The Craft of Child Psychotherapy: Foundations in Practice

About Peter Blake

Peter Blake trained at the Tavistock Clinic in London and is Director of the Institute of Child and Adolescent Psychoanalytic Psychotherapy in Sydney.

He is the author of Child and Adolescent Psychotherapy: Making the Conscious Unconscious, now in its third edition and widely used worldwide. Dr Anne Alvarez has described it as “an original and exciting description of child psychotherapy at its best and a masterly contribution to the literature.”

Renowned for making complex psychoanalytic ideas accessible and practical, Peter bridges the theories of Klein, Winnicott and Bion with the everyday realities of today’s consulting room. With over fifty years of practice, supervision and teaching, he is widely regarded as a master clinician.

Table of Contents

1. The analytic legacy
2. Conceptual framework
3. Psychoanalytic observation
4. Referral and initial interview
5. Individual assessment
6. Assessment for therapy
7. Working with parents
8. The setting, physical and mental, and limits
9. Rethinking interpretation
10. The role of play and its challenges
11. Transference and Countertransference
12. Working with adolescents
13. Endings in therapy
14. Final conversation

01. The analytic legacy

In this opening session, Peter Blake sets the stage for the entire series by tracing the roots of child psychotherapy and the analytic traditions that have shaped his own practice. Drawing on the work of Sigmund Freud, Melanie Klein, and Anna Freud, he explores the early debates about whether children could be analysed, how play came to be understood as a form of free association, and the different emphases placed on the inner and outer worlds.

Peter reflects on the strengths and limitations of these founding figures, showing how their ideas remain both inspiring and contested. He highlights Klein’s groundbreaking use of play as symbolic communication, Anna Freud’s developmental perspective, and the importance of recognising anxieties in children in more nuanced ways. At the same time, he stresses the need for therapists to avoid dogma and to adapt theory to their own personality, style, and clinical encounters.

This session also introduces five key psychoanalytic concepts that underpin Peter’s approach: the unconscious, projective identification, containment, transference and countertransference, and Bion’s opacity of memory and desire. Through vivid case material, he illustrates how these ideas are not abstract theory but lived dynamics in the consulting room, shaping how children communicate distress and how therapists can hold and transform it.

As the foundation to the whole series, this session provides a rich blend of history, theory, and clinical wisdom, offering both context and practical insight for anyone working with children, parents, or families.

02. Conceptual framework

In this session, Peter Blake explores two of the most central and perhaps challenging concepts in psychotherapy: transference and countertransference. Drawing on Freud, Klein, Bion, and his own extensive clinical experience, he shows how these dynamics shape every therapeutic encounter, sometimes in ways that are obvious, but often through subtle feelings, projections, and unconscious exchanges.

Peter reflects on how his own thinking has shifted over the decades, from seeking “perfect interpretations” to embracing humility, uncertainty, and the power of simply experiencing what happens in the room. He describes how children’s feelings are often most safely worked with through play and stories rather than naming them directly. He also shares moving and sometimes unsettling clinical examples, including the case of an autistic girl whose powerful projections gave him vivid violent fantasies, illustrating the intensity of projective identification – and the powerful feelings therapists also experience.

The session also explores Bion’s idea of the “opacity of memory and desire” -the discipline of letting go of past knowledge and future expectations in order to stay fully present with the child. For Peter, this shift from “knowing” to “being” is at the heart of therapeutic change, and it challenges therapists to tolerate not understanding, resist the pressure to tie everything up neatly, and remain open to the immediacy of play and emotional experience.

03. Psychoanalytic observation

In this session, Peter Blake explores how anxiety lies at the heart of child psychotherapy, drawing on the ideas of Melanie Klein and Wilfred Bion. He traces the different “positions” of anxiety, from fragmentation and paranoia to depressive anxieties, and shows how these influence the way children experience themselves and their relationships. Through clinical examples, Peter illustrates how early experiences of loss, aggression, and separation can shape a child’s inner world, and how therapists can tune into these anxieties in play and in the consulting room.

The conversation also highlights the role of psychoanalytic observation as a cornerstone of training and practice. Peter describes his own experiences in infant observation and how carefully noticing details, the “grains of sand” rather than just the “beach”, can deepen a therapist’s understanding of the unconscious. He explains how observation combines openness, intuition, and attention to sequence, allowing therapists to pick up meaning not just from what is said, but from subtle gestures, pauses, and unconscious links.

This session offers both theoretical depth and practical insight, helping therapists recognise different forms of anxiety in children while also refining their own capacity to observe, listen, and think in a psychoanalytic way.

04. Referral and initial interview

In this session, Peter Blake brings his focus to the very start of the therapeutic journey: the first phone call, referral, and initial meetings with parents. He explains why these first impressions are so powerful, describing the therapist at this stage as being at their “most unsaturated”, open, raw, and highly receptive to the feelings conveyed by parents reaching out for help.

Peter offers practical guidance on how to respond warmly and promptly to enquiries, respect the courage it takes for parents to make contact, and begin building a sense of safety and trust from the outset. He shares his structured yet flexible approach to the first meetings with parents, outlining how he gathers background history, explores current concerns, and introduces the framework of therapy.

The session also highlights the importance of treating parents as colleagues rather than patients, emphasising collaboration and mutual respect. Peter covers key areas of history-taking: pregnancy, early feeding, sleep, toileting, milestones, sibling relationships, and play, while showing how even the smallest details can reveal much about a child’s inner world and emotional development.

This session is full of clinical wisdom and practical advice for therapists, offering a step-by-step look at how to set the tone for therapy, create safety for both parents and child, and build a foundation for meaningful work.

05. Individual assessment

In this session, Peter Blake sets out his approach to assessing children in psychotherapy, reframing “assessment” as a process of exploration. Rather than ticking boxes, the aim is to understand the child’s emotional life and inner world through both structured and unstructured encounters.

Peter explains why less experienced therapists may benefit from a more structured approach, and using simple questions, drawing, “three wishes,” and the squiggle game, to help children express themselves. He stresses that every detail of a child’s play, drawings, or conversation can carry symbolic meaning, from the themes in their stories to the way they handle toys or even a pencil.

Alongside practical techniques, Peter highlights the importance of spontaneity, vitality, and the “aliveness” of play. He encourages therapists to trust their intuition, pay attention to the transference relationship, and notice how they themselves feel in the room with the child. For him, assessment is about building a bridge into the child’s emotional world, while also providing parents with invaluable insights.

This session offers a thoughtful and highly practical guide for clinicians, balancing structure with creativity, and demonstrating how early encounters can lay the foundation for meaningful therapeutic work.

06. Assessment for therapy

In this session, Peter Blake shares his approach to one of the most crucial stages of therapeutic work: assessing whether a child is suitable for psychotherapy. Drawing on decades of practice, he sets out the three guiding questions he always asks: Will the therapy be supported? Does the child need it? Can the child use it?

Peter explains why therapy cannot succeed without consistent parental support, and how reliability, punctuality, and parental understanding of the therapeutic process form the external framework that allows inner work to take place. He also explores how to gauge whether a child truly needs therapy, looking at their play, behaviour, and relationships, and the more complex question of whether they are able to make use of it.

Through vivid clinical examples, Peter illustrates the risks of offering therapy in unstable circumstances, the value of short-term “trial work,” and the importance of attunement, curiosity, and negotiation of difficulty in the early stages of contact. He also reflects on how even seemingly unsuccessful therapies can leave a lasting imprint, sometimes resurfacing decades later in a child’s life.

This session offers practical tools and deep insights for clinicians facing the often grey, uncertain territory of assessment, balancing professional judgement with flexibility, honesty, and hope.

07. Working with parents

In this session, Peter Blake focuses on one of the most crucial yet often overlooked aspects of child psychotherapy: working with parents. He describes his widely used “five-meeting model,” where parents are seen before and after a short block of sessions with the child, and explains why this structure often proves as valuable as long-term therapy.

Peter discusses the challenges and opportunities of these parent meetings, how to share observations, convey meaning behind a child’s behaviour, and guide parents towards more reflective ways of responding. He stresses the importance of creating a collegiate relationship, avoiding the “expert model,” and instead helping parents feel empowered, supported, and less alone.

Alongside theory, Peter shares practical strategies parents can use at home, including his simple but powerful OTT (Observe, Think, Talk) framework, the role of imaginative play, and the use of books to help children process anxieties. He highlights how these approaches can transform a child’s emotional world and strengthen parent–child relationships.

This session offers a wealth of insights for therapists and parents alike, showing how the therapeutic process extends far beyond the consulting room and into the family’s everyday life.

08. The setting, physical and mental, and limits

In this session, Peter Blake turns to the foundations of therapeutic work with children: the setting and the boundaries that hold it. He explores how the physical environment, whether a carefully prepared consulting room, a school space, or even the front seat of a car, shapes the child’s experience of safety and containment.

Peter emphasises that while therapists may aspire to an ideal room, flexibility is key. What matters most is not the perfection of the setting but the reliability, predictability, and vitality the therapist brings to it. He discusses practical issues such as toys, tidying up, session timings, and the continuity of the space, weaving in rich anecdotes from his decades of practice.

The conversation also tackles how to set and maintain limits, from handling mess and aggression to navigating sensitive situations around sexuality or taking objects home. For Peter, boundaries are not about rigid control, but about protecting the therapeutic space so children feel both free and safe to explore.

This session is full of practical wisdom and clinical nuance, showing how the “frame” of therapy is itself a form of communication, one that reassures children their inner world can be held and thought about without collapse or chaos.

09. Rethinking interpretation

In this thought-provoking session, Peter Blake takes on one of the cornerstones of psychoanalytic technique: interpretation. While historically seen as the “scalpel” of analysis, making the unconscious conscious, Peter challenges whether direct interpretation is always helpful in child psychotherapy.

Tracing the history from Sigmund Freud, Anna Freud, and Melanie Klein, he highlights the differing traditions of naming unconscious feelings versus safeguarding the child’s developing ego. Peter argues that direct interpretations can often feel intrusive or shaming, especially for children and adolescents with fragile defences. Instead, he advocates for keeping meaning within the play and allowing children to discover insight in their own time, rather than having it imposed by the therapist.

He explores the value of metaphor, displacement, and play as safer, more authentic avenues for meaning-making, and draws on Winnicott’s and Bion’s ideas of containment, non-impingement, and facilitating environments. For Peter, the therapist’s role is not to deliver “truths” but to create the conditions where the child can gradually make their own meanings.

This session offers clinicians a fresh, contemporary perspective on interpretation, blending theory, history, and clinical wisdom, and asks us to consider: is our job to give meaning, or to help children discover it for themselves?

10. The role of play and its challenges

In this rich and engaging session, Peter Blake explores the central role of play in child psychotherapy, arguing that play is the true language of children and the foundation of mental health. Far more than a pastime, play allows children to explore who they are, communicate feelings, and experiment with relationships in ways that words cannot capture.

Peter distinguishes between emotionally alive play; vital, spontaneous, and full of meaning, and “dead play,” which may look rich on the surface but lacks personal connection. He shares clinical insights into how therapists can enter, support, and even become part of the play, while also recognising the challenges that arise when children struggle to play due to trauma, deprivation, or developmental difficulties.

Through examples such as his famous work with “Dust Boy,” Peter demonstrates how moments of immersion in play can break through even the most defensive states, opening up authentic connection and growth. The session also explores the therapist’s role in balancing containment with creativity, the value of humour, and the importance of remaining attuned without impinging.

For clinicians, this discussion is both practical and inspiring, reminding us that play is not just a technique, but fundamental to our therapeutic work with children.

11. Transference and Countertransference

In this session, Peter Blake explores in more detail the vital yet complex role of transference and countertransference in child psychotherapy. He reflects on how these dynamics—once seen as obstacles—can become the most immediate and valuable evidence of how a child relates to the world.

Drawing on both theory and clinical experience, Peter explains the difference between working in the transference and working with it, showing how therapists can hold and process children’s projections without overwhelming them. He highlights the importance of timing, containment, and flexibility, sharing examples of when it is safer to use metaphor, play, or displacement rather than direct interpretation.

The discussion also touches on Peter’s own analytic training and how it shaped his approach to boundaries, attunement, and non-impingement. Through case reflections, including the powerful story of Paul, he illustrates how countertransference can be both a burden and a profound source of understanding. For therapists, this session offers clear guidance on how to use these dynamics thoughtfully, while also emphasising the need for supervision, self-care, and professional support.

12. Working with adolescents

In this session, Peter Blake turns his attention to an area many therapists find challenging: working with adolescents. He explores why this stage of life, marked by rapid physical, emotional, and social change can make therapy particularly complex, with young people often swinging between openness and resistance.

Peter shares candid reflections on the developmental turbulence of adolescence, including issues of independence, identity, and peer-group pressures. He highlights the importance of flexibility in the therapeutic approach, sometimes working with parents alongside the young person, sometimes adjusting session frequency, and often using hobbies, interests, or everyday conversations as gateways to deeper therapeutic work.

Alongside the challenges, such as managing risk, uncertainty, and sudden endings, Peter emphasises the immense rewards of this work. Therapy can offer adolescents a rare space to process powerful feelings, strengthen their capacity to think and reflect, and find meaning amid chaos. For therapists, this session provides both practical guidance and reassurance in navigating the difficult but vital task of supporting adolescents.

13. Endings in therapy

In this penultimate session, Peter Blake explores one of the most challenging and often overlooked aspects of psychotherapy: endings. Drawing on decades of clinical practice, he reflects on how therapists can best prepare children, families, and themselves for the conclusion of therapy, whether it comes after years of work or just a handful of sessions.

Peter emphasises that there is no single “correct” way to end therapy. Instead, endings should be understood and experienced, rather than smoothed over or made artificially “nice.” He shares moving clinical anecdotes and discusses practical strategies, such as preparing children for breaks, recognising signs of progress in play, and navigating abrupt or premature endings imposed by circumstances.

This conversation also looks at the therapist’s own feelings of doubt, privilege, and responsibility, and how endings can echo earlier life experiences of separation and loss. The discussion highlights how endings, however difficult, can become transformative experiences that stay with children and adolescents throughout their lives.

14. Final conversation

In this concluding session of our series, Peter Blake reflects with Jane O’Rourke on more than fifty years of work as a child psychotherapist. He looks back on the evolution of psychoanalytic practice with children and adolescents, from rigid beginnings in the 1970s to the more open, intuitive, and playful approaches of today.

Peter shares personal stories from his early training, candid insights into the challenges and rewards of working with children, and his hopes for the future of the profession. He highlights the central importance of play, presence, and creating conditions for children to feel safe; emphasising that therapy is less about interpretation and more about being alongside the child.

This intimate conversation weaves together theory, practice, and legacy, offering therapists, counsellors, and anyone working with young people a chance to deepen their understanding while also being encouraged to “find their own way.” It’s a moving close to the series from one of the field’s most thoughtful teachers.

Host

Peter was in conversation with Jane O’Rourke.

Jane O'Rourke, founder of MINDinMIND and a former award-winning BBC journalist now practising as a Child and Adolescent Psychotherapist, draws upon her combined expertise to create rich and thoughtful conversations with leading mental health clinicians. Her interviews weave together the personal and professional threads of her guests' journeys, capturing the experiences that have shaped their clinical work and thinking.

Why Train with MINDinMIND

At MINDinMIND we bring together leading clinicians and the highest standards of CPD, while making training accessible to a wide community of mental health professionals.

What makes our approach distinctive is the format. Rather than a standard lecture or a slide deck, Peter and Jane are in conversation as fellow clinicians — unpicking what is truly useful in day-to-day practice. This creates a rich, reflective learning experience that bridges theory and application, supporting therapists in their clinical work and in their own wellbeing.

The series includes:

• The Live Masterclass (20 November 2025) — free when you purchase the series, with recording provided for all participants (2 CPD/CE hours).
• Recorded Training Conversations (12 hours)
  Jane O’Rourke is in conversation with Peter Blake, drawing out the lived craft of his work. These in-depth discussions make visible aspects of child and adolescent psychotherapy rarely covered in textbooks. Warm, detailed and clinically grounded, they explore case examples, consulting room practice and psychoanalytic thinking in action.
• Legacy Interview (1 hour)
  A wide-ranging reflection on Peter’s fifty years in the field and the development of his psychoanalytic approach.
• Reading resources
  A curated set of readings to enrich and extend your learning.

FAQs

Will I receive a CPD certificate?
Yes, a digital CPD/CE certificate is available to download in your account.

Who is this training for?
This event is designed for early- to mid-career clinicians, trainees, and practitioners from other modalities who want to deepen their work with children. It will also benefit experienced therapists seeking a refresher in the practical craft of child psychotherapy practice.