What is the difference between child and adolescent psychotherapy, psychology, psychiatry and other disciplines?
A comprehensive child and adolescent mental health service will include a multi-disciplinary group of staff with a range of training and approaches to the assessment and treatment of emotional, behavioural and mental health problems. Services are most effective when these people work together to support the needs of child, young people and their families. In addition to Child and Adolescent Psychotherapists the range of professionals may include Psychiatrists, Clinical Psychologists, nurses, social workers, counsellors, arts therapists, occupational therapists and other mental health practitioners such as Psychological Wellbeing Practitioners as part of the Improving Access to Psychological Therapy (IAPT) programme.
We are often asked about the differences between psychotherapy, psychology and psychiatry. This is partly a difference in training and professional registration:
- Child and Adolescent Psychiatrists are medical doctors who have trained in psychiatry and are registered with the General Medical Council;
- Psychologists are academically trained to post-graduate or doctoral level and are registered with the British Psychological Society in one of the divisions such as Clinical or Educational Psychology.
- Child and Adolescent Psychotherapists undertake a four-year full time clinical training in the NHS alongside an academic programme up to doctoral level and are registered with the Association of Child Psychotherapists.
It is also to do with a difference in approach to assessing and treating mental health problems:
- Psychiatry is the study of mental health problems and their diagnosis, management and prevention. Psychiatrists are medical doctors who often combine a broad general caseload alongside an area of special expertise and research. They can work in a wide range of settings and presenting problems. Following assessment they may refer to colleagues within the service such as Child and Adolescent Psychotherapists for specialist treatment or occasionally for admission to an inpatient unit. They also provide treatments themselves ranging from cognitive behavioural therapy to family therapy and are also able to prescribe medication when this is indicated.
- Psychologists can specialise in a number of areas, such as mental health and educational and occupational psychology. In healthcare, psychologists specialise in clinical, counselling, forensic or health psychology. Clinical psychologists deal with a wide range of mental and physical health problems including addiction, anxiety, depression, learning difficulties and relationship issues. They may undertake a clinical assessment to investigate a child or young person’s situation through a variety of methods including psychometric tests, interviews and direct observation of behaviour. Assessment may lead to advice, counselling or therapy.
- Child and Adolescent Psychotherapists have a distinctive psychoanalytic approach to understanding the complex emotional lives of infants, children, young people, families and carers. This means they seek to look beneath the surface of problematic emotions, behaviours or relationships and to understand them in depth. Through a developing relationship, which may be fairly brief or sustained over a longer period, a Child and Adolescent Psychotherapist can help a child or adolescent to understand themself and their difficulties. This can lead to more deep seated and sustainable changes in ways of being, thinking and relating that can improve their life chances into adulthood. Child and Adolescent Psychotherapists may work individually with infants, children and young people in a range of different services where this is needed but also bring their specialist skills to work with parents, families, carers and the professional networks that surround children.
How do Child and Adolescent Psychotherapists work?
They see children and young people: Child and Adolescent Psychotherapists may see a child or young person individually, in a group with other children or young people or with parents or other family members. Through the relationship with the therapist in a consistent setting, the child or young person may begin to feel able to express their most troubling thoughts and feelings. Confused, frightened, hurt, angry or painful feelings can gradually be put into words rather than actions. The therapist can help the child make sense of their own experience and develop their own individuality and potential.
They see parents and families: Child and Adolescent Psychotherapists may also see parents or carers without the child being present. Sometimes the child is seen by another professional while work with the parents goes on; sometimes only the parents are worked with. The work may focus on helping the parent make sense of the child's behaviour, as well as understanding how the parents' own conflicts interfere with their ability to parent well. It may also explore different possibilities in parenting styles.
They support other professionals: Child and Adolescent Psychotherapists play a specialist function as part of a multi-disciplinary team, helping to support other professionals including teachers, social workers, health visitors, doctors, nursery staff and youth workers in a range of settings. The supervision, training and consultation they offer can help make sense of contact with highly disturbed and disturbing children and young people.
What happens in a typical session with a child?
Child and Adolescent Psychotherapists tailor their approach to the individual child and work in an age-appropriate way. During an individual session, young children do not usually talk directly about difficult things but will communicate through play using the toys provided. Older children may also play or draw whilst teenagers are more likely to talk about their feelings. Infants and parents are seen together to think about their patterns of interaction.
To a trained eye, play is a powerful form of communication which may express how a child feels and the difficulties he or she may be experiencing. The relationship between the child and the therapist is central to the treatment.
How long does treatment last?
Interventions with children and/or parents may be short- or long-term, from as few as two to six sessions to regular appointments over several years. Research has demonstrated the existence of a ‘sleeper effect’, with adults who had been treated as children or young people still feeling its impact many years later.
What range of difficulties are treated?
Child and Adolescent Psychotherapists see children with a wide range of difficulties, including problems with peer relationships, underachievement at school, aggressive outbursts or tantrums, insecurity and lack of confidence, or more serious mental health conditions including self-harm, eating disorders, oppositional behaviour, depression, anxiety, learning difficulties and disabilities. They also treat children who are suffering the effects of neglect and abuse.
How much does it cost and how can I access this service for my family?
Child and adolescent psychotherapy is available free through the NHS, though access does vary around the country. Child psychotherapy is also available in some schools and through voluntary agencies. Ask your GP, health visitor, social worker or child’s school for a referral to your local Child and Adolescent Mental Health Service (CAMHS) or for information on whether child psychotherapy assessment or treatment is available in other local services. Some services accept self-referrals.
If you are interested in seeking the kind of help a child and adolescent psychotherapist can offer and are in a position to fund this yourself, please visit Find a Therapist to find a practitioner in your area. There is no standard scale of fees and all therapists will discuss their charges on an individual basis with their clients, just like any other professional. You should not feel inhibited about asking how much each stage will cost before you make an appointment