Discussion: Management of Planned and Unplanned Termination

Therapists-in-Training Experiences of Working With Transfer Clients: One Relationship Terminates and Another Begins

Cheri L. Marmarosh and Barbara Thompson The George Washington University

Clara Hill The University of Maryland

Suzanne Hollman The Institute of the Psychological Sciences

Monica Megivern The George Washington University

Data from interviews with 12 graduate-level trainees about their experiences of working with clients who had been transferred to them from another therapist were analyzed using consensual qualitative research. Trainees reported a range of helpful and hindering aspects about the transfer experience related to the client (e.g., client had experienced a prior termination and transfer, client had severe character pathol- ogy), the prior therapist (e.g., prior therapist prepared client for transfer, prior therapists did not process their termination with client), themselves (e.g., participant was open to addressing grief, participant was fearful of rejection), supervision (e.g., the supervisor provided important feedback on dealing with loss, the supervisor failed to address the unique nature of transferring), training (e.g., there was not adequate readings on termination and transfer, there was no readings on transfers), and clinic practices (e.g., meeting with the prior therapist and current therapist facilitated process, having clients end treatment with debt hindered the development of the new relationship). Participants also provided recommendations for improving the transfer process. Implications of these findings for clinical practice, training, and research are addressed.

Keywords: transfers, terminations, training clinics, psychotherapy, therapeutic relationship

The literature on termination in psychotherapy often focuses on the ending of a therapy treatment, but it fails to address what happens when one treatment ends and the client is transferred. Transfers occur when therapists can no longer provide the necessary treatment, when therapists move or retire, or when the clinic provides training to therapists who rotate out of the setting. Clients are often transferred from one therapist to another when therapists-in-training leave the clinics at the end of their training year (Penn, 1990; Super, 1982; Wapner, Klein, Friedlander, & Andrasik, 1986). Given that this is the first clinical experience for many of these therapists, difficulties inevitably arise in understanding how to allow the transferred client to grieve the old relationship and establish a new relationship.

In a review of the client perspectives on the transfer process, Keith (1966) developed the term “transfer syndrome” to denote the difficult emotions and behavioral changes experienced by clients who end treatment with one therapist and begin treatment with another. Re- searchers and clinicians described clients’ feelings of abandonment, grief, and loss (Clark, Cole, & Robertson, 2014), anger/rage toward the transferring and new therapist (Penn, 1990), and feelings of unworthiness (Penn, 1990). Attachment theory has been used to understand why clients with anxious attachments experience aban- donment after the ending with a therapist, whereas clients with avoidant attachments detach and resume therapy as if nothing hap- pened (Holmes, 2006).

Clients are not alone in experiencing the transfer syndrome. Some therapists are able to tolerate clients’ experiences of termination and loss, whereas others who had prior personal losses struggle with termination process (Boyer & Hoffman, 1993) and probably with the transfer process. Unfortunately, we have minimal empirical informa- tion to guide us through this important ending and beginning. The purpose of the present study was thus to study the experiences of therapists-in-training with regard to their work with transfer clients who recently experienced the termination of a relationship. Discussion: Management of Planned and Unplanned Termination

The Impact of Transfers on Clients: Empirical Findings

Much of the transfer research has focused on how the transfer- ring of clients from one therapist to another can impact attrition (Tantam & Klerman, 1979), with some studies reporting a dropout rate as high as 69% after a transfer (Tantam & Klerman, 1979;

Editor’s Note. Mark J. Hilsenroth served as the action editor for this article.—MJH

Cheri L. Marmarosh, Professional Psychology, The George Washington University; Barbara Thompson, Graduate School of Education and Human Development, The George Washington University; Clara Hill, Counseling Psychology, The University of Maryland; Suzanne Hollman, Clinical Psychol- ogy, The Institute of the Psychological Sciences; Monica Megivern, Graduate School of Education and Human Development, The George Washington University.

Correspondence concerning this article should be addressed to Cheri L. Marmarosh, Professional Psychology, The George Washington University, 1922 F Street, Suite 3, Washington, DC 20052. E-mail: cmarmarosh@ gmail.com