Case studies: Child and adolescent psychotherapist: Joanne

Joanne graduated from the Northern School of Child and Adolescent Psychotherapy in 2006 with a Masters in Psychoanalytic Observation. She works as a child and adolescent psychotherapist in the NHS.

I decided to train as a child psychotherapist having worked as a project manager in a residential rehabilitation community for young people recovering from substance misuse, and then later in a Youth Offending Team (YOT) providing therapy to young people. My role with the YOT was particularly challenging as young people were 'sent' to me as part of a court order and were often reluctant to engage with services, let alone therapy.

In both of these roles I encountered various therapeutic approaches to working with young people. I was keen to further my understanding of their difficulties and develop my therapeutic skills, and I undertook training in counselling and group work. My first degree was in applied social science so I already had an interest in the workings of society and the impact on the individual, but this was not enough to help me to make sense of the young people's difficulties. In the spirit of curiosity and optimism, I enrolled on a 'Psychodynamic Approaches to Working with Adolescents' course. The course opened my eyes to psychoanalytic thinking, not as an answer but as a different way of approaching difficulties.

I was drawn to training as a child psychotherapist as it is a method of treatment based on close and detailed observation, which leads to an understanding of conscious and unconscious communication. The training also allowed me to explore, through personal analysis, my own unconscious. In order to be able to understand children and young people and their confusion, distress, rage and despair, you have to be aware of the workings of your own internal world and be as grounded as possible in reality.   

There are many opportunities for child psychotherapists to develop and specialise in particular areas. However, as a newly qualified child psychotherapist finding my feet in a multidisciplinary child and adolescent mental health team (CAMHS), the majority of my day-to-day work comprises individual therapeutic work. On an average day, I might see four or five children, young people and/or their families or carers. Each therapy session lasts for 50 minutes, with additional time needed to write clinical notes, letters to GPs, reports for school, etc.

A child psychotherapist uses their training in close observation to help make sense of a child's difficulties as they communicate with them through play, drawing, words and behaviour, so that the child is more able to put into words the thoughts and feelings that lie behind their troubling behaviour. Some children have become so stuck in their development that they are unable to play. The aim of the therapy would be to help them to play more freely and imaginatively so they are able to continue to grow and develop.

My own interest is in early development and the application of early interventions, particularly in the effects of maltreatment and deprivation on emotional development. In time I hope to be able to specialise in this area, specifically with children in the looked-after system (LAC). I am currently researching this area for my Doctorate, which I hope to complete in the next couple of years.

It is a privilege to work as a child psychotherapist. The role can be emotionally demanding and challenging but is rarely dull, and is often hugely rewarding and satisfying. Having an interest in the human condition is essential, as is an interest in teaching and research. Before beginning the training it is helpful to have a broad experience of working with children and young people in a range of settings. If you only work in a mental health setting, you could develop a skewed view of children's problems, and so an understanding of ordinary child development is crucial to bring a balanced perspective to the work.