Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for September 14th, 2011

The Tardy Patient

Posted by Dr. Vollmer on September 14, 2011

   Lateness is an interesting phenomena. Some folks are chronically late, whereas others are always on time. Typically, patients are one or the other. Few people in my experience are occasionally late. Of course, there are issues of traffic and parking, but prompt folks allow space for that, and tardy folks always feel surprised by those factors. Talking to tardy patients about their tardiness usually makes them defensive. I often hear “well, you get paid the same, why do you care?” My response is often, “no one likes to be kept waiting,” although I say that, knowing that this is not new information. I am also aware that the hostility in the comment might need to be addressed.

    Cynthia, sixty-four, is consistently twenty minutes late. She is neither hostile or apologetic, but rather she laughs at herself as she walks in, while she says, “I think of your start-time as a suggested time, rather than an actual time.” She then launches into her concerns about her marriage, and how troubled she is by her relationship. I think about addressing her lateness, or dealing with the issue that she presents to me. Most of the time, I dealt with the subject that she presented, but after ten years, I wanted to discuss her time management issues, even though she did not seem particularly concerned about her use of our time together. As I suggested that her tardiness affected our ability to talk about her problems, since we have less time to do that, she responded with intense anger. “You know that I am always late. You know there is nothing I can do about that. You have known this for ten years. Why are you picking on me now? Do you want to get rid of me as a patient?” Cynthia says, looking deeply hurt that I confronted her. “I do feel that our relationship can handle this confrontation. I wanted to talk about your tardiness for a long time, and I thought that since your life was relatively stable, this would be a good time to talk about that.” I say, knowing that Cynthia is feeling fragile since I held up a mirror to her tardiness.

   “If I came on time, would things be better?” Cynthia says with hostility and sarcasm. She is implying that more time with me would not be more helpful. “I don’t know, but we could try that out.” I say, trying to explore her ambivalence towards me. “I am not happy with how our relationship has changed.” Cynthia says, referring to my confrontation about her time management. “I can see that,” I say, wondering how this chapter in our long relationship will play out. My inserting this agenda into our session had a bigger impact than I had imagined. Upon reflection though, I can see that Cynthia’s chronic tardiness must be deeply rooted in chronic pain which causes her to avoid getting help from her therapist. Her defensiveness supports that conclusion. I hope we can work our way through this. Time can be a sensitive subject.

Posted in Anger, Psychotherapy | 8 Comments »

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