Endings and beginnings: a thematic analysis of client and psychotherapist experience of an imposed change of psychotherapist

This study explores a phenomenon that has over the years attracted little systematic investigation and has never been addressed from the dual perspectives of client and therapist in a working therapeutic dyad. This original contribution provides knowledge on how an imposed change of therapist can impact individuals, relational dynamics and therapeutic outcome. The research took place in a substance misuse agency with four therapeutic dyads composed of client and replacement therapist. A thematic analysis of semi-structured interviews was used to capture individual client and therapist experiences of the phenomenon, then paired client and therapist interviews were analysed for dyad material. The client experience of the imposed ending and change to a different therapist involved the activation of the attachment system and the possibility of change in substance use or the fear of relapse. For clients there was an accumulation of losses linked to the relationship with the departing therapist, the work done in that relationship and the hope of an outcome from that work. The experience of the therapist working with an imposed change client is documented in their approach to working as the replacement therapist and a presence in the relationship of the first therapist. In the four dyad accounts the findings from individuals are seen to shape the development and trajectory of this second relationship and therapy outcome. From the findings, the importance of acknowledging and working with this phenomenon is discussed and recommendations are made for both practitioners and organisations to benefit client, therapist and organisation. The data not only fills a gap in knowledge but also opens the way for further investigation into the relationship that ended due to the therapist’s departure and the phenomenon’s impact in different clinical settings.