Child psychotherapist

You'll need substantial experience of working with children and adolescents in a social care, health or education setting to work as a child psychotherapist

As a child and adolescent psychotherapist (CAPT), you'll work with children and young people up to the age of 25 who have a range of mental health difficulties, some of which may be severe or long lasting. These can include:

• depression
• anxiety
• development delay
• phobias
• aggression
• gender dysphoria
• consequences of child abuse
• self-harming
• learning difficulties and disabilities
• eating disorders
• psychosomatic disorders.

You'll use psychoanalytic psychotherapy to assess and treat the child or young person and you'll need to use a variety of approaches to suit the child, including talking, drawing and playing. You'll also need to observe what the child may be communicating non-verbally.

You may see the child or young person individually or in a group setting with other children or with their parents, carers or other family members. You may also see parents or carers without the child being present and working with them is part of the child psychotherapy approach.

You'll typically work within children and young people's mental health services (CYPMHS) which are based within communities.

Responsibilities

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

• provide specialist psychotherapeutic assessments of referred children and young people, as well as their parents and carers to decide on the most appropriate treatment
• develop specialist programmes of care and provide psychoanalytic, psychotherapeutic treatment to children and adolescents either individually or in a group
• 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 techniques with younger children but talk about feelings with teenagers
• ensure that treatment is integrated with the work of other professionals in the wider multidisciplinary team
• provide short-term and long-term interventions with children, young people and/or parents, ranging from a few sessions to regular appointments over several years
• attend core group meetings and work alongside other professionals in planning how best to help a child and the child's family, for example in schools, hospitals, children's services and child protection agencies
• regularly review and monitor the outcome of assessments and effects of treatment
• work as part of multidisciplinary teams made up of psychiatrists, psychologists, social workers, paediatric nurses, special educational needs coordinators (SENCOs), family therapists and community psychiatric nurses
• offer psychoanalytic psychotherapeutic advice, training, consultation and supervision to other professionals who contribute directly to the child's treatment plan
• undertake risk assessments and risk management from a child psychotherapy perspective
• receive regular clinical professional supervision from a more senior child psychotherapist
• supervise trainee child psychotherapists and other therapists.

Salary

• NHS pay scales apply to the majority of child and adolescent psychotherapists who are employed in NHS CYPMHS or other mental health services.
• As a trainee psychotherapist, while you're completing your clinical training you'll be paid £35,392 to £42,618 (Band 6 on the NHS pay scale).
• Once fully qualified, you can expect to earn in the region of £43,742 to £50,056 (Band 7).
• Principal/lead psychotherapists will be paid at Band 8 starting at £50,952 and rising to £96,376 for the most senior posts.

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

Working hours within the NHS are generally regular. You may need to work extra hours to attend meetings, run training sessions or take on additional private practice activities. There may be times when you need to be flexible and work some evenings or weekends to accommodate appointments to fit parents' working hours.

Part-time roles are available. It is also possible to take a career break but if you work in private practice you will need to rebuild a client base on your return to work.

What to expect

• Many child and adolescent psychotherapists have several part-time roles, such as working for the NHS, the voluntary sector, schools, social services or local authorities, or in private clinics.
• Self-employment and freelance work is possible. However, it takes time to build up a client base and it's not always possible to achieve a full-time practice.
• Opportunities for work tend to be in cities and large towns but you could set up your own clinic anywhere, as long as there is sufficient demand. The number of jobs within the NHS varies between regions.
• You may offer sessions in person, via the telephone or online (via Zoom, for example).
• The work can be emotionally demanding and a support framework is essential.
• You may need to travel locally during the day if you work for more than one organisation, have consultancy commitments, are involved in training or need to attend meetings. However, time spent away from home is uncommon.

Qualifications

Before training to become a child and adolescent psychotherapist (CAPT), you need to complete a pre-clinical postgraduate course that is approved by the Association of Child Psychotherapists (ACP).

In addition to the pre-clinical training, you'll also need some experience of working with children and/or young people although this doesn't need to be in a mental health setting. Instead social care, health and education will all be relevant.

Following this, you need to complete a clinical training doctorate programme that takes four years (five years if part time). This 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 supervisions.

During this training you'll be paid a salary at Band 6 on the NHS pay scale. The ACP currently accredits five training schools but you can have your clinical training placements in a range of NHS trusts or NHS-funded services across the UK.

You'll be required to undergo personal psychoanalysis or psychotherapy throughout your training, typically having around four sessions a week.

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 problems faced by children, adolescents, young people and their families
• excellent communication skills to be able to connect with children, young people and their families, as well as colleagues
• the ability to cope with the extremes of human emotion, ambiguity and vulnerability
• the ability to work on your own and as part of a multidisciplinary team
• resilience and emotional maturity, to withstand being overwhelmed or burdened by your clients' problems
• the capacity to differentiate your personal feelings and emotions from those of the child or adolescent
• confidence to help children and adolescents explore difficult and painful aspects of their life
• the ability to work in a constantly changing environment
• organisation skills and the ability to prioritise your workload
• self-motivation
• leadership qualities in order to support team members and trainees.

Work experience

Personal suitability is extremely important and this is judged on experience. You'll usually need to have previously worked with children of varying ages or families in a voluntary or professional capacity. This can be within education, childcare, health or social care. Once you have built up some substantial experience you'll be able to apply for pre-clinical training.

You may also move into child psychotherapy as a second career. People enter from a range of background, including:

• medicine
• nursing
• psychiatry
• psychology
• social work
• teaching.

For free mentoring resources and experiences designed to support aspiring healthcare and legal professionals - including virtual work experience that is accepted by medical schools, see Medic Mentor.

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, such as the child and family consultation service, or in hospitals.

You could also find work in other areas, both within and outside the NHS, including:

• eating disorder services
• forensic services
• learning disability teams
• looked-after children teams within social services
• perinatal and parent-infant services
• pre-school, primary and secondary schools
• specialist and residential units
• student health services
• youth justice services
• voluntary sector.

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

A small percentage of therapists are self-employed and work exclusively in private practice. You'll typically need to wait until you have built up some experience before you open your own practice and 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 Online
• British Psychoanalytic Council (BPC) Jobs and opportunities
• NHS Jobs
• NHS Scotland Recruitment

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

Professional development

In order to retain your membership of the ACP, you'll need to undertake continuing professional development (CPD) 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 cognitive behavioural therapy (CBT), confidentiality and report-writing, special interest work and current child protection guidelines.

The ACP also requires you to 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.

Throughout your career you're also required to continue to receive individual clinical supervision from a consultant child psychotherapist or other senior member of the profession. 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 willingness to relocate.

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:

• eating disorders
• forensics
• learning disabilities
• looked-after children
• 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.