No-show fees in psychotherapy: Legal situation, ethics and implementation in Switzerland

Psychotherapists in Switzerland are permitted to charge no-show fees – but the ethical dimension is more complex than in other practices. The relationship of trust must be preserved, the fee must be transparently agreed upon in advance, and the technical implementation via credit card guarantee only works with Visa or Mastercard – TWINT does not support pre-authorisation.

This guide explains the Swiss legal situation (CO Art. 160 et seq.), highlights the ethical specificities within the psychotherapeutic context and describes the technically correct implementation.

1. Why no-shows in psychotherapy are particularly problematic

An unexcused missed appointment in psychotherapy is structurally different from one in physiotherapy: the 50-minute slot can hardly be filled at short notice. Psychotherapeutic sessions cannot be booked spontaneously – they are planned long-term and embedded in a therapeutic process. For the therapist, a vacant slot almost always means a loss of income with no alternative.

At the same time, the topic is psychologically sensitive: patients who miss an appointment sometimes do so precisely when they are feeling very unwell – a symptom, not indifference. A rigid no-show fee in this context can strain the therapeutic relationship. This does not mean that a fee should be waived entirely – but it does mean that communication and goodwill policies must be designed with particular care.

2. Legal situation: CO Art. 160 et seq. and the contractual penalty

As in other therapy practices, a contract is concluded when an appointment is booked – this also applies to psychotherapy. If one party does not comply with the contract, the other can claim damages (CO Art. 97 et seq.). In practice, this is costly: the therapist must prove that the slot could not be filled otherwise and that actual damage occurred.

The more elegant solution is the contractual penalty in accordance with CO Art. 160 et seq.: a flat fee agreed upon in advance which becomes due without proof of damage. Prerequisite: the regulation must be communicated and accepted when the appointment is made. This is done via GTC or an explicit agreement in the registration form – a practice that is commonplace in psychotherapy anyway (consent form, privacy policy, fee agreement).

3. The ethical dimension: When goodwill is appropriate

The Swiss Patient Organisation (SPO) and various professional associations recommend goodwill in cases of cancellations through no fault of one's own. This is particularly true in psychotherapy: if someone misses an appointment because they are feeling very unwell, an automatic fee is counterproductive. The fee should be an incentive for attendance – not a punishment in a crisis situation.

Recommended practice: First no-show always without fee, combined with a conversation about the importance of regular sessions. Charges apply from the second no-show onwards, but with exceptions for proven emergencies. Document this goodwill policy internally and apply it in case of doubt. This strengthens the therapeutic relationship and makes the practice perceived as fairer.

4. How high may the no-show fee be?

In psychotherapy, a fee of 50% to 100% of the session price for short-notice cancellation without a replacement is proportionate – the slot cannot be booked spontaneously. In case of longer notice (more than 48 hours), either no fee or a reduced flat fee is recommended.

5. Technical implementation: Credit card guarantee via pre-authorisation

The most effective technical safeguard is pre-authorisation when making the appointment: the client provides credit card details, but no amount is debited immediately. The card is checked and an amount is reserved. If the client shows up for the appointment, billing proceeds normally (or the payment link is sent after the session). In the event of a no-show, the pre-authorised fee is debited with a few clicks in the Dashboard.

Payrexx supports pre-authorisation for Visa, Mastercard (debit and credit), Apple Pay, Google Pay, and Samsung Pay. TWINT does not support pre-authorisation. This means that clients who wish to pay exclusively via TWINT cannot provide a credit card guarantee. As an alternative: TWINT advance payment of the session with a promise of refund in case of timely cancellation.

Important note on the setting

The credit card guarantee must be carefully introduced within the therapeutic context. Recommendation: Explain the safeguard in the initial registration form or the initial consultation – not as an expression of distrust, but as a structural practice regulation that applies to everyone. This reduces resistance and makes application in individual cases less problematic.

6. DPA-compliant implementation: Separating credit card details and patient data

Credit card data must not be stored in the patient file – this is handled by the PCI-DSS certified PSP. Payrexx stores payment data in a tokenised format, no plain text numbers. For the practice: payment data remains in the Payrexx Dashboard, patient data in the practice software. No linking, no shared database.

According to the revised FADP (since September 2023), Payrexx is a data processor. Conclude a data processing agreement (DPA) according to FADP Art. 9 with Payrexx. In psychotherapy, special requirements also apply to sensitive personal data (health data in accordance with FADP Art. 5 lit. c): the payment solution must not contain diagnoses or psychological findings – neither in the booking text nor in transaction descriptions.

7. No-show policy in psychotherapeutic practice: Sample wording

The following wording is recommended for GTC or registration forms:

'In case of cancellations made less than 24 hours before the scheduled session or in the event of unexcused absence, a cancellation fee of EUR [amount] will be charged. In the event of a proven emergency, the fee will be waived. The first missed session remains free of charge. The fee will be debited via the credit card provided at booking or issued by invoice.'

This wording covers the key elements: deadline, amount, exception, goodwill rule (first session free of charge), payment method.

8. Checklist: Setting up a no-show policy in psychotherapeutic practice

• Formulate a clear no-show policy: cancellation deadline, fee amount, first-session-free rule, emergency exception

• Integrate the policy into the registration form and require written consent

• Set up pre-authorisation in the Payrexx Dashboard (Visa, Mastercard, Mobile Wallets)

• For TWINT clients: advance payment with refund promise as an alternative

• Explain the credit card guarantee in the initial consultation as a structural practice rule for everyone

• Document goodwill policy internally: under what circumstances the fee is waived

• Strictly separate payment data and patient data: no diagnoses in the booking text

• Conclude a DPA with Payrexx (FADP Art. 9)

Payrexx supports pre-authorisation for Visa, Mastercard and Mobile Wallets in all plans including Free. The credit card is saved at booking, and in case of a no-show, you debit the fee with just a few clicks in the Dashboard. For clients without a credit card: TWINT advance payment as an alternative with refund option within 30 days.