Adolescent Mental Health in the Digital Age (In-Person)

Day 1

• 11:30 – 12:00 - Registration and refreshments

• 12:00 – 12:15 - Welcome and opening by Dr Holly Dwyer Hall and Professor Eamon McCrory

• 12:15 – 13:45 - Can we do psychodynamic therapy via text-messages? The case of internet-based psychodynamic therapy (IPDT) for depressed adolescents by Professor Nick Midgley

• 13:45 – 15:00 - Lunch break

• 15:00 – 16:30 - From Embodied Relationships to Mediated Selves: Challenges and Opportunities in Working Clinically with Adolescents in a Digital Age - Structured panel discussion with Dr Holly Dwyer Hall, Dr Nikolaos Tzikas, Dr Flavia Ansaldo and Akin Ojumu

• 16:30 – 17:00 - Refreshments

• 17:00 – 18:30 - From Scrolling Through to Working Through: Adolescence, Algorithms and the Search for Coherence by Professor Alessandra Lemma

• 18:30 - Close

Day 2

• 09:30 – 10:00 - Registration and refreshments

• 10:00 – 11:30 - Clinical groups

• 12:00 – 12:15 - Welcome and opening by Dr Holly Dwyer Hall and Professor Linda Mayes

• 12:15 – 13:45 - Addressing Youth Suicide: A Matter of Life and Death by Dr Christine Cha

• 13:45 – 15:00 - Lunch break

• 15:00 – 16:30 - Working with High-Risk Adolescents: The ECID Project in Barcelona - An AMBIT-Based Model by Dr Mark Dangerfield

• 16:30 – 17:00 - Refreshments

• 17:00 – 18:30 -Epistemic Mistrust and Suicidal Despair: Clinical Work with a High-Risk Adolescents from a Contemporary Psychodynamic Perspective by Dr Mark Dangerfield

• 18:30 - 18:45 – Closing remarks

Please note there will be time for a Q&A at the end of each presentation.

Can we do psychodynamic therapy via text-messages? The case of internet-based psychodynamic therapy (IPDT) for depressed adolescents.

Professor Nick Midgley

In this talk, Prof. Nick Midgley will introduce Internet Based Psychodynamic Therapy (IPDT), and describe a study he worked on to evaluate this text-based therapy for adolescent depression during the COVID lockdown. He will describe some of the reasons for doing the study, the background of IPDT, and what has been learned so far by researchers using this approach. In illustrating the way that the therapy works, he will invite the audience to think whether it is really possible to work in a psychodynamic way when the only contact with the therapist is via text-based chat sessions?

From Embodied Relationships to Mediated Selves: Challenges and Opportunities in Working Clinically with Adolescents in a Digital Age

Dr Holly Dwyer Hall, Dr Nikolaos Tzikas, Dr Flavia Ansaldo and Akin Ojumu

Digital technologies and their inherent algorithms are increasingly shaping how adolescents experience identity, relationships, embodiment and emotional communication. As online and offline worlds become more deeply intertwined, clinicians are encountering new forms of distress, self-presentation, intimacy, withdrawal and relational conflict within therapeutic work.

This panel brings together three psychoanalytic psychotherapists to reflect on the challenges and opportunities of working clinically with adolescents in a digitally mediated world. Through the discussion of clinical material, live reflective commentary and dialogue between panelists, the session will explore themes including embodiment, mentalizing, online identity, gender, intimacy, social withdrawal and the impact of digital culture on the therapeutic relationship itself.

The panel aims to create a thoughtful and clinically grounded discussion about the changing developmental landscapes in which adolescents are growing up and the implications this holds for contemporary psychoanalytic practice.

From Scrolling Through to Working Through: Adolescence, Algorithms and the Search for Coherence

Professor Alessandra Lemma

Digital technologies have become constitutive of adolescent development, shaping the conditions under which identity and self-experience unfold. Within this altered landscape, some young people increasingly turn to online self-diagnosis and health-tracking practices as ways of stabilising a fragile sense of self, each datum an echo that promises self-knowledge but arrives refracted through algorithmic glass.

This paper conceptualises three interrelated dynamics that characterise adolescent engagement with these digital practices, which extend psychoanalytic concepts to accommodate the specific textures of technologically mediated experience. First, digital armouring refers to a process of defensive digital identity crystallisation, whereby repetitive, emotionally charged diagnostic labels and self-tracking practices fosters premature fixation on named identities, foreclosing exploration of unconscious meaning and substituting for psychoanalytic working through. Second, algorithmically mediated projective identification describes how algorithms function as conduits for collective anxieties and symptom narratives, projected into digital environments and re-introjected by adolescents as self-definitions, transforming internal conflict into algorithmically reinforced identity claims. Third, the digital superego designates the internalisation of algorithmic imperatives of optimisation and visibility, which operates as a persecutory agency demanding constant self-surveillance and performance.

Drawing on clinical material, I argue that adolescents’ reliance on digital self-diagnosis and health tracking exemplifies a fragile psychotechnical becoming, exposing how recognition and selfhood are now negotiated through machinic mirrors that both promise control and threaten to erode the essential work of representation.

Addressing Youth Suicide: A Matter of Life and Death

Dr Christine Cha

Suicide is one of the leading causes of death in adolescents and young adults in the United States and United Kingdom. One challenge in addressing youth suicide is that suicidal thoughts and behaviors are notoriously difficult to predict and prevent. In the current talk, we delve into the cognitive-affective profile of suicidal youth to better understand who is (vs. is not) at risk.

We will share recent research advances that uncover how suicidal youth understand and view death, and importantly, how they perceive their continued future life. The talk will conclude with examples of how cognitive-affective mechanisms identified in earlier work may be promising intervention targets to help mitigate risk early in life.

Working with High-Risk Adolescents: The ECID Project in Barcelona - An AMBIT-Based Model

Dr Mark Dangerfield

Adolescents presenting severe anxiety and mood disorders, psychotic spectrum disorders, personality disorders and complex relational trauma represent a growing challenge for contemporary mental health services. These young people often struggle to engage with traditional treatment models due to profound difficulties in trust, reflective functioning, and relational stability. In response to this clinical reality, the ECID (Home Intervention Clinical Team) project in Barcelona was developed in 2017 as a specialized service for extremely high-risk and non-help-seeking adolescents in Barcelona.

This presentation will describe the ECID intervention model, which is informed by the Adaptive Mentalization-Based Integrative Treatment (AMBIT) framework. The service provides intensive psychotherapeutic intervention aimed at stabilizing crises, strengthening mentalizing capacities in adolescents and their caregiving systems, and coordinating care across multiple professional contexts. The principal goal of the ECID is to engage the adolescent in the process of resuming a life project, which includes care for their mental disorders, re-engagement with school and scaffolding existing relationships, while managing the significant risks present in their relational contexts.

The presentation will outline the clinical principles guiding the work, including team mentalizing practices, relational engagement strategies, and collaborative work with families and community networks. It will also present the ongoing research project evaluating the effectiveness of ECID interventions, with emerging findings suggesting promising outcomes.

Epistemic Mistrust and Suicidal Despair: Clinical Work with a High-Risk Adolescents from a Contemporary Psychodynamic Perspective

Dr Mark Dangerfield

Working with highly suicidal adolescents often involves encounters with states of mind characterized by severe psychic equivalence, dissociation, and profound epistemic mistrust. In such contexts, communication may be experienced as threatening or meaningless, and suicidal action may emerge as an attempt to escape overwhelming affect or relational despair.

This presentation will explore the psychodynamic treatment of two high-risk adolescents: one who presented with persistent suicidal ideation and severe relational withdrawal, and another who survived a very serious suicide attempt. Drawing on contemporary psychodynamic and mentalization-based perspectives, the presentation will examine how epistemic mistrust shaped the patients’ relationship to others and to the therapeutic intervention.

Through detailed clinical material, the presentation illustrates the challenges of engaging adolescents whose internal worlds are dominated by primitive modes of experience, in which thoughts are felt as concrete realities and reflective functioning frequently collapses. Particular attention is given to the therapist’s stance, the management of risk, and the gradual emergence of epistemic trust within the therapeutic relationship.

Dr Holly Dwyer Hall DPsych, MSc, BA

Holly Dwyer Hall is a child, adolescent and adult psychoanalytic psychotherapist, Dynamic Interpersonal Therapist, Arts Psychotherapist and qualified Mentalization Based Treatment practitioner, supervisor and trainer with children, adolescents and families and MBT Practitioner with adults.

Her clinical work spans 26 years in both child and adult services in the UK’s National Health Service, social care, education and the private sector and includes; setting up an emotional wellbeing service for children under 5 years of age and working in a specialist service offering assessment and treatment for adults with a diagnosis of EUPD.

She currently provides assessment and treatment for children, young people and families who have experienced complex early trauma and is trained in using the Story Stem Assessment Profile to examine young children’s mental representations of attachment and relationships.

Holly lectures on the Doctorate in Child and Adolescent Psychotherapy with UCL, Anna Freud and the British Psychotherapy Foundation (BPF) and on the MSc Early Child Development and Clinical Applications at UCL and Anna Freud. She is the current Lead for Psychodynamic Psychotherapies and MBT with children, young people and families at Anna Freud.

She has published papers and chapters on mentalization based treatments, rupture and resolution processes in psychoanalytic psychotherapy and the practice of infant observation.

Professor Nick Midgley

Nick Midgley is a child and adolescent psychotherapist and Professor of Psychological Therapies with Children and Young People at UCL. He is the director of the Child Attachment and Psychological Therapies Research Unit (ChAPTRe) at Anna Freud. Until 2023 Nick was also the Academic Director of the Independent Training, a collaboration between IPCAPA, Anna Freud and UCL. Nick’s publications include Reading Anna Freud (Routledge, 2012), Time-Limited Mentalization-Based Treatment for Children: a Treatment Guide (APA, 2017, 2nd edition 2026), and Therapeutic Work for Children with Complex Trauma: A Three-Track Psychodynamic Approach (Routledge, 2023). As a researcher, Nick worked for several years on the IMPACT study, evaluating short-term psychoanalytic psychotherapy for depressed adolescents, focusing in particular on exploring the experience of young people in therapy, and has recently completed a large clinical trial of a mentalization-based Reflective Fostering Programme, to support foster and kinship carers and the children in their care.

Professor Alessandra Lemma

Alessandra Lemma is a Fellow of the British Psychoanalytic Society and a Chartered Clinical and Counselling Psychologist with extensive experience as a clinician, academic, and author. Currently Visiting Professor in the Psychoanalysis Unit, University College London, Consultant, Clinical Psychologist, DIT at the Anna Freud Centre, and Visiting Professor at Centro Winnicott, Rome. Formerly Head of Psychology and Professor of Psychological Therapies at the Tavistock Clinic. Recognized internationally for contributions to psychoanalysis, trauma, impact of technology on the psyche, transgender identities, and ethics. She is the recipient of the 2022 Sigourney Award, the 2025 Scharff Award and the British Psychoanalytic Council’s 2025 Bernard Rattigan Award for Psychoanalysis and Diversity.

Her most recent books are First Principles: Applied Ethics for Psychoanalytic Practice (OUP, 2023) and the Third Edition of Introduction to Psychoanalytic Psychotherapy (Wiley, 2025).Her forthcoming books are: Psychotechnical Becomings; Psychoanalysis, Identity, Desire and Mourning in Times of AI and Digital Mediation (Routledge, April 2026) and Journeying Through Psychoanalysis: Lessons from the Couch (Wiley, 2027).

Dr Christine Cha

Christine B. Cha, PhD, is a clinical psychologist and youth mental health researcher at Yale School of Medicine. She is an Associate Professor at the Yale Child Study Center, and the inaugural core faculty member at the Yale Center for Brain and Mind Health. For the past 18 years, Dr. Cha's research has focused on youth suicide: how best to assess, predict, and reduce the risk of suicidal thoughts and behaviors early in life. Dr. Cha’s work has been funded by the American Foundation for Suicide Prevention and the National Institute of Mental Health (NIMH). She serves on the editorial boards of the Journal of Clinical Child and Adolescent Psychology, Journal of Psychopathology and Clinical Science, and Developmental Psychopathology, and has received the Rising Star Award from the Association for Psychological Science. Prior to starting her position at Yale School of Medicine in 2024, Dr. Cha was a tenured faculty member at Teachers College, Columbia University, where she maintains an affiliation as Honorary Research Associate Professor. Dr. Cha received her BA in Psychology and Spanish from Wellesley College, PhD in Clinical Psychology from Harvard University, and completed her internship training at the Warren Alpert Medical School of Brown University (Clinical Child Track). Dr. Cha is a licensed clinical psychologist in both Connecticut and New York.

Dr Mark Dangerfield, PhD

PhD in Psychology and Clinical Psychologist.

Director of the Vidal & Barraquer University Institute of Mental Health at Ramon Llull University in Barcelona. He has worked for over 25 years in public mental health services in Barcelona. He led the design and implementation of the ECID project (Home Intervention Clinical Team), launched in 2017, a pioneering initiative in Spain, as it is the first clinical service contracted with the public mental health network targeting extremely high-risk and non-help-seeking adolescents. This project received a national award in Spain in 2023 for improving quality in mental health care. He is an AMBIT and MBT-A accredited trainer and supervisor.

Dr Nikolaos Tzikas

Dr Nikolaos Tzikas is an Independent Psychoanalytic Child and Adolescent Psychotherapist who trained at the British Psychotherapy Foundation (BPF) in collaboration with University College London (UCL) and the Anna Freud Centre. He is a qualified member of the Association of Child Psychotherapists (UK) and the Hellenic Association of Child & Adolescent Psychoanalytic Psychotherapy.

Currently based in Athens, he maintains a private practice while holding a Postdoctoral Fellowship at the National and Kapodistrian University of Athens, where he is developing a psychoanalytic tool to measure children’s play qualitatively and quantitatively. He teaches at both Anna Freud and UCL, and the National and Kapodistrian University of Athens.

He is the co-editor and co-author of the book Psychoanalytic Crisis Work with Adolescents: An Independent Approach. His academic work is published internationally in Greek and English. Notably, he recently introduced the concept of the 'Hera Complex' to describe a unique psychic formation in latency-aged children.

Dr Flavia Ansaldo

Dr Flavia Ansaldo is an IPCAPA-trained Child and Adolescent Psychotherapist with over 15 years’ experience working across NHS, third sector, and independent settings. Her clinical work has increasingly focused on adolescents and young adults, and she continues to be deeply engaged by the challenges and possibilities of this developmental stage, particularly within the context of rapidly evolving social and digital worlds. Alongside clinical practice, she is passionate about teaching and currently works as a senior tutor on the IPCAPA training, where she teaches and supervises trainees.

Professor Eamon McCrory - CEO of Anna Freud and Professor of Developmental Neuroscience and Psychopathology at UCL

Eamon McCrory is an international leader in the field of adversity and childhood trauma. He is CEO of Anna Freud and Professor of Developmental Neuroscience and Psychopathology at UCL where he co-directs the Developmental Risk and Resilience Unit. He is also adjunct Professor at Yale University. Eamon co-founded the UK Trauma Council which creates and disseminates resources to support those working with children and young people who have experienced trauma.

Eamon’s research uses brain imaging and psychological approaches to investigate the impact of trauma and adversity on children’s mental health. He is particularly interested in how research can help inform the prevention of future mental health problems and how latent vulnerability following adversity may be mediated by altered pathways of brain and social development.

Professor Linda Mayes

Dr. Linda Mayes is the Arnold Gesell Professor of Child Psychiatry, Pediatrics, and Psychology and Chair of the Yale Child Study Centre in the Yale School of Medicine. Trained as a paediatrician and child and adult psychoanalyst, Dr. Mayes’ research focuses on early childhood adversity and its impact on socio-emotional and cognitive development from infancy through school age. Taking a two-generation perspective, Dr. Mayes also studies the psychobiological underpinnings of parenting and how conditions such as substance abuse impact the adult transition to parenthood. A theme running throughout Dr. Mayes scholarly work is the central role of human relationships in supporting children’s adaptive development and flourishing as adults. An author of over 350 peer reviewed papers and 100 review chapters, her work appears in the developmental psychology, paediatric, behavioural neuroscience, and psychoanalytic literature. She is also the author of seven edited books on topics such as parenting and substance abuse and developmental research and three books for parents and teachers on parenting and fostering resilience. Dr. Mayes is also a visiting professor at Sewanee: The University of the South where she collaborates around courses on historical trauma, psychological journeys across the lifespan, and child and family development in rural Appalachia.

10:00 – 11:30 Friday 18 September - Clinical groups

Those attending in-person have the opportunity to present material for discussion in a small clinical group. Groups will be facilitated by senior child and adolescent psychoanalytic psychotherapists. If you are interested in presenting a case of your work with an adolescent, please email claire.hurst@annafreud.org

Guidelines for preparing

You will need to prepare and send through the following on a password protected word document by midday on Friday 4 September. All material must be anonymised according to the guidelines below. Facilitators will read through the material prior to your presenting orally in the clinical group. No copies of the document will be circulated to group members. The facilitator will have a digital copy of the password protected document, which will be safely deleted following the clinical group.

1. Brief background to the case

These can be bullet points which you can speak to and should include the following:

• Reason for referral

• Describe the adolescent

• Relevant historical background including family, life events and developmental history

• Current context, home, school, community

• Current therapy process assessment or treatment, how long in treatment

• Any existing diagnoses or assessments of cognitive functioning, screening tools or outcome measures which have already been used

2. Detailed clinical notes from one session

3. On your word document you must include the following declaration along with your signature:

Declaration of anonymisation checklist for supervisory clinical groups:

I verify that I have anonymised the patient's identity to be unrecognisable by others and as unrecognisable to him/her/themself as possible and to render all other individuals unrecognisable to third parties. In order to do so I verify that I have anonymised the following:

• Patient name

• All other names

• Patient place of birth

• Patient occupation or schooling

• Dates of treatment

• Organisational or other affiliations

• Exact location of where work took place

Upon booking, you will be asked to confirm that you have read and accept our terms and conditions and our privacy notice. Please read these documents before booking:

• Terms and conditions

• Privacy notice