Brief Psychotherapy with Children in a Specialist School: An Exploration of the Underlying Issues for Children and Mainstream Schools

This thesis explores brief psychotherapy with children on placement at a specialist school setting, as part of an on-site, child psychotherapy outreach provision. The study sought to explore two research questions concerning the themes that could emerge in brief work with children and how these themes could be discussed in relation to the understanding formed by their mainstream school teachers. A qualitative research design was used to investigate these questions. The methods used to collect data were case studies, concerning the brief psychotherapy with 4 boys, aged 7 years, and and semi-structured interviews were conducted with the teachers. Thematic analysis was used to explore the data. The themes that were derived from the analysis were described in detail. The research found that brief work has considerable benefit for children and mainstream schools. Through the brief work intervention, the children all made significant progress in all areas of their lives a school. Contributions that the research makes to related fields, the implications that it has for policy and practice and recommendations for future research were all discussed.

Challenges Facing Long Term Foster Carers: Exploration of the Nature of Psychoanalytic Parent/Carer Support

This research study investigates the role and impact of psychoanalytically-informed short-term parent work with long-term foster carers of looked-after children, in support of the foster placement. The study reflects on the data gathered from four child assessments and five foster families seen by a psychoanalytic child psychotherapist for four sessions each. It draws on psychoanalytic ideas from a range of theoretical traditions, exploring such concepts as trauma, defences, compulsion to repeat, psychological-mindedness, ‘container/contained’ (Bion) and ‘holding environment’ (Winnicott). One distinctive contribution of this research is what it adds to our already existing understanding of the defences (or responses) aroused in the carer when faced with the intense and distressing affect associated with the child’s early trauma; and the impact of this legacy of trauma on the child, on the carer and on the wider Social Services system. Applying Grounded Theory and psychoanalytically-informed clinical case study methodology to the research material, the study breaks down the data analysis into seven stages of coding, from the initial reading of the data to the eventual development of two key hypotheses. One of the predominant themes that emerged from the analysis was the carer’s capacity to remain focused on the child’s emotional needs and how this in turn was linked to the direction of the therapist’s focus. The successive analyses of the data culminated in the hypothesis that the more the therapist focused on the carer and the carer’s emotional states in the course of the parent work, the more the carer was enabled to focus on the child’s emotional needs. As the system of categories emerged according to the themes exemplified in the sessions, a particular focus of analysis became the concept of psychologicalmindedness, considered under several sub-categories: displaying insightful comments; awareness of the child’s bodily states; awareness of the child’s affect; the carer’s ability to recognize the child’s defences; and the carer’s ability to make links between the child’s current difficulties and the child’s past experiences. Through this analysis it became apparent that degree of psychological-mindedness was closely linked to the individual carer’s capacity to metabolize the child’s distressed and distressing communication. This in turn led to a deeper exploration of the situations that were particularly challenging for the carers: i.e., instances when the child was compelled to repeat past traumatic emotional states and as a result was communicating intense distress. This exploration eventually generated the second hypothesis: that in reaction to the child’s distress, the response of each carer could be plotted somewhere along a spectrum, from either distancing themselves from the child’s emotional state to seeking excessive closeness with the child (merging). The next stage of the analysis developed four new categories of carer responses to the distressed child: identification and distancing from the child; identification and merging with the child; the category that describes the carer’s psychologicalmindedness as being ‘impaired’; and ‘good enough’ caring. This then led to an exploration of the carer’s own defences at these most challenging times. This research demonstrates clearly that even within the short space of four sessions of weekly psychoanalytic parent work, it is possible to achieve significant improvement in a carer’s capacity to bear the child’s compulsion to repeat early traumas, and to help the carers become more emotionally available to provide the child with effective psychological parenting at such difficult and challenging times. Key words: looked-after children; long-term foster carers; psychoanalytic short-term parent work; trauma; compulsion to repeat; psychological-mindedness; empathy; defences; psychoanalytically-informed clinical case study research methodology; Grounded Theory research methodology.

An Exploration of Clinical Psychologist and Educational Psychologist Constructs of Mental Health in the Context of Secondary School Aged Children

Over the past decade, Mental Health (MH) has increasingly appeared on the ‘school agenda’, both in terms of rising levels of MH difficulties in the student population, and also the expectation that schools have a role to play in supporting good MH. MH is a term fraught with ambiguities leading to uncertainty around the most appropriate ways to provide support. A review of current literature reveals a wide range of definitions and interpretations, sometimes within the same team of supporting professionals. The current study seeks to explore the perspectives held by two professional groups seemingly well placed to support young persons’ (YPs’) MH. Six Clinical Psychologists (CPs) and six Educational Psychologists (EPs) are interviewed, exploring their constructs of MH, and their perceptions of their own role and the roles of others in supporting secondary school aged YPs’ MH. The data are analysed through Thematic Analysis. Findings suggest that there are variations between the two professions’ constructs of MH, and EPs in particular have no unified concept of MH. This is likely due to less experience or training in this area. CPs and EPs hold similar perceptions of the school’s role for promoting good MH, and flagging up concerns to more specialist professionals when necessary. However, there are discrepancies in the EP and CP perceptions of each other’s roles. The conflicting views appear to emerge through incomplete information about the other, and professional defensiveness in a context where resources and funding are scarce. The current study suggests that these challenges can be addressed through: greater reflectivity on professional biases, exploration of MH constructs within other epistemological positions, and greater communication regarding professional roles, leading to clearer collaboration in supporting the MH of YP.