From Less to More: The clinician’s experience of the transition from non-intensive to intensive psychoanalytic psychotherapy with looked-after and adopted children.

The aim of this study is to explore the clinician’s experience of the transition from non- intensive (once-weekly) to intensive (three-times-weekly) psychoanalytic psychotherapy with looked-after and adopted children (referred to as LAAC) in the NHS Child and Adolescent Mental Health Services (referred to as CAMHS). The study aims to understand more about the processes involved in this transition when it takes place with children who have experienced early and often traumatic discontinuity, as well as the possible impact upon the therapy of this transition. The literature review reveals that the subject of transitions across session frequencies with LAAC has not yet been studied, despite its prevalence and significance as a clinical practice, confirming this to be a new and valid piece of research. The data for this study was collected through semi-structured interviews and analysed using Reflexive Thematic Analysis. The results offer insight into the complexity and challenges involved in this transition, raising questions about the process and arguing for greater understanding of the meaning for each patient of this change in session frequency. The findings conclude that moving LAAC patients out of once-weekly psychotherapy and into intensive treatment is a vastly more complex undertaking than is often acknowledged; attention is drawn to the difference between a successfully managed transition and an unsettling disruption, cautioning that change to the care plan requires significant preparation and understanding of the patient’s object relationship so that the risk of enacting early, traumatic discontinuities may be minimised. This study suggests that increasing session frequency may not always enable hoped-for developments and that, for some children, once-weekly frequency may be preferable. The findings indicate areas for further research while highlighting the need for greater understanding of this practice to enhance clinical judgement when considering this move and its possible implications for the therapy.