Children and young people’s experience of psychoanalytic psychotherapy: a qualitative meta-synthesis

Figures & data

Figure 1. Prisma flowchart.

Table 1. Quality appraisal checklist.

STUDY	Q1	Q2	Q3	Q4	Q5	Q6	Q7	Q8	Q9	Q10	Total (/10)
Bury et al. (2007)	Y	Y	Y	Y	Y	Y	Y	Y	U	Y	9
Carlberg et al., (2009)	Y	Y	Y	Y	Y	N	N	Y	Y	Y	8
Cirasola et al. (2022)	Y	Y	Y	Y	Y	N	Y	Y	Y	Y	9
Housby et al., (2021)	Y	Y	Y	Y	Y	N	Y	Y	Y	Y	9
Lindqvist et al., (2022)	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	10
Løvgren et al. (2020)	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	10
Løvgren et al. (2019)	Y	Y	Y	Y	Y	N	U	Y	Y	Y	8
MacKean et al. (2023)	Y	Y	Y	Y	Y	N	N	Y	Y	Y	8
Marotti et al. (2020)	Y	Y	Y	Y	Y	N	N	Y	Y	Y	8
Midgley & Target (2005)	Y	Y	Y	Y	Y	N	N	Y	U	Y	7
Midgley et al. (2006)	Y	Y	Y	Y	Y	Y	Y	Y	U	Y	9
% YES	100%	100%	100%	100%	100%	36%	55%	100%	73%	100%	95/110

Note: Y = yes; N = no; U = unclear. Q1: Is there congruity between the philosophical perspective and the research methodology?; Q2: Is there congruity between the research methodology and the research question or objectives?; Q3: Is there congruity between the research methodology and the methods used to collect data?; Q4: Is there congruity between the research methodology and the representation and analysis of data?; Q5: Is there congruity between the research methodology and the interpretation of results?; Q6: Is there a statement locating the researcher culturally or theoretically?; Q7: Is the influence of the researcher on the research, and vice-versa, addressed?; Q8: Are participants, and their voices, adequately represented?; Q9: Is the research ethical according to current criteria or, for recent studies, and is there evidence of ethical approval by an appropriate body?; Q10: Do the conclusions drawn in the research report flow from the analysis, or interpretation, of the data?

Table 2. Included findings and credibility rating.

Paper	Finding	Numbered finding	Credibility rating
Bury et al. (2007)	Beginning therapy	1.1	Unequivocal
	Mixed feelings	1.2	Credible
	Therapist’s response	1.3	Unequivocal
	The therapeutic process	1.4	Unequivocal
	Learning the ropes	1.5	Unequivocal
	Facilitative aspects	1.6	Credible
	Power	1.7	Unequivocal
	Endings	1.8	Unequivocal
	Ambivalence	1.9	Credible
	Feelings of separation and loss	1.10	Credible
	Moving on	1.11	Credible
Carlberg et al. (2009),	Children’s post-treatment attitudes regarding psychotherapy	2.1	Credible
	Children’s views of therapeutic effect	2.2	Credible
Cirasola et al. (2022),	‘I didn’t like him. but then I started to trust him … and it all changed’, p960	3.1	Unequivocal
	‘It wasn’t like he did this just because he didn’t want to see me’, p960	3.2	Credible
	‘It kind of hurt’ P960–961	3.3	Unequivocal
	Evidence of positive change, p962	3.4	Unequivocal
	The alliance dynamics and the change process, p962–63	3.5	Unequivocal
Housby et al., (2021)	Therapy as a transformational process, p6–8	4.1	Unequivocal
	‘Just sort of grew on me more’: Adjusting to the therapeutic model, p6–7	4.2	Unequivocal
	‘It transforms you’: Gaining a new perspective, p7–8	4.3	Unequivocal
	Explorative or Exposing: The therapeutic space, p8–9	4.4	Unequivocal
	‘slowly starting to unravel’: An explorative space, p8–9	4.5	Unequivocal
	‘what’s the right answer?’: An exposing space, p8–9	4.6	Unequivocal
	Being Heard and Working Together: the therapeutic relationship, p9–11	4.7	Unequivocal
	‘Being heard’: building trusting relationship, p10	4.8	Unequivocal
	‘we worked a way… to catch it’: working together, p10–11	4.9	Unequivocal
Lindqvist et al. (2022),	A Meaningful and Significant Relationship with Someone Who Cared, p6–7	5.1	Unequivocal
	She knew me, p6	5.2	Unequivocal
	She wanted the best for me, p6	5.3	Unequivocal
	She was a real person, p6–7	5.4	Credible
	A Helping Relationship with Someone who Guided and Motivated me Through Therapy, p7–8	5.5	Unequivocal
	She made me stay and engage, p7–8	5.6	Unequivocal
	She helped me understand myself, p8	5.7	Unequivocal
	She made it about me, p8	5.8	Unequivocal
	A Relationship Made Safer and More Open by the Fact that we Didn’t Have to Meet, p8–9	5.9	Unequivocal
	My information was safe with the therapist, p8–9	5.10	Unequivocal
	Not having to observe and be observed, p9	5.11	Unequivocal
	An Insignificant Relationship with Someone I Didn’t Really Know and Who Didn’t Know Me, p9–10	5.12	Unequivocal
	Not much of a relationship, p9	5.13	Unequivocal
	Her focus was off, p9–10	5.14	Unequivocal
	Distance hindering therapeutic closeness, p10	5.15	Unequivocal
Løvgren et al., (2019)	Exploring oneself, p4–5	6.1	Unequivocal
	Autonomy and acknowledgement, p4	6.2	Unequivocal
	Openness, p4–5	6.3	Unequivocal
	Insight and acceptance of oneself, p5	6.4	Unequivocal
	Therapist relation and characteristics, p5–6	6.5	Unequivocal
	Confidence, trust and support, p5–6	6.6	Unequivocal
	Trustworthy and experienced, p6	6.7	Credible
	Focusing on everyday life, p6	6.8	Unequivocal
	Learning, p7	6.9	Unequivocal
	Practical orientation, p7	6.10	Unequivocal
	Time factors, p7	6.11	Unequivocal
Løvgren et al. (2020),	From conflicted mutuality to friendly mutuality (with no transference interpretations) Storyline: The power of breaking norms, p12	7.1	Unequivocal
	From non-reciprocal mutuality to self-focused mutuality (with no transference interpretations) Storyline: Putting oneself in the foreground, p13–14	7.2	Unequivocal
	From verbal mutuality to tragic mutuality (with no transference interpretations) Storyline: Striving for concrete guidance, p14–15	7.3	Unequivocal
	From agreed mutuality to disempowered mutuality (with transference interpretations) Storyline: The primacy of the body, p15–16	7.4	Credible
	From awaited mutuality to restrained mutuality (with no transference interpretations) Storyline: About normality, not psychiatry, p16–17	7.5	Unequivocal
	From quiet mutuality to conversational mutuality (with transference interpretations) Storyline: Different types of questions, p17–18	7.6	Unequivocal
	From robust mutuality to solo mutuality (with no transference interpretations) Storyline: Allowing negativity, p18–20	7.7	Unequivocal
	From mechanical mutuality to robotic mutuality (with no transference interpretations) Storyline: A decent drop out, p20–22	7.8	Credible
	From unclear mutuality to pseudo mutuality (with transference interpretations) Storyline: Unimproved but safer, p22–23	7.9	Unequivocal
MacKean et al. (2023)	‘Weird sort of friendliness with someone you’ve never met before’: strong therapeutic relationship, p8–9	8.1	Unequivocal
	‘You didn’t have someone there staring into your soul’: less intimidating. p8–9	8.2	Unequivocal
	‘I saw her as a friend almost’: TSW as an equal, p9	8.3	Unequivocal
	‘you have to sort of like give your all time to it’: significant commitment, p9–10	8.4	Unequivocal
	‘For someone who doesn’t really engage … it wouldn’t work at all’: motivation needed, p9–10	8.5	Unequivocal
	‘I probably would have given up’: therapeutic relationship essential, p10	8.6	Unequivocal
	‘Helped me on my journey to cope better’: facilitated change, p10–11	8.7	Unequivocal
	A personalised psychoeducation, p11	8.8	Unequivocal
	‘I feel in more control of my emotions’: skills gained, p.11	8.9	Unequivocal
	‘it’s way better than I thought it would be’: gained appreciation’, p12–13	8.10	Credible
Marotti et al. (2020),	Pain in therapy for a worthwhile process, p407–408	9.1	Unequivocal
	A painful process of self-disclosure, p407–408	9.2	Unequivocal
	‘If you can understand something you can fix something’, p408–409	9.3	Unequivocal
	A relationship unlike others: Creating a space for reflection, p408–409	9.4	Unequivocal
	An understanding, accepting and non-judging relationship, p408–409	9.5	Unequivocal
	The therapist is unlike others, p409–410	9.6	Unequivocal
	Ending therapy with ‘a little bit of a relief and a little bit of hope’, p410	9.7	Unequivocal
	‘Hope I fit everything in’: A wish for more therapy, p410	9.8	Unequivocal
	Finding meaning in therapy, p410–411	9.9	Unequivocal
Midgley et al. (2005),	Attitudes towards being in therapy, p162–163	10.1	Unequivocal
	Memories of therapy and the therapist, p165–171	10.2	Unequivocal
Midgley et al. (2006),	If it did help me, I’m very grateful but – how do I establish that … ?, p 261	11.1	Unequivocal
	Like the BT advert, it’s good to talk, p261–262	11.2	Unequivocal
	I haven’t really changed, but my ability to cope with it has changed, p262–263	11.3	Unequivocal
	The tools for self-analysis, p263–264	11.4	Unequivocal
	I wasn’t at all sure that it was doing any good, p264	11.5	Unequivocal
	I think it really made things worse, p264–265	11.6	Unequivocal

Figure 2. Themes in each synthesised finding.

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