How do child psychotherapists hold their patients’ history in mind? Intersecting unlaid ghosts of intergenerational trauma when working with gender variant young people presenting with mental health comorbidities

This qualitative research project explores the experiences of child and adolescent psychotherapists (CAPs) when encountering intergenerational trauma while working with gender-variant patients presenting at CAMHS with mental health comorbidities. It focuses on exploring the transmission of intergenerational elements in family histories, how CAPs recognise this and manage this alongside live trauma that this patient group might experience. The literature review explores the complex history of psychoanalysis and gender, intergenerational trauma, gender and family history, the role of the therapist’s mind and a summary of the Cass Review 2022/2024. It considers the vast multitudes of projections that a young person (YP) and clinician encounter from society, bringing to light how a YP identifying as gender variant is facing more than just a sense of not belonging to their prescribed natal body but an intersection of challenges. Three CAPs with relevant experience were interviewed twice following a Free Association Narrative Interview approach (FANI) using Interpretative Phenomenological Analysis (IPA), which acknowledges a reflexive approach at every stage and subjectivity of the participants’ and researcher’s lived experiences. The interviews yielded five Group Experiential Themes (GETs): ‘Noticing GAPs’, ‘Enactment’, ‘Active Management’, ‘It’s Personal’ and ‘The Whole Person and Safety’. The GETs describe how the participants held in their mind a combination of both trauma and intergeneration/familial and interwoven themes. The five themes illustrate the CAPs’ ability and role of noticing gaps and associated losses in complex trauma and familial systems, the speed that defences easily become enacted and how to respond creatively, actively and sensitively to manage this risk and vulnerability of interconnected, multigenerational and societal jigsaw pieces. Overall, the results highlight the implications for the CAP in the ongoing political heat of our society’s responses to gender-questioning YP and adults in that gender moves from a highly individualised personal experience to becoming everyone’s business.