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

Abstract

Background The therapeutic alliance is an important factor in psychotherapy, affecting both therapy processes and outcome. Therapy transfers may impair the quality of the therapeutic alliance and increase symptom severity. The aim of this study is to investigate the impact of patient transfers in cognitive behavioural therapy on alliance and symptoms in the sessions after the transfer. Method Patient‐ and therapist‐rated therapeutic alliance and patient‐reported symptom severity were measured session‐to‐session. Differences in the levels of alliance and symptom severity before (i.e., with the original therapist) and after (i.e., with the new therapist) the transfer session were analysed. The development of alliance and symptom severity was explored using multilevel growth models. Results A significant drop in the alliance was found after the transfer, whereas no differences were found with regard to symptom severity. After an average of 2.93 sessions, the therapeutic alliance as rated by patients reached pretransfer levels, whereas it took an average of 5.05 sessions for therapist‐rated alliance levels to be at a similar level as before the transfer. Inter‐individual differences were found with regard to the development of the therapeutic alliance over time. Conclusions Therapy transfers have no long lasting negative effects on either symptom impairment or the therapeutic alliance.

Working alliance after transferring from one therapist to another in a training clinic: Influence of therapist attachment style.

“…As hypothesized, in this study of 23 adult community clients in individual open-ended psychodynamic psychotherapy who transferred from one therapist to another when doctoral student therapists left the clinic, clients on average rated the working alliance as worse with the posttransfer therapist than the pretransfer therapist. This aligns with prior findings that clients’ working alliance, contentment in therapy, and psychological health were lower after transfers (Sauer et al, 2017; Zimmermann et al, 2019). Thus, it supports the theory that therapists experience challenges in helping transferred clients to develop a working alliance with a new therapist (Barrett et al, 2008; Cox, 2017).…”

“…Using Tau- U analysis, also, we could not determine whether there was a recovery in the working alliance over time. Given Zimmermann et al’s (2019) finding that after average five sessions, posttransfer therapist-rated working alliances became similar levels with working alliances rated by the pretransfer therapists, it would be interesting for a future study to explore how therapist attachment styles would predict a recovery in the client-rated working alliance. Another limitation is that our findings may be limited to adult clients and therapist trainees in open-ended individual psychodynamic psychotherapy in a doctoral-level training clinic.…”

“…In exploring the role of therapist attachment on client working alliance after transfers, we tried to control the possible carry-over effect of the pretransfer alliance on the posttransfer alliance. Transferred clients may be more open and collaborative with posttransfer therapists when they have already experienced good alliances with previous therapists (Zimmermann et al, 2019). It is also possible that clients simply have a particular tendency to respond to the questionnaires, which may lead to consistent responses across the two therapists.…”

Court-Mandated Patients’ Perspectives on the Psychotherapist’s Dual Loyalty Conflict – Between Ally and Enemy

“…Earlier research has highlighted that in offender therapy it is crucial to take one's time to overcome mistrust to establish an effective alliance (Marshall and Serran, 2004;Goulet et al, 2019). This might be a particularly important aspect in therapy with persons in detention, as research in the community has shown that patients build up comparable alliance levels after three to five sessions on average (Zimmermann et al, 2019), in contrast, our participants' indicated taking three to 6 months time. It might be particularly difficult to build a strong alliance with patients suffering from substance use or personality disorders (Ross et al, 2008;Meyer et al, 2019), two highly prevalent disorders within the correctional context (Fazel et al, 2016).…”

Imagination exercises improve language in younger but not in older children with autism suggesting a strong critical period

“…To receive optimal therapy, children have to develop a certain degree of connection with a therapist (McIntyre & Barton, 2010). In a field in which frequent rotation of therapists is a norm, a lot of time is wasted on the initial therapist-child bridge-building (Zimmermann et al, 2019). MITA, on the other hand, has only a minimal break-in period.…”