I haven't been on a vacation, or even taken vacation time, in almost 4 years, but I do sometimes travel for work. Even if I don't have to miss my appointment for it, I almost feel more unraveled than when my therapist is gone and I actually have to miss an appointment--so I guess I am the opposite to your dilemma. I need my controlled environment to function and when I'm away from it, having some kind of contact with my therapist helps me not go off the rails. When she's gone, it's hard, but it helps to be at home and have the support of my environment to hold steady.