Why people miss their appointments

You would think that everyone who has personal challenges and in need of professional help would be moving mountains to gain that assistance. But the reality is that many people simply do not keep their appointments with agencies and professionals whose role is to help them in some way.
Counsellors, Youthworkers, Dieticians, Doctors and other helping professionals all know what it is like to bend over backwards finding an appointment for someone in urgent circumstances only to be sitting around twiddling their thumbs when the person does not turn up.
In some agencies which provide free services, up to a third of their clients do not turn up for their very first appointment. (In my private practice, the rate was under 5%). Then there are other clients who drop out early from the helping process.
Why does this occur? Many professionals believe people discontinue due to dissatisfaction with the help given. But this is not always the case. I believe there are five common reasons people disengage from helping relationships and here is what you can do about it.
  1. There is some personal challenge. Whenever a client misses an appointment with me I try to believe there is an ordinary explanation - they or their child was sick, they forgot their appointment, had trouble with transport, or were abducted by aliens. Of course, these sorts of challenges are common. Well, maybe not the last one.

    Of course we can simply cut people some slack or simply give people a reminder about their appointment the day before. However, I have found when people miss an appointment, they will be more likely to do so again. When they do attend, it pays to check that the following factors are not contributing.

  2. You have not established a relationship of trust. Apparently, the majority of people stress about seeing a psychologist, social worker, counsellor, etc - knowing they will be discussing very personal issues, concerned that they will be judged in some way, or perhaps because they have had a bad experience when seeking help in the past. When people initially enquire about making an appointment, your job (or that of your secretary) is to be as personable and reassuring as possible.

    My secretary would often tell my new clients that I was a lovely person to speak to ... even if this was bending the truth a bit. The better the connection when they enquire or present in person, the more likely they will continue.

  3. You are not working with the client on what they really want. Perhaps Centrelink has obliged them to see you for help in gaining employment, for example. Or they have been mandated by a court to have counselling for their problematic drinking. They may well be saying that they want to gain work or address their problem drinking, but perhaps they really don't see their behaviour as a problem and what they really want is for others to get off their back.

    Once they are through your door, your job is to work with them on what they are wanting, if possible, and see if this parallels what others want for them. Everyone is motivated for something. Your job is to find out what they want and link this to the changes that they, and hopefully others, want to see.

  4. The client is not happy with you. Upsets between you and your clients will occur from time to time. Times when I have accidentally double-booked a session come to mind. When upsets or disappointments occur, we need to be quick to repair the relationship and offer what we can for the future. We will at times also have clients who are not finding the way that we are working helpful. This is not necessarily fatal to the helping process, but it is if we are not open to changing the way we are working.

    Outstanding professionals in helping roles are always adjusting themselves for the individuals they see. I must confess that I was at times tempted to give people a menu as to what sort of therapist they needed while they were waiting to see me. Did they want they want the caring Ken who simply listened and empathised with their circumstances? Or did they want the affable Ken who could also make them laugh? Or the practical Ken who could give them some advice on moving forward?

    Of course, I don't really recommend giving people a menu, but you can at least ask how you can be helpful and adjust yourself accordingly. You can also ask what you can change next time you both meet so you can be more on track. I remember one client who was frustrated with me that I wanted to talk things through when she was visual. That was very helpful for me to know.

    Openness to client feedback will not only reduce early drop-out from the helping relationship but also produce improved outcomes. You can make it easier for clients to give you feedback by setting this expectation from the start, by making it a routine part of how you work, and responding non-defensively - perhaps apologising if you were off the mark, but at least offering to make that change for future meetings.

  5. They are happy to continue by themselves. Sometimes clients conclude the helping relationship, not so much because they have achieved their goal, but more because they feel able to continue by themselves. Sure we may think differently. But as professionals we need to appreciate that sometimes people get what they need from their contact with us, or their circumstances change, and seeing us is no longer a priority.

    If one of your clients has ended the helping relationship, you can at least touch base with them by telephone or email seeing how they are going. You can check if they were unhappy with your approach for some reason and let them know you are happy to make changes. And you can also let them know if it is OK for them to re-present in the future.
There are, of course, those clients who you are happy haven't turned up, but that's another story!

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