‘I don’t know, it’s just a feeling and it just comes’: A discourse analysis of anxiety during child psychotherapy assessment.

Anxiety is one of the most significant mental health concerns for young people in the UK (Poppleton, Ramkission & Ali, 2019) and also occurs during Child Psychotherapy Assessments which are a part of Child and Adolescent Psychoanalytic Psychotherapy Assessment practice (Rustin & Quagliata, 2000). Despite this, no qualitative empirical studies were found in the literature examining the nature of anxiety specifically during CAPP assessments (Göttken et al.,2014; Weitkamp et al.,2018); this field study aims to address this gap by asking the question: what is the nature of anxiety which emerges during Child Psychotherapy Assessments? A retrospective design applied Critical Discourse Analysis and Subject Positioning Theory to Psychoanalytic process notes to explore anxious moments. Two male participants were aged 15 and 4 at the time of their assessment with the researcher who was a trainee Child Psychotherapist. Eight prevalent subject positions presented in four pairs reflected discourses which embodied the non-linear trajectory of anxiety, and the defences against anxiety, experienced within the duality of the therapeutic couple. The ‘Powerful and the ‘Powerless’ embodied forceful discourses engaged with the acquisition of power, the ‘Predator and the ‘Prey’ were embedded within combative or hostile discourses and the ‘Disconnected Therapist and Child’ characterised discourses of alienation and disconnection. Finally, the ‘Explorative Therapist and the Complex Child’ emerged within subjective discourses concerned with reflection and the examination of identity. The study operationalised three types of anxiety: persecutory anxiety, depressive anxiety and anxiety about annihilation from the conceptual CAPP literature (Abraham, 1994/1960; Bick, 1968; Klein, 1946; Rustin & Quagliata, 2000; Rhode, 2000); future research could consider how these types of anxiety emerge in other clinical contexts. The study found anxiety to be highly prevalent during Child Psychotherapy Assessment and provides important insights into the child’s experience of assessment work.