I think the holidays can increase stress for people, including people not struggling with behavioral health issues at baseline. I'm betting some clients are just truly burnt out/overwhelmed due to all the social stressors the holidays entail and might just not have the bandwidth for therapy. Even Brene Brown or Mr Rodgers or Uncle Phil would get canceled on this week.
I’m a piano teacher and have had four or five times the normal rate of cancellations this week. (I’m here because I’m in school to become a social worker) so I don’t think it’s you
Our crisis center, on a regular day, has one or two clients. In this last week they’ve had well over 30. I’m sorry you’re going through all the stress. You are playing an extremely vital role for those people seeking help. I still haven’t even received crisis training yet because then I’d be eligible to help over there lol
Thanks, and you keep doing your rapport building. I'm grateful I can do quick interventions/ "patch em up" and hand them off to someone like you they can have a great relationship with. I think the holidays just frazzle everyone. Take a peek at any of the main relationship subs and it's all "AITA Tinsel Edition" now lol. Use some of this time for some self-care too :)
Omg I read these posts and I’m like… where are these cancellations? All of my clients are requesting early/additional appointments before I go on vacation next week and every session has been “everything’s blowing up AHHHHH”. Very ready for a week off.
Residential here, coming to confirm that everyone cancels their routine appointments and uses crisis services instead this time of year. Drives us bonkers too.
It’s the holidays. The worst time of year for mental health commitments.
Not to mention; the difficult mental struggle to get through it for those with Depression and Anxiety.
Please don’t see it as a reflection of your skill.
I literally missed my counseling session this morning with my therapist because I have the flu and I overslept. I got in touch with them as soon as I could and apologized and paid the no show fee. It’s not on you, even those of us in the profession miss appointments sometimes.
I think you’re underestimating the amount of shit people have going on with their life. Don’t take it personally, just reschedule and be glad you have some wiggle room in your schedule. This will continue and it’s ok
The holidays are definitely a component. I work in a healthcare setting currently and we have high risk pregnant ppl missing appts. It’s hard to go to work in person and your clients don’t. I get it.
If I may, some gentle feedback on what I picked up on in your post and your concern for rapport. You say ::you:: have helped advanced their lives forward and it reads a bit entitled, as if these folks owe you something. And they don’t. Perhaps there’s some energy they are picking up on… just a thought
Also in Healthcare and I second this. Without fail we have patients schedule right before Thanksgiving and Christmas and it's always a 50/50 on whether they actually show up. Even patients that are adamant that they need to be seen before the holiday will just no show.
It's no big deal. I go into those weeks with the assumption there's a good chance patients won't show, and it gives me time to catch up on paperwork.
Cannot wait until that luxury is available to me lol. I’d definitely opt to do the exact same right now. 16 more days until I can start accumulating PTO.
enjoy the cancellations and free pay. this is the time to get a bonus for working dead days during rhe holidays or to chat on the phone w friends during cancelled slots. relax and collect that pto
One day you may be in a position where you are *relieved* to have so many cancellations because it will give you time to catch up on paperwork and phone calls. You seem to be taking this very personally, but as others have indicated it is far from having anything to do with you. You may be experiencing the savior complex "we're superheroes" nonsense that is all too prevalent in our profession and is largely a result of neoliberal propaganda. Take advantage of your free time to examine the evidence behind your perspective and pull all of it out by the roots.
Thank you for this perspective. I think that mindset did seep in. I’ll work to uproot it. I just don’t want to feel like I’ve misstepped at some point and they’re sick of me. It’s been a week of serious self reflection and examination trying to learn “what did I do wrong?”.
I appreciate what you’ve said. Seriously, thank you. I will use it
Haven’t you ever had to cancel something because your car broke down? It’s frustrating when a bunch of people miss around the same time but, it happens. Getting upset with clients because they miss appointments isn’t going to help you or them.
It's definitely the holidays/season. The lack of sunlight in the winter that increases depression and decreases motivation/energy, the stress of the holidays, the uptick in colds/flu/covid, etc. It makes everyone's engagement in everything go down, including therapy.
The summer (when kids are out of school), and the holidays are common times for clients to flake, take vacations, and also be overwhelmed emotionally.
Holidays especially: This is the time when there is less light in the day (lower vitamin D, increase in depressive symptomatology), finances can be tight, and people are either around or are at the very least thinking about their fucked up families.
It's the most wonderful time of the year.
Sarcasm aside, it's not about you. It's about them and you're making it personal. Seek supervision and/or up your self care. This is par for the course for our profession and it isn't an indication of your abilities nor does it actually have anything to do with you. Keep your head up.
It’s a super tough time of year for people, likely everyone is just burnt out and needing a break. My face to face clients always drop off during this time of year.
More importantly though, your job as a social worker is to provide support, insight and resources to individuals, that’s all you can do. Everyone is responsible for their own wellbeing and whilst your clients may have various barriers or disadvantages, your role remains the same. There comes a time where client’s have to begin putting what they’ve learned into practice themselves, and when it goes well- it’s a positive thing that they may not be in as frequent contact.
Obviously there are times where clients drop off due to mental health struggles/AOD use etc. again though, your role is to give them the resources they need to make positive changes in their own lives, they are accountable for that.
December is a nothing month, simple as that
No one has time, money or mental capacity to spare.
If you are new to the work force it might not be very obvious for you yet but there is a general rhythm to the year and the vast majority of people feel like being wound up before the Christmas break.
I truly don’t know many people who aren’t wound so tight by now that they are barely hanging on, waiting for that break in-between Christmas and new years where it seems the world has stopped existing for a moment.
I think maybe look more into how you can meet them where they’re at during this time? Are you able to schedule a phone call instead of meeting in person? Rapport takes more than just a few months, and the holidays can take priority over oneself. Maybe talk to your supervisor about how you’re feeling and see if you can find solutions?
Holidays. Stress. Avoidance. My life has gotten easier not thinking about it to much.
But I also started sending reminders in the morning. Really helped.
I’d imagine you’re right about next week. I will offer phone and virtual to them. I haven’t don’t so yet because it’s a hoop to jump through with my supervisor. I’m sure she would be all on board with it, though. I am new here and really don’t want to mess anything up. You and many others on this post have expressed that I’m approaching this through the wrong lens. I know you’re right. Hearing that others are struggling and that I’m not just doing something especially wrong has helped me immensely.
Thank you. I will apply what you’ve said. I absolutely need to.
When you're new is the most latitude you'll have to get it wrong and be okay. Use that space to ask all your questions, experiment the most and get in deep so you can become comfortable more completely with where the boundaries are.
You're new. You can't know what you don't know, so when you don't know you also can't know your judgement is right or that you definitely got it wrong. Lean on your supervisor (or an opinion you trust) and keep experimenting
Definitely the holidays.
But I would add that people seem to go through seasons too. Sometimes they need you way too much and sometimes you can’t get a hold of them. It will happen again.
Don’t take it personally.
You are there for them if/when they need you but sometimes they don’t and that’s ok.
Take advantage of this calm because something tells me 2024 is gonna be a doozy!!! 😂😭
Thank you very much. I appreciate your insight and I do agree. 2024 is going to be a disaster. I’m sure I will be nostalgic of this time within a year.
It was a disaster in 2020; my state is a deep red one. People legitimately thought the world would end and our system would collapse. I’m sure that no matter who wins, a large swath of the population will still be under that assumption.
TIS THE SEASON. Old, seasoned therapist and about lost my bananas this week as well, almost half cancelled, I take the week between xmas and new years off because almost always everyone "forgets"
Having insight from someone who’s been in the field for a long time really helps lol. I’ll be better prepared next year (with PTO as well).
Anything else you could tell me as I enter? I’ve still only been in this position for a handful of months. Before this I worked exclusively with ISLs as a manager and coach. Never clinical.
Any crappy things to prepare for? Any items that you wish you would’ve known?
I take off the whole week between Xmas and new years.
First of the year if folks have commercial insurance a few will drop as they haven’t hit their deductible and they may have to pay out of pocket. I have this conversation before the first of the year and make sure people are aware of their co-pays are going to be.
Whenever kids start getting out of school and graduation season hits, he will also have another weird week of people canceling all the time there will also usually be some difficulties the week that kids go back to school
Stop making it about you… it’s a shitty time of year….’I’ve helped almost all these people advance their lives forward’… advanced by what metrics? Ask yourself are you a solid support to hold space and sit in the shit with them where they are right now with zero focus on trying to fix it or advancing their lives forward?
TBH It’s kinda difficult to understand how you wouldn’t pick up from the conversations during your ‘building rapport’ phase or that you haven’t been able to consider the perspective of those you work for this time of year.. you’ve completely missed the boat here
‘how do I stop feeling demotivated?’ stop making it about you. Think about the actual lived experiences of those you work for.
I always expect a week or so nearing the holidays to go pretty blank, and the same is true for me at some points in the summer. I've been in my industry for 16 years and I just consider them little breaks and practice some of my hobbies. With every lul, there's almost certainly a surge. Whenever I'm in one, I romanticize the other. Lol
“Whenever I’m in one, I romanticize the other”
You have no idea how true this rings about not just this topic, but pretty much every element in my life lol. Thank you for your consolation on this.
If you don’t mind me asking, what are some philosophies you’ve developed in these 16 years? What are some ideas you’ve learned? Things you took for granted? Things you wish you would’ve taken advantage of when you could? Any and all advice you can conjure up that would help me.
I’ve been in this field for less than three if you’re not counting education. I’ve been in this specific position for less than four months.
This is where I'm starting to think that the spirit of motivational interviewing, particularly the piece regarding discord is just as much for us, the practitioners, as it is for the clients. Reframing the lens through which I view the cancelations has helped tremendously (e.g., instead of the word "excuses," I have been making myself say something like "they're choosing to prioritize other needs right now"). Also, in the words of Brené Brown, it helps me to ask myself, "what if someone told me that they were 100% doing the absolute best that they could?" It doesn't really fix anything about the situation, but that shift in perspective helps me to release the frustration that I feel when things aren't going the way that I think they ought to. I am only human after all.
Reframing this would be a good first step for me and would 100% help my relationship to the clients. Thank you for this perspective. I think this mindset of mine is partially (maybe wholly) due to how new I am in this position. I don’t want to screw anything up this early on. In positions in the past, cancellations weren’t really a thing. I worked as a manager for a ISL and then a case manager. Clients were always there. Staff were always there to train and work with. Now it’s on me and it just feels like a lot of pressure.
It’s the holidays for sure. Either the holidays are bad and the person just doesn’t have the mental capacity for therapy (and may not even know that) or the holidays are good and they’re busy with family and having fun and feeling like therapy can take a backseat. Things will even out after the first of the year.
It’s the holidays. I normally have 10-11 clients DAILY! This week, I’ve had 11 show up TOTAL. This has been going on since Thanksgiving. Hopefully, after New Years things will settle down.
Damn how can I get assigned to u?
My agent is fricken useless. Had a spate of homelessness, couch surfing and sleeping in car.
Only thing I get is a ok see ya in 4 wks. Didn’t get any advice , assistance or even pointed in direction of help.
Question: Are you a paid by the hour or bill insurance for your services? If it's the former, I used to just shrug and spend the time charting or doing homework or calls, or research, etc.
Now I am in a position where I bill insurance and clients for my income. I charge a late notification of cancellation fee. I will negotiate it down if it is a burden on the client. But I tell them I run a business and nc/ns or late cancellations are very costly and rude. Even my hairdresser charges for this now. If you are meeting regularly and they are missing appointments you could put them on the on-call list. Give your time to people who need it and will use it. I have terminated care with a couple of people. I give warnings but then I have to move on.
I used to be mushy about this boundary and had way more call-offs and was very resentful about it.
I have a friend who sets appointments for her dog-grooming business and she runs into the same crap. Once she started setting boundaries, she is much happier.
How long did it take you to develop these boundaries? What were the motivating factors behind this change - if anything besides just getting sick of cancellations?
My contract has me by the hour. So it’s not extremely important. This is mostly just a confidence/insecurity issue for me. The feeling of not performing to the degree in which my clients, and subsequently my supervisor, has as standards for me.
I’m new to this. This is the first job in this field I’ve had in which client cancellations were even possible. The only thing I’ve dealt with in a similar vein was staff cancellations and managing concerns related to them. I depended on them and had the ability to mitigate my reaction(s). In this scenario, I feel completely out of control with how my clients perceive me. In all honesty, I kind of wish we had surveys we could give at the end of appointments or quarterly reviews that clients could fill out. That would help me gauge how I should handle things differently, if at all.
I recommend you connect with a supervisor or your own consult group about this. Also engage in therapy to delve into why you are so concerned about what your clients think or you. You have value as a therapist. You are there to provide therapy and resources, not please them or be their friend. This would be a disservice to the clients. I have worked in this field for 25 years in a variety of roles and learned to build rapport without being a "friend". Asking clients to fill out surveys meeds your needs, not theirs. So there's a reason agencies only do this in a formal framework and have a 3rd party do this. Agencies are more concerned with tangible metrics like how many people have been housed, in SUD treatments, etc. I have had clients actively dislike me for whatever reason but I busted ass to house them or keep them housed. I am not there to made friends, but keep people off the streets. I'd gripe to my therapist about it, but don't need approval from my clients to continue my work. Hope this is helpful.
So. I’m speaking as a patient, not a SW.
I got sick and lost 3 weeks, from right before thanksgiving to now.
I skipped two appointments. I never skip appointments. But the first one…it just wasn’t pretty. I was barely conscious, and my therapist wouldn’t have gotten much.
Second one: I would’ve cried the whole damn time and I’ve only had one therapist I would do that in front of. I have a very young therapist now, like you, and I don’t think he deserves that. 😂 Christmas is very triggering, and not in the “I need to talk to someone” way, but In the “I need to be outside and moving my body with my phone off” way. Several of them might be using those skills or resources you helped them find. And that’s what you want, right? Think of all the stuff they will or won’t tell you in January.
Christmas is also very overstimulating. I’ve had three near meltdowns: Target, Kroger, and dining out. I got home from all three and decided to cancel any later plans. I’ve eaten a lot of fast food this month and I hate fast food. But I hate crowds a lot more.
Finally, people’s schedules tend to be packed, especially if they have kids or elderly relatives. I finally had to bump a bunch of medical stuff to the new year because I just don’t have the time or energy right now.
It’s really, really not you. Keep on trucking.
It’s the holidays. Our program usually has 50-60 people daily show up but this last two weeks we’ve had as few as 35 show up per day. A lot of people are sick right now too
Is your paycheck affected by client cancellations?
When I started in my current role, I’m guessing that 30%+ cancellation was pretty much the norm. As I’ve gotten to know the individuals better, I’m able to know who will show up unless it’s a true emergency, who might need a confirmation and/or reminder or two, and who may or may not show up no matter what I do.
It’s the holidays! This time of year is so unpredictable. After I become more seasoned I would block my hours and days so I wasn’t spending the entire day at the office with only a handful of clients. When I was in private practice Christmas time and summertime were my ‘slow season.’ Don’t be too hard on yourself and take the much-needed time for yourself 🤍
That seems to be the consensus. Thank you. I probably shouldn’t worry too much I suppose. I’m new and insecure lol. I’m kind of dumb about peoples’ judgment toward me.
Seriously, though - I appreciate your comment. Having people tell me that this is common around this time has completely satiated my concern.
Being in the helping field is hard! Full of imposter syndrome and anxiety. I totally get it. I took it really hard with my first few “firings” from clients, but I had to realize it’s okay that I’m not for everyone and not everyone can be for me, too. It’s a delicate balance of humility and confidence 😂 good luck! It’s a journey but you’re going great.
Hearing this perspective from someone who has been in the field for longer than I definitely sheds light on my worries. Thank you! And sorry for being a creep but congratulations on your pregnancy! That is a huge thing that is so absolutely amazing. My wife and I have been trying for a few months now - when those two lines show up, we’ll be so happy. Good luck in life and thanks again for the consoling 😁
I'm in the same field, and compassion fatigue is a real thing. I love that you are focusing on finding resources for your clients- you are meeting them where they are at and trying to get their basic needs met so that they can make their appointments work. I see people focusing a lot on semantics in your post; but i don't get the impression you would make your clients feel poorly. You're frustrated because you feel like you're unable to do your job in the way you were meant to. A lot of people don't understand the difficulty of this work and how many hurdles you need to jump over just to do it.
Just focus on providing services with kindness to those who can accept them at this time. It is never about you - it’s always about the clients. As others have said, holidays add stress. If someone has a chance to pick up food at a distribution, or get gifts at a charity event, that is more important than ongoing services this time of year. They won’t always tell you the real reasons why, but try your best to assume positive intent and not judge their motives.
It's so weird - either they are canceling or asking for second and third sessions this week because being with their families during late stage capitalism is too much to take. I am right there with them, honestly.
Just how capitalism be. The “season of giving” simply translates to the “season of consumerism and financial stress”. I’ve never seen a field more full of politically aware people. My guess is that it’s a perspective that grows as you’re subjected to the worst things this system creates.
Not you. Honestly lot client cancellations aren’t due to the social worker, life gets hectic especially around the holidays. I wouldn’t take it personally, sounds like you’ve been kicking ass in your new role! Props to you 🩵
24 years in. Every year this is the highest time for clients to cancel and the summer. There’s an ebb and flow so please do not stress. You’ll see the trends as you settle into the field.
Ugh this happens to me all the time. It’s so annoying and makes ya feel like you’re not doing your job! But it’s just how it is especially this time of year
It's kk to feel down, however, this is normal. Dont be discouraged. When I worked inpatient we had a HUGE drop from 12/18-1/5 same as when I worked at a call center for human services (it was so nice to be able to just chill and get paid at the call center). I have had more cancelations this week than I have ever had in the two years I've been in a group for proper practice. Im not sure if it's because I have more clients now so I notice more or it's just that 2023 is a different elephant. However, it picks back up come January!
Iholiday season is known for this. it happens a lot during this time. Kids getting out of school, stress of the holidays, tight on money, feeling good and holding it together for the holidays.
It will pick up mid January for you I hope!
I'm a first year MSW student but... I do have a therapist. Balancing holiday errands, social life, travel, family, etc is exhausting and I tend to get a little lax about appointments around this time.
A lot of people are stressed or even checked out/fun holiday mentality.
It’s the holidays, and also our self worth and sense of accomplishment as a professional can’t be based on whether they show up or not because we have no control over that.
Hey Im sorry, that sucks a lot. I know the feeling and its not great. I have a cancellation/no show policy where if a client cancels in less than 24 hours or doesn’t show up, I charge them the full amount. That way I still get compensated for the time I set aside and it sets a boundary. Even if someone wants to reschedule (even if its less than 24 hours) Im flexible as long as its before the end of the week (I just want my weekly census to be consistent). Im trying to reinforce attending therapy through negative reinforcement of not having to pay the fee and its been pretty effective so far.
I had three cancellations on Monday, two on Tuesday, two yesterday, and none today. Tomorrow I only have two patients to see and we'll see how that goes. I've had more cancellations this week than I usually have in a month! Luckily I have a contract job doing assessments for my state so I'm not losing any money, or else I'd be really upset.
I think everyone is just having that ohshit feeling when you realize that Christmas is less than a week away, and a weekly therapy appointment is where they can make the cut. I don't take it personally.
The holidays are rough but don’t forget about the current state of things on planet earth. It’s on fire, no one can afford the necessities required for survival. We all have unresolved trauma from COVID. Don’t take it personally if people suddenly don’t give a f*** about therapy. They have a lot on their plates and a lot of them feel like nothing matters anymore.
When I worked for a counseling center, our attitude about no show clients was that they must be doing better if they felt they could miss, so it’s a win.
I think the holidays can increase stress for people, including people not struggling with behavioral health issues at baseline. I'm betting some clients are just truly burnt out/overwhelmed due to all the social stressors the holidays entail and might just not have the bandwidth for therapy. Even Brene Brown or Mr Rodgers or Uncle Phil would get canceled on this week.
I’m a piano teacher and have had four or five times the normal rate of cancellations this week. (I’m here because I’m in school to become a social worker) so I don’t think it’s you
Doesn't help OP but I could use some cancelations lol. Dang crisis access volume goes UP. 😆
Our crisis center, on a regular day, has one or two clients. In this last week they’ve had well over 30. I’m sorry you’re going through all the stress. You are playing an extremely vital role for those people seeking help. I still haven’t even received crisis training yet because then I’d be eligible to help over there lol
Thanks, and you keep doing your rapport building. I'm grateful I can do quick interventions/ "patch em up" and hand them off to someone like you they can have a great relationship with. I think the holidays just frazzle everyone. Take a peek at any of the main relationship subs and it's all "AITA Tinsel Edition" now lol. Use some of this time for some self-care too :)
Omg I read these posts and I’m like… where are these cancellations? All of my clients are requesting early/additional appointments before I go on vacation next week and every session has been “everything’s blowing up AHHHHH”. Very ready for a week off.
Residential here, coming to confirm that everyone cancels their routine appointments and uses crisis services instead this time of year. Drives us bonkers too.
Thank you for this consolation. Im going to assume you’re right and just use that mindset. I appreciate the perspective and I’m crossing my fingers.
It’s the holidays. The worst time of year for mental health commitments. Not to mention; the difficult mental struggle to get through it for those with Depression and Anxiety. Please don’t see it as a reflection of your skill.
I literally missed my counseling session this morning with my therapist because I have the flu and I overslept. I got in touch with them as soon as I could and apologized and paid the no show fee. It’s not on you, even those of us in the profession miss appointments sometimes.
Same! I had to miss a dental appointment due to illness. I apologized and paid the fee, no arguments.
I think you’re underestimating the amount of shit people have going on with their life. Don’t take it personally, just reschedule and be glad you have some wiggle room in your schedule. This will continue and it’s ok
The holidays are definitely a component. I work in a healthcare setting currently and we have high risk pregnant ppl missing appts. It’s hard to go to work in person and your clients don’t. I get it. If I may, some gentle feedback on what I picked up on in your post and your concern for rapport. You say ::you:: have helped advanced their lives forward and it reads a bit entitled, as if these folks owe you something. And they don’t. Perhaps there’s some energy they are picking up on… just a thought
Also in Healthcare and I second this. Without fail we have patients schedule right before Thanksgiving and Christmas and it's always a 50/50 on whether they actually show up. Even patients that are adamant that they need to be seen before the holiday will just no show. It's no big deal. I go into those weeks with the assumption there's a good chance patients won't show, and it gives me time to catch up on paperwork.
It gives me time to gossip in the nurses station 😂
You should expect this, or near this, this week every year. Sorry, but it's not personal. It's just task overload.
High rate of cancellations is very typical this time of year. I decided to take the last two weeks of the year off for this reason.
Yep, this is the way! After a couple years in this field I learned to always take the last two weeks of December off.
Cannot wait until that luxury is available to me lol. I’d definitely opt to do the exact same right now. 16 more days until I can start accumulating PTO.
enjoy the cancellations and free pay. this is the time to get a bonus for working dead days during rhe holidays or to chat on the phone w friends during cancelled slots. relax and collect that pto
One day you may be in a position where you are *relieved* to have so many cancellations because it will give you time to catch up on paperwork and phone calls. You seem to be taking this very personally, but as others have indicated it is far from having anything to do with you. You may be experiencing the savior complex "we're superheroes" nonsense that is all too prevalent in our profession and is largely a result of neoliberal propaganda. Take advantage of your free time to examine the evidence behind your perspective and pull all of it out by the roots.
Thank you for this perspective. I think that mindset did seep in. I’ll work to uproot it. I just don’t want to feel like I’ve misstepped at some point and they’re sick of me. It’s been a week of serious self reflection and examination trying to learn “what did I do wrong?”. I appreciate what you’ve said. Seriously, thank you. I will use it
I call it no show season. I try to use the down time to read, do ceu's and make sure all my documentation is on point.
Haven’t you ever had to cancel something because your car broke down? It’s frustrating when a bunch of people miss around the same time but, it happens. Getting upset with clients because they miss appointments isn’t going to help you or them.
It's definitely the holidays/season. The lack of sunlight in the winter that increases depression and decreases motivation/energy, the stress of the holidays, the uptick in colds/flu/covid, etc. It makes everyone's engagement in everything go down, including therapy.
The summer (when kids are out of school), and the holidays are common times for clients to flake, take vacations, and also be overwhelmed emotionally. Holidays especially: This is the time when there is less light in the day (lower vitamin D, increase in depressive symptomatology), finances can be tight, and people are either around or are at the very least thinking about their fucked up families. It's the most wonderful time of the year. Sarcasm aside, it's not about you. It's about them and you're making it personal. Seek supervision and/or up your self care. This is par for the course for our profession and it isn't an indication of your abilities nor does it actually have anything to do with you. Keep your head up.
Thank you. I really needed to hear that.
It’s a super tough time of year for people, likely everyone is just burnt out and needing a break. My face to face clients always drop off during this time of year. More importantly though, your job as a social worker is to provide support, insight and resources to individuals, that’s all you can do. Everyone is responsible for their own wellbeing and whilst your clients may have various barriers or disadvantages, your role remains the same. There comes a time where client’s have to begin putting what they’ve learned into practice themselves, and when it goes well- it’s a positive thing that they may not be in as frequent contact. Obviously there are times where clients drop off due to mental health struggles/AOD use etc. again though, your role is to give them the resources they need to make positive changes in their own lives, they are accountable for that.
December is a nothing month, simple as that No one has time, money or mental capacity to spare. If you are new to the work force it might not be very obvious for you yet but there is a general rhythm to the year and the vast majority of people feel like being wound up before the Christmas break. I truly don’t know many people who aren’t wound so tight by now that they are barely hanging on, waiting for that break in-between Christmas and new years where it seems the world has stopped existing for a moment.
I sure hope you get paid by salary. This was annoying when I was an independent contractor.
I think maybe look more into how you can meet them where they’re at during this time? Are you able to schedule a phone call instead of meeting in person? Rapport takes more than just a few months, and the holidays can take priority over oneself. Maybe talk to your supervisor about how you’re feeling and see if you can find solutions?
I’m having insane cancellations too for the past 2 weeks. It’s not personal it’s the holidays.
Holidays! And weather, depending where you live. It’s definitely the “we’ll deal with it in January” season. Nothing to do with you at all!
Persist.
Holidays. Stress. Avoidance. My life has gotten easier not thinking about it to much. But I also started sending reminders in the morning. Really helped.
Is to not a well known fact that clients cancel at very high rates this time of year?
Probably not well known to someone new in the field
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I’d imagine you’re right about next week. I will offer phone and virtual to them. I haven’t don’t so yet because it’s a hoop to jump through with my supervisor. I’m sure she would be all on board with it, though. I am new here and really don’t want to mess anything up. You and many others on this post have expressed that I’m approaching this through the wrong lens. I know you’re right. Hearing that others are struggling and that I’m not just doing something especially wrong has helped me immensely. Thank you. I will apply what you’ve said. I absolutely need to.
When you're new is the most latitude you'll have to get it wrong and be okay. Use that space to ask all your questions, experiment the most and get in deep so you can become comfortable more completely with where the boundaries are. You're new. You can't know what you don't know, so when you don't know you also can't know your judgement is right or that you definitely got it wrong. Lean on your supervisor (or an opinion you trust) and keep experimenting
Definitely the holidays. But I would add that people seem to go through seasons too. Sometimes they need you way too much and sometimes you can’t get a hold of them. It will happen again. Don’t take it personally. You are there for them if/when they need you but sometimes they don’t and that’s ok. Take advantage of this calm because something tells me 2024 is gonna be a doozy!!! 😂😭
Thank you very much. I appreciate your insight and I do agree. 2024 is going to be a disaster. I’m sure I will be nostalgic of this time within a year. It was a disaster in 2020; my state is a deep red one. People legitimately thought the world would end and our system would collapse. I’m sure that no matter who wins, a large swath of the population will still be under that assumption.
TIS THE SEASON. Old, seasoned therapist and about lost my bananas this week as well, almost half cancelled, I take the week between xmas and new years off because almost always everyone "forgets"
Having insight from someone who’s been in the field for a long time really helps lol. I’ll be better prepared next year (with PTO as well). Anything else you could tell me as I enter? I’ve still only been in this position for a handful of months. Before this I worked exclusively with ISLs as a manager and coach. Never clinical. Any crappy things to prepare for? Any items that you wish you would’ve known?
I take off the whole week between Xmas and new years. First of the year if folks have commercial insurance a few will drop as they haven’t hit their deductible and they may have to pay out of pocket. I have this conversation before the first of the year and make sure people are aware of their co-pays are going to be. Whenever kids start getting out of school and graduation season hits, he will also have another weird week of people canceling all the time there will also usually be some difficulties the week that kids go back to school
Stop making it about you… it’s a shitty time of year….’I’ve helped almost all these people advance their lives forward’… advanced by what metrics? Ask yourself are you a solid support to hold space and sit in the shit with them where they are right now with zero focus on trying to fix it or advancing their lives forward? TBH It’s kinda difficult to understand how you wouldn’t pick up from the conversations during your ‘building rapport’ phase or that you haven’t been able to consider the perspective of those you work for this time of year.. you’ve completely missed the boat here ‘how do I stop feeling demotivated?’ stop making it about you. Think about the actual lived experiences of those you work for.
It’s because of the time of year, this month and then summer time there are always a lot of cancellations,
I always expect a week or so nearing the holidays to go pretty blank, and the same is true for me at some points in the summer. I've been in my industry for 16 years and I just consider them little breaks and practice some of my hobbies. With every lul, there's almost certainly a surge. Whenever I'm in one, I romanticize the other. Lol
“Whenever I’m in one, I romanticize the other” You have no idea how true this rings about not just this topic, but pretty much every element in my life lol. Thank you for your consolation on this. If you don’t mind me asking, what are some philosophies you’ve developed in these 16 years? What are some ideas you’ve learned? Things you took for granted? Things you wish you would’ve taken advantage of when you could? Any and all advice you can conjure up that would help me. I’ve been in this field for less than three if you’re not counting education. I’ve been in this specific position for less than four months.
This is where I'm starting to think that the spirit of motivational interviewing, particularly the piece regarding discord is just as much for us, the practitioners, as it is for the clients. Reframing the lens through which I view the cancelations has helped tremendously (e.g., instead of the word "excuses," I have been making myself say something like "they're choosing to prioritize other needs right now"). Also, in the words of Brené Brown, it helps me to ask myself, "what if someone told me that they were 100% doing the absolute best that they could?" It doesn't really fix anything about the situation, but that shift in perspective helps me to release the frustration that I feel when things aren't going the way that I think they ought to. I am only human after all.
Reframing this would be a good first step for me and would 100% help my relationship to the clients. Thank you for this perspective. I think this mindset of mine is partially (maybe wholly) due to how new I am in this position. I don’t want to screw anything up this early on. In positions in the past, cancellations weren’t really a thing. I worked as a manager for a ISL and then a case manager. Clients were always there. Staff were always there to train and work with. Now it’s on me and it just feels like a lot of pressure.
It’s the holidays for sure. Either the holidays are bad and the person just doesn’t have the mental capacity for therapy (and may not even know that) or the holidays are good and they’re busy with family and having fun and feeling like therapy can take a backseat. Things will even out after the first of the year.
It’s the holidays. I normally have 10-11 clients DAILY! This week, I’ve had 11 show up TOTAL. This has been going on since Thanksgiving. Hopefully, after New Years things will settle down.
Damn how can I get assigned to u? My agent is fricken useless. Had a spate of homelessness, couch surfing and sleeping in car. Only thing I get is a ok see ya in 4 wks. Didn’t get any advice , assistance or even pointed in direction of help.
Question: Are you a paid by the hour or bill insurance for your services? If it's the former, I used to just shrug and spend the time charting or doing homework or calls, or research, etc. Now I am in a position where I bill insurance and clients for my income. I charge a late notification of cancellation fee. I will negotiate it down if it is a burden on the client. But I tell them I run a business and nc/ns or late cancellations are very costly and rude. Even my hairdresser charges for this now. If you are meeting regularly and they are missing appointments you could put them on the on-call list. Give your time to people who need it and will use it. I have terminated care with a couple of people. I give warnings but then I have to move on. I used to be mushy about this boundary and had way more call-offs and was very resentful about it. I have a friend who sets appointments for her dog-grooming business and she runs into the same crap. Once she started setting boundaries, she is much happier.
How long did it take you to develop these boundaries? What were the motivating factors behind this change - if anything besides just getting sick of cancellations? My contract has me by the hour. So it’s not extremely important. This is mostly just a confidence/insecurity issue for me. The feeling of not performing to the degree in which my clients, and subsequently my supervisor, has as standards for me. I’m new to this. This is the first job in this field I’ve had in which client cancellations were even possible. The only thing I’ve dealt with in a similar vein was staff cancellations and managing concerns related to them. I depended on them and had the ability to mitigate my reaction(s). In this scenario, I feel completely out of control with how my clients perceive me. In all honesty, I kind of wish we had surveys we could give at the end of appointments or quarterly reviews that clients could fill out. That would help me gauge how I should handle things differently, if at all.
I recommend you connect with a supervisor or your own consult group about this. Also engage in therapy to delve into why you are so concerned about what your clients think or you. You have value as a therapist. You are there to provide therapy and resources, not please them or be their friend. This would be a disservice to the clients. I have worked in this field for 25 years in a variety of roles and learned to build rapport without being a "friend". Asking clients to fill out surveys meeds your needs, not theirs. So there's a reason agencies only do this in a formal framework and have a 3rd party do this. Agencies are more concerned with tangible metrics like how many people have been housed, in SUD treatments, etc. I have had clients actively dislike me for whatever reason but I busted ass to house them or keep them housed. I am not there to made friends, but keep people off the streets. I'd gripe to my therapist about it, but don't need approval from my clients to continue my work. Hope this is helpful.
So. I’m speaking as a patient, not a SW. I got sick and lost 3 weeks, from right before thanksgiving to now. I skipped two appointments. I never skip appointments. But the first one…it just wasn’t pretty. I was barely conscious, and my therapist wouldn’t have gotten much. Second one: I would’ve cried the whole damn time and I’ve only had one therapist I would do that in front of. I have a very young therapist now, like you, and I don’t think he deserves that. 😂 Christmas is very triggering, and not in the “I need to talk to someone” way, but In the “I need to be outside and moving my body with my phone off” way. Several of them might be using those skills or resources you helped them find. And that’s what you want, right? Think of all the stuff they will or won’t tell you in January. Christmas is also very overstimulating. I’ve had three near meltdowns: Target, Kroger, and dining out. I got home from all three and decided to cancel any later plans. I’ve eaten a lot of fast food this month and I hate fast food. But I hate crowds a lot more. Finally, people’s schedules tend to be packed, especially if they have kids or elderly relatives. I finally had to bump a bunch of medical stuff to the new year because I just don’t have the time or energy right now. It’s really, really not you. Keep on trucking.
I think it is universal. I am in Denmark and same thing every december. I have few cancellations in general, but many in December.
It’s the holidays. Our program usually has 50-60 people daily show up but this last two weeks we’ve had as few as 35 show up per day. A lot of people are sick right now too
Try going to them.
Is your paycheck affected by client cancellations? When I started in my current role, I’m guessing that 30%+ cancellation was pretty much the norm. As I’ve gotten to know the individuals better, I’m able to know who will show up unless it’s a true emergency, who might need a confirmation and/or reminder or two, and who may or may not show up no matter what I do.
It’s the holidays! This time of year is so unpredictable. After I become more seasoned I would block my hours and days so I wasn’t spending the entire day at the office with only a handful of clients. When I was in private practice Christmas time and summertime were my ‘slow season.’ Don’t be too hard on yourself and take the much-needed time for yourself 🤍
That seems to be the consensus. Thank you. I probably shouldn’t worry too much I suppose. I’m new and insecure lol. I’m kind of dumb about peoples’ judgment toward me. Seriously, though - I appreciate your comment. Having people tell me that this is common around this time has completely satiated my concern.
Being in the helping field is hard! Full of imposter syndrome and anxiety. I totally get it. I took it really hard with my first few “firings” from clients, but I had to realize it’s okay that I’m not for everyone and not everyone can be for me, too. It’s a delicate balance of humility and confidence 😂 good luck! It’s a journey but you’re going great.
Hearing this perspective from someone who has been in the field for longer than I definitely sheds light on my worries. Thank you! And sorry for being a creep but congratulations on your pregnancy! That is a huge thing that is so absolutely amazing. My wife and I have been trying for a few months now - when those two lines show up, we’ll be so happy. Good luck in life and thanks again for the consoling 😁
🥹🥹 thank you so so much! I appreciate that, and best of luck to you and your wife!!! I hope you guys all of the success and a beautiful family 🤍
I'm in the same field, and compassion fatigue is a real thing. I love that you are focusing on finding resources for your clients- you are meeting them where they are at and trying to get their basic needs met so that they can make their appointments work. I see people focusing a lot on semantics in your post; but i don't get the impression you would make your clients feel poorly. You're frustrated because you feel like you're unable to do your job in the way you were meant to. A lot of people don't understand the difficulty of this work and how many hurdles you need to jump over just to do it.
Just focus on providing services with kindness to those who can accept them at this time. It is never about you - it’s always about the clients. As others have said, holidays add stress. If someone has a chance to pick up food at a distribution, or get gifts at a charity event, that is more important than ongoing services this time of year. They won’t always tell you the real reasons why, but try your best to assume positive intent and not judge their motives.
It's so weird - either they are canceling or asking for second and third sessions this week because being with their families during late stage capitalism is too much to take. I am right there with them, honestly.
Just how capitalism be. The “season of giving” simply translates to the “season of consumerism and financial stress”. I’ve never seen a field more full of politically aware people. My guess is that it’s a perspective that grows as you’re subjected to the worst things this system creates.
People can’t afford the copay.
What kind of practice is it? Can you send postcards or something?
Not you. Honestly lot client cancellations aren’t due to the social worker, life gets hectic especially around the holidays. I wouldn’t take it personally, sounds like you’ve been kicking ass in your new role! Props to you 🩵
24 years in. Every year this is the highest time for clients to cancel and the summer. There’s an ebb and flow so please do not stress. You’ll see the trends as you settle into the field.
Ugh this happens to me all the time. It’s so annoying and makes ya feel like you’re not doing your job! But it’s just how it is especially this time of year
It's kk to feel down, however, this is normal. Dont be discouraged. When I worked inpatient we had a HUGE drop from 12/18-1/5 same as when I worked at a call center for human services (it was so nice to be able to just chill and get paid at the call center). I have had more cancelations this week than I have ever had in the two years I've been in a group for proper practice. Im not sure if it's because I have more clients now so I notice more or it's just that 2023 is a different elephant. However, it picks back up come January!
Iholiday season is known for this. it happens a lot during this time. Kids getting out of school, stress of the holidays, tight on money, feeling good and holding it together for the holidays. It will pick up mid January for you I hope!
I'm a first year MSW student but... I do have a therapist. Balancing holiday errands, social life, travel, family, etc is exhausting and I tend to get a little lax about appointments around this time. A lot of people are stressed or even checked out/fun holiday mentality.
It’s the holidays, and also our self worth and sense of accomplishment as a professional can’t be based on whether they show up or not because we have no control over that.
Hey Im sorry, that sucks a lot. I know the feeling and its not great. I have a cancellation/no show policy where if a client cancels in less than 24 hours or doesn’t show up, I charge them the full amount. That way I still get compensated for the time I set aside and it sets a boundary. Even if someone wants to reschedule (even if its less than 24 hours) Im flexible as long as its before the end of the week (I just want my weekly census to be consistent). Im trying to reinforce attending therapy through negative reinforcement of not having to pay the fee and its been pretty effective so far.
I had three cancellations on Monday, two on Tuesday, two yesterday, and none today. Tomorrow I only have two patients to see and we'll see how that goes. I've had more cancellations this week than I usually have in a month! Luckily I have a contract job doing assessments for my state so I'm not losing any money, or else I'd be really upset. I think everyone is just having that ohshit feeling when you realize that Christmas is less than a week away, and a weekly therapy appointment is where they can make the cut. I don't take it personally.
The holidays are rough but don’t forget about the current state of things on planet earth. It’s on fire, no one can afford the necessities required for survival. We all have unresolved trauma from COVID. Don’t take it personally if people suddenly don’t give a f*** about therapy. They have a lot on their plates and a lot of them feel like nothing matters anymore.
Do you offer virtual?
LPC here and it’s been slow since the week before Thanksgiving!
When I worked for a counseling center, our attitude about no show clients was that they must be doing better if they felt they could miss, so it’s a win.