Cripps, Sophie Charlotte; (2023) Processes of Change in Family Therapies for Anorexia Nervosa and the role of Externalisation in Recovery. Doctoral thesis (D.Clin.Psy), UCL (University College London).

Preview

Text Thesis_final_volume1_[Cripps, Sophie).pdf - Accepted Version Download (5MB) | Preview

Abstract

Part 1 Aims: To synthesise young person and family member perspectives on processes of change in family therapy for anorexia nervosa (AN) (including systemic family therapy and manualised family-based treatment) to obtain an understanding of what helps and hinders positive change. Method: A meta-ethnography of 13 qualitative studies focussed on young people and family member experiences of family therapy for AN was conducted. Results: Analysis generated six overarching themes: “Developmental challenges and psychological difficulties”; “The therapeutic relationship”; Confinement to a “script”; A disempowering therapeutic context”; “Externalisation”; and “Family involvement”. Positive change was helped by understanding and support given to developmental challenges and psychological difficulties underlying eating behaviour, positive therapeutic relationships, relational containment within the family system and externalising conversations underpinned by narrative therapy principles. Positive change was hindered by inflexibility in the treatment approach, counter-effects of externalisation, negative experiences of the therapist, a narrow focus on food-intake and weight and neglect of family difficulties, emotional experiences, and psychological factors. Conclusions: Positive change regarding the young person’s eating-related difficulties ensued in the context of positive relational changes between the young person, their family members and the therapist, highlighting the significance of secure and trusting relationships. Part 2 Aims: To explore how externalisation of Anorexia Nervosa (AN) can help and hinder recovery throughout and beyond completion of NICE recommended therapies. Method: Twelve women and one man with a current or past diagnosis of AN participated in semi- structured interviews which explored their experiences of externalisation in treatment and recovery from AN. Reflexive Thematic Analysis (Braun & Clarke, 2022) was applied to their interview transcripts. Results: The experience of externalisation was described as a journey which is depicted by five themes. ‘Separation’ depicts the separation of the individual’s internal dialogue around food and the body from their concept of ‘self’. ‘Making sense of AN’ describes the experience of language and exercises used to separate AN. ‘A third entity in relationships’ illustrates the impact of externalisation on the individual’s relationships. ‘A relationship with AN’ elucidates the use of externalisation to explore the function and effects of the individual-AN entity relationship. ‘Managing AN’ portrays the experience of a continued relationship with the externalised AN entity post-treatment and the use of externalisation to sustain recovery. Conclusion: The notion of separating one’s internal dialogue from one’s concept of self may initially be rejected. As the individual develops trust in the therapist, they may begin to realise two sides within them, the “healthy self” (HS) and the “anorexia voice” (AV). However, social-cultural discourses around eating contribute to ambiguity during the dichotomous categorisation of thoughts. Externalising practices were most helpful when led by the individual using their own experience-near language. Externalisation which did not permit the individual to feel seen as a person beyond AN was hindering to recovery. Therapists, treatment teams and family members should be cognisant to the emotional effects of language used to externalise AN.

Download activity - last month

Export as JSONCSVXML

Download activity - last 12 months

Export as CSVJSONXML

Downloads by country - last 12 months

Export as XMLJSONCSV

Archive Staff Only

View Item