Absenteeism of patients 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 work in the field of psychotherapy, you may have felt upset at some point when you saw a patient not keep scheduled appointments. This gesture can generate discomfort and, especially when you are just starting out, also insecurity. If a person "stands" us, 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 mistakes and learn from clinical experience. However, focusing only on ourselves will prevent us from understanding the full range of factors that can condition a person's response to treatment.

Therefore, in this article we will focus on the causes of absenteeism by patients in the psychotherapy consultation.

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What is therapeutic adherence?

Therapeutic adherence is the consonance of the patient's behavior patterns, on the one hand, and the professional's therapeutic prescriptions, on the other. In addition, 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 adheres 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 of which are unrelated to the professional himself. Therefore, it is important that there is fluid communication between both parties in order to find a joint solution.

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Reasons why absenteeism may appear in the therapy process

Next, we will see some reasons why a patient may stop coming to 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 the sessions are paid for after the fact and not in advance. Also when the conditions surrounding the cancellation of the 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, it is more likely that he will attend. Apart, there are tools like eHolo that allow you to have control over payments and even charge these visits in advance, which decreases that cancellation rate we are talking about.

2. The patient has resolved the symptoms

A therapy process will have a longer or shorter duration depending on the demand. Sometimes, people come without a defined problem, with many open fronts. In these cases, the road ahead may require months or even years of intervention.

However, it is expected that the most bothersome and urgent symptoms (for example, anxiety attacks) will subside in less time. Although the problem has not been solved at its root, the patient no longer feels such a marked interference in his life. This can cause you to have doubts about whether or not to drop out, which translates into irregular attendance. At this point, it is key that the therapist express to the patient the importance of going beyond the tip of the iceberg, since the remission of the most severe symptoms does not indicate at all that there is a recovery total.

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3. Poor time management by the patient

It may seem silly, but often the simplest applications are the most likely. In many cases, patients stop coming to psychotherapy because they are bad at managing their schedule, and by the time they realize they should have left in the direction of the psychology office, it is so late that it is a great inconvenience for them to rush (feeling that they will not be able to have a session anyway). complete).

In this sense, there are very useful tools for psychologists that help them prevent this type of problem; a clear example is eHolo, a digital process automation platform designed specifically for psychotherapists. Among its functions, it allows schedule reminders that appear to patients, and gives the option of making the charges 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. The harmony with the professional is something that cannot be forced, and it is that his style and method of work 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 expected. Finally, he may end up missing sessions due to lack of motivation towards the therapeutic process.

5. Patient willingness to change

According to Prochaska and Diclemente's (1984) transtheoretical model of change, people go through several phases when it comes to producing a change in their behavior. The model describes several stages that show the moment in which 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 is ambivalent about the possibility of changing. You recognize possible advantages of the change, while you feel that not changing will allow you certain gains. In this case, the psychologist will have to help his patient to resolve the ambivalence and find intrinsic reasons for inclining for change. If the practitioner ignores the patient's phase of change, they may overforce the process, leading to resistance and reduced adherence.

6. The patient attends forced

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 "compulsion". 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 not one 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 commitment. Tools like eHolo can help, but it is crucial to establish a strong and trusting relationship with the patient, adapt to their change process and maintain open and empathic communication to overcome barriers that prevent regular attendance at sessions.