Supervising student-therapists: Suggestions for the transfer of long-term psychotherapy patients.

Abstract

This article reviews patient and student-therapist variables thought to confound the transfer or forced termination phase of long-term psychotherapy conducted in training settings. Previous literature has demonstrated that not adequately attending to this critical juncture in treatment often results in the failure or disruption of therapy. Particular emphasis is placed upon examining the effects of countertransferance phenomena resulting from the student-therapist's necessary affective investment in the patient, and how these reactions may undermine the transfer process and the course of psychotherapy. The authors offer suggestions for supervisors in assisting student-therapists to provide more effective treatment at the transfer juncture.

What happens when the therapist leaves? The impact of therapy transfer on the therapeutic alliance and symptoms

“…For example, forced transfer is described as narcissistic mortification comparable with abandonment by a lover and in violation of the implied rule that the therapist should care for the patient unconditionally, leading to a loss of trust and safety (Siebold, ). Such an event could lead to higher dropout rates and diminish the success of therapy (Trimboli & Keenan, ). The therapeutic alliance between therapist and patient seems to be the critical factor explaining these findings.…”

Supervising the Intern Who Inherits a Case: Making the Most of the Change

“…There is an emphasis on the adverse effects the therapist's leaving has on the patient (e.g., Zuckerman & Mitchell, 2004), particularly themes of abandonment and loss. Therapist countertransference enactments due to factors such as guilt, grandiosity, difficulties with loss, and attachment to the patient are also described (Trimboli & Keenan, 2010;Prentice et al, 1977). Little has been written about the experience of the receiving/ inheriting therapist, particularly therapists-in-training (some exceptions are found in Muller, 1986;Prentice et al, 1977).…”

“…Literature about transferring patients to a new therapist tends to focus on the premature termination by the first therapist (Bostic, Shadid, & Blotcky, 1996;Prentice, Goldenberg, & McDevitt, 1977;Trimboli & Keenan, 2010;Zuckerman & Mitchell, 2004). There is an emphasis on the adverse effects the therapist's leaving has on the patient (e.g., Zuckerman & Mitchell, 2004), particularly themes of abandonment and loss.…”

Common Errors in Conducting Psychodynamic Psychotherapy: Illustrative Vignettes and Alternative Strategies

“…Treating the presenting symptoms only reflects a limited understanding of the nature of psychopathology and how individuals attempt to cope with their difficulties. Numerous researchers have noted that dealing effectively with psychopathology requires an understanding of the etiology of the patient's difficulties (Duncan, 2002;Luborsky, 1995;Rosenzweig, 1936;Trimboli and Keenan, 2010;Trimboli, Marshall, and Keenan, 2013). With psychotherapy approaches that are directive and one-dimensional in the conceptualization of psychopathology, the symptom is regarded as the problem and dictates the focus of treatment.…”

“…If the patient returns for the subsequent session, discussing the missed appointment could serve as a fruitful source of understanding the meaning of this event. For example the "no-show" could be an expression of resistance to either the process of psychotherapy (Tidwell, 2004) or to the anxiety associated with the content of what is being discussed (Trimboli & Keenan, 2010). Contacting the patient regarding a no show may seem to be an act of concern and consideration.…”