A Thematic Analysis study of the challenges and potential of child and adolescent psychoanalytic psychotherapy with autistic young women

This study explores the experiences of psychoanalytic psychotherapists working with autistic females in late adolescence, with particular attention to clinicians practising within NHS neurodevelopmental (ND) teams. Using a qualitative design, six child and adolescent psychotherapists were interviewed, with four interviews analysed using Thematic Analysis. The study aimed to identify key themes arising in psychoanalytic work with this patient group, focusing on both clinical challenges and therapeutic possibilities. Five overarching themes were identified: 1. Autism can have different meanings; 2. Unstable relationships, identity and communication; 3. The importance of unconscious communication; 4. The need to offer flexibility and containment and 5. Endings and the complexity of letting go. Therapists described difficulties in early engagement and identity formation, with autistic identity experienced as context-dependent, and both empowering and constraining. Clinical work often required adaptations in technique, including heightened attention to non-verbal communication, careful use of language and sensitivity to countertransference. Therapists also reported adopting facilitative roles within wider professional and family networks, which supported containment and collaborative understanding. Despite the challenges, participants described significant therapeutic change, particularly in longer-term treatments of two years or more. The findings suggest that psychoanalytic psychotherapy, when sustained and adapted to the developmental and relational needs of autistic young women, may support meaningful psychological growth and transformation.