Child psychotherapist

To train as a child psychotherapist, you'll need substantial experience working with infants, children or adolescents in a health, social care or education setting

As a child and adolescent psychotherapist (CAPT), you'll work with infants, children and young people up to the age of 25 who are experiencing a range of emotional, behavioural or mental health difficulties, including:

• anxiety
• depression
• difficulties related to development delay
• phobias and obsessive behaviours
• aggression and behavioural issues
• distress related to gender dysphoria
• trauma resulting from abuse or neglect
• self-harm and suicidal thoughts
• challenges related to learning difficulties or disabilities
• eating disorders
• psychosomatic disorders.

Using psychoanalytic psychotherapy, you'll help children and their families explore and understand their difficult feelings and experiences, often through non-verbal methods such as play and drawing, as well as through talking. Careful observation of non-verbal communication is a key part of the therapeutic process.

You may work with children or young people on an individual basis, in groups or with their parents or carers. Sometimes, sessions will involve just the parents or caregivers, particularly when addressing issues within family dynamics.

Most child psychotherapists are employed within NHS-funded children and young people's mental health services (CYPMHS), often based in community, outpatient or specialist settings, and work closely with other professionals such as psychiatrists, psychologists and social workers.

Child psychotherapists are also known as child and adolescent psychotherapists.

Responsibilities

As a child and adolescent psychotherapist (CAPT), you'll need to:

• carry out detailed assessments of referred children, adolescents and, where appropriate, their parents or carers to determine suitable treatment approaches
• provide psychoanalytic psychotherapy to children and young people either individually, in groups or with family members
• carefully observe children and young people and respond to what they might be communicating through their behaviour and play
• tailor your approach to the individual child and work in an age-appropriate way. For example, you might use play or drawing with younger children but talk about feelings with teenagers
• offer both short-term and long-term interventions, ranging from a few sessions to regular appointments over several years
• work collaboratively with parents and carers, offering support and psychoeducational input, and helping them to better understand their child's emotional world
• ensure that treatment is integrated with the work of other professionals in the wider multidisciplinary team who are involved in the child's care
• liaise and collaborate with professionals in education, social care, CYPMHS and safeguarding to support the mental health and wellbeing of the child or young person
• attend and contribute to case reviews, core group meetings and child protection conferences where necessary
• conduct ongoing evaluations of therapy, monitor progress and make adjustments as needed
• maintain up-to-date records in line with clinical governance requirements and data protection legislation
• provide consultation, training and reflective practice to other professionals, such as teachers, social workers and health visitors, supporting them in their work with children
• assess and manage clinical risk, including safeguarding concerns, from a child psychotherapy perspective
• receive regular clinical professional supervision from a more senior child psychotherapist to support reflective practice and ensure safe and ethical delivery of therapy
• (experienced child psychotherapists) provide clinical supervision to trainee child psychotherapists and contribute to their training and development.

Salary

• NHS pay scales apply to the majority of child and adolescent psychotherapists who are employed in NHS CYPMHS or other mental health services.
• Trainee child psychotherapists are paid £38,682 to £46,580 (Band 6 on the NHS pay scale).
• Once fully qualified, you can expect to earn in the region of £47,810 to £54,710 (Band 7).
• Salaries for senior/lead child psychotherapists typically start at £55,690 (Band 8a). Salaries at consultant level or in management or teaching roles may be higher.

If you're self-employed your income will depend on the fees you charge. These can vary depending on your client base, experience and location. Some psychotherapists may provide low-cost therapy for unemployed or low-income clients.

Income data from Agenda for Change (AfC) pay rates. Figures are intended as a guide only.

Working hours

You'll usually work Mondays to Fridays, 9am to 5pm, in the NHS, although some flexibility may be required to attend meetings, deliver training sessions or take on additional private practice activities.

There are opportunities for part-time and flexible working.

What to expect

• You can work for the NHS, the voluntary sector, schools, social services or local authorities, or in private clinics and may combine part-time roles across different settings.
• Most opportunities are based in towns and cities, but you could set up your own private practice anywhere, if there is sufficient demand. Self-employment and freelance work are possible. However, it takes time to build up a client base and it's not always possible to achieve a full-time practice.
• You may offer sessions in person, online or, occasionally by phone, though in-person work remains central, especially with younger children.
• The work can be emotionally demanding, and a support framework is essential.
• Some local travel may be required to attend meetings or training, or if you work for more than one organisation, but overnight stays or extended travel are rarely necessary.

Qualifications

To become a child and adolescent psychotherapist, you will usually start by completing a pre-clinical postgraduate course that is recognised by the Association of Child Psychotherapists (ACP). This learning is needed for applicants to meet the entry requirements for the doctoral-level child psychotherapy clinical training. In some cases, applicants may meet clinical training entry requirements through a more modular or portfolio route, subject to ACP approval.

Search the list of ACP-approved pre-clinical courses.

To get a place on a pre-clinical course, you'll need experience of working with children, young people and their families. This can be within settings such as early years, mental health, social care, health, youth work or education.

After completing a pre-clinical course, you'll apply to undertake a four-year, full-time (or five-year, part-time) clinical training doctorate programme at an ACP-accredited training school. During this training you'll usually be employed by an NHS or NHS-funded service and paid a salary at Band 6 on the NHS pay scale.

Clinical training includes:

• training in long and short-term psychoanalytic work with children, young people and parents
• assessments and work with groups and families
• consultation with other professionals
• clinical practice under supervision
• empirical research.

You'll also be required to undergo personal psychoanalysis throughout your training, typically having around four sessions a week. (It is recommended that you begin personal psychoanalytic psychotherapy or psychoanalysis before you apply to the training.)

The ACP currently accredits five clinical training schools in Birmingham, Glasgow, Leeds and two in London, with clinical placements available in NHS trusts or NHS-funded services across the UK.

Search the list of ACP-accredited clinical training schools.

Once qualified, you must register as a member of the ACP and appear on the ACP Register of Child Psychotherapists, which is accredited by the Professional Standards Authority.

Skills

You'll need to have:

• sensitivity, empathy and a genuine interest in the emotional and psychological problems faced by children, young people and their families
• excellent communication and interpersonal skills to build positive relationships with children and young people, as well as their families
• the ability to observe, interpret and respond to non-verbal communication, play and behaviour
• emotional resilience and maturity to handle strong emotions, vulnerability, uncertainty and ambiguity within the therapeutic process
• an understanding of the importance of individual cultural identity
• the ability to work independently and as part of a multidisciplinary team
• strong self-awareness and the ability to maintain clear professional boundaries
• confidence and sensitivity in helping children and young people explore painful or traumatic experiences
• organisational skills and the ability to manage your workload and competing demands
• written communication skills for producing clinical notes and reports
• an understanding of confidentiality and safeguarding policies and procedures
• a commitment to reflective practice, ongoing personal development and supervision
• the ability to provide guidance and support to colleagues, trainees and other professionals when required.

Work experience

You'll need experience of working directly with children, young people and their families in a professional or voluntary capacity. This experience is essential to demonstrate your personal suitability for the role. Relevant settings include:

• childcare
• education
• family support services
• health or social care
• mental health
• youth work.

Once you have some experience, you'll be able to apply for a pre-clinical course.

Experience should involve face-to-face interaction with children and young people of different ages, particularly those facing emotional, behavioural or developmental challenges. Roles that involve observation, listening and relationship-building are particularly valuable.

Many people enter child psychotherapy as a second career. Trainees often come from backgrounds such as teaching, psychology, nursing, medicine, psychiatry or social work. What's essential is a strong foundation in working with emotional and developmental needs, alongside the maturity and self-awareness needed to undertake intensive therapeutic training.

Find out more about the different kinds of work experience and internships that are available.

Employers

The majority of child and adolescent psychotherapists (CAPTs) work for the NHS in CYPMHS, community-based clinics or in hospitals.

You may also find work in other settings, both within and outside the NHS, including:

• eating disorder services
• forensic services
• hospital teams for children with physical illnesses and disability
• in-patient units
• learning disability teams
• looked-after children's teams within social services
• perinatal and parent-infant services
• pre-school, primary and secondary schools.

You could be employed by more than one type of organisation, for example the NHS, a private clinic and voluntary organisation.

Some child psychotherapists are self-employed and work exclusively in private practice. You'll need to follow strict guidelines, organise your own insurance, provide practice premises, pay your own income tax and arrange clinical supervision.

It's also possible to work in training institutions or universities as a lecturer or clinical tutor.

Look for job vacancies at:

• BACP Jobs
• British Psychoanalytic Council (BPC) Jobs and opportunities
• NHS Jobs
• NHSScotland Jobs

Details of job vacancies are made available to members of the ACP.

Professional development

You'll need to undertake continuing professional development (CPD) annually to retain your membership of the ACP and to keep up to date with clinical and theoretical advances.

Relevant activities may include:

• work-based learning - supervision, in-service training, peer review and discussion with colleagues
• professional activity - involvement in a professional body, lecturing and teaching, presenting at conferences
• formal training and education - top-up courses, submission of papers to a journal, undertaking research
• self-directed learning - reading professional journals and updating your knowledge via the media
• relevant short courses - in areas such as confidentiality and report-writing, special interest work and current child protection guidelines.

You must also undertake a minimum of 12 hours per month of psychotherapeutic contact with children, adolescents or parents and families, in order to maintain your core skills. Clinical teaching, parent work, supervision and consultation can be part of this. Find out more about ACP continuing professional development.

You're also required to receive individual clinical supervision from a consultant child psychotherapist or other senior member of the profession throughout your career. The number of hours needed in supervision depends on your experience.

Accredited training schools provide post-qualification courses and workshops. Charities working with children and young people, such as YoungMinds, may also run relevant short courses.

Career prospects

Child and adolescent psychotherapy is a small and specialised profession, so opportunities for advancement will vary depending on your areas of specialism, experience and geographical flexibility.

If you're working in the NHS for a CYPMHS team or other related setting, there are opportunities to develop specialisms in areas such as:

• early years
• eating disorders
• forensics
• learning disabilities
• children looked after
• neonatal work
• parenting groups.

You can also take on managerial responsibilities in a service leadership role within an NHS mental health service, or you could move into a supervision, teaching or research role.

If you're working in private practice, your success will depend on building a reputation and a network of contacts. You'll need a good head for business, as well as administration and marketing skills.