Adolescent Psychotherapist Research Articles

Perceived barriers and facilitators for the initiation of psychotherapy: perspectives of youth patients and child and adolescent psychotherapists

Zusammenfassung Hintergrund und Ziel Diese Studie erweitert bisherige Ergebnisse zu Barrieren und Faszilitatoren um die Berücksichtigung der Sichtweise ambulant tätiger Kinder- und Jugendlichenpsychotherapeut*innen (KJP). Die Ergebnisse werden mit wahrgenommenen Barrieren und Faszilitatoren bei Patient*innen in ambulanter Psychotherapie verglichen und in Bezug zu bereits identifizierten Barrieren und Faszilitatoren gesetzt. Methode Es nahmen 61 Patient*innen im Alter von 15 bis 21 Jahren (M = 18,4, SD = ±1,6, 77 % weiblich) und 80 KJP (M = 42,3, SD = ±8,8, 81 % weiblich) aus dem ambulanten Psychotherapiesetting an der Studie teil. Barrieren und Faszilitatoren wurden in einer Onlineerhebung mittels eines explorativen deskriptiven Mixed-Methods-Designs untersucht. Ergebnisse Als Barrieren zur Aufnahme einer Psychotherapie wurden von Patient*innen und KJP Wahrnehmung von Hilfesuchstigma, Angst vor öffentlicher Stigmatisierung sowie Angst vor dem psychotherapeutischen Setting genannt. Patient*innen berichteten von einer stärkeren Problemleugnung als Barriere im Vergleich zu KJP. Als Faszilitatoren wurden übereinstimmend mehr Wissen über Psychotherapie, eine höhere gesellschaftliche Akzeptanz und geringere strukturelle Barrieren genannt. KJP berichteten als zusätzliche Faszilitatoren besser psychologisch geschulte Ärzt*innen und Lehrkräfte (im Sinne von Gatekeepern) sowie positive Vorerfahrungen mit Psychotherapie. Patient*innen nannten die frühzeitigere Wahrnehmung und Anerkennung des Hilfebedarfs und ein größeres Selbstbewusstsein als wichtige Faktoren zur Steigerung der Inanspruchnahme. Diskussion Die Ergebnisse betonen den Bedarf eines Ausbaus sowie der Dissemination von Interventionen zur Senkung von Barrieren zur Aufnahme einer Psychotherapie. Sie verdeutlichen weiterhin die Notwendigkeit, multi- und interdisziplinäre Ansätze und die Komplexität der Zusammenwirkung von Faktoren zur Steigerung des Hilfesuchverhaltens abzubilden (z. B. auf individueller, gesellschaftlicher und politischer Ebene).

On the State of Training in Parent-Infant/Toddler Psychotherapy in Germany

Regulation disorders in early childhood and postpartum mental disorders of parents can be effectively treated by interventions that involve parents and child (so-called parent-infant psychotherapy, PIP). Availability of PIP in routine care remains low, even though the intervention is in high demand. This study aims to map the current situation of psychotherapy training in PIP in Germany, to record existing obstacles from the perspective of the institutes, and to obtain indications for improving training. Contact persons of training institutes all over Germany were invited to participate in an online survey. N = 95 persons answered questions about possible training in PIP and related advantages and hurdles as well as conditions for a future implementation. Nineteen (22.4 %) of the institutions indicated that PIP was part of their training concept. In 84.2 % of the cases this was aimed at child and adolescent psychotherapists. In 63.6 % of the institutes PIP was treated comprehensively. On average, 2.55 barriers were perceived, most frequently of an organizational nature. 75.9 % of the institutes that did not yet offer PIP would be willing to do so in the future under at least one condition. Among those conditions, information on PIP curricula and specific training content was most frequent (40.7 %).The low implementation of PIP in training seems to be mainly due to barriers of an organizational nature that can be overcome by some simple means, such as the dissemination of model curricula.

Mindfulness skills in trainee child and adolescent psychotherapists: Exploring the effects of mindfulness‐based workshops in a mixed‐methods study

AbstractObjectivesMindfulness may be a helpful tool to enhance psychotherapists' self‐care and intrapersonal skills. To gain deeper knowledge about how to improve mindfulness skills in child and adolescent psychotherapists, we investigated the impact of two mindfulness‐based workshops and a self‐experience interval (individual homework practice of mindfulness exercises) on quantitative and qualitative measures in a nonrandomised study.MethodsThirty‐six trainee psychotherapists took part in the 6‐week workshop‐based mindfulness intervention (experimental group, EG). Twenty‐one trainee psychotherapists served as a comparison group (CG). All participants completed the Kentucky Inventory of Mindfulness Skills (KIMS‐D), the Self‐Compassion Scale (SCS‐D) and the Empathy Scale for Social Workers (ESSW) at pre, post and 6‐month follow‐up. Benefits of the regular use of mindfulness practice of 10 trainee psychotherapists in the EG were analysed using qualitative content analysis at the 6‐month follow‐up.ResultsThe quantitative analyses revealed a significant increase over time on the KIMS‐D subscale “acting with awareness” in both groups and a significant increase over time on the KIMS‐D subscale “accepting without judgment” in the EG in contrast to the CG. The qualitative analyses indicated good acceptance of the mindfulness‐based workshop intervention. Qualitative changes referred to the achievement of knowledge in theory and practice concerning mindfulness and the integration of mindfulness‐based interventions in everyday life.ConclusionThe mindfulness intervention appeared to produce quantitative long‐term changes concerning mindfulness aspects and qualitative changes. Future research should elaborate conditions (i.e., intervention length, intensity and setting) that may influence the manifestation of quantitative and/or qualitative changes in mindfulness‐based workshop interventions in professionals.

Relational processes and power dynamics in psychoanalytic group supervision: A discourse analysis

ABSTRACT The authors explore the relationship between language and interpersonal dynamics within supervision groups for psychoanalytically oriented child and adolescent psychotherapists working at a charitable clinical service in a large metropolitan city in the UK. Using discourse analysis, the authors identified key interpersonal functions of language in a professional supervisory setting. Results revealed linguistic processes through which power identities and dynamics were enacted and multiple opinions and perspectives negotiated during group supervision. The authors then make practical suggestions regarding the management of power differentials and interpersonal relationships to facilitate more constructive group supervision and promote better therapeutic outcomes.

Insider, Outsider, Observer: Reflections of a Young Black Female Trainee on a Psychiatric Placement

This paper explores the experience of a short-term psychiatric placement completed by a first-year Child and Adolescent Psychotherapist in training. Thought is given as to how three specific attributes of the trainee: being black, being female, and being a participant observer shaped the author's experience and the lessons learned. The theory of Internal Racism (Davids, 2011) is used to highlight how a racist structure in the mind acted to navigate and resolve anxiety before the placement began and during its course. Fanon's (1952/2008) notion of ‘the Black Problem’ is also used to show how historical colonial patterns of relationship have been internalized into a social unconscious and so shaped the trainee's interactions with all individuals on the ward. Two examples are described to illustrate how exchanges with others can be influenced by race. These include ‘the nod’, a subtle form of recognition used amongst black people and ‘racial codeswitching’, adjusting one's self-presentation with the purpose of assimilation. Further thought is given to the practicalities of therapeutic treatment in contrast to medication.

Tavistock Centenary: the Tavistock Autism service over four decades

An event held in December 2020 explored the rich clinical work and innovative thinking around Autism Spectrum Condition at the Tavistock over the past four decades. Consultant Child and Adolescent Psychotherapists Sue Reid and Anne Alvarez describe their early groundbreaking work within the Tavistock Autism Team and Workshop. This work yielded the fascinating clinical observations that there were some children with the condition who made significant gains in therapy, leading to major developments in psychoanalytic techniques for this group. Since then, there has been a continuing influence of psychoanalytical, systemic perspectives on the Tavistock approach to Autism. It is an approach which at the same time is firmly rooted in the research around Autism’s neurodevelopmental basis. Nechama Polak, Clinical Psychologist, provides an account of how the current work of the team has increasingly focused on supporting young adults with the condition, and their parents, whilst Myooran Canagaratnam, Consultant Psychiatrist, describes the Tavistock approach to diagnostic assessment.

Lockdown and adolescent mental health: reflections from a child and adolescent psychotherapist.

The author, a child and adolescent psychoanalytic psychotherapist working in the UK NHS, discusses the varied impacts of 'lockdown' on adolescents, their parents and the psychotherapists who work with them, during the COVID-19 pandemic, in this short observational paper that contributes to the Waiting in Pandemic Times Wellcome Collection in response to COVID-19. She asks, particularly, how psychological therapies are positioned during such a crisis, and whether the pressures of triage and emergency can leave time and space for sustained emotional and psychological care. She wonders how psychoanalytic time with its containing rhythm can be held onto in the face of the need for triage on the one hand and the flight to online and telephone delivery on the other. Above all, the author questions how the apparent suspension of time during lockdown is belied by the onward pressure of adolescent time, and how this can be understood by, and alongside, troubled adolescents.

Väter in der Elternarbeit in psychodynamischer Kinderund Jugendlichenpsychotherapie und -psychiatrie: Wunsch und Realität

Summary Fathers in psychodynamic child and adolescent psychotherapy and psychiatry: Hopes and reality Central tasks of paternal education consist in triangulation, the promotion of exploration and autonomy development as well as structuring and setting boundaries. Especially in these developmental areas many of our patients have striking deficits. Therefore, these tasks often are taken on by the therapists, on behalf of parents, in the context of psychodynamic child and adolescent psychotherapy (Grieser 2018). However, fathers are of great importance for a successful and sustainable transfer of such developmental tasks into the everyday context. In this article, we will compare the role of fathers we would hope for as child and adolescent psychotherapists, with situations, as we experience them in everyday psychotherapy, and would like to use exemplary case vignettes, to provide an insight into our experiences with regard to challenges and opportunities in the work with fathers.

Lockdown and adolescent mental health: reflections from a child and adolescent psychotherapist

The author, a child and adolescent psychoanalytic psychotherapist working in the UK NHS, discusses the varied impacts of ‘lockdown’ on adolescents, their parents and the psychotherapists who work with them, during the COVID-19 pandemic, in this short observational paper that contributes to the Waiting in Pandemic Times Wellcome Collection in response to COVID-19. She asks, particularly, how psychological therapies are positioned during such a crisis, and whether the pressures of triage and emergency can leave time and space for sustained emotional and psychological care. She wonders how psychoanalytic time with its containing rhythm can be held onto in the face of the need for triage on the one hand and the flight to online and telephone delivery on the other. Above all, the author questions how the apparent suspension of time during lockdown is belied by the onward pressure of adolescent time, and how this can be understood by, and alongside, troubled adolescents.

Lockdown and adolescent mental health: reflections from a child and adolescent psychotherapist.

The author, a child and adolescent psychoanalytic psychotherapist working in the UK NHS, ponders the varied impacts of 'lockdown' on adolescents, their parents and the psychotherapists who work with them, during the COVID-19 pandemic. She asks, particularly, how psychological therapies are positioned during such a crisis, and whether the pressures of triage and emergency can leave time and space for sustained emotional and psychological care. She wonders how psychoanalytic time with its sustaining rhythm can be held onto in the face of the need for triage on the one hand and the flight to online and telephone delivery on the other. Above all, the author questions how the apparent suspension of time during lockdown is belied by the onward pressure of adolescent time, and how this can be understood by, and alongside, troubled adolescents.

How Much Time Do We Need? Time and Psychoanalytic Psychotherapy in CAMHS

The author considers what seem to be norms and values concerning session frequency and length of treatment in ‘traditional’ and current child and adolescent psychotherapy practice, and the impact of training expectations and models of training on identity and status as a child and adolescent psychotherapist. In the UK National Health Service, there is pressure to do more in less time: the norm is once‐weekly work. Such an expectation does not sit comfortably with psychoanalytic theory and training, which remains rooted in higher frequency, longer‐term cases. For trainees, this can lead to feelings of fraudulence and questioning whether less frequent therapies imply that the work is not psychoanalysis. The author explores, through a literature review, a case study and research material, how one might acknowledge the tension between these conflicting values about time; how psychoanalytic work in all its forms might be valued and be valuable for patients; and urges the need to feedback clinical experience into training structures and ongoing learning.

The Frequency of Cases of Child Abuse - Results of a Survey of Brandenburg Child and Adolescent Psychotherapists

Within the field of (medical) child protection, child and adolescent psychotherapists are an important occupational group. However, that fact has mostly been overlooked in scientific discourse. The objectives of this study were to determine the prevalence and the approach to dealing with cases of (suspected) child abuse in psychotherapeutic practice. All KJP who are admitted in the federal state of Brandenburg were asked to answer a questionnaire about the frequency of child abuse, divided by form of abuse and age. Furthermore, the number of reports to an authority/ agency, reasons for not reporting a (potential) case as well as necessary prerequisites for reliable recognition, evaluation and initiation of medico-legal, medical and psychotherapeutic interventions were recorded. In 2016, 74.4% and in 2017, 87% of child and adolescent psychotherapists registered at least one case of (suspected) child abuse. For both years, emotional negligence and emotional abuse were the most common types of abuse. The age group 6-13 was most affected by child abuse. In 2016, 34.4% and in 2017, 35% of child and adolescent psychotherapists who saw at least one case of (suspected) child abuse reported those to an agency. The most common reason (47.6%) for not reporting cases of (suspected) child abuse was the child's wish to not share any content discussed in therapy. 83.7% stated that clear criteria to reliably diagnose emotional negligence and emotional abuse are missing. Continuing education on medical/ psychotherapeutic and medico-legal aspects (53.3%), better cooperation between involved professions (43.4%) and inclusion of the overall topic in psychotherapist training and education (26.7%) were mentioned as the most important requirements for effective child protection. Cases of (suspected) child abuse are highly relevant in ambulant psychotherapeutic practice. Due to their close relationship with the patient, child and adolescent psychotherapists can identify emotional negligence and emotional abuse especially well. Their contribution to the care of children affected by abuse requires continuing education offers specific to their profession, the development of clear measures regarding the cooperation with Child Protective Services (county-level) as well as binding definitions and criteria for the different types of abuse.

A qualitative exploration of psychoanalytic child psychotherapists’ perspectives on the links between personal analysis during training and professional development

ABSTRACT Personal analysis is a central requirement for the training of UK child and adolescent psychotherapists and is part-funded by the National Health Service in the UK. Empirical research on the significance of analysis for the professional development of child psychotherapists is virtually non-existent. Some empirical literature supports the importance of personal psychotherapy for the training of adult psychotherapists, but the differences between adult and child psychotherapy make the findings of this literature tenuous and difficult to apply directly to the child psychotherapy training. This study aims to explore this issue by studying qualified child psychotherapists’ views on the role that personal analysis has played in their professional development, with a particular focus on the ways in which it affects the relationships they form with their patients. Semi-structured interviews were conducted with six UK-based child and adolescent psychotherapists, focusing on their views about the role of personal analysis in their professional development during training and post-qualification. These interviews were audio-recorded and analysed using thematic analysis. Thematic analysis of the interview material points to three main themes: the holistic experience of being a patient; the supportive aspect of analysis during training; and factors associated with the impact of the analysis being part of the training. In brief, it appears that personal analysis during training enabled the participants to learn things they would not have been able to learn in any other way; however, the close links between the training schools and the analysts were seen as a more controversial topic.

The Role of Psychotherapy in the German Health Care System: Training Requirements for Psychological Psychotherapists and Child and Adolescent Psychotherapists, Legal Aspects, and Health Care Implementation

In Germany every citizen must acquire either public or private health insurance from companies which then cover the expenses for psychotherapeutic in-patient and out-patient treatments within a given set of regulations. Since the commencement of the Psychotherapists' Law in 1999, psychological psychotherapists and child and adolescent psychotherapists are permitted to diagnose and treat mental disorders with psychotherapy under their own responsibility as a legally defined healing profession. Psychotherapists have to use scientifically approved psychotherapeutic approaches for treatment. The qualification and licensure of psychotherapists are highly regulated by the Psychotherapists' Law, which is currently undergoing a process of change. 2.86 million patients are in outpatient or inpatient psychotherapeutic care per year in Germany, tendency rising. Psychotherapeutic care is highly regulated, only scientifically approved approaches are admitted. Psychological and child and adolescent psychotherapists treat patients under their own responsibility. Future courses of study and advanced training for psychotherapists will be similarly structured to those of the medical profession. 2.86 million patients are in outpatient or inpatient psychotherapeutic care per year in Germany, tendency rising. Psychotherapeutic care is highly regulated, only scientifically approved approaches are admitted. Psychological and child and adolescent psychotherapists treat patients under their own responsibility. Future courses of study and advanced training for psychotherapists will be similarly structured to those of the medical profession.

Exploring the factors affecting child and adolescent psychotherapists' and counsellors' decision‐making in clinical work with parents

AbstractThis study examined interventions with parents/carers in child and adolescent counselling and psychotherapy (CAP). The aim was to investigate clinicians' rationale behind their decision to work with parents and what types of interventions they use. Furthermore, the nature of clinicians' core training with regard to interventions with parents was investigated. The study used both quantitative data and qualitative textual data from an online survey of 110 CAP clinicians. There was significant agreement, regardless of previous training or level of experience, that clinical work with parents in CAP is beneficial, but little consensus for a rationale or model for best practice. There was a relationship between training, theoretical orientation and whether CAPs felt competent to work with parents. Unexpectedly, a significant number (83%) of integrative practitioners said that there had been ‘little’ to ‘none at all’ focus on working with parents on their core training course. Other unforeseen findings were in the domain of working outside generally accepted boundaries for CAP, with a notable number of clinicians making home visits—24.1% with parents alone and 38.9% with parent and child together—along with 47.2% using phone calls and/or email for coaching and support with parents. Many clinicians were candid about their sense of a lack of competence in working with parents, even though at least half were senior, experienced clinicians. A number of these practitioners made specific reference to the wish for further specialist training, with many asking for signposting to where further training could be obtained.

Socioeconomic status and health insurance expenditures for children and adolescents with conduct disorder : An analysis of statutory health insurance data

For various psychiatric and somatic disorders, there is evidence of an association between patients' socioeconomic status (SES), healthcare utilisation, and the resulting costs. In the field of child and adolescent psychiatric disorders, studies on this topic are lacking. To exploratively analyse the association of healthcare expenditures for children and adolescents with conduct disorder (including oppositional-defiant disorder) - one of the most prevalent child and adolescent psychiatric disorders - and SES. The analysis is based on routine data from the German statutory health insurance company AOK Nordost for the calendar year 2011, covering 6461 children and adolescents (age 5-18 years) with an ICD-10 diagnosis of conduct disorder. The insureds' SES was estimated indirectly, based on the social structure of the postcode area, using the German Index of Multiple Deprivation (Mecklenburg-Vorpommern, Brandenburg), and the Berliner SozialindexI (Berlin), respectively. From the two indices, quintiles were derived. Based on these quintiles, average costs per case for the following cost types were analysed: inpatient healthcare, outpatient healthcare (general practitioners, paediatricians, child and adolescent psychiatrists, child and adolescent psychotherapists), and prescribed medication. There was no significant functional association between SES and healthcare costs for any of the analysed cost types. In contrast to findings in adults, this study on children and adolescents with conduct disorders did not reveal an association between SES and healthcare costs. Within this group of patients, social inequality does not seem to have asignificant influence on healthcare utilisation in Germany.

The role of observation within a project aiming at facilitating the transition of young patients with juvenile diabetes from paediatric to adults’ services

ABSTRACTIn recent years, the spread of juvenile diabetes has increased exponentially causing major psychological, economic and social costs and raising concern among health professionals and policy makers in relation to supporting these children and adolescent patients. The patients’ transition from Paediatric to Adult services is a critical moment with a high percentage of treatment drop-outs. This has been the focus of research carried out by a team of paediatricians, adult diabetologists, and child and adolescent psychotherapists in the Medical School of a large Italian city. This paper focuses on the role of psychoanalytical observation applied in work discussion seminars with the staff of Paediatric and Adult services in the hospital. The observations were conducted in the joint outpatient clinic, a new Service introduced experimentally to facilitate the transfer from Paediatric to Adult Dibetology Clinics. The seminars included the diabetologist for the last paediatric medical appointment and a paediatrician for the first young adult appointment. The paper discusses the methodology and the data gathered, focussing on the dynamics between the two doctors in the joint outpatient clinic, and on the impact of the social defences, which initially interfered with the joint work.

OSE: A New Education and Treatment Program for Preschool Period

The OSE program is of particular importance for young children to be healthy and successful and alleviate their suffering. If necessary, child psychiatrists will be contacted and appropriate medications will be used. Medications can have a positive effect on children's learning skills. In addition, the OSE program will help to determine the frequency of psychiatric problems in children. The OSE program provides a special service for children and adolescents with serious, complex and persistent disorders. Child and adolescent psychiatrists, social workers, clinical psychologists, psychiatry nurses, and child psychotherapists can work as a team. In this way, new generations will grow up healthy.

Social differences in the utilization of medical services by children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study.

Data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) enable conclusions about the utilization of outpatient and inpatient medical services by children and adolescents accounting the family’s socioeconomic status (SES). Results from the second follow-up to the KiGGS survey (KiGGS Wave 2), which covers the years 2014 to 2017, clearly demonstrate that children and adolescents from families with a low SES visit specialists in general medicine, gynaecologists and psychiatrists, as well as child and adolescent psychiatrists, psychotherapists and psychologists more frequently. In contrast, children and adolescents from families with a high SES visit paediatric, dermatological, dental and orthodontic practices more often. No statistically significant differences between the status groups with regard to the utilization of outpatient medical services in hospitals were identified. However, children and adolescents from the low status group received inpatient hospital treatment more frequently and, on average, spent more nights in hospital. These results reflect status-specific differences both in disease prevalence and care, as well as in patterns related to the utilization of medical services.

TIGA-CUB \u2013 manualised psychoanalytic child psychotherapy versus treatment as usual for children aged 5\u201311 years with treatment-resistant conduct disorders and their primary carers: study protocol for a randomised controlled feasibility trial

BackgroundThe National Institute for Health and Care Excellence (NICE) recommends evidence-based parenting programmes as a first-line intervention for conduct disorders (CD) in children aged 5–11 years. As these are not effective in 25–33% of cases, NICE has requested research into second-line interventions. Child and Adolescent Psychotherapists (CAPTs) address highly complex problems where first-line treatments have failed and there have been small-scale studies of Psychoanalytic Child Psychotherapy (PCP) for CD. A feasibility trial is needed to determine whether a confirmatory trial of manualised PCP (mPCP) versus Treatment as Usual (TaU) for CD is practicable or needs refinement. The aim of this paper is to publish the abridged protocol of this feasibility trial.Methods and designTIGA-CUB (Trial on improving Inter-Generational Attachment for Children Undergoing Behaviour problems) is a two-arm, pragmatic, parallel-group, multicentre, individually randomised (1:1) controlled feasibility trial (target n = 60) with blinded outcome assessment (at 4 and 8 months), which aims to develop an optimum practicable protocol for a confirmatory, pragmatic, randomised controlled trial (RCT) (primary outcome: child’s behaviour; secondary outcomes: parental reflective functioning and mental health, child and parent quality of life), comparing mPCP and TaU as second-line treatments for children aged 5–11 years with treatment-resistant CD and inter-generational attachment difficulties, and for their primary carers. Child-primary carer dyads will be recruited following a referral to, or re-referral within, National Health Service (NHS) Child and Adolescent Mental Health Services (CAMHS) after an unsuccessful first-line parenting intervention. PCP will be delivered by qualified CAPTs working in routine NHS clinical practice, using a trial-specific PCP manual (a brief version of established PCP clinical practice). Outcomes are: (1) feasibility of recruitment methods, (2) uptake and follow-up rates, (3) therapeutic delivery, treatment retention and attendance, intervention adherence rates, (4) follow-up data collection, and (5) statistical, health economics, process evaluation, and qualitative outcomes.DiscussionTIGA-CUB will provide important information on the feasibility and potential challenges of undertaking a confirmatory RCT to evaluate the effectiveness and cost-effectiveness of mPCP.Trial registrationCurrent Controlled Trials, ID: ISRCTN86725795. Registered on 31 May 2016.