What to Do if You Need to Cancel a Therapy Session

Two weeks ago, I encountered a situation that isn’t really all that uncommon for me: I woke up to a fairly intense migraine attack. I followed my usual routine of taking abortives and placing an ice pack on my head, but I knew I couldn’t possibly go back to bed. I had to take my children to school, I had a lengthy list of tasks for work, and I had a therapy session scheduled during my lunch break. So, I decided to “suck it up” and push through.

I continued to feel worse with each passing hour. Two hours before my therapy session, I contemplated emailing my therapist to cancel the session, but I worried about what she’d think. As lunch time arrived, I tried taking a different medication, chugging water, and applying a new ice pack to my head before I hopped onto my therapy session.

My therapist could tell something was wrong the moment she appeared on the screen, and asked me if I was dealing with a migraine attack. As I responded with a nod, she asked if there was anything urgent we needed to discuss. When I said no, she simply said, “I really think the most therapeutic thing you can do right now is go lay down in a dark room and treat your migraine.”

As I hopped onto my virtual therapy session the following week, we briefly discussed the situation from the previous week. Through our conversation, I learned two things: everyone has to cancel therapy sessions sometimes, and it’s OK to communicate that ahead of time. Because this information was news to me, I thought it might also be something that fellow therapy-goers may not know either. So, I decided to share the love in case anyone else ever needs to cancel a therapy session.

Be honest with yourself

Personally, I have a hard time cancelling therapy sessions because I see them as the single most important part of maintaining my mental health. However, there are times when cancelling is not only better for my overall health, but necessary.

If you are contemplating cancelling a therapy session but feel uncertain about the decision, I suggest you take just a minute to be honest with yourself about the situation. Doing this may help you realize that, for whatever reason, you do legitimately need to cancel your therapy session. You can check the facts and say, “I’m not physically well enough for therapy today,” or “My loved one really needs me by their side right now,” which will make it easier to cancel.

Contact your therapist as soon as possible

Whether it is 48 hours or 48 minutes before your session, you should always contact your therapist as soon as you realize you will not be able to make it for your session. This tells your therapist that you are safe and doesn’t leave them hanging. It shows that you can communicate, prioritize your needs, and manage interpersonal relationships effectively. It’s also just common courtesy.

Keep in mind that your therapist may have cancellation policies in place and these policies may require you to pay a late cancellation fee if you contact them less than 24 hours before your scheduled appointment. If it’s a true emergency, your therapist may be willing to make an exception. In your therapist’s eyes, any sort of heads-up is better than no communication.

Don’t over explain or make excuses

We all have the right to cancel or reschedule a therapy session as we see fit. However, anxiety and a desire to “keep the peace” can often get in the way of communicating our needs. Oftentimes this either turns into us not asking for what we need or overcompensating with our words. Instead of offering an overly drawn out excuse or trying to explain all of the hypotheticals that contributed to your need to cancel, just state the facts in a clear, concise manner.

For example, if I had emailed my therapist on the day I woke up with a migraine attack, I would have simply said, “Unfortunately I woke up with a horrible migraine this morning. Is it possible to reschedule today’s session?” Similarly, if I had an emergency with my children, I could send a message saying, “I’m dealing with a family emergency that will make it impossible to attend today’s session. I will reach out when I have time. Thanks for understanding!”

Regardless of the situation, brief messages help convey what you need to say without making it sound like you are trying to avoid therapy. They also help your therapist get the information they need without overwhelming them with excess information.

Avoid the shame spiral

Unfortunately, one of the hardest parts of cancelling a therapy session isn’t dealing with your therapist, but rather your own emotions after the fact. You may feel like you’ve let your therapist down. You may think you can’t maintain commitments because you cancelled a single time. Worst of all, you may think you are a bad person for cancelling the session even though you legitimately needed to.

Here’s the thing though: All of those things your brain is telling you are lies. They’re nothing more than your mental illness talking and trying to pull you down. It’s that shame spiral we all know far too well.

Although it’s hard to avoid these automatic thoughts, it’s important to do so as much as you can. Or, if you can’t shut them down, try reframing them into something more positive or using distraction techniques to keep your mind occupied. Over time, that voice inside your head will get quieter.

Therapy is definitely important for anyone who lives with a mental health condition. However, there are times when we all need to cancel or reschedule sessions—we’re human. If you find yourself in a situation when you need to contact your therapist and cancel a session, I hope this guide based on my own experience will help, even if it’s just a little bit.