-show because of their mental health issue. For these clients, it may help to write a behavioral contract. Sit down with the client and explain the problem. Give them details of how many appointments they rescheduled or missed. Let them know that you are concerned about their behavior and their mental health. Make an agreement with them for how often they will attend appointments and what the consequences will be if they fail to follow the agreement. There has to be some consequence. Without it, the contract is meaningless. The consequence can be an increased fee for missed appointments or referral to another provider. They may need a higher level of care if they are unable to stick to an appointment schedule. Or they may not want to continue therapy and this is their passive aggressive way of dealing with it. Whatever the case, making a behavioral contract is an opportunity to discuss why they are missing appointments and come to a solution.

New Treatment Plan

If the client is having life issues which are interfering with coming to appointments, a new treatment plan that addresses the issue may help. The client may have transportation issues so making a plan for taking the bus could be part of their treatment. If they are having trouble with child care, this could be a treatment plan goal. Whatever the problem, you can address it in the treatment plan and come up with a plan of action.

New Client Relationship

Since new clients are most likely to miss their appointment, you have to begin building a relationship with them from the first phone call. If you miss their call, promptly call them back. Try not to wait until the next day. Many people finally call a therapist when they are distressed.

Begin thinking of your first call from a client as more than an opportunity to make an appointment and a time to secure insurance information. What is the point of setting an appointment if they don’t show up? Think of the first phone call as your first contact with a new client. This phone call is the beginning of the therapist-client relationship.

Before even asking when they want an appointment, ask them what brought them to calling a therapist. Ask them what issues they are having and how you can help them with their issues. Discuss what techniques you would normally use with a client with these issues and ask them if they think that might help them.

Use this first phone call as a consultation and an opportunity to begin building a relationship with the client. You may spend 15 to 20 minutes on the phone with them that you cannot bill for but you will be building a relationship with the client. You are showing them that you care about their problems, understand what they are going through and you have the knowledge to help them.

Best of all, you can set yourself apart from other therapists. When a client calls a large practice, they speak with a receptionist who just takes their information. They don’t have the opportunity to talk to a therapist until they come for their first appointment. Since the therapist-client relationship is so important for the client to make progress, many clients get frustrated when they show up and find they don’t like the therapist or they don’t think the therapist understands their problem and can help them. Think about it from the client’s perspective. Wouldn’t you rather see a therapist who talked to you for some time before rushing to make an appointment? Wouldn’t you rather find a therapist who is a good fit for you and your issues and not just go to anyone who is available?

Finding a therapist is like interviewing for a job. The company wants to find an employee who is a good fit for the company and will bring the most to the job. In this scenario, you are the employee and the client is the company. After all, the client is paying for your services. They want to get the most for their money. Especially since therapy can be expensive and time-consuming, they want to find a therapist who they believe has the qualifications and experience to help them. They don’t want to waste their time either.

However, most clients aren’t comfortable asking a therapist what their qualifications are or how they can help them. Many people think they are contacting a professional and they have no right to question the professional’s ability to do the job. To decrease no shows from new clients, you need to get across to them in a short amount of time that you are qualified, that you can help them with their issues and that therapy will be worth the time, effort and money they are investing in it.

If a client calls at a time when you don’t have enough time to give them a free consultation, tell them that as a part of your process you like to talk to a new client for about 15 to 20 minutes before making an appointment. You can tell them that this is important so that you can do a brief assessment to decide if you can help them before taking them on as a client. Ask them for a phone number that you can call them back at and a good time to call. This shows them you value them and want them to find a therapist who will be able to help them. Wouldn’t you appreciate a therapist who wanted to know if he or she could help you before making you an appointment?

How to Do a Phone Consultation

There are certain points that you want to carry out during the phone consultation. Remember, this is your first contact with the client. Try to keep the following things in mind during the consultation:

  • Discover the client’s issues and why they are calling you. Give them time to talk about their issue without letting them monopolize your time.
  • Let the client know you understand their issues. Use active listening skills by clarifying, reflecting emotions, using open-ended questions, validating and summarizing.
  • Let the client know you are qualified to handle their issue.
    • You can quickly review your education, experience and credentials.
    • You can point out trainings, classes or experience you have had with their issue. (“I just had a training on using play therapy with children who have experienced trauma”)
    • If their issue is beyond the scope of your qualifications, ethically you must refer them to someone else.
  • Let them know about the theory you use in your practice.
  • Briefly explain techniques you may use and how you believe they will help the client.
  • Let the client know that what they tell you is confidential.
  • Show the client you value them and will be non-judgmental.
  • Subtly show the client that your time is valuable as well.
  • Set an appointment.
  • Get insurance information if they have insurance.
  • If they are private pay, review your fees and a sliding scale if you use one.
  • Ask them to bring a pay stub if they are requesting to use a sliding scale.
  • Ask them to bring their insurance card.

I know that’s a lot to cover in 15 or 20 minutes and you won’t cover it every time. Check out the Phone Intake form to help you keep these points in mind and use them when you feel they are appropriate to use. You can add some points you want to cover at the end of the Phone Intake form. The most important thing is that the client feels you have heard them. Check out the Phone Intake form to help you do a phone consultation.