Clients' perceptions of the therapeutic relationship in the treatment of anorexia nervosa: qualitative findings from an online questionnaire

The therapeutic relationship plays a unique and pivotal role in the treatment and recovery of individuals with mental illness. The aim of the questionnaire was to understand clients’ perceptions of the factors affecting the formation of the therapeutic relationship during treatment or recovery from self-reported anorexia nervosa. Former or current individuals diagnosed with anorexia nervosa, 18 years and over, were invited to participate in an online questionnaire developed by the researchers. Eating disorder organisations in Australia and the United Kingdom advertised the study and provided the link to the online questionnaire. The questionnaire collected both quantitative and qualitative data, with quantitative data analysed using descriptive statistics and qualitative data using conventional content analysis. Findings revealed only 25% of participants (n=33) believed treatment providers listened and understood (to a great extent) their concerns during treatment and 30.08% (n=40) did not have sufficient trust or confidence in providers. The four qualitative themes identifying factors affecting therapeutic relationships are described. Healthcare providers working in acute and primary health settings should persevere with the development and maintenance of the therapeutic relationship in adults with anorexia nervosa. An investment in this relationship will be the catalyst driving motivation to change.

Psychodrama and Moviemaking in a Death Education Course to Work Through a Case of Suicide Among High School Students in Italy

This study describes the psychological effects of an experience of death education (DE) used to explore a case of suicide in an Italian high school. DE activities included philosophical and religious perspectives of the relationships between death and the meaning of life, a visit to a local hospice, and psychodrama activities, which culminated in the production of short movies. The intervention involved 268 high school students (138 in the experimental group). Pre-test and post-test measures assessed ontological representations of death, death anxiety, alexithymia, and meaning in life. Results confirmed that, in the experimental group, death anxiety was significantly reduced as much as the representation of death as annihilation and alexithymia, while a sense of spirituality and the meaning of life were more enhanced, compared to the No DE group. These improvements in the positive meaning of life and the reduction of anxiety confirmed that it is possible to manage trauma and grief at school with death education interventions that include religious discussion, psychodrama and movie making activities.

Suicide attempts versus suicidal ideation in bulimic female adolescents

BACKGROUND

Suicide attempts by adolescents continue to be a major public health problem. The purpose of this study was to examine the difference in the family functioning and sociopsychopathological risk factor relationship between female bulimic adolescents with suicidal ideation only, and those who attempted suicide.

METHODS

A group of 211 patients were observed for 12 months. Data from 63 subjects (SUG [suicide group], age 17.2 +/- 1.3 years) who had attempted suicide were then compared with 148 (control group, age 18.1 +/- 1.5 years) who had expressed suicidal ideation but did not follow through.

RESULTS

Those in the suicide attempt group had been exposed more frequently to physical/sexual violence in childhood. As adults they either lived alone or were dissatisfied with their partnership. The frequency of borderline personality disorders and depressive disorders in this group was significant. Psychosomatic symptoms, disturbed coenesthesia, substance abuse, social impairment and interference with their perception of their own life circumstances, as well as their job performance, often preceded the suicide attempt. Nine genuine risk factors that occurred significantly more often in the SUG were calculated out of all the stress factors using stepwise logistic regression: 'as a child I was even hit with a stick or whip', 'I had no set orientation in life', 'I had a feeling of loneliness despite family and friends', 'I could not relax', 'incapable of dealing with the public', 'I do not like to be touched', 'parents have psychiatric disorders', 'misuse of stimulants', and 'as a child I felt lonely' (odds ratio, 10.56-1.90).

CONCLUSION

Adverse family experiences and multiple sociopsychopathological factors may increase the risk of suicide in female bulimic adolescents.

The Needs of Adolescent Girls who Self-Harm

People who self-harm are typically intelligent, adolescent or young adult, middle to upper class girls, who do so to feel something or, paradoxically, to stop feeling and calm down. Girls who self-harm need to feel understood, listened to non-judgmentally, and responded to in relation to the unspoken suffering behind the self-harm behavior. The aim of treatment of girls who self-harm is to facilitate understanding of the act and provide alternative, healthier coping strategies.