Exploring the views of child and adolescent psychotherapists on psychoanalytic remote work carried out during the COVID-19 pandemic: A reflexive thematic analysis study

The COVID-19 pandemic changed the way that child and adolescent psychoanalytic psychotherapists worked, almost overnight, by requiring the vast majority of therapy to be offered remotely, using telephone or video call. As the restrictions of the pandemic have been lifted, the interest in remote psychotherapy remains as an option that could widen access to treatment. There is a need to develop guidelines on best practice for on-going remote work. Prior to the pandemic very little psychoanalytic remote work was offered to children and adolescents. The literature regarding adult patients suggests a relatively high prevalence of psychoanalytic remote work taking place in recent years. This work with adults has received a mixed reception, with questions arising on how a psychoanalytic setting and approach can be maintained remotely. This research aimed to explore the views of a team of NHS child and adolescent psychotherapists working during the pandemic. Seven members of the psychotherapy team took part in a semi-structured interview, exploring their thoughts on the scope and limitations of remote work in child psychoanalytic psychotherapy. I used Reflexive Thematic Analysis (Braun and Clarke, 2006; 2022) to generate themes that represent the participants’ views. The findings of this study suggest that there are fundamental differences between in-person and remote child psychotherapy. Most significantly the absence of the patient and therapist being physically together appears to change the nature of communication and containment in the dyad. This study tentatively suggests that young patients with significant disturbance or impoverished capacities might struggle to make good use of remote work. Minimum requirements in the young person’s physical and family environment are also described. Recommendations for further research into specific aspects of remote work are made.