What is Child and Adolescent Psychoanalytic Psychotherapy

Children and young people do not always have the words to explain what is troubling them. Sometimes their feelings are communicated instead through their behaviour, their relationships, their play, or in ways that are difficult for them — and for the people around them — to understand.

Child and adolescent psychoanalytic psychotherapy is a reflective, non-directive form of therapy. Rather than beginning with a set programme or agenda, I pay careful attention to what a child or young person brings to each session and, over time, try to understand what their words, play, behaviour and relationships may be communicating about their emotional world.

The aim is not simply to change a behaviour that is causing difficulty, but to develop a deeper understanding of what may lie beneath it.

Understanding what lies beneath the surface

Psychoanalytic psychotherapy recognises that not everything we feel or do is within our conscious awareness. Children, like adults, can be affected by feelings, experiences and conflicts that they do not yet understand or cannot easily put into words.

Early relationships and experiences also shape how we come to understand ourselves and what we expect from other people. These expectations can continue to influence later relationships, sometimes in ways we are unaware of.

The relationship that develops between a child and their psychotherapist is therefore an important part of the work. The ways in which a child approaches me, keeps their distance, seeks reassurance, becomes angry, trusts or mistrusts me can gradually help us understand something about how they experience themselves and other people.

Over time, things that have been difficult to think about can become more understandable and, eventually, more manageable.

Play as a way of communicating

For younger children especially, play can be as important a means of communication as words.

Each child has their own box of materials, chosen with their age and developmental stage in mind. This might contain small figures and animals, drawing and art materials, Lego, stationery, playdough or clay.

There is no particular way that these materials are supposed to be used. I carefully observe what a child chooses, what they create, the stories that develop in their play and how this changes over time.

Even the way a child relates to their box can sometimes be meaningful. A child may immediately claim it as their own, barely acknowledge it, take great care of its contents, or repeatedly destroy what they have made. Rather than interpreting any one action in isolation, I become curious about patterns that develop across many sessions and what they might tell us about the child's experiences, anxieties and relationships.

For older children and adolescents, sessions may involve much more conversation, although drawing, making things or other forms of expression can still have a place if they find them helpful.

A consistent and private space

Another important aspect of psychoanalytic psychotherapy is what psychotherapists sometimes call the frame.

In practice, this means making therapy as consistent and predictable as possible. Sessions usually take place in the same room, on the same day, at the same time and for the same length of time each week.

There is no pre-planned agenda for a session. The space belongs to the child or young person, and we can think together about whatever they bring.

That consistency can be particularly important for children whose lives or relationships have at times felt unpredictable. Knowing that the room, time and therapist will be there provides a dependable setting within which difficult feelings can gradually emerge and be thought about safely.

Working with parents and carers

Children develop within relationships, so working with parents and carers is an important part of my approach.

I meet with parents regularly alongside a child's individual psychotherapy. This gives us an opportunity to think together about what may be happening for their child, changes they are noticing at home, and ways of understanding behaviour that may previously have felt confusing or difficult to manage.

With babies and younger children, particularly those under five, the work will often take place with a parent or primary carer and child together.

Every child and young person is different, and deciding whether psychotherapy might be helpful begins with getting to know them and their unique circumstances.