Clinical psychologists' experiences of client non-attendance in Health Service practice : a conflict of responsibilities?

Within psychotherapy process research, the effects of client non-attendance upon therapists has generally been neglected. The present study interviewed six qualified clinical psychologists concerning their experiences of client non-attendance in health service practice. Their accounts were analysed qualitatively using a grounded theory method. Based on the analysis, a core category was identified and termed Responsibility. This highlighted conflicting relationships between participants' responsibilities in several areas. These included participants' responsibilities to their employers, their clients and themselves. A process model pertaining to non-attendance was also developed. Client non-attendance was seen to produce a level of disruption, experienced by participants as an affective reaction. This reaction was often experienced in terms of negative affect. In response, re-organisational strategies were utilised to restore equilibrium. Reasons were suggested as to why negative affective reactions were often experienced. These included factors concerning therapeutic competency, but in a wider context also reflected upon the profession's espousal of an 'all-knowing' expert identity. This was seen to be incongruent to the complexities of clinical practice. The role of the re-organisational strategies were discussed and included strategies as a means of repairing therapeutic alliance breaches and as defences against anxiety. Implications in terms of clinical psychology training and the profession are discussed. A critical reflection on the study is also presented.