Who is allocated to psychoanalytic psychotherapy in a Tier 3 CAMHS setting?

At a time when Child and Adolescent Mental Health services are seeing unprecedented demand (Look Ahead, 2023), the question of which patient needs which intervention has becoming increasingly important to understand. Linked to this is whether the clinicians responsible for making these decisions are consistent across the different disciplines that work together. This qualitative study aimed to explore the clinicians’ understanding of ‘Who is allocated to psychoanalytic psychotherapy’ in a Tier 3 CAMHS service, and whether a patient profile could be developed for patients deemed appropriate for psychotherapy. Data was collected through 5 semi-structure interviews with clinicians from various health care backgrounds, all working in the same multi-disciplinary team (MDT). Thematic analysis was used to identify common themes in the data. Six main themes emerged: (1) Preliminary patient characteristics, (2) Going deep, (3) One size does not fit all, (4) Team process, (5) Clinical intuition versus guidelines, (6) Issues of disagreement. The findings highlighted some consistent characteristics of those allocated to psychotherapy, including internalizing patients, who had suffered complex forms of relational trauma and were understood to need a new kind of relationship with the therapist to work these through. Despite these, several clinicians stated they were unsure what treatment with psychotherapy was and would like to know more. The findings also identified factors beyond the patient themselves including team dynamics and, notably, the influence of resource pressures on the decision-making process. These findings have implications for understanding how the MDT functions in the current economic climate of CAMHS, and the need for a more coherent narrative on what psychotherapy is to enhance clinician confidence on allocating to this intervention.