How to Handle No-Show Clients in Therapy Practice

Clients not showing up for appointments, often referred to as “no-shows”, is something most therapists experience at some point. It’s a common topic in professional conversations, and can be frustrating as well as disruptive to your practice and income.

How Many Clients Don’t Attend?

Client DNA (Did Not Attend) rates have been identified differently in studies:

• 20 to 57 per cent of people in therapy don’t return after the initial session (Lambert and Barley, 2001).
• 37 to 45 per cent attend therapy only twice (Schwartz et al., 2013).
• 8.9 per cent overall DNA in a primary care psychological therapies service (Binnie and Boden, 2016).
• Non-attendance is more common among clients referred by professionals than among those who self-refer (Morgan and Miller, 2025).

Of course, that’s therapy in general, and if you’re a hypnotherapist, most of your clients are probably self-referrals, which Morgan and Miller say reduces the odds of no-shows. But if your stats are lower than these, you may still be doing better than you think!

Even so, understanding how to handle missed appointments is an important part of running a therapy practice. It helps to keep things on a professional level, rather than letting it become personal.

Why Do Therapy Clients Miss Appointments?

There are probably as many answers to this as there are clients who don’t show. We can guess the most likely answers, though. For example:

• There is a miscommunication between you: somehow, you and the client have different times or days in your diaries.
• Your cancellation policy is non-existent, or 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: they may be wary of contacting you in case you try to persuade them otherwise.

Some people will get in touch even if it’s at the last minute. I was quite impressed that one of my clients emailed me at 4 am to say she had been up till then with a sick child and wouldn’t make it to our 9 am appointment. But others don’t. And, in an emergency, people are often too caught up in their situation to think of contacting you.

How Therapists Feel When a Client Doesn’t Turn Up

Not much research has been done on the effects on therapists when clients fail to turn up. But I did find these:

• Client non-attendance was seen to produce “a level of disruption, experienced as an affective reaction and often experienced in terms of negative affect” (Tweed and Salter, 2011).
• Six main responses were found by Kirby and Bailey (2025):
  • Self-doubt, such as thinking “Is it me?” especially common in newer therapists.
  • Expectation fulfilment: some populations were felt to be more likely to default on sessions, such as those working on overcoming addiction, and therapists were less inclined to see these as personal failings.
  • Emotional dissonance: sometimes a feeling of relief that the client didn’t come, followed by guilt about that reaction, along with emotional ambivalence about enforcing no-show payment policies and how that might affect rapport and empathy.
  • Emotional investment and detachment: therapists felt disappointment and even loss, especially when the non-attender was a client who was doing well. This often led to emotional detachment from all clients to avoid these feelings in future.
  • Organisational pressures: therapists who worked in larger organisations associated DNA clients with safeguarding and accountability pressures linked to the extra administration tasks laid down by their employer. Examples would be having to try to contact the client and find out why they didn’t attend.
  • Uncertainty: Non-attendance often involved the therapist worrying, “particularly about what might have been missed, left unspoken, or allowed to escalate outside [their] view” (ibid. subtheme 6.2) and whether a risk factor might have been missed.
• I’d add one extra to that, since Kirby and Bailey were looking at a group counselling practice, where therapists got paid a wage, regardless of client attendance. In private practice, therapists often worry about the financial implications of clients not turning up as well.

In my experience, you should always have something with you that you can do if a client doesn’t show. Brainstorm blog titles, answer some emails, or even just have some “me time”, playing Scrabble on your phone. It significantly reduces your stress levels if you use the time productively, and you can greet the next client professionally and calmly.

How to Reduce No-Shows

The best way to deal with this situation probably depends on many factors, such as

• which of the above reactions you tend to default to
• if you pay for your room by the hour, and lose money for no-shows,
• if you have a waiting list, made longer by frequent no-shows,
• how often you get clients who don’t turn up,
• how often this client in particular doesn’t show up,
• how much it bothers you,
• why the client didn’t show up.

But here are some ideas.

Set clear policies for no-shows

• 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 something to say they have read it.
• Remind them verbally as well when you book the next appointment, especially if they have missed appointments before.
• Make regular checks on how well the client feels things are going and how happy they are with the therapy.

Reduce No-Shows in Your Practice

• Write everything down – don’t rely on your client’s memory, or your own.
• Send a routine text, call or email reminder to the client 24 or 48 hours ahead of their appointment. Include a request for them to contact you if they are unable to attend. Sims et al, (2012) showed a 25-28% reduction in missed appointments by simply using text-message reminders!
• Especially if you pay for your room by the hour, consider taking a non-refundable deposit or full payment when you book an appointment. This at least covers the cost of your room and probably focuses the client’s mind on attending. It’s also easier to refuse a refund than it is to get payment from a client who didn’t turn up.
• Binnie and Boden (2016) found that it was more effective to have positive notices thanking people for turning up for appointments than the usual negative approach of posting how many missed appointments you had last month. This might not be useful for sole traders working alone, but if you’re in a group practice with a waiting room, it might be worth considering.

Have a missed appointment routine

For example,

• If the client is ten minutes late, send a text along these lines. ‘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, they’re likely to get back to you.
• If you don’t hear from them after 24 hours, invoice them for the missed appointment. (A short delay allows the client time to get in touch with you if they’re going to, or for any emergency to pass.)
• If they don’t pay, send a polite reminder that refers to your terms and conditions. Tell them you will consider legal action if they fail to pay. 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 online these days, if you want to follow through.

Yes, this is tough, but it’s fair and professional. Probably, 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. You can always be more lenient than your T&C now and then, if you feel that’s fairer.

Should you charge therapy clients for missed appointments?

According to my T&C, yes, and I follow the routine I’ve given you above. However, I tend to waive non-attendance fees in one-off occurrences where the client has been unable to give enough notice due to an unexpected problem on the day. For example, a client was once hit by a car on her way to see me. She was in an ambulance heading for the local hospital at the time of our appointment. Fortunately, she was unhurt and went home the same day. But I could understand how contacting me was not a priority.

Clients Who Miss Multiple Therapy Sessions

• Think about why the client has recurring problems getting to appointments. Is the reason you are working with them likely to be a part of the problem? Do they have motivation issues? Or emotional or physical difficulties leaving home, etc? If so, you may need to address those issues before things improve, or perhaps offer online sessions instead of face-to-face.
• Consider offering appointments at a different time or on a different day of the week, if that makes things easier.
• 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 to a therapist with a more flexible diary. 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 review your routines to help prevent this from happening again.

Can You Completely Avoid No-Shows?

Probably not. A small number of no-shows are probably an inevitable part of working as a therapist. But handling them carefully means they don’t have to disrupt your business or knock your confidence. Set clear boundaries, communicate expectations, and respond fairly, and you can reduce missed appointments to a minimum. Like many aspects of running a therapy practice, it’s about finding an approach that works for you while maintaining fairness and a good relationship with your clients.

References

This article was originally published in 2018 and significantly updated in 2026.

• Binnie J, Boden Z (2016), “Non-attendance at psychological therapy appointments”. Mental Health Review Journal, Vol. 21 No. 3 pp. 231–248, doi: https://doi.org/10.1108/MHRJ-12-2015-0038 [Accessed 11.4.2026]
• GoodTherapy.org (2013). Why Do People Leave Therapy Prematurely? [online] GoodTherapy.org Therapy Blog. Available at: https://www.goodtherapy.org/blog/why-do-clients-leave-therapy-prematurely-0627137. [Accessed 10.4.2026]
• Kirby, L. and Bailey, R. (2025). CBT therapists’ responses to client non-attendance and drop-out: A preliminary qualitative thematic analysis. Psychotherapy Research, pp.1–12. doi:https://doi.org/10.1080/10503307.2025.2576769. [Accessed 10.4.2026]
• Lambert, M., J. & Barley, D., E. (2001). Research Summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy, 38, 4, 357-361.
• Morgan, D. and Miller, D.L. (2025). P-44 Thank you! Attending your appointment today matters, for you and for others waiting. Patient & family care, [online] pp.A27.1-A27. doi:https://doi.org/10.1136/spcare-2025-huk.65. [Accessed 11.4.2026]
• Schwartz, Bernard, PhD and Flowers, John, PhD. (2010). How therapists fail: Why too many clients drop out of therapy prematurely. Impact Publishers.
• Sims, H., Sanghara, H., Hayes, D., Wandiembe, S., Finch, M., Jakobsen, H., Tsakanikos, E., Okocha, C.I. and Kravariti, E. (2012). Text Message Reminders of Appointments: A Pilot Intervention at Four Community Mental Health Clinics in London. Psychiatric Services, 63(2), pp.161–168. doi:https://doi.org/10.1176/appi.ps.201100211. [Accessed 10.4.2026]
• Tweed, A.E. and Salter, D.P. (2000). A conflict of responsibilities: A grounded theory study of clinical psychologists’ experiences of client non-attendance within the British National Health Service. British Journal of Medical Psychology, 73(4), pp.465–481. doi:https://doi.org/10.1348/000711200160660. [Accessed 11.4.2026]

Disclaimer
The information and ideas shared on this blog are based on the author’s professional experience, research, and training. They are intended for educational purposes and to support reflection and professional development. Therapists should always apply their own professional judgment and consider the needs of individual clients when using any techniques or suggestions discussed here.
While every effort is made to ensure the information is accurate and helpful, no responsibility can be accepted for any loss, damage, or difficulties arising from the use or misuse of material contained in these articles.