An exploration of the emotional impact on Child and Adolescent Psychotherapists (CPTs), working therapeutically with adolescents presenting with suicidality

Objective: This study explores and further develops our understanding of the emotional impact on Child and Adolescent Psychotherapists (CPTs) working therapeutically with adolescents presenting with suicidality. Methods: Semi-structured interviews were conducted with five qualified CPTs who had extensive experience working with adolescents presenting with suicidality. The transcribed data was analysed using Interpretative Phenomenological Analysis (IPA). Results: IPA revealed five superordinate themes: 1. CPTs experience fluctuations between believing suicidal attempts can and cannot be prevented (feelings of helplessness, self-blame, omnipotence and acceptance); 2. Importance of understanding suicidality as an ordinary part of adolescence; 3. The emotional disturbance experienced by CPTs when working with patients with deeply ingrained suicidality; 4. The paramount importance of the team as a container; and 5. CPTs’ varying experiences of risk assessments and safety plans. Discussion and Conclusions: The findings produced valuable insights that could lead to improvements in clinical practice. This study highlights the profound impact that working with suicidal adolescents has on CPTs, both in their professional and personal lives. Additionally, there is a need for greater organisational support to reduce burnout and improve staff retention in NHS settings. Key recommendations include fostering awareness of the emotional toll on clinicians through specialised training, establishing peer support groups and encouraging open, supportive relationships within teams. CPTs also emphasised the importance of shared decision-making around risk and patient safety, access to senior clinician support and protected thinking spaces within teams to avoid working in isolation on complex cases. These elements are fundamental to working psychoanalytically with these patients. Standardising risk assessment training and providing clinicians with crisis team experience were also suggested as essential for helping clinicians feel more secure and confident when working with high-risk patients. Joint working with other CPTs and multi-disciplinary colleagues was recommended over working alone in community, inpatient and private settings.