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

Psychotherapists in Switzerland may 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 seqq.), shows the ethical specificities in the psychotherapeutic context, and describes the technically correct implementation.

1. Why no-shows are particularly problematic in psychotherapy

An unexcused missed appointment in psychotherapy is structurally different from physiotherapy: the 50-minute slot can rarely 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, an open slot almost always means a loss of income without an alternative.

At the same time, the topic is psychologically delicate: patients who miss an appointment sometimes do so precisely when they are feeling 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 must be waived – but it means that communication and goodwill policies must be designed with particular care.

2. Legal situation: CO Art. 160 et seqq. and liquidated damages

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

The more elegant solution is liquidated damages under CO Art. 160 et seqq.: a flat fee agreed upon in advance that becomes due without proof of damage. Prerequisite: the regulation must have been communicated and accepted when the appointment was booked. This is done via GTC or an explicit agreement in the admission declaration – a practice that is customary 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 for cancellations through no fault of one's own. This applies especially to psychotherapy: if someone misses an appointment because they are feeling very unwell, an automatic fee is counterproductive. The fee should be an incentive for punctuality – not a punishment in a crisis situation.

Recommended practice: First no-show always without a fee, combined with a conversation about the importance of regular sessions. From the second no-show, apply a fee, but with an exception for proven emergencies. Record this goodwill rule 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 is proportionate in the case of short-term cancellation without rebooking – the slot cannot be filled spontaneously. With longer advance 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 protection is pre-authorisation when booking an appointment: the client enters credit card details, no amount is charged 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). Note: a reservation is only valid for a few days – for bookings made well 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 charged 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: clients who wish to pay exclusively with TWINT cannot leave 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 in a therapeutic context. Recommendation: explain the guarantee in the admission declaration or the initial consultation – not as an expression of distrust, but as a structural practice rule that applies to everyone. This reduces resistance and makes application in individual cases less problematic.

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

Credit card details must not be stored in the patient file – this is handled by the PCI-DSS-certified PSP. Payrexx stores payment data tokenised, 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 according to FADP Art. 5 lit. c): the payment solution must not contain any diagnoses or psychological findings – neither in the booking text nor in transaction descriptions.

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

For the GTC or admission declaration, this wording is recommended:

'For appointment cancellations less than 24 hours before the agreed session or in case of unexcused absence, a cancellation fee of CHF [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 charged via the credit card provided at booking or sent by invoice.'

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

8. Checklist: Set 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 admission declaration and require written consent

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

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

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

• Record the goodwill rule internally: when 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 across all plans including Free. The credit card is stored upon booking; in case of a no-show, you charge 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.