Tales of the unexpected: What needs to be understood by a child psychotherapist when taking up their role working with under-fives in a mental health service? Reflexive thematic analysis of professionals’ experiences

This is a qualitative study which sought to understand professionals’ experience of and views regarding their roles as providers of services and/or personnel serving under-fives’ mental health and wellbeing. The study was prompted by anecdotal controversy regarding views on how under-fives’ mental health and wellbeing needs are met. Fifteen professionals, from a wide range of children’s services, took part in interviews which were analysed using reflexive thematic analysis. It was hoped that prior controversy could be understood through analysis of dialogue with professionals. Existing research literature, exploring professional experiences, found that they expressed a range of disturbing emotional states in the course of their work encountering distressed under-fives and families. Variations were highlighted amongst inter-discipline/-agency working experiences with mixed perceptions regarding what constituted barriers and/or successes in meeting under-fives’ needs. Some reported that integrated multi-discipline services were best. Others felt it was more about how services or disciplines communicated with each other rather than the level of integration or separateness of team/service organisation. Findings from existing literature presented variations regarding solution ideas. Thematic analysis, using a psychoanalytic lens, was conducted and sought to understand meaning in this study’s data. Results found echoes with existing research selected in the literature review. Similar emotional experiences were expressed and participants conveyed similar mixed views regarding service integration or separateness, and solutions. Unexpectedly findings revealed new controversy which seemed associated with systemic factors and primitive internal states. A notable finding was the portrayal of representations of infants by some participants. These conceptualisations appeared almost concrete in nature and came with ideas regarding how and where they fit into society and/or who might be responsible for their wellbeing. It seemed likely that the unexpected and notable revelations contribute to the original controversy. Findings demonstrated the complexity of the topic and arena: what is at play concretely and what is unconscious, and how difficult this might be to contemplate within the auspices of the field and what might get caught up and/or result in muddles in the work. I gained insight and there were lessons for me and other child psychotherapists. In particular, how child psychotherapist’s and, separately, CAMHS are perceived and/or experienced directly impacts inter-agency/-service working. Further, and importantly, these factors were found to have implications for the infants and families with whom we work, in terms of treatment pathways. Findings demonstrated how infants, colleagues and services are seen, and/or whether they are unseen, is likely to relate to outcomes for infants/families. Findings pose significant and interesting dilemmas for the study locality, seemingly highlighting endemic issues which could benefit from further thinking to aid long-term strategies and planning for the under-fives’ population.