When I first started working as a fee-for-service clinician, one of my pet peeves was not getting paid for missed sessions. I felt that the financial part of the issue clouded my ability to make a good clinical judgement of the situation. And, of course, I didn’t like not getting paid.

I’ve since made my peace with clinic work life and its realities, but I sometimes find myself stuck once again on missed appointment and late cancellations. It can be so difficult to get at what the client needs when my own finances are involved.

I find it helpful to pretend that I’m getting paid anyway. Then I am able to approach the issue more clinically, to more easily address the issues of resistance and personality that may be at play. This often leads to very productive conversations about what is holding the client back from attending sessions. When I have done this with my clients, so many salient issues have come up. Issues like disorganization, ambiguity about being in therapy, difficulties with stress, chronic lateness, family dynamic issues, latent anger...the list goes on. Some of these I may have thought of on my own, but many of them I could not have guessed.

This may not be news to some of you, but I think it’s a good reminder. When we are willing to move past what we bring into the room, and are willing to take a peek beyond the surface, there is so much more to be found. Nearly always.

Shimmy Feintuch, LCSW CASAC-G maintains a private practice in Brooklyn, NY, and Washington Heights, NYC, with specialties in addictions and anxiety. He is also an Adjunct Professor at the Wurzweiler School of Social Work at Yeshiva University. Contact: (530) 334-6882 or shimmyfeintuch@gmail.com. 

Sign up for the Spiritual Sofa newsletter to receive each blog post before it's posted here!