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Tijdschrift voor Psychiatrie 46 (2004) 2, 101 - 107

Essay

Why didn't you tell me before?

A.E.J.G. Wiersma

summary The article describes how patients respond to the departure of their therapists and how the therapists themselves feel when they have to leave their patients. Literature on the subject is extremely limited. The reactions of patients can be explained by the psychiatric disorder from which they are suffering, by their personal histories and by the coping mechanisms they have developed. The therapist also experiences various and at times contradictory reactions which in many respects resemble those of his patients. He needs to become aware of his countertransference feelings and of the defensive mechanisms he employs to suppress these feelings. It appears that the patient has to be prepared well in advance for the impending departure of the tharapist and that good matching is very important. The therapist too has to prepare the way for his own departure. It is essential not only for experienced therapists but also for trainees to be engaged in consultation and supervision as the time for departure approaches. The mental health services need to pay more attention to such matters.

keywords departure, parting, therapist