Episode 2: When the Therapist Cancels

In this episode of Both Sides of the Couch, Kari dives into a rarely discussed topic: what happens when the therapist has to cancel. From both the professional and human sides, she explores the guilt, boundaries, and grace wrapped up in letting people down, even when it’s unavoidable.

Kari shares two deeply personal stories: the first time she ever had to cancel sessions due to sudden illness, and another when chronic pain made it impossible to follow through on plans to pick someone up from the airport. Both moments highlight how easily compassion can flow outward but how hard it can be to extend it inward.

As a therapist and a chronically ill human, Kari reflects on the emotional weight of canceling, the fear of disappointing others, and the importance of building systems, both in work and in life, that make room for humanity. She reminds listeners that being your own boss means you can (and should) treat yourself like a good boss: one who honors limits and creates balance.

The episode ends with a thoughtful takeaway:
 ✨ Reflect on how you handle cancellations—are you holding yourself to harsher standards than others? How can you align your expectations and give yourself the same empathy you’d offer someone else? ✨

Transcript

0:01

Welcome to both sides of the couch. I'm Carrie, a therapist who also happens to be a human navigating chronic illness, which means I see life from both sides. This is where I share honest stories, lessons, and little reminders that you don't have to have it all figured out to keep showing up. Let's get into today's episode. Welcome back, episode two when the therapist cancels. Today we're talking about canceling as a therapist and as a human, because both of those happened to me. So canceling as a therapist. It's a taboo topic, one that's I think, talked a lot. In like therapists, online forums and stuff like that. And, I hear it from clients too about how sometimes this can be controversial. As a therapist, I'll say, I rarely ever cancel. I can count on one hand the number of last minute cancellations I've had since I've been in private practice, which has been, gosh, 11 years, I think maybe 12. Usually, I mean, I take time off for sure, like sometimes I schedule doctor's appointments during work hours or at vacations, things like that. But I, I'm giving my clients a week or more notice for most of those cases, but I'm talking about last minute cancellations, like. Between our last scheduled appointment and the next appointment, usually like the day before or the day of cancellations. Those are super rare for me. The first time when I was in private practice, I ever canceled at all. It was a same day cancellation. Um, I, I was really struggling, I'll say at that time I was really struggling with canceling when I needed to. I was definitely chronically ill at the time, but this first time was a situational illness. I, I don't still, not a hundred percent sure. I believe I had food poisoning. Like I was just unbelievably sick and it started the evening before and I don't know, like late evening, nighttime, I would say like 10 or 11:00 PM is when the. Vomiting started and I'll save the gory details, but it was going on for so long. I couldn't keep any water down. I got so dehydrated. I ended up walking from the bathroom back to bed to go tell my partner I needed help. I passed out and hit my head on the wall. I don't know how long I was out somehow before I passed out. I quietly. Said my partner's name, but they heard me and got out of bed and came to meet me, passed out. I don't, so, yeah, probably not long, but it was bad and my head hurt. Like I hit it hard enough that I knew I hit my head I think that it was probably really early morning at that point, like three or 4:00 AM got some water in me, got stable. I basically stayed awake all night. So in that in itself, being up all night long, I really wouldn't have been in a good place to provide therapy the next day. But I was also sick, like still sick, severely dehydrated, and I hit my head. So I canceled, I think around 6:00 AM Like I waited until it was like. I don't know. Not in the middle of the night crazy time to text my clients because I don't even think I could have made a phone call at that point. And I texted my whole day. I don't remember how many clients I had that day, but the first one was probably at like nine or 10:00 AM I mean, it was still like hours of notice. It wasn't like they were already at my office or on the way or anything like that. But I'll keep it brief for. For confidentiality purposes, but the first client responded to me very poorly. They were using abusive language towards me and I fired them. I let them know this was against the policies that we talked about. When I did inform consent, um, I ended up getting an apology, but I stuck with the decision to fire that client. It was traumatic for me. I did not want to cancel. My clients. I had this horrible guilt about doing it, but logically knew I was not gonna be able to work that day. And like, who would want their therapist in there when they're feeling like that, right? Like, you know, the rest of my clients were like, oh my gosh, I'm so sorry. I hope you feel better. But anyways, that was tough and that was the first time. And did the way that client respond make it easier for me the next time to cancel? No. Even though I knew my boundaries had been crossed and it was inappropriate, like I think to this day the guilt kind of hangs with me. The fear of canceling last minute on a client and them being mad at you and they were really mad at me. I knew it really had nothing to do with me. Like I get that whole therapy aspect, but yeah, definitely makes it hard. Okay. And I'm gonna share a human side too, of canceling. Because a lot of times with chronic illness or just like for anybody not feeling well or being more tired than they expected, or, or just not wanting to do something anymore can happen, right? But this one sticks out in my mind again because I felt so incredibly bad about it. I was dealing with a chronic illness that had severe debilitating pain. And I think this was so early on, like most people did not know that I had this chronic illness and they didn't know that I was dealing with pain like this. I masking, that's a whole, that's a whole nother subject, but yeah, I'm masked all the time. Like when you had. Chronic pain, you don't get to take a day off from it, right? You, you're, you're dealing with it all the time. So you get to be really good at masking that pain. But occasionally the pain would be so bad. I would pass out. I would throw up. I literally couldn't stand. But this day I was supposed to pick up someone from the airport. This airport was like an hour and a half away too. And they were coming for like work, but also to stay with us and visit, and this was planned ahead of time. I had actually canceled clients weeks in advance to be able to pick this person up from the airport. And I woke up that morning. I think I need to leave. It was like later in the morning, maybe 10 or so. And I was in terrible pain. I think the night before it had been really bad, but I woke up early and I was like, all right, let me take my pain medicine, which was just over the counter by the way. Um, you know, use a heating pad, lay in bed, like do my best. It was just unbelievably bad. And like, it was like up until the minute I was supposed to leave.'cause I was so hopeful that it would pass enough. I could drive for an hour and a half, but it didn't. At the time my mom was living with us, luckily, and she wasn't working, so she came to check on me and was like, oh, are you headed out? I was sobbing. I was like, I can't go, I can't go get them. I feel so awful. Can you please go? I'm so sorry to ask you this last minute. My mom didn't like driving unfamiliar places. It was a far drive. She knew this person, but they weren't like super comfortable with each other. So there was so many layers to this that I felt bad about. But my mom, of course, like seeing me in pain and crying was like, off, no problem, no problem. I'll leave right now. And left like within two minutes. I'm like, okay, I am gonna let them know. I'll give you, I'll text and so you guys can exchange numbers. Um, call me, both of you can call me like if there's an issue. So then I had to send this text to a person who was. On a plane and was not gonna receive the text until they landed and found out that I was not coming to get them. But at least I had sent someone in my place and here's a picture of them. If you don't remember what they look like and here's their number, it was, I just felt awful. And of course the person was like super understanding, like, oh my gosh, I hope you feel better. No problem. And it worked out. It was fine, but I just felt so bad about, you know what? It's crazy that I felt bad for canceling, but not bad for myself. That I was in so much pain I couldn't drive. And I remember worrying later too. Because when they got home from the work event that day to my house, I wasn't in severe pain and looked normal. I think we ended up going out to dinner. So my mind is always like, do they think I was faking this? Are they secretly upset? We didn't really talk about it though. So yeah, canceling as a therapist and as a human is really hard. It's really hard, but something that needs to happen sometimes. So for me, I can easily tell my therapist friends, oh my gosh, you're human and you're allowed to have an illness and you're allowed to have personal issues that come up and you can cancel on clients last minute, even if it's five minutes before. Like that's just life. We don't have to be perfect. We don't have to never have things happen to us that cause us to not be available. But when I say that to myself. 9.9 times outta 10, I'm not gonna cancel. Like I know that, I know this is true. I'm, I know I'm allowed to not feel well. I know I'm allowed to have personal issues, but I'm not gonna cancel. And there's a lot that goes on. Some of that is like when you don't feel well, being distracted and helping somebody else can be really helpful. We work the kind of job as therapists where you. Don't only work under perfect conditions, right? Like yeah, we're doing really difficult emotional work sometimes, and there's extra layers to that. That can be hard when you're not feeling well or you have something that you're going through yourself. But the average person couldn't take off an infinite amount of time to deal with a personal issue or an illness, especially if you work in private practice and you don't get paid if you're not working. So, there's just a lot of dynamics that go into that, but. Over the years. I think something that I really learned about working for myself is that I don't ever have to be angry at my boss. Like I can never be the person that complains about their boss. I can be the best boss ever. Once I realized that, I don't have any excuse to be mad at my boss because. She is me and I can treat myself the way I deserve to be treated. The shift of work life balance and the way that I view things was completely different, and I think that's easier for me because. I am a good employee, right? Like I'm a reliable employee. I'm never gonna do things that are inappropriate. So I can be a great boss, but I can also be a great boss of like saying like, oh, this number of hours is the ideal amount of hours. Sure you can work that. I'm not gonna pressure you to work more. I actually have control over all that stuff. So I can shift my schedule, I can do what I need to do to find balance, and ultimately that allows me to give the best care to my clients. And that's kind of like how I operate as a boss and a quote business person, because I don't really think therapy is a business as much as it is a service, if that makes sense. But, that's kind of how I operate. Like what do I need to do for me? To be the best version of Carry the Therapist for my clients. So that is a lot of stuff outside of work hours that I do. And that's a lot of stuff with my work hours that I do. And like home scheduling breaks, you know, how I, what time I will schedule clients, what days I schedule clients, stuff like that. When it comes to canceling, allows me the ability to hardly ever cancel, like I'm allowed to make these accommodations for myself and not feeling well, and also for my, my mental health, my energy, all that emotional aspect of being a therapist. I have the ability and I have used that ability to create the best version of my job for myself. So I really don't need to cancel very often. I can count on one hand that knock on wood, luckily I haven't had that many horrific things happen to me that I needed to cancel last minute. Not to say that if those things are happening, I wouldn't cancel. I certainly would. There just hasn't been many cases of that. And I'm super grateful for that. Now as a human, as the human side of me, I have kind of the same mindset of like, you don't get an excuse to be mad at your boss. Like you have no excuse to be mad at yourself. You have control over your life and your friends and the people that are in your life. Like, for example, the airport story, I wouldn't. Be picking somebody up from the airport that was gonna be mad at me because I was in debilitating pain and couldn't come get them right? Like even if I didn't have an alternative person to send to pick them up. The type of people I have in my life would be like totally empathetic and understanding of that and be like, no worries. I'll just rent a car, take an Uber, like it's not a big deal. It was nice of you to try to accommodate me. So yeah, I don't keep people in my life who don't treat me the way I deserve to be treated like I'm the standard in a way if you're not gonna treat me the way that I treat me. I'm fine without you. And that's a boundary that for me personally, has been very important, I think, as a therapist and as a human. And that doesn't just go for like friends, that goes for family. Like everyone, everyone, you're living up to the standard of me. I really value communication from both sides. So I kind of think about it like if I have to cancel on something or back out of something, whether it's a lesson it or not. If it were the other way around, I would want the other person to communicate with me about that. Like, obviously, tell me you're not coming, tell me why, if that's okay for you to share with me. I would hope if we're friends, you would be able to tell me that. And, you know, tell me that you feel bad about it like that for me, I'm like, oh, no worries, but like, if you don't tell me you're canceling on me, you're out. Like, that's it for me. And that's just kind of the way my boundaries are set up. So things that I do to make sure that I don't have to cancel at work or in my personal life is really preparing in advance for things. I talked about that a little from work, but like personally, if I have a big or important event that I have advanced notice of something coming up, even if it's something fun for myself, like a vacation. I make sure that I prepare myself for that situation, make sure that I'm gonna be able to accommodate myself whatever needs I have. That could look so different depending on the event or what it is, but also with like casual stuff. Like if a friend invites me out to dinner or something in the middle of the week, that's hard for me because I don't have a lot of energy on work days. But I'll just ask for my needs, like, oh, can we go here because it's closer to home, and can we meet as early as you're able to? So that way I can get home, relax, and get to bed by a normal time. Doing things like that allows me more flexibility and being able to show up for things and not needing to cancel things at the last minute. But yeah, like of course there was nothing I could do with the airport story and there's nothing I could do with the food poisoning story. So those are the outliers. Those are easy for me to remember because they rarely ever happen. The things that happen more frequently are me putting in effort and preparing and advocating for my needs to be able to do things and enjoy my life the same way that everyone else does. So the takeaway today, I want you. To focus on a little bit of self-reflecting. When we think about cancellations, ask yourself, are my cancellations things I would be angry at others for doing? And if so, is that rational? So what I mean by that is, is it it just an irrational act? Like, oh, I would be. Um, mad no matter what, if somebody cancel on me, there's no good excuse. That's not rational, right? Like there are excuses, there are reasons people can't do things, are my cancellations things I would be angry at others for doing how can you align yourself with the expectations you have for others? Like if you are not communicating those cancellations, so you would be mad at someone else if they didn't communicate those cancellations. How can you align yourself with those expectations you have for others? Communicate it. That's how you fix that. So just some food for thought. And remind yourself that we're human, we're allowed to cancel, even though other people sometimes are disappointed by that. That doesn't mean that we need to feel guilty for it, but all right. I think that's it for today. Thanks for joining me on both sides of the couch. If something you heard today resonated, share this episode with someone who might need it. And if you'd like to support the show or find more of my work, check the links in the show notes. Until next time, take care of yourself on both sides of the couch.