Perceived barriers and facilitators for the initiation of psychotherapy: perspectives of youth patients and child and adolescent psychotherapists

Background and aim: This study extends previous research on barriers and facilitators by including child and adolescent psychotherapists fromoutpatient treatment setting. Results will be compared to perceived barriers and facilitators among patients in outpatient psychotherapy and related to previously identified barriers and facilitators. Method: Sixty-one patients aged 15 to 21 years (M= 18.4, SD= +/- 1.6, 77% female) and 80 child and adolescent psychotherapists (M= 42.3, SD= +/- 8.8, 81% female) participated in an online survey. This study used an exploratory descriptive mixed methods design. Results: Barriers to initiate psychotherapy reported by patients and therapists were the perception of help- seeking stigma, fear of public stigmatization and fear of the psychotherapeutic setting. Patients reported more problem denial as a barrier than psychotherapists. As facilitators, more knowledge about psychotherapy, a higher social acceptance and less structural barriers were reported. Psychotherapists reported psychologically trained pediatricians and teachers (as gatekeepers) and positive previous experience with psychotherapy as additional facilitators. Patients named earlier awareness and recognition of the need for help and greater self-confidence as important factors in increasing the initiation of psychotherapy. Discussion: The findings emphasize the need for expansion and dissemination of interventions to lower barriers accessing psychotherapy. They further highlight the need for multi- and interdisciplinary approaches and the need to map the complexity of how facilitators and barriers interact to increase help-seeking behavior (e.g. at an individual, societal, and political level).