Patient Absenteeism In Psychotherapy: Why Does It Happen?
If you are reading these lines, it is likely that you dedicate yourself to practicing psychology. The truth is that this is an exciting profession, but also full of challenges. If you are in the field of psychotherapy, you may have on occasion felt upset when you see that a patient does not attend scheduled appointments. This gesture can generate discomfort and, especially when you are just starting out, also insecurity. If a person leaves us “stuck,” we can assume that this is because we have not done our job well. However, the reality is that there are many other reasons that can explain the patient’s lack of adherence to therapy.
Of course, it is important that as professionals we know how to exercise self-criticism and try to work to correct errors and learn from clinical experience. However, focusing solely on ourselves will prevent us from understanding the full range of factors that can affect a person’s response to treatment.
Therefore, in this article we will focus on the causes of absenteeism by patients in the psychotherapy consultation.
Therapeutic adherence is the consonance of the patient’s behavioral patterns, on the one hand, and the professional’s therapeutic prescriptions, on the other. Furthermore, good adherence involves generating a bond that unites the patient and the professional and makes them collaborate and complement each other to reach long-term goals; a relationship based on trust and commitment.
Attendance at scheduled sessions is one of the many signs that a person is committed to the psychotherapy process. Thus, when a patient begins to repeatedly miss meetings with his therapist, it is necessary to review the situation to understand what is happening.
The truth is that this situation can be caused by many variables, some beyond the professional’s control. Therefore, it is important that there is fluid communication between both parties in order to find a joint solution.
Reasons why absenteeism may appear in the therapy process
Next, we will look at some reasons why a patient may stop attending their appointments.
1. The patient has problems with payment
Despite their importance, formal issues are often overlooked. The risk of absenteeism on the part of the patient is always greater when sessions are paid for a posteriori and not in advance. Also when the conditions surrounding the cancellation of sessions are not made clear. If, for example, the patient is informed that he will have to pay the price of the session if he cancels less than 24 hours before, he is more likely to attend. Apart, There are tools like eHolo that allow you to have control over payments and even charge in advance for these visits which reduces the cancellation rate we talked about.
2. The patient has resolved the symptoms
A therapy process will have a longer or shorter duration depending on demand. Sometimes, people come without a defined problem, with many open fronts. In these cases, the path forward may require months or even years of intervention.
However, it is expected that in less time the most annoying and urgent symptoms (for example, anxiety attacks) will subside. Although the problem has not been resolved from the root, the patient no longer feels such a marked interference in his life. This can make you feel hesitant about whether to drop out or not, resulting in irregular attendance. At this point, it is key that the therapist expresses to the patient the importance of going beyond the tip of the iceberg, since the remission of the most severe symptoms does not at all indicate that there is a total recovery.
It may seem silly, but often the simplest applications are the most likely. In many cases, patients stop going to psychotherapy because they are bad at managing their schedule and, by the time they realize that they should have left for the psychology consultation, it is so late that it is a delay. big inconvenience of rushing (feeling like they won’t be able to have a full session anyway).
In this sense, there are very useful tools for psychologists that help them prevent this type of problems; A clear example is eHolo, a digital process automation platform designed specifically for psychotherapists. Among its functions, it allows Schedule reminders to appear for patients and gives the option of making payments in advance, greatly reducing the cancellation rate that professionals receive.
4. There is no harmony between patient and therapist
Finding a psychology professional is not always easy. Harmony with the professional is something that cannot be forced, and his style and working method may be suitable for some people and not for others. When this harmony does not appear, it is natural that adherence to treatment is damaged. In these cases, the patient may feel a certain reluctance and even notice that the therapist does not understand him as he expects. Finally, he may end up missing sessions due to lack of motivation towards the therapeutic process.
5. Patient’s disposition towards change
According to Prochaska and Diclemente’s (1984) transtheoretical model of change, people go through several phases when producing a change in their behavior. The model describes several stages that show where people are during the change process, showing that At certain stages, resistance to the new arises.
If, for example, a patient is in the contemplation phase, this means that he or she is ambivalent about the possibility of changing. He recognizes possible advantages of change, while feeling that not changing will allow him certain gains. In this case, the psychologist will have to help his patient resolve the ambivalence and find intrinsic reasons to lean toward change. If the professional ignores the patient’s phase of change, he or she may force the process too much, which will generate resistance and reduce adherence.
6. The patient comes obliged
It is true that when it comes to minors, they attend or stop depending on the criteria of their parents. However, there are adults who also go to therapy out of “obligation.” Technically, no one can force them to do so, but they can come to the consultation due to pressure from someone (a family member, another professional…). In these cases, it is always more likely that attendance at appointments will be irregular, since there is no intrinsic motivation that led them to ask for help.
In conclusion, absenteeism in psychotherapy can be due to multiple factors. As therapists, it is essential to recognize and address these elements to improve patient adherence and engagement. Tools like eHolo can help, but it is crucial to establish a solid and trusting relationship with the patient, adapt to their change process and maintain open and empathetic communication to overcome the barriers that prevent regular attendance at sessions.
