The Psychology of Missed Appointments

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’ve noticed a slight increase in 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 illnesses, accidents, sick children, lack of childcare — we have all been there with our fair share of legitimate reasons we cannot make it to appointments. Often, 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 is 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. It’s understandable that, as the client, it can be challenging to commit to therapy. Therapy requires a lot of bravery and a willingness to go to potentially painful and uncomfortable places within our minds. 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 anxiety 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 20-minute phone consultation to get to know your therapist prior to your first session — to help address some of those first-session jitters and worries you might be experiencing. We encourage our clients to ask as many questions in the consultation as they would like. Think of it like a job interview: you are interviewing us as much as we are getting to know you. For therapy to be most effective, it’s important that you feel comfortable and connected to your therapist.

Getting the most out of your consultation

You might consider asking about some of the following areas:

• Fee for service
• How many years they have been practising
• Areas of specialization
• Their specific approach to therapy
• When was the last time they worked with a client who had similar concerns to you?
• What can you do to help therapy be most successful?
• What is their ideal client?
• What is a typical session like?
• What can you expect for the first session?
• Do you set goals and expectations for therapy? How will progress be measured?
• Do they give homework to clients? What is some typical homework they might give?
• What can you do to prepare for the first session?

Remember, the consultation is a way for you to gauge whether 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, rather than booking one because you feel pressured to do so. We want this to be an inviting process, and we welcome you to take the time to think about your options. Attending therapy is a big step in working on yourself, and it can sometimes take time to come around to the idea of fully committing.

A therapist’s perspective

Most therapists have clear cancellation policies that they follow. Why? Your therapist has reserved specific, exclusive time for your appointment, meaning that if it is not attended, other people who could have benefited from this time are unable to access it. Therapists also set aside time in their schedule to meet with certain clients and expect to be compensated for that time. For these reasons, many therapists have 24–48 hour cancellation policies. This provides ample time 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.

Why don’t clients cancel?

This is a hard question to answer, as it can be challenging for clients to open up about. In my experience, clients most often no-show for some of these reasons:

• Avoiding cancelling due to embarrassment
• Being afraid of conflict, or fear of offending their therapist
• Fear of disappointing the therapist
• Being unhappy with the counselling they are receiving, fearful of confronting the therapist, and lacking the assertiveness to say they are unhappy
• Being afraid of beginning therapy
• Having been pressured into therapy by a family member and not truly being ready
• Therapy feeling too hard and unrewarding
• Feeling like they are in a good place and not wanting to open up about difficult things
• Things going well, 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. It’s entirely okay to cancel even after you have committed to it, and it’s okay to feel that you are not fully ready to take the plunge into therapy. Cancelling not only gives you the opportunity to save money — it also allows the therapist to fill the spot. Mutual respect can be developed through cancellations, as each party is left understanding the situation that has occurred. If committing to appointments is something you struggle with, it might be useful to let your therapist know. You can develop a plan together to hold yourself accountable to attending. As is often included in the therapeutic agreement, it is your right as the client 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 to discontinue 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 and are having some difficulty with your emotions or feeling fearful of discussing certain topics. If you are new to therapy, it might help to tell the therapist so that they can guide you through the uncertainty and uncomfortable feelings that arise from discussing your concerns.

Always book a free consult

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