In the evolving landscape of online psychodynamic psychotherapy, the phenomenon of clients not showing up for scheduled sessions is a situation that every therapist will encounter at some point. While missed appointments are often viewed through a logistical lens—disrupting the therapeutic schedule or resulting in financial loss—they also hold significant psychological meaning within the therapeutic context. Understanding these absences, especially within the psychodynamic framework, requires delving into the unconscious processes that may drive a client’s decision not to attend.
The Surface Level: Practical and Logistical Challenges
Before delving into the deeper psychological implications, it’s important to acknowledge that there are often practical reasons for a client’s absence. These can range from technical difficulties (like poor internet connection or unfamiliarity with the online platform) to scheduling conflicts, time zone misunderstandings, or sudden personal emergencies. The online setting, while offering convenience, can sometimes make therapy feel less immediate or easy to postpone, leading to an increased likelihood of no-shows compared to in-person sessions.
Beyond the Surface: The Unconscious Meanings of Absence
From a psychodynamic perspective, a client’s absence can be rich with unconscious meaning. Unlike other therapeutic modalities, psychodynamic therapy emphasizes the exploration of unconscious motivations, defenses, and the therapeutic relationship itself. A no-show is not merely a disruption; it may be an expression of unconscious resistance, anxiety, or a reenactment of past relational patterns.
Resistance to Therapy
In psychodynamic therapy, resistance is a common and expected part of the therapeutic process. It occurs when a client unconsciously defends against the insights or emotional experiences that the therapy is bringing to the surface. Missing a session can be a form of resistance—a way for the client to avoid confronting difficult emotions or memories that the therapy might be approaching. This resistance is often not conscious; the client might genuinely intend to attend but find themselves “forgetting” or experiencing technical issues that prevent them from logging in.
Testing the Therapist
Another layer to consider is the client’s relationship with the therapist. In psychodynamic therapy, the therapeutic relationship is a central focus, and clients often bring their past relational patterns into this new, therapeutic relationship. A no-show might be a way for the client to test the therapist—perhaps to see if they are missed or how the therapist will respond. This could be particularly pertinent if the client has experienced abandonment or inconsistency in important relationships in the past. The missed session might then represent an unconscious attempt to recreate these dynamics, giving the therapist valuable insight into the client’s relational world.
Avoidance of Intimacy
Therapy, especially psychodynamic therapy, can be an intensely intimate process. For some clients, the growing closeness and vulnerability with the therapist can feel overwhelming, leading them to pull back. Not showing up might be a way for the client to maintain distance, to avoid the intimacy that is developing in the therapeutic relationship. This avoidance might reflect a fear of dependence, vulnerability, or the reawakening of unresolved attachment issues.
The Therapist’s Response
When faced with a no-show, the therapist’s response is crucial. A psychodynamic therapist will typically explore the absence with the client in subsequent sessions, gently inquiring about what was happening for them at the time. The goal is not to reprimand or enforce compliance but to understand the unconscious meaning of the missed session. Was the client feeling overwhelmed by the material being discussed? Were they unconsciously testing the therapist’s reliability? Or was there an external factor at play that might hold symbolic meaning?
By approaching the no-show with curiosity rather than judgment, the therapist can help the client explore underlying fears, resistances, and relational patterns. This exploration can lead to valuable insights, deepening the therapeutic work and helping the client move forward.
The Role of Technology in Online Therapy
The online setting introduces specific dynamics that can both facilitate and hinder therapy. The physical distance and the screen can create a sense of emotional distance, which some clients might use as a defense against the intensity of the therapeutic process. Alternatively, the convenience of logging in from home might make the therapy feel less formal or less of a commitment, leading to a higher likelihood of rescheduling or forgetting.
However, the online modality also offers unique opportunities. The client’s environment—visible to the therapist through the screen—can offer additional context for understanding the client’s life and emotional state. Additionally, the flexibility of online therapy can be a double-edged sword: while it increases accessibility, it may also require a stronger commitment from clients to engage consistently.
Conclusion: No-Shows as an Opportunity
In psychodynamic therapy, no-shows are not simply interruptions—they are moments rich with meaning that can offer deep insights into the client’s inner world. By approaching these absences with a psychodynamic lens, therapists can transform a missed session from a frustrating disruption into a valuable opportunity for exploration and growth. Understanding the unconscious motivations behind a client’s decision not to attend can help uncover underlying fears, resistances, and relational patterns, ultimately facilitating a more profound therapeutic process.
Online therapy presents unique challenges and opportunities in this regard. The virtual environment may influence the frequency and nature of no-shows, but it also provides new avenues for understanding and engaging with clients’ unconscious processes. By staying attuned to the multiple layers of meaning in a client’s absence, therapists can continue to foster a deep, transformative therapeutic experience—even when the client isn’t in the room.
By Ari Sotiriou M.A. psychodynamic psychotherapist co-founder Online Therapy Clinic