Step 1: Attend

The Dilemma

I was talking with a colleague the other day who was consulting on an appropriate referral for a client. He told me the client felt like they weren't making progress in therapy and stated it was because they were not getting the help they needed. Indeed, my colleague agreed that the service his client was asking for was outside of his area of expertise.

Then my colleague said something interesting. He said he felt some relief because the client had been missing a lot of appointments with him and wondered if something was wrong. He was glad the client self-advocated and was gratified the client had been able to solve this problem by asking for help with a referral.

All of this sounds reasonable at face value. It is good for clients to self-advocate. It is true that psychologists cannot provide all of the answers. Sometimes the best work I do with a person is providing an appropriate referral for additional services. But the thing I couldn't get past was the recent history of no-shows for therapy.

The Primacy of Participation

Attending therapy is a basic, fundamental, and primary requirement for making progress in therapy. This is not to say that clients don't need referrals, or that any of those other true and good things were illegitimate, but it just makes sense that a more proximal reason for failure to make progress in therapy is that the client wasn't attending therapy.

Admittedly, this could be a chicken and egg (which came first?) situation. The client was saying they didn't attend because it wasn't working, and I'm saying it might be the case that therapy is ineffective because they didn't attend. However, the only way to resolve this issue is to attend therapy consistently. If you attend and it doesn't work, then you have your answer. Does this mean I just want to be right? Not really. What if the main issue is attendance? Another referral won't fix the attendance issue. More likely, they'll have yet another ineffective therapy experience.

The other thing I will say is that I have heard in the past - and maybe you've experienced this - that therapy doesn't work for some people. I think this is certainly possible. However, when I hear this I can find that what they experienced was not really therapy. Therapy often requires regular attendance, active treatment planning, and work in and out of sessions to be effective. For many reasons I think people can have an experience that approximates therapy, but doesn't quite check all of the boxes. In that case, it makes sense that they decide therapy doesn't work for them, or was a waste of time. Therapy, when the therapist and client are fully engaged, is challenging yet satisfying. Even if it does result in another referral.