‘A missed session is still a session’: How Child and Adolescent Psychotherapists understand the meaning of non-attended sessions with patients aged 18-25.

This research project aimed to explore the individual experiences of Child and Adolescent Psychotherapists (CAPTs) working with patients aged 18-25 who, at times, do not attend - or ‘DNA’ - their sessions (as distinct from cancelling in advance). Current discourse around non-attendance largely focuses on its financial and emotional cost to services and patients; the aim of this project was to explore the deeper meaning behind non-attendance and the way it is understood in the context of psychoanalytic psychotherapy. Semi-structured interviews were conducted with qualified CAPTs and analysed using Interpretative Phenomenological Analysis (IPA). Findings revealed the feelings stirred up in CAPTs by their patients’ unexplained absences, ranging from rejection to relief, with notable anxiety in response to an absent patient who is at risk of self-harm or suicide. These responses were often understood in the context of unconscious communication and projection. Clinicians emphasised the need for a certain degree of tolerance of no-shows with this age group, sharing the view that non-attendance does not necessarily equate to non-engagement. They highlighted the importance of the patient’s communication being received and understood, which can in turn lead to progress in therapy. However, clinicians described the importance of limits and boundaries around non-attendance; this was in acknowledgement of limited resources, and also to encourage the patient to take responsibility for their therapy in order to aid development. Evident overall was the conflict felt by clinicians between the importance of working therapeutically with absence, and the pressure to discharge patients who aren’t attending. The importance of making decisions on a case-by-case basis was highlighted. An understanding of the potential therapeutic significance behind young people missing sessions could hopefully contribute towards developing a more informed and tailored approach to thinking about non-attendance in psychotherapy and policy development, particularly given current pressures on services. It may also help to shape the way we think about how young adults engage with mental health treatment.