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 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.), outlines the ethical specifics within 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 one in physiotherapy: the 50-minute slot can hardly be filled at short notice. Psychotherapeutic sessions cannot be booked spontaneously – they are planned long in advance and embedded in a therapeutic process. For the therapist, an open slot almost always results in a loss of income with no alternative.

At the same time, the topic is psychologically delicate: patients who miss an appointment sometimes do so precisely when they are struggling – it is 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 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 fulfill 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 the contractual penalty pursuant to CO Art. 160 et seq.: a pre-agreed flat fee that is payable without proof of damage. Prerequisite: the regulation must have been communicated and accepted during the appointment scheduling. This is done via terms and conditions (GTC) or an explicit agreement in the intake form – a practice that is standard in psychotherapy anyway (informed consent, privacy policy, fee agreement).

3. The ethical dimension: when goodwill is appropriate

The Swiss Patients' Organisation (SPO) and various professional associations recommend goodwill in the event of unpreventable cancellations. This applies particularly to psychotherapy: if someone misses an appointment because they are unwell, an automatic fee is counterproductive. The fee should serve as an incentive for appointment adherence – not as a punishment during a crisis situation.

Recommended practice: the first no-show is always free of charge, combined with a conversation about the importance of regular sessions. From the second no-show onward, a fee is charged, but with exceptions for proven emergencies. Document this goodwill policy internally and apply it when in doubt. This strengthens the therapeutic relationship and makes the practice appear 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 a short-notice cancellation without replacement – 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 safeguard is pre-authorisation during appointment booking: the client enters credit card details, but no amount is debited immediately. The card is verified and an amount is reserved. If the client attends the appointment, the payment is processed normally (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 best suited shortly before the appointment or as an advance payment. In the event of a no-show, the pre-authorised fee is debited within 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 provide 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 in the therapeutic context. Recommendation: explain the safeguard in the intake form or during the initial consultation – not as an expression of distrust, but as a structural practice policy that applies to everyone. This reduces resistance and makes enforcement in individual cases less problematic.

6. FADP-compliant implementation: separating 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 in tokenised form, without plaintext card 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 effect since September 2023), Payrexx acts as 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 pursuant to FADP Art. 5 lit. c): the payment solution must not contain any diagnoses or psychological findings – neither in the booking reference nor in transaction descriptions.

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

For the GTC or intake form, the following wording is recommended:

'For appointment cancellations made less than 24 hours prior to the scheduled session or in the event of an unexcused absence, a cancellation fee of EUR [Amount] will be billed. 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 to the credit card provided at booking or invoiced separately.'

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

8. Checklist: setting up a no-show policy in 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: offer advance payment with a refund promise as an alternative

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

• Document the goodwill policy internally: when the fee is to be 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 stored upon booking; in the event of a no-show, you can 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.