This dissertation uses a modified systematic literature review to look at working with parents and carers within child and adolescent psychotherapy, and to consider this tasks relationship to therapeutic outcomes for children and adolescents. The topic is important because psychotherapy with children and adolescents inevitably involves additional relationships. The literature indicates the way this undertaking has been regarded has varied through the history of psychodynamic child and adolescent psychotherapy. Numerous writers reflect on the ongoing neglect and absence of systematic thinking in relation to the task of work with parents and carers. This lack of attention is understood to have been influenced by the traditional model of child and adolescent psychotherapy where the source of the child or adolescent’s distress or difficulty was regarded as being primarily intrapsychic. What is now known regarding the current and active nature of the child or adolescent’s relationship with the parent or carer, and the power and persistence of the parent-child bond has resulted in an acknowledgement of the need for a more equitable balance of focus between internal and external factors. In acknowledging that the external can no longer be seen as peripheral there are compelling clinical reasons to work with parents and carers. This undertaking should not be seen as dependant on the therapist’s orientation or interest. The significant scope of possibilities for work with parents and carers within child and adolescent psychotherapy is explored; however there is a lack of data relating to the clinical effectiveness of these approaches. The future need is for systematic thinking, and the development of practice guidelines for this clinical task.

Parent-infant psychotherapy is a small but growing field in South Africa. Its potential to contribute to mental health services in South Africa is, by contrast, vast. This thesis contributes towards much-needed research on the state of the field in the country and its potential applications across different sectors. Drawing on Daniel Stern’s concept of ports of entry, it is argued that an expansion of ports of entry offers an important integrating tool through which different aspects of parent-infant psychotherapy can be examined and adapted to the South African context. A history of parent-infant psychotherapy in South Africa is offered, together with an analysis of the experiences of current practitioners in the field. These aspects of the thesis draw on interviews with key stakeholders. The dominant context of private practice is then explored through two case study based papers. The first explores the meaning of symptoms in parent-infant psychotherapy. The second introduces the ‘grandmaternal transference’ as an important but under developed port of entry. These different aspects of parent-infant psychotherapy in South Africa are then considered through the prism of ports of entry in order to argue for a flexing of the psychoanalytic frame. Implications for the growth of the parent-infant psychotherapy field in South Africa are considered.