Therapists engage in transfers-a specific type of termination-with clients who will be continuing treatment with new therapists after they depart. Consequently, new therapists begin treatments in the shadow of the loss of outgoing therapist. These transfer experiences frequently occur in yearlong training settings, where therapists-in-training encounter some of their first therapy experiences and subsequently move on to other training settings or graduation. Transfers also occur in clinical settings when therapists retire, become ill, or need to end the treatment prematurely. In this article, the authors address transfer terminations using attachment theory and the literature applying attachment theory to psychotherapy. The authors incorporate relevant literature, research, and case examples that highlight how therapists can best address these losses and transitions in treatment. This article concludes by offering recommendations for supervisors of students in training settings and detailing some of the unique benefits for clients who experience multiple transfer terminations in treatment. Clinical Impact StatementQuestion: How does attachment theory guide us when working with patients and therapists who have to transfer treatment in training clinics? Findings: Theory and clinical experience have revealed that it is critical to treat the transfer experience as an ending or form of termination. Helping address this loss is important and meaningful for the patient. Meaning: To maximize treatment, therapists should explore the impact of the transfer and raise upcoming transfers early in the treatment. Next Steps: In future studies, researchers need to explore how addressing transfers impacts treatment, what individual differences moderate or mediate transfer outcomes, and how we can best train therapists to openly explore loss in psychotherapy treatment.

This article aims to address Rangell's (2011) observation that psychoanalytic insight-often regarded as at or near the center of therapeutic action for psychoanalytically informed psychotherapy (Jones, 2000;Stark, 2000)-is an insufficient vehicle of patient change because it often leaves patients asking their therapists, "So what?" (Rangell, 2011, p. 34). I encountered the insufficiency of psychoanalytic insight in my clinical work with a patient I saw in therapy at a community mental health center. My work with this patient inspired me to hypothesize that the introduction of an existential line of inquiry into psychoanalytically informed psychotherapyparticularly around the construct of existential responsibility-could resolve the insufficiency of insight Rangell (2011) and I observed. I reviewed and critiqued the literature on the role of insight in psychoanalytic psychotherapy-as well as the literature on existential responsibility in existential philosophy and psychotherapy-in working toward a resolution. Reexamining my work with this patient from this perspective, I then put forth my own formulation of existential responsibility in psychotherapy and argue-using clinical material-how it could potentially bolster and complement the psychotherapeutic effects of insight. The importance and implications of this article's findings are drawn out and suggestions for future research are presented.