Reducing no-shows in a therapy practice

A Cochrane review of mobile phone messaging reminders (Gurol-Urganci and others, 2013) pooled 7 studies with 5,841 participants. Text message reminders raised attendance compared with no reminder (risk ratio 1.14, 95% confidence interval 1.03 to 1.26). In those studies, attendance was 67.8% with no reminder, 78.6% with a text message and 80.3% with a phone call, and text messages worked about as well as calls. Reminders were sent 24 to 72 hours before the appointment.

For psychotherapy specifically, a meta-analysis of 31 randomised trials with 4,422 people (Oldham and others, 2012) found that steps to improve attendance had a small to medium effect. The most effective were letting clients choose their appointment time or therapist, motivational interventions, preparing people for what therapy involves, giving clear information, attendance reminders and case management.

Across healthcare, a review of 105 studies (Dantas and others, 2018) found an average no-show rate of about 23%, and the factors reported most often were a long wait between booking and appointment and a history of missed appointments. A 2023 review of 61 studies of behavioural approaches found good evidence for reminders and little for the other approaches it looked at.

1. Remind every client 24 to 72 hours before the session, and again on the day if your clients find it useful.
2. Ask clients to confirm, and follow up with the ones who have not.
3. Make cancelling easy. A slot freed two days ahead can be offered to someone else; a silent no-show cannot.
4. Keep a waitlist so a freed slot goes to someone who wants it.
5. Shorten the wait for a first appointment where you can, since a long lead time is one of the most reported causes of no-shows.
6. Let clients choose a time that suits them, and keep regular clients on a steady weekly slot.
7. Prepare new clients: tell them how the first session works, how long it is and what it costs.
8. Track no-shows by client. A pattern is often worth talking about in session.

We could not find a systematic review that measures how fees change attendance in therapy, so treat a fee as a fairness policy rather than a proven fix. If you charge one, put the notice period and the amount in writing at intake, apply it the same way to everyone, and decide in advance when you will waive it, such as illness or an emergency.