The missed session: A neglected aspect of psychodynamic psychotherapy.

Abstract

Missed sessions, whether initiated by the patient, therapist, or nature, are events in psychotherapy, not non-events. When appropriately handled, missed sessions provide valuable opportunities for therapeutic exploration. A clear cancellation policy, discussed early in therapy, offers a frame within which therapist and patient may understand the meanings of the missed session. An awareness of transference and countertransference contributes to therapeutic implementation of the cancellation policy and resulting maintenance of exploratory space. Therapists whose cancellation policies are unclear, too rigid, or too lenient render the therapy unsafe. Addressing the financial implications of a missed session before attending to motivations and feelings surrounding it is a clinical mistake.

Ethical dilemmas in mental health resources for college students: A reflective case study

“…In this context, it would be desirable to establish a uniform cancellation policy (22). While it is understandable that clients would like to see their therapists more often (with a smooth process towards a slot of their choice), the reality for the SSC is that it has to accommodate a fast-growing demand for mental health support from a sizeable student population.…”

Common Errors in Conducting Psychodynamic Psychotherapy: Illustrative Vignettes and Alternative Strategies

“…A "no-show" occurs when a patient misses a scheduled therapy appointment without notifying the therapist (DeFife, Conklin, Smith & Poole, 2010). While seemingly insignificant, calling a patient about a no-show may have the potential to undermine the therapeutic process (Gans & Counselman, 1996), with the possible exception of calling an established patient for whom abandonment is a primary dynamic. Although there may be a number of important and unavoidable reasons for missing a session, we contend that the "no-show" itself may be a significant communication.…”

“…At the beginning of psychotherapy, the therapist typically discusses his or her policy regarding missed sessions. This includes the handling of charges for missed sessions and the practice of not charging for sessions that are cancelled by the patient with appropriate advanced notice (Gans & Counselman, 1996). However, therapists rarely discuss the policy for sessions that the therapist must miss or cancel without appropriate notice.…”

The analyst as father: remembering and repeating – in the hope of working through

“…The signifi cance of late or missed sessions has received much interest in the literature (Miller & Twomey, 2000). Special attention has been drawn to the rationale for charging (Blackmon, 1993;Tulipan, 1983); its meaning for the patient (Mitchell, 1993); and the need for proper handling (Gans & Counselman, 1996). Whatever the policy decided upon by the individual analyst, there does seem a clear message that the patient can feel "traumatized and inadequately held" (Gans & Counselman, 1996, p. 47).…”