Intensive Psychoanalytic Psychotherapy with Looked After and Adopted Children: Exploring the experiences and perspectives of trainee Child and Adolescent Psychotherapists

Objectives: This study sought to explore the experiences and perspectives of trainee Child and Adolescent Psychotherapists (CAPTs) offering intensive psychoanalytic psychotherapy to looked after and adopted children (LAAC) within Child and Adolescent Mental Health Services (CAMHS). The study was interested in researching both clinical experiences within the consulting room, as well as work with the network supporting the therapy, consisting of adoptive parents and foster carers, the professional network, and intensive case supervisors. Methods: Five trainee CAPTs were interviewed, using a semi-structured interview format. Interviews were transcribed verbatim and analysed using Reflexive Thematic Analysis. Results: The impact of experiences of trauma and loss were considered in relation to the: LAAC, carers, adoptive family and professional network involved, and on the therapy. The propensity for splitting and re-enactments due to the disturbing impact of trauma was emphasised. Concerns regarding pressures on the CAMHS and on the individual therapist and parent worker’s capacity to link-up and work collaboratively were raised. Intensive case supervision was deemed an important space where thinking and hope could develop. The prevalence of ambivalence, destructiveness and violence in the therapy was indicated. Participants emphasised the developmental focus of the therapy, and how the CAPT’s reverie was considered an essential aspect of the therapeutic experience. Variations and creativity in technique were emphasised as necessary for this population. Conclusions: The findings emphasise how trauma can have an ongoing impact on both child and network, leading to splits, fragmentation and re-enactments; pressures on CAMHS make this more likely to occur within the treating team, and the importance of linking up between professionals is stressed. Intensive psychotherapy can be experienced as both a threat to the child’s defences, but also a space where trust and understanding can grow, and where development can take place. Further larger-scale research on intensive psychotherapy is recommended.