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

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. © 2013 Informa UK, Ltd.