ABSTRACT
The patient’s pressure to treat the incident extra therapeutically was severe in the instructions case, but when the therapist maintained the therapeutic role, some dynamics became apparent. Social message was designed to give the therapist very little choice but to make arrangements for changing the hour. It is the very pat nature of this type of message, however, that should help the therapist disengage from its social demand. The predictable social response to a request for a change of appointment hour is often used by patients as a means of obtaining reinforcement for their neurotic dilemma. The patient has searched for the therapist’s areas of vulnerability in order to produce an emotional climate that represents more than a request for a change of appointments. Although many psychotherapists attempt to sidestep the problem of missed appointments by discussing issues such as cancellation every therapist is faced with the issue of missed appointments.
