A patient perspective on non-attendance for psychotherapy in psychiatric outpatient care for patients with affective disorders

Abstract To explore the phenomenon of non-attendance for psychotherapy in psychiatric outpatient care for patients with affective disorders. Ten patients, seven women and three men, aged 25–51 years, agreed to participate in the study. The participants were recruited from a psychiatric outpatient clinic for patients with affective disorders at Sahlgrenska University Hospital, Sweden. A semi-structured interview guide was used during the interviews, which were audiotaped, transcribed and analyzed using content analysis. All informants expressed concern that they had been absent from booked appointments. The main reason given was that the mental illness that caused the need for treatment also caused the absence. They expressed ambiguity about the goals and method of treatment and showed ambivalence regarding the possibility of being helped and achieving change. The participants also highlighted shortcomings in communication with the psychologist regarding their non-attendance. Four themes were generated: A vicious circle, Processes without direction, Ambivalence and Inadequate communication. The study shows that missed appointments have a negative effect on the treatment process. If the patient and the psychologist jointly decide to start psychotherapy, it is thus important that the psychologist promptly addresses the problem of missed appointments and takes a professional responsibility for limiting the risk of another failed attempt at psychotherapy. In some cases, it is necessary to consider whether psychotherapy is an appropriate form of treatment or not. Practitioner points The study shows the importance of a careful assessment phase, where questions about motivation, goals and previous experiences of missed appointments are examined. The informants were not able to raise the issue of missed appointments in a larger perspective; their but focus was rather on the current symptom burden. It is therefore the responsibility of the psychologist to raise the issue and maintain a dialogue about goals, direction and evaluation of the psychotherapy. The psychologist bears a professional responsibility to limit the risk of another failed attempt to provide psychotherapy.