This blog is about Reframing Cancellation Policies in Psychotherapy: A Therapeutic Opportunity
On social media in therapist Facebook groups, cancellation policies are often viewed as practical tools designed to safeguard the therapist’s time, manage the business side of the practice, and ensure continuity of care. But this view only scratches the surface. For many clients, therapy is a space to repair deep wounds caused by early childhood emotional neglect, attachment, complex or developmental trauma, or chaotic family dynamics where their needs were consistently overlooked. It is crucial, therefore, that we approach cancellation policies with a deeper, more meaningful intention.
The Therapeutic Frame: A Space for Healing
Many clients come to therapy with histories where their needs were secondary to those of their parents or primary caregivers. Whether due to addiction, mental health issues, transgenerational trauma, or other factors, these clients may have grown up in environments where they were unseen and felt unimportant. In therapy, we aim to provide a corrective and reparative emotional experience—one in which the client’s needs are consistently placed at the centre. This is why the therapeutic frame, with its structure of every week, same day, same time, same place, and when working in an agency, same therapist, becomes so vital. It creates a reliable and predictable environment that counters the instability many clients have experienced earlier in life.
A cancellation policy, then, should not be about penalising the client or merely focusing on the therapist’s loss of income. Instead, it should be a conscious and compassionate extension of the therapeutic frame. When we set this policy in place, it’s not to punish clients but to support their healing journey by reinforcing that the therapeutic space belongs to them, whether or not they are physically present.
Holding Space: The Client is Irreplaceable
When a client cancels a session, traditional business logic might dictate that we fill the spot with another client. However, this approach can inadvertently mirror the very neglect or abandonment clients may have experienced in childhood—where their space, their presence, was interchangeable or unimportant. Instead, we need to hold that space for them, sending the clear message: You are irreplaceable.
By holding the client in mind during their scheduled session, even if they are not physically there, we create a therapeutic environment that mirrors Donald Winnicott’s concept of the “holding environment.” This holding space, even in their absence, reinforces the client’s worth and the seriousness of the therapeutic work. It shows the client, I care about you, and you matter to me, whether you are here or not. This is your space, and I hold it for you.
This approach also mirrors an alternative to “cancel culture,” where out of sight often means out of mind. Rather than dismissing the client’s absence, we honour their space and continue to hold them in mind, reinforcing continuity of care and aiding the development of what Winnicott terms as a sense of ‘going on being’.
Exploring the Client’s Needs During the Cancelled Session
When discussing the cancellation policy with clients in the initial session, we can offer a meaningful alternative to simply “missing” the time. Instead of the therapist filling the hour with another client, the therapist can ask how the client would like their time to be used in their absence. For example, the therapist could read a book, article, or watch a film or video that holds meaning for the client. This could become an ongoing conversation that deepens the therapeutic process, as the therapist can explore with the client upon their return how this material speaks to them, what themes resonate, and what emotions surface.
For example, one client may ask their therapist to watch Firefly Lane, a series that delves into themes of trauma, friendship, and personal struggles. Watching the show and then discussing its portrayal of trauma, or any other theme, allows for a deeper exploration of their own history, relationships, and emotional responses. It also shows the client that the therapist is engaging in their world and cares about what matters to them.
In another instance, a client might suggest that the therapist read Jane Austen, perhaps exploring the themes of abandonment found in Emma or Sense and Sensibility. Austen’s narratives of abandoned or orphaned babies, and characters navigating their place in society with limited emotional and financial support, can resonate deeply with clients who have experienced early childhood neglect or feelings of being unwanted. When the therapist reflects on these themes in a session, it offers a doorway into discussing the client’s own experiences of being emotionally or physically abandoned.
This approach turns cancellations into opportunities for further reflection and relationship. It encourages the client to feel held, even when they cannot attend. For many clients, particularly those with attachment injuries, knowing that they are being thought of, and that their space is maintained, can be profoundly healing and corrective experience.
Managing Our Own Reactions: Self-Supervision in the Client’s Absence
As therapists, it’s important to self-supervise around the emotions that arise when clients cancel. Feelings of rejection, frustration, or inconvenience may emerge, but we must be mindful of how these reactions could unconsciously influence our work. A client’s cancellations may be an unconscious enactment of their attachment history, a re-creation of past dynamics where relationships were unpredictable or unreliable. By self-supervising during the hour that was held for the client, we can reflect on our own reactions and explore what the cancellation might mean in the context of the therapeutic relationship.
For instance, does the client struggle with showing up consistently in other areas of their life? Are they testing the reliability of the therapist? Angry because the therapist missed them in some way. How might their attachment style be playing out in the pattern of cancellations? By using the time to reflect on these questions, we not only deepen our understanding of the client but also ensure that our emotional responses are managed in a way that remains client-centred.
This is another reason why personal psychotherapy is crucial for therapists – it deepens their capacity to disidentify from the parts that become activated and identify with the organising principle; the self.
The Power of Holding Space: Building Trust and Connection
When we hold space for clients during their cancellations, we are doing more than following a policy, we are nurturing the therapeutic relationship. We are saying, Your healing matters. I am here for you, even when you are not present. This reinforces trust and connection, helping the client feel cared for in a way that may be new and unfamiliar, especially if they have experienced a lifetime of neglect or abandonment.
By reflecting on this with the client when they return—What was it like for me to hold your space while you were away?—we open the door to therapeutic depth. Clients may begin to realise that therapy is not just something transactional, but a deep, meaningful process where they are genuinely cared for and held in mind. This can be transformative, especially for clients who have never experienced such care before.
A Deeper Approach to Cancellation Policies
Cancellation policies in psychotherapy should be more than a business transaction; they are an integral part of the therapeutic frame. By holding the client’s space, even when they are not physically present, we offer a powerful message: You matter. Through this approach, we can transform cancellations into opportunities for deepening trust, fostering connection, and addressing early childhood wounds in a meaningful way. Rather than seeing these policies as punitive, they become an essential part of the client’s healing journey, a reminder that they are seen, held, and cared for, no matter what.
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