Exploring clinicians’ experience and understanding of psychoanalytic psychotherapy with children who are perpetrators of sexual violence: an interpretative phenomenological analysis

This thesis explores the experience and understanding of Child and Adolescent Psychoanalytic Psychotherapists working in a specialist provision with children who have perpetrated sexual violence. Part one reports a literature review carried out to establish and critically appraise relevant theoretical psychoanalytic literature concerning the origins of sexual perversions, as well as relevant research literature examining the experience of working with this population psychoanalytically. Part two reports a small-scale empirical qualitative research study. Five Child and Adolescent Psychotherapists participated in semi-structured interviews which were analysed using Interpretative Phenomenological Analysis. Results revealed four group experiential themes: (a) the experience of the therapist, (b) matters of approach and technique, (c) conceptualising the roots of perpetrating behaviour, (d) considering the function of therapeutic work. Working with enactments is found to be a fundamental part of the work as is the therapeutic use of the countertransference. The findings are discussed in detail, considering the complexity of the therapeutic process and managing patients’ difficulties with intimacy, as well as how to engage meaningfully with powerful, disturbing clinical material, whilst allowing an understanding of its meaning and function to develop. Key aims of therapeutic work are explored including the integration of the victim and perpetrator parts of the patient’s identity and the development of healthy aggression. Methodological, theoretical and clinical implications of the findings are examined with consideration of the study's limitations. In conclusion, the study highlights the need for perpetrating behaviours to be uniquely hypothesised and worked with using an applied version of traditional psychoanalytic technique. Long-term interventions are required to treat this patient group effectively, as well as preserving space for therapists to share and digest their experience within a supportive team.