The interrelationship between brain, mind, and relational experience: psychoanalytic work with families attending Under-5 CAMHS to help their potentially autistic child

The study explored what psychoanalytically informed Early Childhood Mental Health Specialists offer in their parent–child work with autistic children and those under consideration for autism, and how opportunities and barriers shape the way they use their understanding of the interrelationship between brain, mind and relational experience. Five specialists from the same team were interviewed using semi structured interviews, and the transcripts were analysed using reflexive thematic analysis. The findings highlight a contrast in how expertise is perceived between ECMHS and professionals such as doctors who assess and diagnose autism and are often viewed as holding the authority. This affects how ECMHS can offer their own expertise and experience to multiagency discussions and to work with children presenting with autism or possible autism. A strong focus on behavioural and diagnostic models may reflect individual and societal defences against thinking more deeply about the emotional life of infants and young children and their relational context. The study identifies several barriers to working with the emotional relationship between parents and children, often rooted in parents’ own complex infancy and early lives, shaped further by class, socio economic status, race, culture, language and the wider systemic context. ECMHS offer sensitive and nuanced work with parent–child dyads, drawing on psychoanalytic theory in both understanding and practice. Their approach seeks to understand unconscious processes, relational dynamics and modes of functioning, considering the complex lives and histories that influence these. In doing so, they aim to support parents and professionals to engage more deeply with the emotional and relational world of the infant or young child, rather than focusing solely on behaviour and strategies. The study argues for recognising the interrelationship between brain, mind and relational experience as central to development and to the context in which autistic traits emerge. It highlights evidence for early intervention in the parent–child relationship and draws attention to the defences against thinking that operate at individual and systemic levels. In a period of limited resources and increasing reliance on diagnosis as a gateway to support, the study positions relational work as essential to infant and early childhood mental health and to public health more broadly.