Why Do I Cancel a Counseling Appointment When I Need It the Most?

Reader’s Question

I’ve been going to counseling for awhile. Why is it, when I need a session the most, I call and cancel?

Our Clinical Psychologist’s Reply

When we need it the most is typically when we are very emotionally upset, distressed, or troubled. During such difficult times we are often hesitant to attend counseling/therapy as the professional will recognize and explore our distress — something that is very uncomfortable. It’s like having a toothache but not wanting to go to a dentist because the treatment procedure might be painful. Over the years I’ve received many of these cancellations, including a recent call to say “I’m too upset to come in”.

After cancelling a session, in the next session it’s helpful to discuss why the prior session was cancelled. You and your counselor can then develop a strategy for such situations. Highly upset folks often need an “overload indicator” in the therapy session, something they can do or say when their distress level is very high, using that signal to alert the counselor/therapist that they need to talk about something else for a short time to get a break from the distressing topic. Over the years, I’ve had clients use a time-out hand signal or most recently, a football fan will suddenly state “How about those Browns?” — referring to a regional football team. If we know the counselor will allow us to discuss our stressful situation with some safety, we don’t tend to cancel. If going to the dentist is fairly painless, we tend not to cancel.