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 maintained, 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 framework (CO Art. 160 et seq.), highlights the ethical specifics in the psychotherapeutic context, and outlines the technically correct implementation.

1. Why no-shows are particularly problematic in psychotherapy

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 within a therapeutic process. For the therapist, an unfilled slot almost always means a loss of income with no alternative.

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

2. Legal framework: CO Art. 160 et seq. and contractual penalties

As in other therapy practices, booking an appointment creates a contract – including in psychotherapy. If one party fails to comply with the contract, the other party may claim damages (CO Art. 97 et seq.). In practice, this is cumbersome: the therapist must prove that the slot could not be filled otherwise and that actual damage was incurred.

The more elegant solution is a contractual penalty under CO Art. 160 et seq.: a pre-agreed flat fee that falls due without proof of damage. Prerequisite: the regulation must have been communicated and accepted when the appointment was booked. This is done via terms and conditions or an explicit agreement in the intake form – a practice that is customary in psychotherapy anyway (informed consent, privacy policy, fee agreement).

3. The ethical dimension: when goodwill is appropriate

The Swiss Patient Organisation (SPO) and various professional associations recommend goodwill in the event of unavoidable cancellations. In psychotherapy, this applies especially: if someone misses an appointment because they are feeling very unwell, an automatic fee is counterproductive. The fee should be an incentive for appointment adherence – not a punishment during a crisis.

Recommended practice: first no-show always without a fee, combined with a conversation about the importance of regular sessions. From the second no-show onward with a fee, but with an exception for proven emergencies. Document this goodwill policy internally and apply it when in 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 cancellations without rebooking is proportionate – the slot cannot be filled spontaneously. In the event of earlier 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 during appointment booking: the client enters credit card details, but no amount is debited immediately. The card is validated and an amount is reserved. If the client attends the appointment, regular billing takes place (or the payment link is sent after the session). Please note: a reservation is only valid for a few days – for bookings made far in advance, pre-authorisation is only suitable shortly before the appointment or as an advance payment. In the event of a no-show, the pre-authorised fee is debited within the Dashboard with just a few clicks.

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: clients who wish to pay exclusively with TWINT cannot leave a credit card guarantee. As an alternative: TWINT advance payment for the session with a promise of refund in case of timely cancellation.

Important note on the setting

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

6. FADP-compliant implementation: separating credit card data and patient data

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

Under the revised FADP (in force since September 2023), Payrexx is a data processor. Conclude a Data Processing Agreement (DPA) under FADP Art. 9 with Payrexx. In psychotherapy, special requirements also apply to sensitive personal data (health data under FADP Art. 5 let. c): the payment solution must not contain diagnoses or psychological findings – neither in the booking description nor in transaction details.

7. No-show policy in the psychotherapy practice: sample wording

For the T&Cs or intake form, the following wording is recommended:

'In the event of appointment cancellations less than 24 hours prior to the agreed session or unexcused absence, a cancellation fee of EUR [amount] will be invoiced. 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 sent by invoice.'

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

8. Checklist: setting up a no-show policy in the psychotherapy practice

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

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

• Set up pre-authorisation in the Payrexx Dashboard (Visa, Mastercard, mobile wallets)

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

• Explain the credit card guarantee during the initial consultation as a structural practice policy for everyone

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

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

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

Payrexx supports pre-authorisation for Visa, Mastercard, and mobile wallets across all plans, including Free. The credit card is registered during booking; in the event 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 a refund option.