I was talking to an overseas colleague today about the provision of psychotherapy services to young people who are in the most desperate of circumstances. This includes young people who are no longer able to be cared for in a family-based care environment, who find themselves bouncing between residential care, secure care, youth training centres (juvenile justice facilities), and homelessness. Often attempts are made to refer these young people to conventional mental health services, only for the young person to “not engage” or not meet service eligibility requirements. The latter often occurs when the young person does not have a stable care placement, and where mental health professionals express concern that without a stable attachment figure in the young person’s life there is a risk that the young person “might form an attachment to the therapist”. In many instances, this is seen as an adverse outcome for the young person.

For more than a decade I have been an option of last resort for deeply hurt and troubled children and young people. After speaking to my colleague I thought about sharing some insights about this work and what I offer that has helped many, if not all such children and young people. In this article I will share some general themes, which I will return to in more detail in follow-up articles. For readers who would like to access a broad description of my therapeutic approach, I would recommend accessing A Short Introduction to Attachment and Attachment Disorder (Second Edition), for which I will provide links below.

In the meantime, here are a number of key ideas that inform my approach and which I will endeavour to elaborate on in future articles:

• I do not believe that a child or young person should be excluded from receiving a psychotherapy service just because there is a risk that they may “form an attachment” to the therapist. If this was a generalized exclusion criteria for accessing mental hearth service provision, these children and young people might never receive a service.
• In the absence of any other potential attachment figure, I believe it is permissible (as well as likely) for the therapist to be an attachment figure and provide reparative attachment experiences in therapy, just as teachers, coaches and other adults often fulfill an attachment role.
• This means that therapy is necessarily frequent (at-least weekly to begin with), consistent and long-term. In fact, there is no set number of sessions and the therapist should be prepared to provide therapy for as long as the young person needs it (in many cases, this is a period of years) to approach life and relationships in a positive and self-promoting manner. This may pose a difficulty for some services and necessitate a change in their service model to cater to the needs of these young people.
• Psychotherapy needs to be experiential and process-oriented. Deeply troubled young people need to experience themselves and others in a different way, so that they might, ultimately, see themselves and others in a different way.
• Psychotherapy needs to promote ideas of self-worth and trusting relational connection to others. These are two of the most important regulating influences over the way in which the young person will approach life and relationships.
• Psychotherapy with these young people is, essentially, relational. The therapeutic relationship is the most important aspect of the therapeutic process.
• Though many find these young people challenging and, indeed, unlikable, I generally find them to be likable in one or more ways. As a result, the young people I work with experience themselves as likable (and capable, and worthy) when they interact with me.

The young people I have worked with randomly check in with me during adulthood. One such young person once asked me what the age cut-off for accessing a service from me is. I replied “thirty-eight”. The young person looked perplexed. I clarified that they can continue to access a service from me as and when they need it until I retire. Their relief was palpable and, as I expected, they have been able to get on with their life independently of the need to access regular psychotherapy across almost five years since this interaction occurred.

If you enjoyed reading this article and would like me to write about related topics, please leave a comment.