Psychology of Missed Appointments

Updated: Dec 23, 2020

Table of Contents

• What Counts as a Missed Appointment?

• What You Might Be Thinking

• Getting the Most Out of Your 20-Minute Consultation

• A Therapist's Perspective

  • Why Don't Clients Cancel?

  • How To Cancel A Therapy Session

  • It Is Your Right to Cancel Therapy at Any Time

  • Always Book a Free Consultation

• References

In the era of virtual counselling and appointments, it can be easy to forget that we have scheduled places to be, without the need to commute to our destinations. Missed appointments, otherwise known as “no shows”, are scheduled appointments that a client does not attend. In my experience, I have noticed a slight increase of no showed appointments with the introduction of online tele-psychology.

Sometimes no shows happen for very legitimate reasons. As psychologists, we understand that life happens! Serious illness’, accidents, sick children, lack of childcare, we have all been there with our fair share of legitimate reasons as to why we cannot make it to appointments. Often times, people simply forget. Particularly during COVID-19, life has become hectic and we entirely understand that.

The odd time, however, a client may not show up to a first session, and are no longer contactable when the psychologist reaches out to connect with them. This can be frustrating for the therapist to navigate, uncertain of the reasons a client may have changed their mind. Understandable that as the client, it can be challenging to commit to therapy. Therapy requires a lot of bravery, and willingness to go to potentially painful and uncomfortable places within our minds. Furthermore, taking that leap and attending a first counselling session can be very hard. Particularly leading up to the session, you might develop some worry or anxieties in anticipation of meeting your therapist.

What You Might Be Thinking:

• Will my therapist be nice?

• Will they understand what I’m trying to say?

• Will I have enough time to share everything that is on my mind?

• Will my therapist judge me?

• Will my therapist like me?

• Will I feel like an emotional mess after this?

• What if I cry in front of my therapist?

• What if I run out of things to say?

These are all valuable and worthwhile questions to ponder, which is why we offer a free 20-minute phone consultation to get to know your therapist prior to your first session to somewhat address some of those first-session jitters and worries you might be experiencing. We encourage our clients to ask as many questions in our free consultation as they would like. Think about it like a job interview, you are interviewing us as much as we are getting to know you! In order for therapy to be the most effective, it’s important that you feel comfortable and connected to your therapist.

Getting the Most Out of Your 20-Minute Consultation

You might consider asking and gathering information on some of the following areas:

• Fee for service

• How many years they have been practicing

• Areas of specialization

• Their specific approach to therapy

• When was the last time you worked with a client who had similar concerns to me?

• What can I do that will help therapy to be most successful

• What is your ideal client?

• What is a typical session like?

• What can I expect for the first session?

• Do we set goals and expectations for therapy? How will you measure my progress?

• Do you give homework to clients? What is some typical homework you might give?

• What can I do to prepare for the first session?

Remember, the consultation is used as a way for you to gauge if the therapist is a good fit for you. Never feel pressured to set up a session if you are uncertain. We would be more than happy to have you contact us when you are feeling ready, comfortable, and fully committed to attending a session instead of booking one because you feel pressured to do so. We want this to be an inviting process for you and welcome you to take the time to think about your options. Attending therapy is a big step to take in working on yourself, and can sometimes take some time to come around to the idea of fully committing to therapy.

A Therapist’s Perspective

Most therapists have strict cancellation policies that they follow. Why? Your therapist has reserved specific and exclusive time for your appointment, meaning that if it is not attended, other people who could have benefitted from this time are unable to access it. Additionally, therapists have set aside time in their schedule to meet with certain clients, and expect to be compensated for that time. Therefore, many therapists will have 24-48 hour cancellation policies. This provides ample time to be able to offer the session to others in need.

Remember, therapists are humans, too! The odd time, we may have to cancel last minute due to illness, family emergency, client emergencies, or personal concerns that require us to cancel last minute.

Why Don’t Clients Cancel?

This is a hard question to answer, as it can be challenging for clients to open up about this. In my experience, however, most often I find that client’s often no show for some of these reasons:

• Avoid cancelling due to embarrassment

• Being afraid of conflict, fear of offending their therapist

• Fear of disappointing the therapist

• Unhappy with counselling that they are receiving, fearful of confronting the therapist and lacking assertive skills to inform the therapist they are unhappy

• Afraid of beginning therapy

• Having been pressured into therapy by a family member and not truly ready

• Therapy is feeling too hard and unrewarding.

• Feeling like they are in a good place and not wanting to open up about difficult things to ruin their day or their momentum

• Things are going well for them so they feel they don’t need the session

• Not wanting to talk about hard things

What Should You Do?

If you can, please cancel your appointment! Please know, it’s entirely okay to cancel your appointment even after you have committed to it.  It’s okay to feel that you are not fully ready to take the plunge into therapy.  This not only  provides you the opportunity to save money, but it allows for the therapist to fill the spot. Mutual respect can be developed through cancellations as each party is left understanding of the situation that has occurred. If committing to attending appointments is something that you struggle with, it might be useful to let your therapist know. You can develop a plan together to hold yourself accountable to your schedule and attending your appointments. Often included in the therapeutic agreement, as the client, it is your right to cancel or terminate therapy at any time.

“As the client, it is your right to cancel or terminate therapy at any time.”

Please know that your therapist will respect your decision should you decide to go with another therapist, or cannot continue therapy for various reasons. We understand that life gets busy, finances get in the way, or you may not be getting out of therapy what you were hoping for. 

If you are cancelling or no-showing for a particular reason, perhaps to avoid something troubling, it may be useful to bring this up with your therapist. Be open, and honest and let them know that you are struggling to open up but are having some difficulties with your emotions and feeling fearful of discussing certain topics. If you are new to therapy, it might be helpful to inform the therapist of this so that they can help guide you through uncertainty and uncomfortable feelings that arise from discussing your concerns.

Always Book a Free Consultation

We understand that times are difficult now more than ever. If you are new to therapy, or are curious about embarking on therapy for yourself, feel free to reach out to inquire about your free 20-minute consultation. Our therapists would be more than happy to chat with you and answer any questions you might have regarding therapy, or specifically to find out if we would be a good fit for your therapeutic needs.

References: 

Meyer, William. (2001). Why They Don't Come Back: A Clinical Perspective on the No-Show Client. Clinical Social Work Journal - CLIN SOC WORK J. 29. 325-339. 10.1023/A:1012211112553

Molfenter, T. (2013). Reducing appointment no-shows: going from theory to practice. Substance use and misuse, 48(9), 743-749. https://doi.org/10.3109/10826084.2013.787098