When Therapists Make Mistakes

We don’t often talk about therapeutic blunders, although they happen all the time. There are so many ways for therapists to fail clients. There is probably the most common: a mismatch of styles, or a therapist who is not really helping her client. Then there are those moments when perhaps we fail our clients by not responding in the moment in the way the client might desire. Maybe we sometimes challenge when we should nurture. Or we nurture when we should challenge. Or we may do any number of subtle things, perhaps below the threshold of consciousness, not even fully acknowledged by our clients, but which create distance, disappointment, or detachment. Some examples of this are the stifling of yawns, spacing out for a moment, or failing to remember an important name or detail and the client feels we are not really fully present or engaged with them. This lack of connection may trigger feelings of disappointment, loss, or abandonment. For clients with relational traumas, events such as vacations, emergencies, or even adjustments in session times may also cause feelings of loss and abandonment.

Recently, I was having one of those weeks. The details aren’t important, but I’ll acknowledge that I had taken on a few too many things. Top it off with having a few people needing to meet at different times. Add to that one way I manage client confidentiality: putting client names into my hard calendar (which I do not carry about with me) and then transcribing the sessions later to my iPhone calender simply as “client,” to preserve confidentiality in the event that my phone is lost or stolen.

The result?

I mistakenly transposed a client session time from my hard calendar to an hour later in my phone. And, yes, I missed the client appointment. A client arrived at my office, waited in the waiting room, perhaps knocked on my door, wondering about my whereabouts, and I wasn’t there. The mistake was realized within the hour and I phoned her and we spoke.

But still. I was confused and felt bad that it had happened.

After eleven years of becoming accustomed to some clients not showing up, some clients canceling last minute…this was new. Never before had I been the one to miss the session.

Therapy is about being present. Being witness to your client’s emotional life, and literally, being awake and engaged for fifty minutes at a time, taking in all that your client shares and responding based upon your knowledge of the history of this person. What then, do you do when you fail to be present in the most obvious of ways? By actually not showing up?

This event brought me back to 1992:

A year into therapy with my therapist, I show up at her office, which also happens to be her home. As I pull my car into her long gravel driveway, deep into the woods of Pittsboro, NC, I notice that her car isn’t there. Hmm.

Maybe her car is being serviced?

The front door of her home is unlocked, as usual and I open the door and let myself into her office and sit down on her couch to wait. Her orange tabby cat pokes his nose into the office and then rubs his body against the doorframe as he sways back into the recesses of the house.

I wait for about ten minutes, but I think I knew she wasn’t there from the instant I’d arrived. Still, it slowly dawns on me that she’s not just running late…but she probably isn’t coming to our session at all. This is….different.

I stand and walk into the hallway and hover there, weighing the threshold between her therapy office and the rest of her home..the edge where her work life ends and her real life begins. I look for the first time into her living room…forbidden territory which I’ve never had a real glimpse of before. I scan the room, taking in all I can from my vantage point in the doorway, looking at signs of her lived life: a blanket on the sofa, books and magazines on the table, pictures on the walls, a coffee cup on a side table. I call out her name. Nothing. Nobody home. I note the desire to walk further into her home and poke around. This seems such a unique opportunity to learn more about her, but the thought of being discovered wandering around her home is a strong deterrent. I slowly leave her house, get back into my car, and drive home.

When I get home, I call and leave a message: “It’s Keely. I think you forgot our appointment today.” She calls back later that day to apologize and I joke on the phone,”Well, I was going to discuss my abandonment issues with you today, but you didn’t show up.” I appreciate how it feels completely okay for me to make this joke because she has been there for me, week after week, for over a year. It is clearly a joke, and her missed appointment this day is a clear aberration. I know she will laugh at my joke. And she does. And that feels good. I know she knows it’s not a big deal to me, and that she is forgiven.

I can’t even remember if we spent any more time of it other than a brief acknowledgment at the beginning of the next session.

Back to 2009:

But here I am, 17 years later, a therapist myself, who is earlier into treatment with some clients who do not yet know or trust that I will be there for them. When we make mistakes as therapists, how do we convey both our regret, and the reassurance that this is not typical. And, more importantly, despite the fact that (hopefully) mistakes of this nature are atypical how do we position ourselves to be fully available for the range of our client’s feelings, whether they be rage, despair, sadness, or blame over the fact that we have let them down? Some clients may shrug off a mistake as no big deal, but for others it can be a very big deal. We cannot let our own desires for forgiveness and understanding get in the way of our first job to our clients which is to be present for their feelings.

Many of our clients have long histories that involve being let down by others. When a therapist fails the client in any way, this often ripples on the theme of being let down by others. It can be important to show up and be present for the processing of how this affects our client. Patients can also use their own responses to therapist errors to explore past failures by others in their own lives. When a therapist hides or denies her mistake, she not only risks avoiding an opportunity to move the therapy forward, but also creates a second breach by showing she cannot be trusted to model appropriate responsibility or, even, the ability to enact human error.

This brings me to my other point: the awareness that for some of my clients, a big piece of the work is about perfectionism and self-forgiveness. How do we allow ourselves, as therapists, to be both present for our clients, and, at the same time, models of real human beings who are imperfect? Is my self-flagellation a lesson I want to share with my client? Or would it better benefit her for me to be self-forgiving? Where does one find the balance, and how much of this can we convey to our client? How do we create appropriate space to talk about mistakes without spending too much time on them? Do we make it clear that the client can return to it, if we move on and she later finds it’s still nagging at her? Difficult questions and likely the right response depends upon each particular client.

Another factor for consideration: my office policy explains that I charge my full fee if a client does not adhere to my 24-hour cancellation policy. I do not feel it bodes well for the therapeutic relationships if we convey the belief that we value our own time more highly than those of our clients. This can be an interesting conversation to have with a client. What would she think is fair in the event of a therapist missing the session? A free session? A half-fee session? An extra fifteen minutes at the end of one session? A free pass for a same-day cancellation in the future without the penalty of full-fee? What is appropriate for a therapist to offer and what veers again into the zone of being too repentant? This exchange can be a rich opportunity for exploration with clients who wish to engage in it. Again, this can also bring up deeper issues related to fairness and resolution connected to other issues in our client’s lives.

In the end, an important lesson for me as a therapist was that sometimes unintended things happen. We may strive for consistency and perfection, but we are all imperfect. We hope that over time that our consistency and responsibility will become apparent to our clients. But one goal of therapy is to reach a safe attachment in which one can weather disappointments and unintentional blunders without either party (especially the client) having to experience the threat of losing the relationship. Mistakes do happen and sometimes it’s just as important for us as therapists to remember this as it is for our clients. And, as in all relationships ― not just the therapeutic ones ― it’s often not about whether mistakes occur, but how they are acknowledged and repaired that really counts.

35 Responses to “When Therapists Make Mistakes”

  1. Sheila

    This is a good issue and well-presented. But rather than have a discussion about what is fair compensation for missing the appointment, I think you should flat out make the next session free. Anything less is just guilting the patient into accepting a less than fair deal. It’s manipulative. I would never expect to pay for the next session after a therapist has missed one.

    Reply
  2. drkkolmes

    Sheila, while I tend to agree that what you think is fair is certainly one form of equity and just good customer service, there are some clients who might ― for a variety of reasons, including cultural or other embedded beliefs about money or healthcare ― feel you undervalue your own services if you apologize and automatically give away a free session.

    I think the discussion (and it doesn’t have to be a very long one) can be worthwhile, regardless of what resolution you offer.

    Thanks for your comment.

    Reply
    • jan

      that seems just wrong. If you miss a session and it is your error the next one should be free. It only makes sense. Someone took the time to see you. That time is valuable as well and should be compensated in some form..in this case a free session seems appropriate

  3. Kristine

    Hello! Thanks for the post. It’s been really helpful as I needed a therapist point of view on this matter. My therapist missed last sesion after his holiday and I felt really angry and sad. I find it difficult to accept that he has forgotten my appointment as I mostly talk about men who forget about me. 🙁 I know he’s human being but it hurts a lot. Still haven’t talked about it..

    Reply
    • drkkolmes

      It can feel very hurtful when a therapist does something that ripples off of other hurts in your life. But it can often be very useful if you feel safe enough to bring it up, even if it is some time after the events. And having a place where it is safe to express anger, sadness, and disappointment can help you to learn how to express those feelings in other relationships. But I recognize how hard this can be. I wish you the best and hope you can heal it at some point.

  4. bookmont@gmail.com

    My last therapist skipped a regularly scheduled and weekly re-confirmed session claiming she’d noted the wrong date in her book. I know it was her way of telling me she was done with me as a client and I quit the next session, after telling her I didn’t trust her.

    Reply
    • Oranjwoman

      We can never know the thoughts, motives, intentions, and desires of another person unless they tell us with words. To think we can is to believe in mind reading. This is what we call a cognitive thinking error. It is true, that sometimes we can correctly guess someone’s thoughts because of their body language, (or lack of). But for instance, to believe that someone is annoyed with you because they frown is irrational. There could be multiple other reasons for the frown, i.e. he experienced a sudden pain in his body, saw someone behind you misbehaving, or even was upset with himself when he recalled something he had forgotten about you. When someone isn’t even present, it is even more ridiculous to make assumptions. Then we believe we can teleport and mind-read. Maybe the therapist legitimately forgot what day of the week it was, and that, on top of it being on the wrong date in the calendar, messed up their internal rhythms. Maybe they thought it was Wednesday (when it was really Thursday), looked at your time on the calendar for Wednesday and thought “this is wrong, I only see this person on Thursday” and then didn’t show up. I recommend you find another counselor to help you with your issues. When we take someone else’s behavior personally it is a sign that we have boundary issues. Unhealthy boundaries are the death of most relationships. Let the death be caused by someone else’s bad boundaries, not your own.

  5. Jodie

    Hi
    I’ve been in therapy on and off for over a decade. I feel that to maintain trust and honouring in this situation, the therapist should offer the following session without fee. As this is symbolically a movement of warmth and generosity towards the client.

    Reply
    • drkkolmes

      Dear Jodie, I tend to agree. I also think that offering a free session doesn’t mean all clients would feel comfortable accepting the offer. Some may feel uncomfortable with a free session, but greatly appreciate the apology, so there needs to be room for talking about it.

      It also doesn’t mean that the client doesn’t need or want to unpack some of what s/he experienced emotionally by the missed session. There is both “what shall we do?” regarding the fees involved if a therapist is late or misses a session, and also “how do you feel about what happened?”

      Some people may say it’s no big deal. But for others, lateness or mixing up appointments may be enough to sever the relationship. I think it’s helpful if people get to process those feelings with the therapist instead of just leaving or instead of it being just a decision regarding the business transaction. Although I know we therapist sometimes annoy our clients with our pushing towards, “what was that like for you?” 🙂

    • Jodie

      Thanks for a personal response. This has happened to me recently with a relatively new therapist. We discussed it and put it down to ‘life happens’. I wonder that if one is presenting with issues to do with abandonment, that such a situation could be triggering. And as such an opportunity to create a new, healed response to perceived abandonment, or be scared off and leave the therapist, which would reinforce the abandonment pattern. I think it takes a very skilled and aware therapist to acknowledge how sensitive clients can be. Finally the money issue – could be a symbolic gesture of repair, but what is important is acknowledging the feelings of hurt that are triggered and validating them, that would be the true need. To be reassured verbally by the therapist is one matter, but what matters is the consistent showing up of the therapist at the designated time. I hadnt really understood how fundamentally important that was until now, gratitude for this conversation.

    • drkkolmes

      You are very welcome, Jodie. I do believe (as disappointing as it may feel in the moment) that for some clients, “firing” a therapist for such a transgression may also be part of the work they need to do, in order to stand their ground and lay down limits. Of course, this can feel rotten for both parties, but as you note, for someone with a history of abandonment or relationship disappointments…for some, this may be part of “the work.”

      I’m glad you were able to discuss it with your therapist. I agree that consistency over time is very important. But sadly, some people may not get to observe that if such a breach happens early in treatment. Glad you visited and commented on this thread!

  6. But therapists are only human | the harm of our mental health system

    […] References and Further Reading: Therapists are human, too; Therapist Mistakes; When therapists make mistakes. […]

    Reply
  7. James Genovese, LPC, LCADC

    I charge $50 for missed sessions or sessions canceled within less than 48 hours, the exception of course being the weather (I’m based in the Northeast; ’nuff said). The workaround is that if the client reschedules the missed appointment within seven days and keeps their next scheduled appointment, then I waive that fee.

    My reasons, I explain to clients, are that (a) I prefer to earn my money over taking it by default; and (2) My goal is to help them achieve the best outcome in the shortest amount of time, and for this to happen we must have continuity.

    I also hold myself to the same standard.

    I don’t (thank God) miss sessions often, but when it does happen and we can’t reschedule, then I owe my client 50 bucks. We can either apply this as a credit to their copays or I’ll cut them a check. This shows clients that I take our sessions as seriously as I expect them to.

    So far, in nearly five years of private practice, I’ve cut two such checks. Both clients were surprised (if not dumbfounded) but also appreciative.

    BTW, $50 is also a great incentive for me to not miss appointments!

    Reply
  8. Elizabeth

    Hi there,
    Thank you for writing such an insightful and informative post. It really gave me much needed perspective and answers to questions I had.
    I came upon this post after my newish therapist cancelled an appointment. The arrangement is to meet once a week, but due to cancellations and her request to change appointment times, it will be a month (or potentially more) since I last saw her. This led me to a few different questions. As a grad student studying to be a therapist, I started to consider what I would do and how I would approach clients if I had to take an extended amount of time off. I have clients for the job I currently hold and I know how they react to cancellations or my lack of availability now, so it was interesting to consider how a client would react in a therapeutic setting.
    As a client though, getting a call less than 8 hours before the scheduled appointment from a person I don’t know telling me that the therapist is off because she still isn’t feeling well, I find it frustrating. I could have worked additional hours (made additional money), made plans to do something, or just had a better idea of what my day looked like. When beginning therapy with this therapist I had to sign a contract agreeing to adhere to a strict attendance policy. I have been seeing this therapist since March and have missed only one appointment due to a vacation, and I told the therapist I would not be there weeks in advance. She has cancelled at least 4 times and I have yet to receive notice more than 12 hours in advance. I really like her, in fact I started out with a different therapist that was an ill fit and moved to the current one, but I am a bit unsure of how to keep going. If I did fine without going for a month, I question whether or not I need to go at all, probably not a good thought. Plus, it is extraordinarily selfish, but I wonder if it is me. If I am a difficult client, then I would really like her to just tell me. In your experience, is it ever the client? And also, how does a client work to trust a therapist after such a lack of consistency? I really do hope she is okay and do not mean to sound insensitive. I do believe that much of my frustration is more about the presentation (the lack of notice, lack of concern about the cancellations). Any input you are willing to give would be greatly appreciated. Though, you wrote this post years ago, so I also understand if you no longer comment.
    Thank you.

    Reply
    • drkkolmes

      Dear Elizabeth, you are asking great questions. A few comments and responses:

      1. Yes, I can imagine it must be frustrating to you (or my clients) when they are called sometimes just hours before a session and told that we are sick. What I can tell you from this side of the couch is that as a private practice clinician, I will do almost anything to avoid canceling. Not meeting with people means no income. Sometimes this means that I have waited too long to realize I should have gone home two hours ago. In a handful of occasions, I have even had to stop sessions mid-stream and apologize to someone and say, “I’m so sorry. I’ve been feeling ill today and I thought I could make it, but I’m feeling much worse and can no longer give you the attention you deserve.”

      Talk about a last minute cancelation!

      But I’d rather be aware (when I’m aware) that I’ve crossed the threshold and should have canceled rather than continue to sit with someone when I’m more focused on feeling horrid. Fortunately, this has only happened with a couple of people who are established and have seen me for years, so I have a good track record with them.

      2. One time I had the misfortune of being late to two out of the first three meetings with a new client. I felt awful. This person decided not to return because she assumed this was a regular thing for me. All I could say was that I understood her decision and that I trusted her to make the right choice for herself. (This will bring me to #5.)

      Ironically, the following week, I was two minutes late for someone who had been coming for about six years. When I apologized, this person rolled her eyes and said, “Please, you are two minutes late for the first time in six years? I think I’ll live.” So two people had very different impressions of me and, I suppose, both were accurate.

      3. Probably due to item #1, if my own therapist called me even 1 hour before the session, I’d just make other plans. I assume she wants to work and wants to earn money, so she must be pretty sick. If my therapist showed up incredibly sick and worked through it, I’d worry about her self-care and whether she was a good judge of when to call it quits. If she called in sick for a majority of the sessions, I’d be more worried about her and probably inquire about her health and note that it’s affecting our work but I’m also concerned about her.

      4. If your therapist is canceling this often, it’s very possible she is having a more serious health issue (or life stress issue) and she hasn’t yet figured out what to do about it. As you will learn as you become a therapist yourself, we are all human. Of course, we do have to think about making arrangements for interim care if and when we become too unwell to come in. Some therapists provide teletherapy in these cases. Some are trying to figure out if, when, or whether to share a major health issue with clients. Some will tell clients they are dealing with a setback and others will not want to be that transparent and may just say they need to take a temporary leave of absence. But it is possible this is what is happening with your therapist and if you are truly concerned about her and your therapy, you should ask when you next meet. And yes, if she is a conscientious clinician, one would hope it is also on her agenda to discuss when you next meet too.

      5. You ask: “I wonder if it is me,” and wonder if you are a difficult client. I truly doubt your therapist would go to such trouble to miss your sessions when she could easily say it isn’t the right fit or she isn’t sure she can be helpful to you. But in the “is it is ever the client?” question, I’d note that oftentimes what happens in the relationship can mirror and bring up issues we all have in the world. So if there was someone else who wasn’t there for you or who was consistently unreliable, it may be more agonizing to deal with a therapist who fails to show up, although what you describe does seem like a lot of cancellations. I think with the example I gave, in which I was late for two out of three sessions, it was probably especially important for that particular client of mine to have someone she felt she could count on. Sadly, my track record with her undeniably gave the impression I was not that person. But, as noted, someone who worked with me for years would have been surprised to hear I’d ever been late.

      And from the other side, I had a wonderful therapist whom I had to speak with at one point because it bothered me that he didn’t call to tell me he’d be late. What was true for me was that I didn’t mind the lateness as much as the lack of courtesy to call and let me know he was running late. I was just left to stand in the hall until he showed up, sometimes 15 minutes later. It was very helpful to talk about this with him and I was touched that the next time he was very late, he did call. Sometimes these small things can be very healing moments. I hope you can have such a positive exchange with your therapist about how the cancelations make you feel.

      (And I hope you can remember it when you are in the position of having a client talk to you about how something you did affected him or her. It can be easy to become defensive but it’s so very important to be attentive to the client’s experience.)

    • Sherri

      I know this post is old but I appreciate your comments. My therapist just cancelled on me for the 2nd time in two months and inbetween these times her secretary called to ask if I was on the way and when I said I was she said “o.k. then nevermind” like she was trying to cancel or reschedule again. (I live 40 minutes away and my apt. was an hour away) So like you mentioned I feel like she doesn’t like me or that I’m pathetic which is one my issues anyway. So anyway I’m glad I’m not the only one who has had this happen and felt this way. Thanks again just for posting!

  9. Chavela Montano

    I would say free session. There’s no negotiating on your end when someone cancels the day of the session – so why wouldn’t it work both ways. From a clients perspective – sometimes we prepare for the session (mentally) and to be let down like this is HUGE, or can be. I know it would be for me. And to think the client may have to wait another full week to see you again. TOTALLY NOT FAIR. Give a free session, at the very least.

    Reply
  10. Ashley

    My therapist has cancelled twice on me and I didn’t take it well either time. It is a trigger for my feelings of abandonment. The first time, I felt angry and let down, particularly since she took a long time to call for reschedule. The second time was just yesterday, and I only had a couple hours’ notice. I thought I was okay with it at first, but later I felt sad and angry, and wondered if the reason her office gave was the truth. I accepted the alternate appointment, but am now wondering if I feel like talking to her anymore. The cancellations are difficult for me and seem to be affecting how much I trust her. I feel like shutting down and putting my wall back up for self-preservation.

    Reply
  11. Krista

    My therapist took two weeks off around the holidays. Then he sent me an email the night before the next scheduled appointment saying he was sick and would see me next week. I have a standing appointment. Ok, no problem. I don’t want him to work or to be in contact with him when he’s sick. It turned out to be very inconvenient for me. He is almost an hour away and I had arranged to go pick up some medicine for my dog at a location another 15 minutes from his office. I could have had it mailed if I had known sooner but I was going to run out if I didn’t go that day so I had to make the trip anyway. Both the dog and I have cancer. So I had to get the medicine and the trip was not easy for me to make right now as I am recovering from treatment.

    The following week I showed up for my appointment at my regular time and he had double booked. He put someone else in my in my slot, actually changed it in his calendar, and moved me to another slot the following day. Then he forgot to call me to ask me if it was ok.

    I’m having a very hard time with this. I was standing there in his office with this other guy there while my therapist was looking through his calendar and I knew I was going to lose it, so I left. Essentially I was getting triggered and even though it was my appointment, I didn’t want to stand there talking about it with this other guy present. Fight or flight kicked in and I flew.

    My therapist called right away to tell me be had me scheduled for the next day if that worked for me. It didn’t. On that day I have another commitment in the evening and to do both things in one day I have to drive into town and back twice which is too much driving for me in one day. Something we’ve talked about, actually.

    My therapist has been very good to me. He lets me cancel with less than 24 hours notice when I’m not feeling well – which is something I don’t abuse. I’ve never missed or been late for an appointment. The one problem with my therapist is that he won’t take personal responsibility when he makes a mistake. He makes non apologies e.g. “I’m sorry you feel that way.” It’s like he gets a free pass for his behavior and I get to look at how it affected me. If I try to talk about what he did he gets angry or defensive.

    I need a real apology. “I’m sorry I did something that hurt you and I won’t do it again.”

    I think that changing the appointment without asking me first was out of line. It doesn’t matter if he was intending to call me to find out it if was ok after the fact. I would have said no to the appointment the following day because of the driving issue.

    I know that the fact that I was triggered by it is my issue, as was my inability to deal with it in the moment. But, that doesn’t change the fact that the situation would have been easily preventable by his checking with me first. I feel that it was a situation that I shouldn’t have been put in.

    Reply
  12. Megan

    I had this happen to me today. I was given an appointment two weeks after my first appointment. I got there and my therapist called another patient into the room at the time I was scheduled. I was unsure whether I should wait or say something, instead I went to the bathroom. When I came back they told me they had me down in March, even though my appointment card had the day I came in written on it by the therapist. They also have a 24 hr cancellation policy. At first I was a little taken aback by it, but I rescheduled. I understand that therapists are people too and people make mistakes. It did come at a very difficult time for me in my life (when I was on the verge of opening up about things I’ve never been able to talk about), not to mention that I have to drive an hour two ways to come see her. Thank you for this article, it calms my concerns a bit and hopefully I don’t clam up and am able to bring it up.

    Reply
  13. Ivy

    A week and a half ago, my therapist kept me waiting ten minutes after our scheduled appointment time, and ended our session 5 minutes early. I was extremely angry. I usually have two sessions a week, but I had to miss my next appointment because I got sick, then I realized I had only scheduled one for this week–today. I arrived at the clinic (not private practice) several minutes late, which is actually common for me, only to be told by the receptionist that my therapist couldn’t see me because she had decided to take a new-intake when I hadn’t shown up (I was seven minutes late–I’m normally only five minutes late). But that was MY appointment time! I didn’t get an apology for being kept waiting, and I didn’t get an apology for her taking a new client instead of seeing me. (I do try to be on time, I normally call when I’m running behind–but today I was in traffic, and I always apologize when I’m late. It’s my therapy time it’s eating into, anyway.) This, on top of kicking me out early last week, and feeling lately like she’s (literally and metaphorically) distancing herself in our sessions (she used to sit out in a chair, the past month or so she’s been behind her desk) has gotten me into quite a state. Anyway, today I asked the receptionist how I would go about switching therapists, so mine called me later (she left a voicemail, I was busy), saying that she was calling to give me the information on switching. No apology, no explanation, no concern that I was upset. I don’t have any appointments next week, because she was already booked up when I was scheduling, so it will end up being three weeks that I won’t have any therapy sessions, when I really “need” two a week! I feel disrespected, and like I can’t trust her. (I have a long history of abandonment, betrayal, and emotional neglect, causing my C-PTSD, plus I have two anxiety disorders and Bipolar 1.) I want to just shut down and stop seeing her, but I feel like that will only hurt me in the end. I can’t have issues with my therapist! She’s the only person I can talk to about my issues with other people! She was the “safe” one! And now I have to wait almost two more weeks to talk to her. I’m kind of freaking out. I need someone I can trust, and I need to talk to someone about all this.

    Reply
  14. Lisa

    So I have a couple of experiences of my therapist either seriously letting me down around an appointment or last minute cancellation.

    The first one was a therapist I’d been working with for 8 months. We were in a tough place and I was extremely distressed and coming off a work trip that she knew would be incredibly hard and I was seeing her at my regularly scheduled session time … Except when I got there … Someone else was there waiting too… She came out and I was really hurt that she hadn’t kept my time sacred with her! She said something about not knowing I was coming (although I hadn’t cancelled this regularly scheduled session). In actuality I had scheduled my business trip around my sessions because of how hard this trip would be. In the interim I also had an ethical concern to address with her. She took the other client and told me to come back in a couple hours. At such time she was angry with me for showing up!!! The session went terribly and at the last 15 minutes she told me that I was to never come back again! No closure sessions … Nothing! I was being punished for her mistake! And she charged me for that session which I felt unfair because it was all spent in this appointment issue and ethical concerns.

    Second one – therapist I dearly love and work with currently…she and I had this thing since I had a really early appt time at 8 am that I might get hung up in commuter traffic and she might get caught up in carpool. So as it goes one of us was usually 3-5 minutes late. We both tried to text if either was going to be late. I got almost to her office and was going to be 5 minutes late so I text her to tell her this … She responded that she had totally forgotten our regularly scheduled session … Be right there in 20 minutes! I felt hurt and it was a while working through this… How could she forget me? I needed her! After all this is a regularly scheduled session! She made the reparative action and came even though it was a bit later … She disclosed that she had been to the ER the night before and got some migraine Meds and she purely just lost track of which day of the week it was… Human error but This brought up trauma I needed to work through …

    Third therapist – currently work with – on my first meeting with her I showed up to her office and she never came out to get me … After 15 minutes I text asking if I had missed something because I thought we had an appointment … She apologized and asked if I could go grab some lunch and meet her back in 1 hour … She responded … “I’m not usually this flakey … And yes we were suppose to meet but she missed it in her calendar” … We met I decided to continue to work with her … I didn’t expect any adjustments to fees or anything this time.

    About 2 years into Our work my therapist got sick … Terrible case of the flu. She texted to cancel the first days appointment … I got upset at her and texted that I needed her and this was so terrible abd I couldn’t believe she was doing this to me. After all it had been a holiday weekend and I was already suffering and white knuckling through to next session… I was scheduled for the next day too… She didn’t cancel the next day … I took one look at her realizing she needed to be in bed taking care of herself and she had no resources to take care of me and I felt bad and guilty for making her come in to see me when clearly she needed to be in bed. I promised next time if do better…

    Now fast forward with this therapist to 2 1/2 years later … I was emotionally flooding and I felt it was all I could do to get to session that morning .. I was looking forward to working through this and hoping for relief. I had seen my art therapist right before and was carrying this emotion into the next session 45 minutes later with my main therapist … Today was a day I needed to work and I was feeling so grateful that I was on my way to my therapist office… I looked down and realized I needed gas … I turned around and was pumping gas when I grabbed my phone to check the time. While doing so I saw a text from my main therapist saying she needed to cancel as she had last minute moving stuff to do and she was sorry. Let her know I got the text… I was crushed and it took quite a while to get over … I needed her… She had no idea what I was bringing in and I felt I couldn’t tell her… I was all alone in it…

    So in all these examples here was my take away – if I end up spending the next session talking about the missed session then it’s probably a good gesture to not charge me for it. But I would say it depends on why… Like the first example – yes I expected a no charged session… But then the second one – I didn’t expect s free session from that exchange … Plus she came to repair it … Yes it stirred up my trauma and we dealt with it for weeks but isn’t that also too part of therapy. The third example – I almost felt like I should pay her for the missed session or double for coming in when she was sick … This is where we accept human nature and I hope she would give me the same slack if I were sick.

    On the 4th session- it did give me heartburn that I’m required to tell her 48 hours in advance to cancel and here I was less than an hour out and on my way when she cancels on me …. We spent weeks of sessions over this … I needed her and she wasn’t sick like the last time… Was this just poor time management on her part?! She knew she was moving so why a sudden cancellation! On this I also didn’t expect a free session but I do expect a likewise accommodation without charge … If she can do it then so can I without penalty. Now if I do this consistently or cancel to avoid working on my stuff then I do expect her to charge me!

    I do like the idea of a fee that’s applied to the next session if scheduled within 7 days…. That way if it’s a must and not an avoiding tactic … Then the money isn’t wasted and dies encourage continuity for both therapist and patient and shows commitment from both parties too.

    Reply
  15. Hershe

    I’ve been with my psychologist and psychiatrist a very, very long time. Before truly trusting, working therapeutic relationships were established I took any change as a sign that I was about to be told, yet again, that I was far too complicated and diffficult to work with, and end up terminating. I feared that they would become sick, hurt, or simply accept another position and need to move. I’ve had 16 therapists, so not only was my past traumatic, so was finding help for my severe Mental Illnesses. As you noted, a vacation, sick day, or even a flat tire that interferred with therapy, was cause for alarm. Once my psychologist wore a different shade of lipstick and I panicked, convinced that somehow that meant I wasn’t doing the appropriate work, that she no longer cared, and that I was about to be terminated. Both docs stuck with me, and I gained trust from their consistency. Unfortunately I recently started up WWIII between my psychologist and myself (basically I felt trapped, and extremely scared, and “attacked”). We’re trying to work through it. I have the ability to verbally tear down someone, striking at their so-called weaknessess. It’s not something I’m proud of. We’re still seeing each other in session, but she no longer encourages email updates, nor does she return my emails, simply to note that she got them. I guess onlly time will tell if we’ll get through this. A therapeutic relationship is both extremely strong, and unimaginably fragile.

    Reply
  16. EllieB.

    Need some help, two yrs w/ therapist. She tends to like to give her opinion about my life, etc. And she gossips about people I went to HS with, and tries to get me to tell her personal details if family and friends…like, oh what town do they live in? I try not to answer. But many times she simply starts telling me about Her life, Her problems, Her husband, etc. I have called her on the phone twice about it and both times she apologized. Recently, while knowing this is my hardest month, I was talking about the many people who took their lives, since my girlhood.
    As I was leaving she said it was very unusual (I am a freak?) and then added she’d never had any in Her life cept her bro in law last year.
    It completely freaked me out, cause lady year was my worst ever moments, ever, and Now I had to feel bad FOR HER! so I left her a message saying I don’t care about her family, I doubt want to hear about them, and that I can’t do my work and police her mouth. Also, I doubt trust that she will nit gossip about me. She called to terminate me. Next visit, she gave me a piece of paper, telling me some referrals. I said nithing, she said nothing but a very sarcastic good luck. I then called to ask if she could promise she would never talk about me outside the profession. She yelled at ne, said she was sick of my asking that. I said I didn’t care, and she responded very sarcastically, fine, i never talked about you and hung up. I’m in shock.

    Reply
  17. Teresa

    My therapist is always late (I’m her first appointment of the day) and she shows up without an apology 5-10 minutes late then makes her instant coffee and sets up in her office for a few minutes so we start fifteen minutes late. She has arrived with her shirt on inside out, with no texts saying she’s running late and I’m expected to wait fifteen minutes before leaving in case she’s with a clientemergency situation but it seems she uses that window of time as an excuse to just generally show up and make her coffee.why should I wait every week without so much as an apology when she is just showing up late not coming from another client. Additionally if I am late I’m charged almost double (full price compared to the price with insurance) and charged if I cancel less than 24 hrs notice. I am an Aba therapist and understand rushing to sessions but I am always on time to therapy. I don’t understand that fifteen minutes grace period she allows herself is this common practice? What should I do?

    Reply
    • drkkolmes

      My general response to such scenarios is a recommendation to bring up how it makes you feel. That is no guarantee that you therapist will be able to respond non-defensively and with curiosity and compassion, but I hope that she can. If she can’t, it is your time and money and if you think her policies and professionalism are not a good fit, you can find someone else. But hopefully she can hear how this is affecting you and adjust her habits (or perhaps you can find an appointment time when she’s already been at the office and she can be late for the person before you!).

  18. Stephanie

    I wonder if you will see this and reply or not!
    This week I showed up to my appointment and waited quite a while before I realized that my therapist wasn’t showing. He has gone out of town for Thanksgiving and had not bothered to tell me. I had been having a very difficult time the week before and this week. He’d gone so far as to text me on Monday to check and see if I was feeling better (I replied that I was not) I was really trying to hold on till I could get to my appointment.
    Honestly, I just don’t know that I can trust this person to help me. There have been other issues, like moving my appointment around so that he could accommodate a friend’s needs, etc which have happened lately.
    I know I am a very difficult client. I’ve PTSD and I’m hyper-sensitive to sound which has made things hard.
    Am I right to want to cut and run?

    Reply
  19. Monika

    Thank you for this post. I was looking for some advice on presenting my disappointment and anger with my therapist this coming week because it scares me. I have been seeing her for 2 years and we have communicated via text between sessions many times, always with the understanding that is she’s busy or thinks it’s a matter best suited for session she won’t respond. Last week I got a message from her that all this time I’ve been using her private phone, not her patient phone, to text her and she doesn’t want me to do that anymore. She gave me a different number. So my brain started reeling. How is it that in two years she never brought this up? I felt like I violated a boundary I wasn’t aware was there. She gave me that number on our first day of therapy! So I brought it up last week. She said she’s just trying to keep her personal and office life more separate. Ok. I appreciate that. But I asked her about not telling me this a long time ago. She says she did and it’s in text. I told her I’m pretty sure she did not but I will respect her future wishes. Then she said, she knows she has given me mixed messages but she has decided I can’t text at all between sessions unless it’s an emergency. Again, this is a totally new rule all of a sudden. I kept asking what I did wrong and if she’s angry with me or something. She insisted she wasn’t and everything was ok. So I’ve been thinking about it and thinking about it and I’m more and more angry. I saved all my texts from the last two years and went through them. The other number was never brought up except as the emergency number to call if I’m feeling suicidal. That’s it. She never asked me to use a different number and she has always told me texting is fine. She changed all the rules on me without any explanation and it’s making me feel badly. I know I need to discuss this with her but I’m afraid she’ll abandon me. Any suggestions or thoughts would be appreciated. Thanks.

    Reply
  20. AB

    My T uses the restroom prior to almost all of our sessions.
    I enter her office and sit down. Then she tells me she will be right back, uses the restroom, and re-enters.
    I confronted her about it several months ago and she said that she just has to go to the bathroom sometimes– you know, like all human beings. She didn’t leave much room for discussion following.
    Our sessions typically begin at 5:45 and end at 6:30. She sees her next client at 6:45.
    That gives her 15 minutes to pee or whatever. I get that she has notes to write…etc but can’t she fit that in?
    I have read that behaviors such as this may indicate negative counter-transference.
    Do you have any input? Should I inquire again?
    She is a skilled therapist, but she has a certain analytic rigidity. I really do not want to incite a rupture/ baby impasse by asking again…

    Thanks

    (I am a clinical psychology doctoral student, so I certainly understand that psychologists are HUMAN beings that make mistakes… If she has a urinary problem or something, I’d rather she just tell me that… )

    Reply
    • drkkolmes

      It’s not clear from your post whether you object to her use of the bathroom at all and she is arriving on time for the session or if her use of the bathroom is routinely making her late to your sessions?

      It’s so hard to tell someone what to do in such situations, but I think many a clinician would be interested in exploring the impact of their routines on your feelings about the therapy. Or they might decide they need to adjust their own schedule if they find themselves frequently late.

      You also have the freedom and autonomy to decide that you would prefer to work with a therapist who is timely or who explores your feelings about such things in a more open way, with less rigidity.

  21. S. Gray

    I’m so happy that I found this site & particularly subject, but not at all happy that I needed to find it! I also don’t know if this is the way to post on this blog, but I’ll find out soon enough, I guess — so here goes….

    Just 2 weeks ago my Psychiatrist (Manhattan, NY) unbeknownst to me deleted my standing weekly appt at 1 pm from his calendar. I didn’t receive his 2 day advanced “robo” call to confirm. When realizing this, “I” emailed the office to confirm my appt. The secy em’d back that I wasn’t on the calendar. Eventually my Dr. em’d at the end of the day expressing his apologies for the “oversight”. – No reason. I canceled my following appt. by email explaining that not only wasn’t I on the calendar & not notified but that recently I’ve been having “vibes” that he’s lost interest in my narrative/the same old & he seemed less engaged & now I’m feeling un-welcomed. He convinced me to keep my following appointment to discuss. I went. Then & there he admitted, that He, not his secy removed me b/c he had to cut his day short to leave for a holiday dinner & “forgot” to email me to tell me. At that moment, I was pleasant but after thinking more about it, the insult, disrespect & my unimportance, my disappointment in hm, & my anger started to build-up in me & to make this short, I have fired him – terminated all future appointments. I was seeing him for 3 years & we had a very comfortable relationship. In fact, he related personally to many of my issues. Problem there(?)-countertransference? Anyway, I took this very personally. It triggered all my abandonment issues. I also feel who knows because I can be cynical or realistic (depending on your person’s lens) that he took me off & replaced me with a self-pay patient or a new patient or accommodated another one, etc. I don’t trust him anymore. I “had” so much trust & respect for him which makes this all the more hurtful. I’m very hurt, disappointed & angry. He wanted me to go in to discuss this again & I wouldn’t. A day later I thought of all other possibilities, e.g, he’s grown weary of my narrative & he wants ME to quit so that he wouldn’t have to terminate me; thereby, it wouldn’t be HIM adding to my abandonment issues or as I said, he had a new or more important or profitable patient. I r.e.a.l.l.y dressed him down via email mentioning some of these possibilities along with questioning passive-aggressive behavior on his part & countertransference. I would be very appreciative if anyone would share their thoughts because I’m very distressed over this.

    Thank you!

    S.

    Reply
    • drkkolmes

      I am sorry that I am unable to respond to all of the posts on this topic. I have had so many comments and I appreciate just how troubling it can be for people to feel disappointed by their therapist. Generally, with scenarios like this, and with a history of a good relationship with the therapist, I do recommend bringing up how it made you feel. Of course, if the error is egregious such as sexual contact or inappropriate behavior (as opposed to something that hurts your feelings), it may be safer not to return. But in the scenario described, I think these are important feelings to bring up and it may be something that can be repaired. Best wishes.

  22. merrikay baxendale

    My therapist just up and left. When I showed up at her office the doors were locked and it was for rent! I emailed her at the time and I did receive a vague email about her having a problem and couldn’t use the phone. So, that was 6 months ago. I desperately need my records. My emails are not answered (just asking for records or a referral) and her phone says VM is not set up “yet”. I think she is totally gone. What recourse do I have to get my records. How do I find her? Should she belong to a psychology group? Thank you

    Reply
    • drkkolmes

      Dear Merrikay, it may be worth contacting the licensing board in your state to see if your therapist is still licensed. The licensing board may have an address on file. While all therapists are supposed to set up a plan for continuation of care for clients in the event of illness, death, or emergency, many optimistic clinicians fail to do so (or they keep meaning to get to it). It is possible your therapist was unable to do this before whatever occurred that caused her to close her practice, but you may be able to get help from the state licensing board. Best wishes.

  23. Jane

    Hi this isn’t directly related to this thread but I am looking for thoughts from others on this topic. I recently started se in a therapist and she’s changed appointments on me pretty frequently and I even saw that she had placed a call to me at 2am (out late at night, a pocket dial..?). Anyway I was running late from work and texted to confirm our appt and let her know I was stuck in traffic. She made it seem like no big deal but ended the session at the same time as when we would have had I been there a half hour earlier. That was a little annoying – it would have been nice to know that ahead of time – but what really chapped me was that at the end she stood up and glared at me when I could mutinied talking about something. Yes I know my time was up but I was raising a topic for the next session. I felt an aggression and anger from her that just flickered and I don’t know if I want to go back. We were amicable and jokey at the end but deep down inside I don’t know if I can trust her robe a kind person. The therapy hasn’t been amazing so far. But I was optimistic.. what do you think?

    Reply

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