Difficult encounters in psychoanalytic parent work: Exploring the clinical experiences of child and adolescent psychotherapists through qualitative enquiry.

Psychoanalytic parent-work is a routine intervention offered by Child and Adolescent Psychotherapists in the UK. However, there remains a disjointedness in clinical approaches to this complex area, and it is described as a neglected area of practice. This study explored parent-work encounters which a group of Child and Adolescent Psychotherapists found more difficult than usual, and why. Four therapists spoke about their difficult encounters in psychoanalytic parent-work, during semi-structured interviews. Data was analysed qualitatively, using Interpretative Phenomenological Analysis. Participant encounters were formulated as including contact with something threatening, linked with Klein’s “bad” object, Bion’s “nameless dread”, and concepts of vicarious trauma. These were associated with collapses of thinking or meaning making, and distress experienced at the compromised or lost ideal self. This linked with a loss of meaning or disillusionment, including inner conflict arising from the wish to avoid knowing. Whilst participant experiences offer phenomenological universality, they appeared to be exacerbated by a profession-wide reluctance to think about trauma as it presents in the external world, rather than the playroom. Idealised expectations of psychoanalysts were noted, meaning experience of professional shame and inadequacy were more likely in situations of difficulty. Lastly, containing parental experience appeared more difficult for practitioners lacking a sturdy, integrated theoretical parent-work framework to draw upon. Overall, it is suggested participants had come to a complex, multi-layered and difficult work theoretically and practically unprepared. The Child Psychotherapy profession may benefit from further thinking around psychoanalytic parent-work as it is theorised and trained for. Without this, psychoanalytic practitioners may continue to find themselves overwhelmed as they draw upon primarily dyadic models of working, within a non-dyadic ‘external’ space.