The Role of containment and holding in Psychoanalytic Psychotherapy with Children in Care

This thesis is an evaluation comprised of two studies exploring the implementation of a new pathway for Children in care (CiC), and the experience of Psychoanalytic Psychotherapists from the same CAMHS who deliver treatment to children in care. In 2018, the CQC gave a rating of ‘requires improvement’ for safety to the CAMHS due to long waiting times. In response, a Children and Young People Joint Agency Pathway (CYPJAP) was implemented in April 2019 to replace the previous Looked After Children’s pathway. Routinely collected clinical data were used to examine waiting times for first appointment and length of treatment for the historical LAC pathway (2018 –2019), the new CYPJAP (2019 – 2020) and Core CAMHS (2018-19/ 2019-20) as a control. It was hypothesised that there would be a significant difference in waiting times for first appointments between the two pathways for children in care. A Mann Whitney U test indicated a significant reduction in waiting times on the CYJAP (p<0.0001). The interview study aimed to explore the Psychotherapists’ experience of containment (Bion, 1962b) and holding (Winnicott, 1963) in work with CiC and how this may present in the clinical work. Four Psychotherapists were interviewed, and thematic analysis used to analyse the data. The themes which emerged described the child’s journey through Psychotherapy. This included ‘holding and containing the network’. The second stage of the journey explored children’s communications related to their early life in ‘projections, enactment and the depriving therapist’. In the third theme ‘being in touch with what’s missed’, the children recognised experiences they had missed. The final theme, ‘journey to integration’ described children’s improved emotional regulation, indicative of a more integrated state of mind. The new pathway significantly improved CiC’s access to a specialist treatment, and psychotherapists demonstrated a shared understanding of CiC’s need for containment and holding to improve mental functioning. Key words: Containment; holding; children in care; primary maternal preoccupation; skin-to-skin; integration; journey; Psychotherapy