A qualitative exploration of psychoanalytic psychotherapists' experiences working with young people who have perverse sexual fantasies and/or engage in harmful sexual behaviour

Objective: This study explores psychoanalytic psychotherapists’ (CPTs) experiences of working with young people (aged 14-25) who have perverse sexual fantasies, and/or engage in harmful sexual behaviour. Methods: Semi-structured interviews were conducted with five qualified CPTs working at the Portman Clinic. Interpretative Phenomenological Analysis (IPA) was employed to analyse the transcribed data. Results: IPA revealed 5 superordinate themes: 1. CPTs view perversion as an entrenched solution to emotional pain; 2. ''…it’s very, very disturbing to get hold of the aggressive, perverse part of the patient''; 3. In CPTs’ views, starting psychotherapy significantly increases the risk of harm to self and others, and it cannot be contained individually; 4. CPTs' gender matters; and 5. “an antidote to the disturbance” Conclusions: These findings have significant implications for clinical practice, emphasising the need to structure services with an awareness of the high risk involved, and the need for supervision and team support. They also highlight the benefits of long-term, open-ended treatment for these patients. Finally, it was revealed that having expertise in how to work with the aggressive part of these patient was another major necessity for all professionals working with these patients. Key words: Perversion, sexual offending behaviours, psychoanalysis, psychotherapy, counter-transference, adolescents.