Concentric circles of containment: a psychodynamic contribution to working in pupil referral units

This article aims to reflect on the lessons learnt from using a psychodynamic approach to offering onsite therapeutic child and adolescent mental health services (CAMHS) in four pupil referral units (henceforth referred to as PRUs). The PRUs cater for six- to 16-year-old children and adolescents permanently excluded from mainstream schools. The work takes place in an inner London borough. The approach described evolved over five years through practice-based evidence of what worked well in each particular setting. This was viewed both in terms of sustaining families' engagement in the therapeutic process, and also effectively supporting child and adolescent mental health services and education staff in their respective tasks. The model which gradually evolved owes much to Bion's concept of containment as the necessary foundation for emotional growth and genuine learning. It also draws on ideas from psychoanalytic consultation and open systems theory. The importance of work discussion groups in this setting will also be evident. Some links are made to relevant Buddhist concepts and metaphors.