Tales from the edge : sufferers’ perspectives of the role of psychotherapy in recovery from anorexia nervosa
As a psychotherapist working in the field of eating disorders, I have a long-standing interest in accessing the subjective expertise of a wider group of sufferers, including what it is like and what it means to suffer from anorexia, the factors that help to support recovery and the role psychotherapy plays in contributing towards the recovery process. This study provides a timely addition to the literature on the nature and role of psychotherapy as a treatment for anorexia. Studies that explore the sufferer’s understanding and experience of developing anorexia are extremely limited and a gap exists in examining the role of psychotherapy from the recipient’s position and the ways in which psychotherapy supports an individual's recovery process. However, as this thesis demonstrates, people who have suffered and recovered from anorexia hold valuable information on the factors that support recovery and their expertise as recipients of psychotherapy has much to teach clinicians and researchers in the field of eating disorders. The theoretical foundation of this study conceptualises experience in relation to its narration. I recruited twelve participants drawn from across Scotland who provided narrative data during a focus group and a semi structured individual interview. Participants provided experiential accounts on developing anorexia, on recovery and the role of psychotherapy in their recovery process. A phenomenological approach to data analysis was deployed using Smith et al’s (2009) Interpretative Phenomenological Analysis (IPA) as a methodological guide. Drawing upon an IPA methodology I identified a number of central themes. Within accounts of developing anorexia, themes relating to interpersonal attachment, trauma and/or identity played a central role in the illness beliefs and experiences of participants. Within accounts of recovery, participants offered two main framings. The first defined recovery as an achievable completion point, signally the end of illness. The second defined recovery as an on-going process concerned more with the management of anorexia than the elimination of it. Factors that support recovery included those that are integral to the individual participant as well as those that are made available by their environment. In accounts of the role of psychotherapy, a number of common factors across participants’ experiences of psychotherapy were identified spanning support, learning and action factors. In addition, the quality of the therapeutic relationship with the psychotherapist played a crucial role in supporting the recovery process. I argue that participant beliefs about and experiences of recovery directly relate to their understandings and perceptions about what precipitated anorexia. Recovery took place when changes could be made in relation to these significant themes and psychotherapy was most effective when it addressed these issues as part of the psychotherapy process. The findings from this study point to the importance of working with the subjective understandings and beliefs sufferers have about their illness experience as a key objective within psychotherapy practice. They also underline the significance of a strong therapeutic relationship as a key component of the recovery process.