Shirah Vollmer MD

The Musings of Dr. Vollmer

The No-Show Returns

Posted by Dr. Vollmer on September 13, 2011


Zach, having come consistently for a year,, did it again. His standing appointment, every week, same time, comes around and  he does not show up. He does not call me. Hmmm, I think, what is going on here. Do I call him, I wonder. I do call, get his voicemail, continue to wonder. Did something happen? Somehow, I do not think so, but maybe. Is he doing his avoidance thing? I think this is the most likely. What is he avoiding, I ask myself. I think long and hard about our last session. There is the upcoming family reunion that he was dreading. Maybe he felt guilty about talking about how much he did not want to spend time with his family. This seems to make sense to me. I have a working hypothesis; a theory to test out when he returns. When will he call me to let me know what is going on? I notice that. Does he worry about me worrying? I don’t think so, but I wonder why not. Is he not used to people being concerned about him? Does he resist taking care of me in that way? The richness of the no-show comes alive. It gives me pause and deep thought that helps me understand Zach, or at least stimulates questions I have for Zach, in a way that showing up every week does not. At the same time, the frustration of not knowing what is going on lingers and is uncomfortable. It feels like the picture above. There is a missing piece, and I want to find it. Something terrible could have happened. I really hope not.

7 Responses to “The No-Show Returns”

  1. Melanie said

    Do you think Zach knows/undertands that you do worry about him? I find that sometimes we patients “forget” that our therapists are truly concerned/do truly care about our well-beings. I had one situation with my therapist when I was waiting for my bar exam results. I was on edge, and I was so scared to fail at something when I had never failed anything during the first 26 years of my life. This was my second bar exam in 2 years. The first one was “easy” (I had no doubt that I had passed). The one in question 3 years ago was a different ball game because I was in a new state and was working full time while I was studying (always knowing that my therapist was there for me every Thursday at 4:00 during that grueling summer to just listen to me vent). The first time that I knew she truly cared (after seeing her for almost a year) was the night I finished that bar exam. Instead of being relieved that it was over, I was an absolute mess because it was finally over and I was just physically and emotionally sepnt. I called her because I didn’t feel like I had anyone else to turn to, and she listened to me cry for over an hour and asked me to come in the next day (on her birthday) so we could talk some more. I never got the impression from her that night on the phone or the next day during our session that I was burden. I just felt like she truly cared. As November approached (after anticipatory anxiety all of October — all I talked about was failing the bar exam and how I will be a failure to the whole “world”). We knew the day that the results would be out, but we didn’t know the time. I saw her late the night before. We had a plan. She made me promise that I would call her that day, and if she hadn’t heard from me by a certain time (and I was supposed to see her that night too), she was going to call the police. I was angry at her for being so “harsh,” but I knew she had my best interest at heart. Thankfully, I was able to call her early that afternoon to tell her that everything was fine.

    So I guess the question to myself right now that I may pose to her tonight (after almost 4 years together and 4 times a week for close to 2.5 years) is why am I at a point again where I am feeling that she doesn’t truly care about me? Is there some unresolved “thing” somewhere from my past that I need reassurance and reaffirmation that I am cared about? She told me last night that I will continue this pattern until we really understand the root of this “issue” (didn’t use the word issue). I said I am stuck, and I don’t know how to understand — a recurring theme. It just feels like sometimes I am “Zach.” While I have never skipped an appointment without notifying my therapist via phone or email, I have not “shown up” at many appointments (physically there) for whatever reason. Sometimes, we patients just need to get away. I hope for Zach and your sake, he is fine.

    • Hi Melanie,
      Thanks for your comments. The never-ending question of caring within the context of a professional relationship causes the “drama,” if you will, in the relationship. Within this question lies deeper intimacy in the relationship and deeper insight into yourself. I encourage you to keep struggling and thereby keep talking about your doubts about how much your therapist really cares. That is a rich discussion. Zach, by the way, is fine. He “got caught up with so many other things.” We have work to do.

  2. Shelly said

    I had to go back a few blogs to finally find out how old Zach is (41); by your description, I thought he was only 17 or 18. One would think a responsible adult would call if he wouldn’t be able to make an appointment. Avoidance or not, one can still be responsible. No need to make the therapist worry needlessly. I still think that you are an unusual therapist, Shirah. Not all therapists care about their patients and are as devoted as you are…but maybe I’m just biased.

    • Zach is a responsible adult, and yet, a few times, not very often, he “spaces” out on his appointments with me. I think it is an interesting psychological phenomena, so although I don’t like worrying about him, I am intrigued by the dynamics associated with this behavior. Thanks for your kind words.

  3. Ashana M said

    I suppose every Zach has his own reasons, but I can say for myself that the idea that a therapist cared about me in a personal way came to me only with profound astonishment. It is, after all, your job to help your clients. It isn’t your job to care. That’s a bonus I don’t ask for or expect, and you give it to your patients only because that’s the kind of person you are.

    Understanding that people care just because they do is such a difficult idea for me, if I really think about it, my head hurts a little at the strangeness of it–like how my students feel when they are exposed to a very advanced type of math. Because it is not quite solidly in my mind that other people have the capacity to care in a sustained way. I grew up surrounded by people who interacted with others solely to use them, and who mimicked an appearance of care for personal gain or just to look good to themselves.

    It isn’t that I think people can’t care about me, but that I’m not clear that others can care about anyone. My model of normal human behavior and thinking continues to be, to some extent, grossly pathological–I still assume people’s insides to be vast emotional wastelands, although I do know better.

    If the issue for Zach in your mind is about care, then I would guess some element of that may be at play: he grew up with profoundly selfish people, and still assumes emotional callousness and disengagement are what he can expect from others. If you disrupt that view by being caring, it may even frighten him, as that means he lives in a world he now does not understand and cannot trust himself to be able to navigate safely or successfully.

    A world in which people care is not necessarily a safer world to Zach. It can seem dangerous. Selfish people have flattened inner worlds, and less complex desires and responses. They may be violent and homicidal, but they will be predictably violent. They can be managed with a little attention and skill. Caring people are complex. There’s no telling what they will do.

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