1
|
Albano G, Teti A, Scrò A, Bonfanti RC, Fortunato L, Lo Coco G. A systematic review on the role of therapist characteristics in the treatment of eating disorders. RESEARCH IN PSYCHOTHERAPY (MILANO) 2024. [PMID: 38988291 DOI: 10.4081/ripppo.2024.750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/04/2024] [Indexed: 07/12/2024]
Abstract
Treating patients with eating disorders can be challenging for therapists, as it requires the establishment of a strong therapeutic relationship. According to the literature, therapist characteristics may influence intervention outcomes. The aim of this systematic review was to identify and synthesize existing literature on therapist interpersonal characteristics that could affect psychotherapy relationship or outcomes in the context of eating disorder treatment from both patients' and therapists' perspectives. We conducted a systematic search using electronic databases and included both qualitative and quantitative studies from 1980 until July 2023. Out of the 1230 studies screened, 38 papers met the inclusion criteria and were included in the systematic review. The results indicate that patients reported therapist's warmth, empathic understanding, a supportive attitude, expertise in eating disorders, and self-disclosure as positive characteristics. Conversely, a lack of empathy, a judgmental attitude, and insufficient expertise were reported as therapist negative characteristics, which could have a detrimental impact on treatment outcome. Few studies have reported therapist's perceptions of their own personal characteristics which could have an impact on treatment. Therapists reported that empathy and supportiveness, optimism, and previous eating disorder experience were positive characteristics. Conversely, clinician anxiety, a judgmental attitude, and a lack of objectivity were reported as negative characteristics that therapists felt could hinder treatment. This systematic review offers initial evidence on the personal characteristics of therapists that may affect the treatment process and outcomes when working with patients with eating disorders.
Collapse
Affiliation(s)
- Gaia Albano
- Department of Psychology, Educational Science and Human Movement, University of Palermo.
| | - Arianna Teti
- Department of Psychology, Educational Science and Human Movement, University of Palermo.
| | - Arianna Scrò
- Department of Psychology, Educational Science and Human Movement, University of Palermo.
| | | | - Lucia Fortunato
- Department of Psychology, Educational Science and Human Movement, University of Palermo.
| | - Gianluca Lo Coco
- Department of Psychology, Educational Science and Human Movement, University of Palermo.
| |
Collapse
|
2
|
Dunlop R, Simonds LM, John M. Self-disclosure by adolescents in therapy for eating difficulties: A Q-Methodology study. Clin Child Psychol Psychiatry 2024; 29:90-102. [PMID: 37879067 PMCID: PMC10748442 DOI: 10.1177/13591045231209648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Facilitating client self-disclosure is essential to therapeutic effectiveness. Given the long-term consequences of eating difficulties for adolescents, there is a need for more research on self-disclosure in this group. This study investigated factors likely to influence adolescents' decisions to self-disclose during psychological therapy for eating difficulties using Q-methodology. Participants (n = 28), recruited through child and adolescent mental health services in the UK, completed a task that involved sorting 47 statements to represent their viewpoint on self-disclosure. The 28 completed sorts were subjected to a by-participant factor analysis in order to identify distinct viewpoints in the sample. Three distinct factors were extracted. One factor emphasised the importance of therapist self-disclosure on decisions to disclose. In contrast, another factor placed more emphasis on the influence of eating disorder identity and readiness to change on disclosure decisions. The third factor placed emphasis on the quality of the therapeutic relationship and readiness to change as having most influence. Given the absence of a unifying factor representing what influences the decision to disclose, clinicians should ensure they explore with young people what might influence their decision to disclose.
Collapse
Affiliation(s)
- Rhiannon Dunlop
- Department of Psychological Interventions, University of Surrey, UK
- Solent East CAMHS Eating Disorder Service, Solent NHS Trust, UK
| | - Laura M Simonds
- Department of Psychological Interventions, University of Surrey, UK
| | - Mary John
- Department of Psychological Interventions, University of Surrey, UK
| |
Collapse
|
3
|
Lev Ari HS, Gur E, Lotan‐Wohl M, Bernstein ZL, Tuval‐Mashiach R. Facilitators and obstacles to therapeutic alliance among patients with anorexia nervosa: A qualitative dyadic research. COUNSELLING & PSYCHOTHERAPY RESEARCH 2023. [DOI: 10.1002/capr.12617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
| | - Eitan Gur
- Sheba Medical Center Ramat Gan Israel
| | | | | | | |
Collapse
|
4
|
Graham MR, Tierney S, Chisholm A, Fox JRE. The lived experience of working with people with eating disorders: A meta-ethnography. Int J Eat Disord 2020; 53:422-441. [PMID: 31904870 DOI: 10.1002/eat.23215] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Working with people with eating disorders (EDs) is known to elicit strong emotional reactions, and the therapeutic alliance has been shown to affect outcomes with this clinical population. As a consequence, it is important to understand healthcare professionals' (HCPs') experiences of working with this client group. METHOD A meta-synthesis was conducted of qualitative research on HCPs' lived experiences of working with people with EDs. The results from the identified studies were analyzed using Noblit and Hare's meta-ethnographic method. Data were synthesized using reciprocal translation, and a line of argument was developed. RESULTS Thirty-seven studies met the inclusion criteria. Reciprocal translation resulted in a key concept: "Coping with caring without curing." This was underpinned by the following third-order concepts: (a) "The dissonance and discomfort of being a helper struggling to help," (b) "Defending against the dissonance," and (c) "Accepting the dissonance to provide safe and compassionate care." These concepts were used to develop a line-of-argument synthesis, which was expressed as a new model for understanding HCPs' experiences of working with people who have an ED. DISCUSSION Although the conflict associated with being a helper struggling to help led some HCPs to avoid and blame people with EDs, others adopted a compassionate stance characterized by humanity, humility, balance, and awareness.
Collapse
Affiliation(s)
- Meghan R Graham
- Department of Psychology, Royal Holloway, University of London, Egham, UK
| | - Stephanie Tierney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Amy Chisholm
- Vincent Square Eating Disorder Service, Central and North West London NHS Foundation Trust, London, UK
| | - John R E Fox
- South Wales Doctoral Programme in Clinical Psychology, School of Psychology, Cardiff University, Cardiff, UK
| |
Collapse
|
5
|
Murphy K, Simonds LM, Spokes N. Disclosure in therapy by clients with eating difficulties: a Q-Methodology study. Eat Disord 2020; 28:32-46. [PMID: 30676885 DOI: 10.1080/10640266.2018.1560239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Disclosure by those with eating difficulties is of considerable importance to clinicians and researchers. The aim of the present study was to explore variability in factors considered likely to influence the decision to disclose during psychological therapy by people who experience such difficulties. Thirty-seven participants recruited through a UK-based eating disorder charity completed a Q-sort task. This invited them to sort 47 statements onto a grid reflecting what would make them more or less likely to disclose in therapy. The thirty-seven Q-sorts were analysed using PQ method software. This resulted in the extraction of three factors explaining 41 percent of the variance. Participants loading on the first factor considered maintaining an eating disorder identity as most influential whilst participants loading on the second factor considered the therapeutic relationship as most influential. Those loading on the third factor considered personal readiness and feelings of security as most influential. This study suggests that clinicians need to assess influences on the decision to disclose for individual clients and to modify the early stages of intervention accordingly. Future research could assess the utility of using the Q-sort process and materials in this study as a way to elicit influences on disclosure decisions.
Collapse
Affiliation(s)
- Karen Murphy
- School of Psychology, University of Surrey, Guildford UK.,Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Naomi Spokes
- Tavistock and Portman NHS Foundation Trust, City and Hackney Primary Care Psychotherapy Consultation Service (PCPCS), London, UK
| |
Collapse
|
6
|
Lockertsen V, Nilsen L, Holm LAW, Rø Ø, Burger LM, Røssberg JI. Experiences of patients with anorexia nervosa during the transition from child and adolescent mental health services to adult mental health services. J Eat Disord 2020; 8:37. [PMID: 32793350 PMCID: PMC7418380 DOI: 10.1186/s40337-020-00313-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/12/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The transition between the Child and Adolescent Mental Health Services (CAMHS) and the Adult Mental Health Services (AMHS) is identified as an especially critical time for the continuity of care for patients with anorexia nervosa (AN). However, research on this topic is scarce. In the present study, we explore the patients' experiences of the transition between CAMHS and AMHS. METHODS A qualitative explorative study was carried out based on recorded interviews from one multi-step focus group and six individual interviews with patients who experienced the transition from CAMHS to AHMS in Norway. This study is service user-initiated, meaning service users were involved in all steps of the research process. RESULTS The adolescents' experiences are characterized by four overall themes regarding the transition process between CAMHS and AMHS: (1) "Being unprepared and alone in the transition process" describes how a lack of preparation for the transition between CAMHS and AMHS makes them feel alone and increases stress. (2) "It takes time to create a trusting relationship" describes how time influences patients' trust in therapists and motivation for treatment. (3) "We are not all the same" describes how adolescents develop differently but are not treated differently despite their diverse ability to be self-sufficient. (4) "How they see me and treat me affects my hope for the future" describes the interaction between adolescents and therapists. CONCLUSIONS Acknowledging the patients' needs during the transition period and considering their readiness for the transition is important. Taking into account the four dimensions described in the present study might improve the transition process and enhance the patients' self-sufficiency and maturity.
Collapse
Affiliation(s)
- Veronica Lockertsen
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, Nydalen, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | - Liv Nilsen
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, Nydalen, Oslo, Norway
| | | | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Ullevål HF, Postboks 4950 Nydalen, 0424 Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | | | - Jan Ivar Røssberg
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, Nydalen, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| |
Collapse
|
7
|
Graham MR, Tierney S, Chisholm A, Fox JRE. Perceptions of the "anorexic voice": A qualitative study of health care professionals. Clin Psychol Psychother 2019; 26:707-716. [PMID: 31368595 DOI: 10.1002/cpp.2393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/07/2019] [Accepted: 07/11/2019] [Indexed: 12/27/2022]
Abstract
People with anorexia nervosa (AN) often report experiencing a highly critical inner voice (AV) focused on their eating, shape, and weight. There are promising preliminary findings for its role in the treatment of AN, and the support of staff is vital for the AV to be embedded in treatment, but their views remain unknown. The aims of this study were to undertake a qualitative exploration of the perceptions of the AV among health care professionals (HCPs) in specialist eating disorder services. A thematic analysis was applied to interviews with 15 HCPs, including nurses, therapists, psychiatrists, health care assistants, psychologists, and dietitians. Two overarching themes were identified: "The AV is a vehicle for increasing compassion" and "It's not a one-size-fits-all." The AV was seen as a means of developing and sustaining compassion, but participants noted that it does not resonate for all clients. All HCPs in this study believed that there was potential benefit in utilizing the AV in their work with people with AN, and it is likely that doing so would help to reduce burnout and frustration within clinical teams.
Collapse
Affiliation(s)
- Meghan R Graham
- Department of Psychology, Royal Holloway, University of London, Egham, UK
| | - Stephanie Tierney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Amy Chisholm
- Vincent Square Eating Disorders Service, London, UK
| | - John R E Fox
- School of Psychology, Cardiff University, Cardiff, UK
| |
Collapse
|
8
|
Zugai JS, Stein-Parbury J, Roche M. The nature of the therapeutic alliance between nurses and consumers with Anorexia Nervosa in the inpatient setting: A mixed-methods study. J Clin Nurs 2017; 27:416-426. [DOI: 10.1111/jocn.13944] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Joel S. Zugai
- Australian Catholic University; Banyo QLD Australia
- University of Technology Sydney; Ultimo NSW Australia
| | | | | |
Collapse
|
9
|
Hannon J, Eunson L, Munro C. The patient experience of illness, treatment, and change, during intensive community treatment for severe anorexia nervosa. Eat Disord 2017; 25:279-296. [PMID: 28448243 DOI: 10.1080/10640266.2017.1318626] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study explores experiences of intensive community treatment, illness, and change among patients with severe anorexia nervosa (sAN), particularly seeking to understand the processes involved in change and inability to change. A qualitative design with purposive semi-stratified sampling, using semi-structured interviews and interpretive phenomenological analysis, investigated in detail the experiences of five participants. Participants all had sAN at the start of treatment and represented a spectrum of outcomes from deterioration to full recovery. Six super-ordinate themes emerged from the analysis: treatment experience, function of anorexia, self-criticism versus self-acceptance, isolation versus connection, hopelessness versus hope, and stuckness versus change. Results describe the valued function of the illness, barriers to change, the lengthy struggle for change, and how this can be supported by intensive community-based treatment. Necessary ingredients in the process of change, arising from the analysis, are proposed. We conclude that the experiences of these patients reflect the particular functions of AN for each individual, and that both clinical deterioration and full recovery can occur with prolonged intensive community treatment.
Collapse
Affiliation(s)
- Julia Hannon
- a Anorexia Nervosa Intensive Treatment Team , NHS Lothian , Edinburgh , Scotland , UK
| | - Lindsey Eunson
- a Anorexia Nervosa Intensive Treatment Team , NHS Lothian , Edinburgh , Scotland , UK
| | - Calum Munro
- a Anorexia Nervosa Intensive Treatment Team , NHS Lothian , Edinburgh , Scotland , UK.,b Department of Psychiatry , University of Edinburgh , Edinburgh , Scotland , UK
| |
Collapse
|
10
|
Simonds LM, Spokes N. Therapist self-disclosure and the therapeutic alliance in the treatment of eating problems. Eat Disord 2017; 25:151-164. [PMID: 28060578 DOI: 10.1080/10640266.2016.1269557] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Evidence is mixed regarding the potential utility of therapist self-disclosure. The current study modelled relationships between perceived helpfulness of therapist self-disclosures, therapeutic alliance, patient non-disclosure, and shame in participants (n = 120; 95% women) with a history of eating problems. Serial multiple mediator analyses provided support for a putative model connecting the perceived helpfulness of therapist self-disclosures with current eating disorder symptom severity through therapeutic alliance, patient self-disclosure, and shame. The analyses presented provide support for the contention that therapist self-disclosure, if perceived as helpful, might strengthen the therapeutic alliance. A strong therapeutic alliance, in turn, has the potential to promote patient disclosure and reduce shame and eating problems.
Collapse
Affiliation(s)
- Laura M Simonds
- a School of Psychology , University of Surrey , Guildford , UK
| | - Naomi Spokes
- b Tavistock and Portman NHS Foundation Trust , City and Hackney Primary Care Psychotherapy Consultation Service (PCPCS) , London , UK
| |
Collapse
|