Why People Book Therapy — Then Cancel: Understanding the Push–Pull of Healing

If you’re a therapist, you’ve likely seen it happen:
someone reaches out, shares a heartfelt message, books their first session… and then cancels, postpones, or disappears.

It can look like avoidance or inconsistency, but beneath it is something far more human — ambivalence about healing.
When the mind says “I want to get better,” but the nervous system says “I’m not ready,” cancellation becomes the body’s compromise.

Let’s unpack why this happens and what it means — both for clients and therapists.

1. The Nervous System’s Conflict: Safety vs. Change

Therapy, by design, asks people to face feelings, memories, or truths that their system once had to avoid in order to survive.
So even the idea of therapy can activate the body’s threat response.

On one hand:

“I want to heal. I’m tired of feeling stuck.”

On the other hand:

“If I go there, I might lose control, fall apart, or uncover something painful.”

That internal tug-of-war isn’t resistance — it’s protection.
The same nervous system that adapted to danger by avoiding pain now interprets therapy itself as potential danger.

2. Ambivalence: The Mind Wants Healing, The Body Fears It

Ambivalence is one of the most common — and least discussed — parts of therapy.
It’s the simultaneous longing for change and fear of it.

For trauma survivors or people with histories of emotional neglect, safety and vulnerability have been wired as opposites.
So when they book therapy, it can unconsciously trigger a “conflict alarm”:

• “What if I’m judged?”

• “What if this doesn’t work?”

• “What if I can’t handle what comes up?”

Cancelling becomes a way to turn the alarm off.
The decision feels logical (“bad timing,” “too busy,” “money’s tight”), but beneath it is emotional protection.

3. The Shame Barrier

Booking therapy can stir up deep shame — especially for those who were raised to handle everything alone.
Asking for help can feel like admitting failure or weakness.

When that shame surfaces, the brain quickly finds rational reasons to cancel:

“Maybe I’m not that bad.”
“I should be able to fix this myself.”
“I’ll go when things calm down.”

In reality, that voice is the inner critic — the same one that once kept them safe by staying small.
Therapy threatens that pattern, so the critic steps in to regain control.

4. Fear of the Unknown

Therapy involves entering unfamiliar emotional territory — sitting opposite someone you don’t yet trust, opening up parts of yourself you’ve kept hidden.
The unknown can feel deeply unsafe to a nervous system that equates control with survival.

Even positive change is stressful.
From a brain perspective, predictability feels safer than happiness.
So someone may unconsciously prefer the familiarity of pain to the uncertainty of healing.

5. Early Attachment Patterns Replaying

Sometimes, booking and cancelling therapy mirrors early attachment dynamics — the dance of reaching out and retreating.

• Anxious attachment: reaches out impulsively, then feels exposed and withdraws.

• Avoidant attachment: wants help but fears dependence or intrusion.

• Disorganized attachment: craves connection but also expects disappointment or danger.

The therapeutic relationship itself can trigger these patterns before it even begins.

6. Practical Reasons That Aren’t Just “Practical”

Clients may cite scheduling, finances, or timing — and sometimes that’s true.
But even these surface reasons often carry emotional weight.
For example:

• “I can’t afford therapy” may also mean “I don’t believe I’m worth investing in.”

• “I don’t have time” may also mean “My needs always come last.”

• “It’s not the right moment” may mean “I’m scared of losing the version of me that’s kept me safe.”

Understanding this doesn’t mean dismissing the reason — it means seeing the feeling beneath it.

7. The Therapist’s Role: Safety Before Strategy

For therapists, it’s easy to personalise cancellations or assume the client wasn’t serious.
But often, the best response is gentle empathy, not persuasion.
A message like:

“No problem at all — take your time. Reaching out is already a big step, and I’ll be here whenever you feel ready.”

This signals safety — the opposite of pressure.
When the nervous system feels safe, curiosity about healing can return.

8. The Hope: Avoidance Is Still Contact

Even cancelling therapy means something powerful has already begun.
That first outreach shows a spark of readiness.
The cancellation shows fear — which means the protective system is alive and doing its job.

The work isn’t gone — it’s simply paused at the edge of safety.
And when the person feels ready, that edge becomes the entry point for real transformation.

In Summary

People cancel therapy not because they don’t want to heal — but because healing activates the very defenses that once kept them alive.
The push-pull between “I want to get better” and “I can’t do this” is part of the process, not a failure.

Every step — booking, cancelling, trying again — is the nervous system negotiating safety.
And when therapy finally begins, those same protective parts can be welcomed into the room too.

Because the truth is: healing starts the moment someone reaches out — even if they’re not ready to stay yet.