To attend or not attend? A critical review of the factors impacting on initial appointment attendance from an approach-avoidance perspective

Abstract

Background: A large proportion of initial therapy appointments are not attended. Whether this reflects service-user choice or an unmet need for therapy, non-attendance can impact on patients, therapists, services and research evaluation.

Aims: To understand the complexities of this phenomenon, this paper reviews the mental health literature to gain further insight into how predictor variables can influence professional help-seeking decisions.

Methods: This review reveals a modest success at identifying specific demographic and psychological factors, yet methodological issues surrounding data collection techniques have often led to contradictory and inconclusive findings.

Conclusions: This paper examines the possibility that approach-avoidance conflict [Kushner, M.G. & Sher, K.J. (1989, 1991). Fear of psychological treatment and its relation to mental health service avoidance. Professional Psychology: Research and Practice, 20, 251-257; The relation of treatment fearfulness and psychological service utilization: An overview. Professional Psychology: Research and practice, 22, 196-203] could explain the contradictions in the literature because, in this model, different factors involved in driving engagement versus avoidance become more salient depending on a dynamic interplay of timing, the individual and their service context. The core principles behind this approach-avoidance conceptualisation are explained and further avenues for research are identified.