“I’ve always struggled to put the label on it”: Clinicians’ conceptualizations and support needs for working with dissociation in children and adolescents.

Objective: This study investigated how mental health clinicians conceptualize and work with dissociation in children and adolescents, and their perceived support needs to work effectively with this population.Method: Four focus groups (23 participants; 4-10 per group) were conducted with multidisciplinary clinicians from three Child and Adolescent Mental Health Service programs in Western Australia.Data were analyzed using reflexive thematic analysis.Results: Five themes were developed.(a) "It's quite a hidden thing, isn't it?":Dissociation was viewed as a common but an often subtle trauma response that is difficult to define and recognize.(b) "You probably wouldn't treat dissociation": Clinicians expressed a cautious hesitancy toward labeling dissociation and viewed it as not always requiring targeted intervention.(c) "It's hard to have a shared dialogue about it": A lack of shared ways to describe dissociation with families and schools, compounded by clinicians' own uncertainty, affected collaborative care.(d) "Systems are overburdened and stressed": Systemic pressures and caregivers' own difficulties limited appropriate support.(e) "We don't want a tick-box exercise": Clinicians desired dissociation-specific training to improve their knowledge and confidence.Conclusions: Despite recognizing dissociation as common and clinically important, clinicians' limited prior training led to individualistic ways of conceptualizing, assessing, and intervening with each case.To improve outcomes for children and adolescents with dissociation, clinician training should address misconceptions, provide clear clinical guidance, and equip clinicians with tools for engaging families and schools. Clinical Impact StatementClinicians working with children and adolescents in mental health services often have difficulty identifying dissociation, believe dissociation may not always require targeted intervention, and lack shared language to communicate about it with families and schools.These views and difficulties may reflect gaps in clinical training, which may be amenable to improvement through targeted training.Comprehensive, practiceoriented training that addresses misconceptions, skill gaps, and systemic challenges could enhance recognition, collaboration, and treatment, ultimately improving outcomes for young people who dissociate.