We usually offer initial consultation to parents before meeting a child or young person, so that issues can be shared and discussed without concern for the impact this might have on the child if they were in the room. At this appointment we will gather a detailed picture of the current difficulties, and a history of the child’s development. In taking this history, we will be looking for clues as to the roots of the presenting problem, with particular attention to changes, times of stress, separation, illness, loss or bereavement in the family. It may seem strange at first to consider the impact of very early experiences on your child, but as we think together, this will hopefully help us to make sense of the current issues for them.

There may be circumstances which indicate that consultation to parents, teachers, social workers or other professionals might be the best approach in tackling the difficulties seen in the child. Sometimes children let us know that they aren’t willing to come to therapy, but this needn’t mean there can be no help for parents. Helping promote a reflective and robust approach to a problem through work in parenting appointments can help children feel more contained and help settle their anxieties.

The next stage in the process is for us to undertake a thorough assessment of your child, their mental state, attachment relationships, and any particular concerns brought by them or by you. We will also be assessing their suitability for psychotherapeutic treatment, and if this is not the right modality for them, to consider what might be most helpful and where to find it.

Sessions may be with parents, or with children or young people alone. These are likely to be non-directive, allowing the child to bring whatever is uppermost in their mind into the room to be thought about. Parents are often struck by how openly and directly children can approach this task, even if they need some time to get used to being in a new environment and with someone different. For younger children, there will be toys and drawing materials which they can use if words are hard to find. Older children and young people might also like to use art materials, either as part of an art therapy assessment, or with their Child and Adolescent Psychotherapist. In both approaches, the therapist’s task is to closely listen and observe both verbal and non-verbal communication and to use this to build a picture of the child’s internal world- the world built up of their experiences, feelings, thoughts and fantasies which may or may not match up with external reality.

The length of an assessment is usually around four or five appointments, followed by a review appointment with parents, which may include the child if appropriate. This is a chance for the therapist to share the emerging picture of the child, and their capacity to use psychotherapy. It is useful too for us to hear how the child has been at home or school during the assessment, and how they have felt about attending appointments. At this review meeting, we will agree on a plan for the next stage or decide to close the intervention.

The assessment and review meeting may lead to your child beginning psychotherapy. Appointments are usually fortnightly for family or parent child work, and weekly for individual work. Sometimes it can be helpful for children to attend more frequently, up to three times weekly. Sessions are always on a regular day and at the same time, to enable a routine to be established. The timing of appointments might take some work to arrange in fitting in with school, work and other commitments, and once work begins, we will try to keep your appointments consistent. However, if something comes up which means you won’t be able to attend, we will try to rearrange given sufficient notice.

As during the assessment phase, the content of sessions is confidential. This allows children to explore issues more freely, without worry about parental opinion or feelings. Progress is discussed on a regular basis in review meetings which take place at least once a term.

Therapy usually takes place during school term times, with breaks during school holidays. We don’t usually give children the whole of the long summer break off, as a gap of this length would make it harder for them to keep their train of thought.

Psychotherapy is a form of treatment which works best where the child is allowed to become temporarily dependent on the therapist, whose role is to support them while old ways of managing are changed and adjusted in favour of new, healthy ways of being and relating. Since it works at a deep level, it is important for the end of treatment to be prepared for and planned well in advance even in shorter term interventions. For this reason, parents are asked to make decisions about suspending or ending therapy in the consulting room together with the therapist rather than at home with the child.