title: Young clinicians dealing with death: Problems and opportunities.
abstract: The formation of a strong bond between patients and therapists can lead to successful treatment outcomes. Yet, little is known about the mechanisms that function to control this relationship. The objective of this case report was to examine the ruptures and repairs in the working alliance between a young therapist and an elderly caregiver, and to suggest ways in which to deal with age-related challenges to such an alliance.
  
  
  
  In order to examine the ruptures and repairs in a working alliance, this case report reflects on the interdependent relationship among therapist variables, patient variables, and the therapeutic alliance. The clinical experience presented describes a newly educated psychologist's struggles to overcome the challenges in forming a strong working alliance with an elderly dying cancer patient's spouse. The spouse was enrolled in the DOMUS study (Clinicaltrials.gov: NTC01885637), an ongoing randomized controlled trial of a patient-and-caregiver intervention for facilitating the transition from an oncology ward to palliative at-home care, and then bereavement. As part of the DOMUS study, the patient and spouse received a psychological intervention based on existential-phenomenological therapy.
  
  
  
  A therapist's therapeutic approach to breaking down age-related barriers to communication matters greatly. The existential-phenomenological method of epoché offers a way to effectively address ruptures and repairs in a working alliance, as it enhances the therapist's openness to learning. In addition, the insights of senior supervisors can promote a therapist's openness to learning.
  
  
  
  In conclusion, the method of epoché benefits the working alliance in several ways, as it enhances personal insight and provides methods for repairing an alliance. The reflections in this paper may be applied to clinical settings in oncology, gerontology, and palliative care, which are likely to be of great interest to young clinicians experiencing age-related challenges in their daily work.
authors.affiliation: Department of Psychology,University of Copenhagen,Copenhagen,Denmark.
authors.forename: Kathrine G
authors.initials: KG
authors.lastname: Nissen
mesh_terms: D001293:Attitude to Death; D001601:Bereavement; D003142:Communication; D003376:Counseling / Q000379:methods; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000379:methods / Q000523:psychology / Q000592:standards; D011369:Professional-Patient Relations; D000078329:Workforce; D055815:Young Adult
keywords: Advanced cancer; Caregiver; Distress; Psychological intervention; Therapeutic alliance