No-shows happen in every therapy practice, and how therapists respond affects both the therapeutic relationship and future attendance. Addressing missed appointments requires balancing compassion with clear professional boundaries while maintaining the trust necessary for effective treatment.

No-shows represent one of therapy's most common challenges. When clients miss scheduled appointments without notice, therapists face both practical concerns, lost time and revenue, and clinical questions about client engagement, motivation, and the therapeutic relationship itself. The words therapists choose when reaching out after a no-show can either strengthen the therapeutic bond or create distance.

Key Takeaways

• No-shows are common across mental health settings, with research showing rates between 2-30% for ongoing appointments. How therapists respond affects client retention and treatment outcomes.

• The language used after a no-show should express concern without judgment, acknowledge the missed appointment directly, and leave the door open for continued treatment.

• Multiple no-shows require more direct conversation about barriers to treatment and whether therapy remains appropriate for the client's current circumstances.

What to Say After the First No-Show

The first no-show warrants a compassionate response that acknowledges the missed appointment while inviting the client to continue treatment.

Example Scripts

Warm and Open: "Hi [Name], I noticed you weren't able to make your appointment today at [time]. I hope everything is okay. Please reach out when you can so we can reschedule. I'm here when you're ready to continue our work together."

Direct but Caring: "Hi [Name], I was expecting you for your session today and wanted to check in. I understand things come up, let me know if you'd like to reschedule."

For Clients Working on Difficult Issues: "Hi [Name], I noticed you weren't able to make it today. Sometimes the work we're doing can feel overwhelming, I'm here when you're ready, no judgment."

Keep initial messages brief and focused on expressing concern. Avoid lengthy texts that might feel overwhelming.

Handling Multiple No-Shows

When clients miss two or more appointments, the response requires more directness while maintaining compassion.

Send a follow-up acknowledging the pattern: "Hi [Name], I've noticed you've missed your last few scheduled appointments. I'm wondering if now might not be the right time for therapy, or if there are barriers we should discuss."

Request a conversation about attendance: "I'd like to schedule a brief call to talk about what's making it difficult to attend. Understanding the challenges you're facing can help us find solutions."

Reference your practice policy while assessing whether treatment still fits: "It's important that therapy works with your life circumstances. If this isn't the right time or approach, we can discuss other options."

Sample Scripts for Different Scenarios

The Engaged Client with One No-Show

"Hi [Name], I missed seeing you today, I hope everything is alright. Let me know when you'd like to reschedule, I’m looking forward to continuing our work!"

The Ambivalent Client

"Hi [Name], I noticed you missed today's appointment. I've been thinking about our last session when you mentioned wondering if therapy was helping. Sometimes not showing up is a way of communicating those doubts, would you be willing to schedule a session to discuss how therapy is going for you?"

The Client Facing Financial Barriers

"Hi [Name], I wanted to reach out after you missed today's session. I recognize that the cost of therapy can be a burden, and I'd like to discuss whether there are options we haven't explored, like adjusting how often we meet or connecting you with lower-cost resources."

The Client in Crisis Who Disappeared

"Hi [Name], I'm concerned because I haven't heard from you. When we last met, you were going through a difficult time, and I want to make sure you're safe. Please reach out as soon as you can, and If you're in crisis, please call 988 or go to your nearest emergency room."

Preventing Future No-Shows

While prevention isn't always possible, certain practices reduce missed appointments and improve engagement.

Send automated reminders 24-48 hours before appointments via text or email, establish clear cancellation policies during intake and apply them consistently, offer flexible scheduling including evenings or telehealth when possible, regularly ask clients whether therapy timing and frequency work for them, and address barriers when clients mention concerns about cost, scheduling, or treatment approach.

Strong therapeutic relationships reduce no-shows. Regular feedback about the therapeutic process, collaborative goal-setting, and genuine empathy all contribute to consistent attendance.

Frequently Asked Questions

Should I charge for no-shows?

Whether to charge depends on your practice policies and individual circumstances. Many therapists charge for late cancellations and no-shows as stated in their informed consent documents.

Consider whether you charge your full fee or a reduced fee, if you differentiate between first-time and repeat occurrences, and whether you make exceptions for emergencies. Discuss fees directly with clients rather than surprising them with charges.

Some therapists choose not to charge for first no-shows, using them as opportunities for clinical discussion about barriers. Whatever your policy, apply it consistently.

What if I'm worried about their safety after a no-show?

Safety concerns require immediate action. Trust your clinical judgment about risk level.

Attempt multiple contact methods within a short timeframe, leave messages expressing concern and requesting immediate contact and include crisis resources in your communications. Contact emergency services if you have immediate safety concerns based on recent session content. Document all outreach attempts and clinical decision-making in your records.

Can I terminate a client for one no-show?

Terminating a client for a single no-show is generally not appropriate. Professional codes of ethics emphasize therapists' responsibilities to avoid abandonment and ensure continuity of care.

Appropriate grounds for termination typically include multiple no-shows despite outreach, client refusal to engage in discussions about attendance, or situations where therapy is no longer beneficial.

When considering termination, provide adequate notice, assist with referrals to other providers, offer crisis resources, and document reasons clearly. Frame conversations around clinical appropriateness rather than punishment.

Establishing Clear Policies

Prevention starts with clear communication during intake. Your informed consent should address appointment policies, including required notice for cancellations, fees associated with late cancellations and no-shows, how many no-shows may result in termination discussion, and how to cancel or reschedule.

Review policies verbally during intake rather than simply having clients sign forms. "I want to make sure we're on the same page about appointments" opens dialogue about potential barriers.

Bottom Line

How therapists respond to no-shows significantly affects client retention and the therapeutic relationship. Compassionate communication that balances clear boundaries with empathy helps clients feel supported while maintaining professional standards.

Effective no-show management requires clear policies communicated during intake, personalized responses based on individual situations, and willingness to explore underlying barriers. No-shows provide clinical information about client engagement, readiness for treatment, and the therapeutic relationship itself.

By approaching missed appointments with curiosity rather than frustration, therapists create opportunities for deeper understanding and stronger therapeutic alliances. Clear communication combined with genuine concern for client wellbeing reduces future no-shows while preserving the trust essential for meaningful therapeutic work.

Sources

1. Lefforge NL, Donohue B, Strada MJ. Improving session attendance in mental health and substance abuse settings: a review of controlled studies. Behav Ther. 2007;38(1):1-22.

2. Muppavarapu K, Royce C, Saeed SA. Study of Impact of Telehealth Use on Clinic "No Show" Rates at an Academic Practice. Psychiatr Q. 2022;93(2):689-699.

3. DeFife JA, Conklin CZ, Smith JM, Poole J. Psychotherapy appointment no-shows: rates and reasons. Psychotherapy (Chic). 2010;47(3):413-417.

4. American Psychological Association. Ethical Principles of Psychologists and Code of Conduct. 2017.

5. National Association of Social Workers. NASW Code of Ethics. 2021.

6. Kheirkhah P, Feng Q, Travis LM, Tavakoli-Tabasi S, Sharafkhaneh A. Prevalence, predictors and economic consequences of no-shows. BMC Health Serv Res. 2016;16:13.

Disclaimer: This article is for informational purposes only and is not a substitute for professional clinical judgment, supervision, or continuing education. Therapists should consult current clinical guidelines and use their professional discretion when applying this information to individual client cases.