You wouldn’t think twice about being charged for a missed hotel booking or a last-minute flight cancellation. You accept that the time was reserved, the room was prepared and the service was allocated, whether or not you showed up.
Yet, in therapy, this same understanding can feel harder to grasp.
It’s not uncommon for patients to cancel a session less than 24 hours in advance and express frustration when asked to pay the agreed-upon late cancellation fee. “But I didn’t attend,” they say. “Why should I pay for something I didn’t use?”
The intention behind this blog is not to shame or scold, but to gently clarify. To offer insight into the therapist’s side of that boundary, and to invite reflection on the deeper emotional and relational layers that exist between therapist and patient.
Because therapy isn’t just a service. It’s a commitment– a space that, when treated with mutual respect, becomes a container for healing.
The Common Assumption: “If I Didn’t Go, I Shouldn’t Pay”
At first glance, this logic seems fair. If you didn’t use the session, why should you be charged for it?
But this viewpoint misses something crucial: Therapy isn’t a commodity you use, it’s time that’s reserved for you.
When a therapist holds a slot for a patient, they turn away other appointments, arrange their schedule around that time and often mentally prepare to meet you in that space. That hour is yours, regardless of whether you show up. And unlike many other services, therapy can’t be “rebooked” at the last minute.
This is why the cancellation policy exists. It is a respectful boundary that acknowledges the value of time, the integrity of the work and the fairness of the agreement made at the start of the therapeutic journey.
Boundaries That Heal
In the therapist’s office, boundaries are part of the treatment itself.
When a therapist enforces a late-cancellation policy, it’s to protect their time, model consistency, self-respect and accountability.
So when a patient cancels at the last minute and resists paying the fee — even after signing a contract — what’s happening may go beyond inconvenience.
It may be brushing up against deeper emotional discomfort:
- The guilt of disappointing someone
- The fear of being “in trouble”
- The belief that one’s needs or struggles justify bending the rules
- The difficulty in accepting limits
Understanding this can help reframe the situation: The cancellation fee is not a judgment, it’s a consistent holding of boundaries that can, in itself, be healing.
What It Means to Commit to the Work
Therapy requires time, presence and investment from both sides.
It is expected that patients will consistently come up, even when it is uncomfortable, just as a therapist gives their all for their patients.
Cancellations, of course, happen. Life is unpredictable. But when they happen frequently or when patients resist the consequence of those cancellations, it may signal deeper patterns worth exploring. These are not surface-level frustrations, they are opportunities to reflect on emotions and behaviors that may echo in other relationships and responsibilities.
And therapy offers a space to explore that.
- What makes it hard to honor this boundary?
- Does showing up consistently trigger deeper fears or resistances?
- Is there discomfort around being “held accountable”?
- Do old wounds around authority, fairness, or money arise in these moments?
The Paradoxical Relationship of Business and Human Connection
Often, when a patient challenges the cancellation fee, they say, “It’s not about the money, it’s the principle.”
In reality, the picture is much more complex than that. Because, in truth, it’s both the principle and the money — where one cannot exist without the other.
As a therapist, I wear the hat of empathy, warmth, and care to foster connection in a safe environment. My role is to uphold ethical standards, ensure emotional safety, and provide high-quality care to support your healing process.
As a businesswoman, I wear the hat of responsibility, accountability, and sustainability to ensure the survival of this practice and the wellbeing of its staff, who are equally committed to providing the best possible care. My role is to maintain a structure that allows us to continue showing up — consistently and reliably — for every patient.
One hat cannot exist without the other. My ability to show up with presence and care is directly tied to the integrity and sustainability of the business itself.
This is why paying the cancellation fee isn’t about punishment or profit — it’s about preserving the integrity of the therapeutic relationship and the continuity of care. It sends a message that both parties are taking the work seriously, that the space being held has value, and that the agreement matters.
A Note to Patients
If you’ve ever struggled with a cancellation fee, here are a few things to consider as gentle reflections:
- Therapy is not just a service, it’s a shared space.
- That space has been prepared and held for you.
- The late fee isn’t punitive. It’s protective, both for the therapist and the work.
- If the fee feels unfair, explore the emotion underneath.
- Talk to your therapist and try not to avoid them. Repair is always possible.
Honoring the Invisible
Therapy works because it rests on a foundation of trust, boundaries and presence. When we cancel late and resist accountability, it’s a missed opportunity to grow through discomfort.
By honoring the agreement, by paying the fee and by having the hard conversations, we aren’t just respecting our therapist’s time. We’re respecting the process.
And in doing so, we give ourselves the chance to build something far deeper than a single session: a relationship rooted in honesty, mutual respect, and lasting change.