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Sagal Hassan, Child and Adolescent Psychotherapist, photographed in a calm consulting room

How I work: clinical approach and evidence

Psychodynamic, low-demand and needs-led child psychotherapy

My clinical approach

Psychodynamic and psychoanalytic child and adolescent psychotherapy

My approach is psychoanalytic child and adolescent psychotherapy. NICE includes psychodynamic psychotherapy among the options for moderate to severe depression in children aged 5–11. For ages 12–18, it is an option when individual CBT is unsuitable or would not meet the young person’s clinical needs. These recommendations concern particular presentations; they do not mean that one approach suits every difficulty. It pays attention to what a young person communicates through words, play, behaviour, relationships, the body and the way they use—or cannot yet use—the therapeutic setting. The work is interested in what a difficulty may mean and what function it may be serving, not only in suppressing the most visible symptom.

Research reviews have found evidence for psychodynamic psychotherapy with children and adolescents, particularly for internalising difficulties such as anxiety and depression, while also identifying limitations in the quality of many studies. In my practice, I consider whether this approach fits a child who cannot easily explain what is wrong or whose previous support has felt too direct or task-based.

Low-demand and highly structured

I work at each young person’s pace and do not expect children or teenagers to speak about their thoughts or emotions before they feel ready. I call this a low-demand approach, within a dependable structure.

Structure is maintained through what we call in psychotherapy “the frame”: the same day, time and duration each week. Regular parent appointments, agreed contact with school or a child’s medical team, and termly reviews provide continuity around the sessions. Within this structure, the young person’s way of engaging guides the pace and form of the work. Early on, I may gently share my thoughts aloud while the child plays, makes something, or uses art materials, sensory objects, movement, games or music. Lowering unnecessary demands protects engagement while clinical responsibility and boundaries remain in place.

Autism and ADHD are not conditions I aim to remove. The work may explore masking, shame, identity, sensory or relational overwhelm, executive strain and the emotional effects of being repeatedly misunderstood.

Read more about psychotherapy with autistic and ADHD children

A biopsychosocial approach: understanding the whole child

My work moves beyond simple divisions between body and mind, health and illness, or strengths and difficulties. I respect the complexity of a young person’s inner world and do not believe that their experiences can be fully explained by a diagnosis, their family history, neurodivergence or any single aspect of who they are. I do not promise quick fixes within a set number of sessions or assume that there will be easy, fixed explanations. Diagnoses and formulations may need to be revisited as our understanding develops and different perspectives become available. This is why I sometimes refer to colleagues, medical or otherwise, and actively seek consultation. My approach is also informed by mindfulness approaches, neurobiology and an understanding of the developing body, including how developmental and physiological changes can shape emotional experience.

Adapting therapy technique to the young person

I aim to tailor psychotherapy to a child’s developmental age and preferences. For some children, particularly those with a trauma history or those who find open-ended play difficult, a non-directive setting can feel unfamiliar or frightening. I may suggest activities or offer more direction to help make the setting secure enough for play and spontaneity to develop. Some young people, including neurodivergent young people, find it difficult to express their preferences and may readily follow an adult’s suggestions; I pay attention to whether an activity is something they can use. Sessions may include play, games, drawing, conversation or periods of quiet. I adapt the pace, structure and style of communication for autistic, ADHD and other neurodivergent young people. Progress is not measured through increased eye contact, compliance, conventional sociability or a stronger ability to conceal distress. Each therapy relationship has its own rhythm and rituals, and this is part of treating the individual as unique rather than a diagnostic profile.

Building a relationship

I see the therapeutic relationship as the foundation of therapy. Its quality matters to how the work develops. I approach each young person with humility, openness and curiosity, hoping to build a relationship in which their experience can be explored and, over time, understood and accepted. A relationship cannot be forced into existence, and sometimes the fit is not right. The three-session assessment gives your child time to experience the work and have a meaningful say before ongoing therapy is agreed. I do not want a child to enter ongoing therapy only to please their parents. I often say, “As long as 1% of you wants to be here on your own terms, that’s enough for us to work with.” As my career develops, I am increasingly cautious about treating any one approach as universally superior. I encourage parents to ask: can this person get my child, and might my child come to trust them enough to open up?

It is through relationships that we begin to understand how we feel about ourselves, how we relate to others and who we want to become.

Sagal Hassan standing beneath flowering wisteria in a garden

Therapy can therefore become an important space for self-discovery, self-acceptance and meaningful change.

Parents are part of the treatment context

Parent work is included because children do not change in isolation. It provides a place to think about responses, routines, ruptures, school communication and the pressures around the child without turning the child’s session into a report or assuming that parents caused the difficulty.

Assessment, formulation and treatment planning

My clinical doctorate and clinical experience equip me to carry out biopsychosocial and developmentally informed assessment, psychodynamic formulation, treatment planning, risk assessment, safeguarding, clinical review and planned endings.

A formulation brings together the child’s emotional life, development, relationships, attachment history, family circumstances, school environment, cultural experience, physical health and possible neurodevelopmental differences. It asks both what is difficult and what function a symptom, behaviour or defensive pattern may currently be serving.

This also involves recognising the limits of psychotherapy. Assessment may indicate that another psychological therapy, psychiatric or medical input, neurodevelopmental assessment, educational support, changes around the child or a different level of mental-health care should lead.

Psychotherapy and treatment options

Options discussed may include short-term psychodynamic psychotherapy (STPP), interpersonal psychotherapy for adolescents (IPT-A), parent interventions, family work or parent–child psychotherapy. Intensive psychotherapy may also be considered. Work outside the standard private-practice arrangement depends on assessment, clinical suitability, availability and a separate agreement.

Outcome-informed rather than target-driven

Treatment has aims and is reviewed. Outcomes may include symptom or attendance change, but can also involve greater choice, self-understanding, recovery, communication, relationships and the ability to seek support. If the work is not useful, the plan needs to change; longer is not automatically better.

Relationship to i-THRIVE

My pathway is inspired by the THRIVE Framework because it reflects the needs-led, shared and outcome-informed way I worked in NHS CAMHS. It separates advice, focused help, more extensive help and risk support according to current need. My practice adapts those principles to a small independent service.

The Parent Consultation can stand alone. Assessment gives the young person direct experience before weekly treatment is considered. The ongoing psychotherapy programme is not assumed, and I pay particular attention to compliance, people-pleasing and the difference between tolerating an appointment and choosing to use it. The i-THRIVE framework is useful because it organises support around a child or family’s current needs and choices rather than treating care as a ladder of diagnosis or severity. It emphasises shared decision-making, clear goals, partnership working, review and thoughtful endings.

A whole-team approach

While the therapy itself remains your child’s work, change rarely happens in isolation. Where helpful, parents may benefit from having their own counsellor with whom they can explore parenting, family relationships and the pressures surrounding their child’s difficulties. With your consent, I can also liaise with schools and other professionals involved in your child’s care, and recommend further support through my professional network across healthcare and education.

Frequently asked questions

A child is not required to talk on command, make eye contact, sit face-to-face, complete worksheets or disclose before trust exists.

No. Autism and ADHD are not conditions the psychotherapy aims to remove or conceal.

Progress may include greater choice, self-understanding, recovery, communication, relationships and the ability to seek support—not only symptom or attendance change.