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. In the current study, we examined symptom changes over the course of 4 pretransfer and 4 posttransfer sessions in a sample of 35 adult clients receiving psychotherapy services from master’s- and doctoral-level trainees in a psychology training clinic. At intake, clients completed a measure of adult attachment orientation and for each session, clients completed a measure of their overall psychological distress for the week preceding the session. Multilevel modeling analyses revealed that client attachment orientations and gender were significantly associated with transfer-related therapy outcomes. Clients with increasing levels of distress pretransfer were most at-risk for not following through with treatment posttransfer. Also, for those who did follow through, clients with more anxious attachment orientations were likely to report higher levels of psychological distress posttransfer than were those with less anxious orientations. Future work should examine whether such increased distress levels persist or are ultimately reduced through additional treatment sessions. Results suggest several issues that should be considered by supervisors and clients during the process of transferring clients to a new therapist.

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