The Cost of Client Transfer

Abstract

Clients undergoing transfer from one counselor to another were compared on the Generalized Contentment Scale and a DSM-III-R measure with clients staying with the same counselor over the same length of treatment. In three 12-week blocks, the clients with the same counselor made the greatest progress in the first 12 weeks, making less progress in each successive block. The clients who were transferred in the middle of the second 12-week block also made the greatest progress in the first time block, lost some of the progress in the transfer block, and made significant progress with the new counselor in the third time block, ending with no significant differences in either generalized contentment or DSM-III-R outcome from clients who had not been transferred. There has been very little literature on the transfer of clients because it is not thought of as a common part of a client's experience. In private practice, referral is either made early in treatment or the counselor usually continues with the case until termination. Nevertheless, there are many cases in which transfer is common, and its effects are unknown. With the advent of psychoeducational treatments of specified time lengths, it is becoming more common for agencies to offer many services, and for clients with multiple problems to be transferred from one psychoeducational treatment to another as the case requires. In the literature in which transfer has been reviewed (Gavazzi & Anderson, 1987;Wapner, Klein, Friedlander, & Andrasik, 1986), it has been addressed with interesting suggestions but with no empirical evidence.In training settings, referral is not only common, it is structurally part of the treatment facility. Transfer is so common that O'Reilly (1987) has called the process involved "the transfer syndrome, " and Muller (1986) has claimed that these cases are different from all other cases. When a client starts with a trainee, that client will either terminate treatment before the trainee's termination, or will have to transfer, unless the trainee can take the client to whatever job the trainee gets. This ability to take the client to the new job is rare. The trainee would have to get a job in a practice for which this client is appropriate and in the same geographic region. Additionally, most clients in training facilities are unable to afford the treatment outside the training facility, even when other conditions are met.When transfer does occur, the common assumption is that transfer interrupts the counseling process (O'Reilly, 1987) and that a client being transferred will improve more slowly than a client being seen continuously for the same period by the same counselor. Nevertheless, there is tangential evidence that this may not be true. The metastudy by Howard, Kopta, Krause, and Orlinsky (1986) indicated that half of the gain in counseling is made in the first 10 sessions. Although the first 10 sessions with a second (or third) counselor are not the same as the first 10 sessions with the first counselor, the relevant variables (such as a...

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

“…Flowers and Booraem () conducted one of a few quantitative studies investigating the association between transferring patients and therapy outcomes. They compared patients treated in a training clinic who stayed with their therapists for the entirety of their treatment with those who were transferred to another trainee.…”

“…So far, there is little empirical evidence on whether and/or how patients are affected by such transfers (for a notable exception, see Sauer, Rice, Richardson, & Roberts, 2017). Flowers and Booraem (1995) conducted one of a few quantitative studies investigating the association between transferring patients and therapy outcomes. They compared patients treated in a training clinic who stayed with their therapists for the entirety of their treatment with those who were transferred to another trainee.…”

Influence of client attachment and gender on therapy transfers: A multilevel examination.

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Transferring psychotherapy clients from one clinician to another has been a common practice in most psychological training facilities (Clark et al, 2011;Flowers & Booraem, 1995). Despite this practice, very little empirical research has examined the impact of this process on psychotherapy retention and client outcomes.

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Benefits of Brief Counseling Training for Master's‐Level Trainees in University Counseling Centers

“…It is difficult for both counselor and client to engage in long-term, complex work knowing that the client will be transferred to a different counselor trainee at the end of the year (Burrall, 1991). Research shows that most clients generally make the greatest progress during the first 12 weeks of counseling (Flowers & Booraem. 1995); therefore, turnover does not seem to have an adverse effect on most clients.…”