July Quandary: Occasionally, I have to cancel scheduled sessions with clients due to personal family issues. I always give plenty of notice, but occasionally clients ask if everything’s okay and I’m never sure what to say, even when the reason for canceling is relatively benign. When clients ask why I’m canceling, how should I respond?
1) A Matter of Connection
If I was this clinician, I’d respond by telling them the truth. This seems particularly obvious if the specific reason for canceling is benign, as you indicate.
This question points to the larger question of therapist disclosure. To be clear, I’m a firm believer in disclosure—in my experience, to a much higher standard than many of my peers. I have some strong thoughts as to why.
To begin, the time-honored notion of self-disclosing if the information may be helpful to the therapy relationship is unreasonable. We readily self-disclose many times in sessions through what clothes we wear, what books we have on our shelves, and our nonverbal gestures. They reveal something about us and may be interpreted by the client as helpful or harmful to the relationship—often, we have no idea how they interpret it. It’s absurd to think we can sterilize ourselves and our working environment to the point that we won’t elicit a reaction from our clients, nor is it desirable.
Self-disclosing only if the information may be helpful to the therapy is also foolish. In therapy, we help clients work on human interaction, whether it’s with others or themselves. How are we to do this if we’re constantly monitoring what information we may be disclosing? How are we to create an honest relationship in good faith with the client if we fear the very connection necessary for that relationship? How can we genuinely connect and teach genuine connection if we’re not being genuine ourselves? We expect our clients to be honest with us and often stress the importance of vulnerability and honesty.
Personally, I see no other alternative foundation for the therapeutic relationship other than mutual disclosing, relating, and understanding. I’m sure I’ve ruffled a few feathers thinking in this way, so let me revise: Perhaps it’s best to not disclose anything that may be harmful to the therapeutic relationship or anything that might compromise our integrity. Most of this just means being thoughtful and using our common sense.
Carl Mothes, LPC, NCC
Minneapolis, MN
2) Keep It Simple
Quite frankly, whether you give a client ample notice or very little notice in changing their appointment time, it’s best to keep your explanation simple. On the rare occasion that I need to move a client’s appointment, I simply say, “There’s been a change in my schedule. May I offer you another appointment time instead?”
I state this very matter-of-factly, regardless of the actual reason for canceling their appointment. Yes, our clients are curious to make sure we are okay, especially during these challenging times. Everyone is learning to be more adaptable and flexible, and appointment changes happen.
I can’t actually recall a time when a client asked why I was canceling, but I can recall clients asking if everything was okay. Of course, our response should be yes, and we should thank them for their concern. If a client is persistent in asking you why you’re rescheduling, make note of it. At their next appointment, this could be a rich in-vivo exploration—an opportunity to discuss what thoughts, perceptions, and emotions they were experiencing.
Of course, all therapists experience life situations in which they need to make emergency cancellations. Since I adhere to a very strict late-cancel and no-show policy, I respect that boundary and reciprocate with an explanation, but I keep it brief. Once, one hour before a session, my basement flooded. Obviously, it was an emergency situation that required a last-minute cancellation. I simply said, “I apologize but my basement has flooded and I’ve reached out to my plumber who’s on the way.” While I was completely overwhelmed, I kept my response calm and clear. Naturally, the client was very understanding.
It sounds as though you’re a very tenderhearted and empathic clinician. Nurture that, but never offer any more information than necessary. Right now, all clinicians are stressed and stretched thin. There’s no need to put unnecessary pressure upon yourself.
Amelia Dunn, MA, LCPC, NCC
Ashtabula, OH
3) A Glimpse of Our Humanity
Clients worry about others, and their therapists are no exception. There have been a handful of times when I’ve had to suddenly cancel an appointment and the client has asked if I’m okay or why I had to cancel. In those moments, I’ve felt and thought a number of things. First, I’ve felt the temptation to avoid answering the question or brush it off and move on to the client’s problems, fearing it might detract from the real reason the client is in therapy. Second, I’ve felt uncomfortable talking about my own problems, no matter how small, for the same reason. Third, I’ve acknowledged my discomfort and weighed the pros and cons of sharing why I’m canceling. Fourth, I’ve realized how sharing the reason for canceling could help build rapport with the client.
When I do share why I’m canceling and the client and I talk about it, I usually feel a sense of relief. My explanation is usually brief and vague. I might say something like, “I had a family matter, and I wanted to make sure that I wouldn’t be distracted while we were in session. I want to be able to give you my full attention.”
Whether or not to share personal information—and if so, how much—depends on the therapist’s comfort level, but their response should come from a genuine place, and they should have the skills to attend to how this display of concern might relate to the client’s presenting problems and remain mindful of how the disclosure could impact the therapeutic alliance. Is the client asking why you’re canceling due to a fear of abandonment, or are they just showing you compassion?
If we seem caught off guard by our client’s questions, they’ll notice. Talking about the elephant in the room could determine how the session plays out and put our client’s worries at rest. It might be an opportunity for clinical insight and further exploration, or at the very least, a chance to build rapport in that we’re providing a glimpse into our own humanity. It is a great reminder that signs of inner discomfort don’t always signal that we should steer clear from the topic at hand.
Ekaterina Kapoustina, MA
Hilo, HI
4) Bringing Our Best Selves to Treatment
I understand where this therapist is coming from. It appears that they feel some guilt due at having to leave their client hanging. First of all, this feeling is normal. I’d suggest that they be honest if they’re asked if everything is okay. Giving your reason as “handling family business” is a great response. It gives a reason for a canceling without giving the client too much access to your personal life. Being honest also demonstrates vulnerability and shows that you’re a therapist but a human first, and experience unexpected life situations just like your clients do.
When I have to cancel a session and my client asks me if everything is okay, I usually answer yes if it’s a normal situation, such as a scheduling conflict with one of my children’s activities. If the answer is no, I’ll say as much, but let the client know that things will get better. Transparency contributes to a healthier clinician-client relationship. However, you should always ensure that the therapy doesn’t become more about you than the client, otherwise you risk losing the focus of treatment. With that said, I think it’s fine to be honest with your clients about your reason for canceling.
Another important point: always make sure you apologize for any inconvenience when canceling an appointment. Everyone’s time is valuable and should be treated as such. You should also look for rescheduling opportunities and resume treatment as soon as possible in order to preserve the therapeutic relationship.
In a nutshell, why do we cancel? In large part, it’s so that we can bring our best selves on the journey to helping our clients become their best selves.
K.J. Brown, LPC
Atlanta, GA
Next Month’s Quandary: After a long day of working with clients, I often find it hard to decompress, destress, and leave my worries behind at the office. Making the reentry into home life is tough. What are some creative ways you wind down from especially tough days at work?
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