The Psychology of Missed Appointments

Also known as “no-shows”, the definition of missed appointments is pretty self-explanatory.  An appointment is reserved for the client, the client does not attend.

I’d like to be clear that sometimes this happens for very legitimate reasons: an accident, serious illness or other calamity.  Other times, folks just plain forget.  I did this once many years ago when I was a counselling client; I was horrified when I realized that I’d unintentionally wasted my counsellor’s time. Back in those days my mind was often racing with thoughts and worries, often crowding out important daily life details.  My counsellor and I worked it out and continued on from there.

And sometimes people miss an appointment, often a first appointment, and are not contactable, when the counsellor tries to get in touch with them.

Attending a first counselling appointment can be especially hard. There are risks involved such as:

  • What is the counsellor like? Will I feel comfortable with her or him?
  • How open should I be?
  • Will I face judgment from the therapist, or even judge myself?
  • Will I get what I need from the session?
  • Will I need to discuss things outside of my comfort zone?
  • Will I feel like an emotional mess afterwards?

These are all important questions and even though clients have rights there is no guarantee that it will be a comfortable experience, although screening a counsellor well beforehand can help ensure that counselling is a helpful and worthwhile process.

I’ve also noticed that missing counselling appointments is more likely when people have chaotic lifestyles, which may or may not include variables outside of their control.  Factors which can increase missed appointments can include:

Counsellor Perspective

Most counsellors have firm policies around missed appointments, usually charging clients the cost of the appointment. Why?  This time has been reserved exclusively for the client, meaning other people who could have benefitted from this appointment time, cannot use it.  Additionally, when counsellors have reserved  the time in their work schedule, they expect to be compensated for that. Most therapists will have a 24-hour cancellation policy as it’s typically hard and often impossible, to fill appointment spots on short notice. Some counsellors ask for 48 hours notice.  Counsellors may even charge less if the client cancels outside of the cancellation window than if he or she outright does not show.

Counsellors themselves are not immune to missed appointments.  In my experience it’s pretty rare, but it’s theoretically possible for the counsellor to, for example, experience an emergency before a scheduled appointment.  It happened to me three years ago when I was involved in a car accident on my way to work.

Why don’t clients cancel?

This is a hard question to answer because most clients don’t feel comfortable discussing it.  What I have gleaned over the years is that clients may be:

  • Embarrassed
  • Afraid of conflict
  • Fearful of offending the counsellor
  • Fearful of being questioned by the counsellor
  • Worry that the counsellor will not support a change of mind about starting or ending therapy
  • Unhappy with the counselling they are receiving
  • Not wanting to discuss the reason for the cancellation or prompt a discussion about an uncomfortable topic
  • Angry at the counsellor but lacking the assertiveness skills to express this
  • Terrified of starting counselling
  • Counselling is feeling “too hard.”  This can happen at any point in the counselling, ranging from short or long-term therapy.

What to Do

Please cancel if you need to, for whatever reason!  It’s actually OK to decide for yourself whether or not you want to participate in counselling and to change your mind even if you already have an appointment set up.  Not only does it save you money, counsellors feel that their time is being respected and it also allows them to open up the spot for someone else who may need it. If the counsellor quibbles with you about cancelling, unless you have set up a formal agreement around attendance, this may be a sign that you should seek a different counsellor.

There is another option, particularly if you trust your therapist.  If you are cancelling your counselling appointment to avoid something, often emotional, sometimes it can be useful to bring up your feelings or fears with your counsellor in a session.  This is not a guarantee that this conversation will go well, however, if you have trust in your therapist, the conversation could be a pathway to addressing deeper issues. If it’s your first time trying counselling, let the counsellor know so that she or he will be more attuned to the fact that this is a new experience for you.

Bottom line: cancelling an appointment should be a straightforward process and is always better than just not showing up.