Institutional transference: a new look at an old concept

In reviewing the early development of institutional transference, the concept was defined as the patient's identifying the treatment relationship with a clinic rather than with an individual therapist and a form of "distancing." More recently, the literature reflects a debate about whether the phenomenon is an outcome of patients' inability to maintain an individual relationship or their adaptation to changing therapists within a clinic over time. In our clinical experience, we have observed that institutional transference is strongly associated with the clinical outcome. In the clinical examples, we demonstrated that being aware of the potential for institutional transference and allowing it to develop can facilitate the development of a more trusting relationship between the patient and clinic staff. Institutional transference can coexist with individual transference and help facilitate rather than hinder the development of a therapeutic relationship. In our experience, the sense of a relationship with the clinic or treatment center is an important aspect of care. Therefore, recognizing institutional transference enables the clinician to pace the development of the relationship with the patient.