This study examined how mental health clinicians conceptualise, assess, and treat dissociation in children and adolescents, and examined their confidence in working with these presentations to inform clinical practice.

Twelve semi-structured interviews (10 females and 2 males) were conducted with mental health clinicians from specialist Child and Adolescent Mental Health Services (CAMHS) sites in Western Australia. Interview data were analysed using reflexive thematic analysis.

Five themes were identified. Clinicians recognised dissociation as a diverse range of experiences (Theme 1: Dissociation is conceptualised as multi-faceted) that can serve adaptive and maladaptive functions (Theme 2: Dissociation is adaptive until it is not). Clinicians viewed assessment as reliant on clinical acumen and critical to effective treatment (Theme 3: Dissociation is assessed within an attuned therapeutic dyad). Safety emerged as the central principle guiding clinicians’ therapeutic decisions (Theme 4: Safety shapes therapeutic interventions). Theme 4 included two subthemes focused on supporting young people to reduce dissociative episodes (Subtheme 4a: Building awareness and coping skills) while considering factors like pace and developmental stage (Subtheme 4b: Tailored, collaborative & gradual treatment). Lastly, clinicians reported varying levels of confidence (Theme 5: Confident to a point).

Clinicians described dissociation as a multifaceted phenomenon, requiring established relationship and advanced skills to assess and treat. Even within this specialist service, clinicians’ confidence varied, highlighting the need for dissociation-specific training to better support clinicians and the young people in their care.