Therapists’ Experience of the Challenges of Psychoanalytic Psychotherapy with Adolescents

BACKGROUND: Adolescent psychotherapy in high-demand settings like Child and Adolescent Mental Health Services (CAMHS), presents unique challenges. Despite rising referrals, high drop-out rates highlighting difficulties in engagement and retention. Systemic pressures — long wait-times, resource constraints, and high caseloads — impact therapy outcomes and therapist well-being. While the therapeutic alliance is central to outcomes, little is known about how therapists manage these complexities. This study explores therapists’ lived experiences to inform service improvements and enhance adolescent engagement. METHOD: Semi-structured interviews about the challenges of adolescent psychotherapy with nine psychotherapists were analysed using Reflexive Thematic Analysis (Braun & Clarke, 2006, 2013, 2020). FINDINGS AND DISCUSSION: Participants described how adolescents’ struggles with autonomy, ambivalence, and countertransference evoked strong emotional and somatic responses, often intensified by institutional pressures. Supervision, theoretical grounding, and self care were vital to sustain their work. Despite its emotional toll, participants found adolescent psychotherapy deeply fulfilling. CONCLUSION: Greater systemic flexibility and reflective spaces were seen as essential to sustaining therapeutic and outcomes.