Shirah Vollmer MD

The Musings of Dr. Vollmer

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.

8 Responses to “The Tardy Patient”

  1. Shelly said

    Why is there nothing that Cynthia can do about her chronic lateness? Does she feel that leaving 20 minutes earlier for her appointment is beyond her control? Doesn’t she feel it’s disrespectful to you to be late? Perhaps if you let her know how you felt about her lateness then she would understand? Cynthia apparantly does not like your setting the agenda of your appointments. What does lateness symbolize to you?

    • The reason Cynthia is late is largely unconscious. Each visit she says there is traffic, it is hard to park, etc. These reasons do not add up because she can anticipate those problems, hence the underlying reason for her lateness must be out of her awareness. My task is to get Cynthia to be curious about her behavior. This is a challenge. Yes, you are right that when Cynthia is late, we work on her time and not mine. There is an element of control. Our goal is to talk about these issues in a manner which is both meaningful, but at the same time, does not make her feel too vulnerable. By vulnerable, I mean that she could feel like I am criticizing her, as opposed to curious. This is a very delicate balance. Thank you, as always, for your comments.

  2. Melanie said

    What amazes me is that Cynthia’s tardiness has been consistent for 10 years and nothing has really been said until recently. I would be extremely upset. I have experienced that with teaching kids for their Bar and Bat Mitzvahs (side job throughout the years). There was a definitive time set, and I had other obligations to attend to. It is just rude to be consistently late.

    Looking at it from my perspective, I am the “queen” of being on time (at least 5 minutes early). I KNOW that my therapist will be at least 5 minutes late and sometimes up to 10 minutes late. This has been going on for almost 4 years, and I don’t expect otherwise. Since we see each other during the evenings 4 times a week, I am usually “ok” with her tardiness because I am not going back to work. I have worked my life around our schedule together (and am fully appreciative that she sees me after work because there are days that I wouldn’t be able to “handle” work after our sessions). I am able to plan social engagements around our sessions. When she is super late, she always asks if I have time (she never cuts our sessions short because of her tardiness). Once a month or so, I’d like her to be in “on time” because I have to get to a meeting that is about 10 minutes away. She told me once that I could always give her a heads up…I still think she would be on “her” time. There was one occassion where I had to pick up my car from the shop, and I just knew I was going to be late for my appointment. I was so on edge. I was angry because she is late all of the time, and the one time that I could have been late, I was freaking out. I actually got there at exactly the scheduled time. I was a mess for the whole session though. We did talk about why I was so nervous, and I finally told her that you know, you are never on time (nervous about her reaction to my bluntness). She asked how did I feel about that — and I said, it is ok most of the time. But it is my time. Ironically, yesterday your post popped up in my inbox 10 minutes before my session, and I was just walking out the door (I live about 1 mile from her office and she lives next door…). I saw the word tardiness and laughed a little. I actually encountered more traffic than usual, and I was still in my car sitting at a red light when our official time had passed. I wasn’t worried because I knew I had a cushion — and low and behold, she opened the door as soon as I sat down (2 minutes after our scheduled time…which was at least 3 minutes earlier than normal). The question is: how would she and/or I have reacted if she had actually opened the door and I wasn’t there — the patient/client who is there at least 5 minutes early and sits usually for 10 or 15 minutes waiting?

    • Hi Melanie,
      You bring up some interesting issues. One point is that time is also about control. The person who is waiting is out of control. Accepting that can be troubling to some. You also raise the issue that some resistances, if you will, such as being late, are noted, but not addressed until a much later time in the psychotherapy. This was my decision with Cynthia, which although I held off for quite some time, I now think I was premature in my confrontation. The timing has to be right, and this can be tricky. Thank you for your comments. Good luck in your psychotherapeutic relationship.

  3. Danny said

    Ten years and still she is late for her appt(s) as well as reluctant to even talk about it . Also what strikes me is that after such a long time shes avoiding actually getting help from therapy ? So the question is why us she still coming to therapy. Enjoy reading these blogs .

    • Thanks, Danny. Yes, I point out one dominant feature in our fictional therapeutic relationship, without mentioning all of the positive energy which flows back and forth. She comes to therapy because she feels she has me on her “team”. Still, there is still reluctance to engage with me, so she compromises by being consistently late.

  4. I had a client who was late for his appointment. He rung to say he’d be late (he wasn’t normally late) and he arrived about 15 minutes late.
    I ended the session on time (I had another client arriving) and he was obviously shocked. In fact he was really angry with me, and could not see why he shouldn’t have his full session.
    It wasn’t pleasant to be the focus of his anger, yet interestingly, after that session, we moved into a far more intimate and useful therapeutic space. He appeared to become more relaxed and able to look more deeply at issues he was bringing.

    • Interesting…I imagine that once he vented his anger towards you, he opened up to a deeper relationship with you since he respected the way you managed his feelings, however unjustified they might have been.

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