In 1962 the outpatient department of the division of psychiatry at the Boston
University School of Medicine had too few professional therapists to provide
for a growing list of patients awaiting assignment. Because the outpatient
department was staffed by psychiatry residents at the time, the problem
became mine as director of psychiatric education.
Not unexpectedly, a review disclosed that a significant number of
patients were being seen regularly over long periods of time, even for years.

Since they were being treated by residents who rotated from one psychiatric
service to another every six months their treatment was interrupted twice a
year. An examination of the records of some of these long-term patients
revealed that, although they apparently related well to their new therapists,
they tended to reexamine with each therapist much of what had already been
discussed. Further, we noted that these patients did not appear to react
strongly to the loss of the previous therapist; thus, we wondered whether
transference to the institution and to the outpatient department had become
more significant than transference to the therapist. It would seem that
patients could go on forever, having their dependent needs well gratified—
although their best interests would not be served. Patients awaiting
treatment remained at a disadvantage.