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The majority of the work done in the Portman Clinic is with adult patients, but there is also a small child and adolescent psychotherapy team (three part time psychotherapists plus a trainee) who make a significant contribution to the life of the clinic.
The work undertaken by this team mainly consists of consultations, risk assessments, assessments for psychotherapy, individual on-going psychotherapy and parent work, plus we all teach regular seminars, contribute to CPD events and provide supervision.
The Portman patients are both disturbed and disturbing. Their referral to us can have a ‘last chance saloon’ quality to it. Other interventions have been tried and failed. For the purposes of writing this introduction I did a rough audit of referrals to the child and adolescent psychotherapy team over an 18 month period to give a flavour of who is referred to us, by whom, why and what we do with the referrals.
Eighty-one per cent of our referrals are male and the average age of those referred is 15. We do see younger patients but it is often when a young person reaches adolescence that the behaviours escalate and the level of anxiety rises, triggering a referral to us. Behaviour which can just about be tolerated in a younger child by parents/carers/teachers/social workers or society in general, can become unbearable and unacceptable when the young person’s body becomes mature enough for them to act out sexually in a more harmful way. For a disturbed young person who is already struggling to maintain an emotional equilibrium, the added turbulence of adolescence can increase their drive to act out in harmful ways, in an attempt to avoid feeling something unbearable. We assume that feeling the unbearable thing is worse than the consequences of carrying out a sexual or violent attack.
In 84% of our referrals, the presenting difficulty is of a sexual nature and in 16% it is violence, although the two often go hand in hand.
Sixty-four per cent of our referrals come from CAMHS, o