Changes in the sense of agency: Implications for the psychotherapy of bulimia nervosa‐ A case study

Kristmannsdottir, Gudrun; Keski‐Rahkonen, Anna; Kuusinen, Kirsti‐Liisa

doi:10.1002/jclp.22787

Cited by 8 publications

(12 citation statements)

References 24 publications

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“…Presenting agency problems at the onset of therapy is common in patients (Toivonen et al, 2019(Toivonen et al, , 2020, and thus regaining a sense of agency has been identified as a crucial focus in psychotherapy practice (e.g., Lilliengren and Werbart, 2010;Levitt et al, 2016;Wahlström and Seilonen, 2016). When analyzing patient narratives over the course of therapy, a stable increase in agency was found across patient characteristics (e.g., demographics, personality traits), and in various conditions (e.g., Kristmannsdottir et al, 2019). Increase in agency was indeed found to be related to improvement in mental health; moreover, increases in agency occurred prior to improvement in mental health (Adler, 2012).…”

Section: Continuity With Prior Empirical Researchmentioning

confidence: 99%

Agency via Awareness: A Unifying Meta-Process in Psychotherapy

Gorlin

Békés

2021

Front. Psychol.

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To address the need for conceptual and clinical consensus within the field, psychotherapy research has increasingly focused on identifying common principles of change. While the field contends that this approach is atheoretical, we argue that principles of change cannot be fully understood or applied without the context of some theoretical framework. This article develops such a framework by identifying and explicating two theoretical assumptions that are implicitly shared by multiple therapeutic approaches: (1) that increasing agency is a fundamental aim of psychotherapy, and (2) that therapists enhance clients' agency by increasing their awareness. Building on the largely disparate empirical literatures demonstrating the importance of client agency and awareness to successful therapeutic outcomes, we provide a theoretical account of the highly iterative and synergistic meta-process by which these two factors jointly produce change. Explicit identification and empirical investigation of this Agency via Awareness psychotherapy meta-process, we argue, could facilitate scientific and clinical progress within the field. The hypothesized meta-process is discussed in relation to existing integrative models of therapeutic change, and its manifestations in the theory and practice of major therapeutic orientations are reviewed and illustrated. We discuss how this framework can facilitate psychotherapy research by providing a common language and conceptual foundation for wide-ranging therapeutic approaches, constructs, and findings. Finally, by raising clinicians' awareness of the implicit assumptions underlying their therapeutic work, we suggest that the Agency via Awareness framework can increase their agency over when and how they apply these assumptions in therapy to maximize client improvement.

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Section: Continuity With Prior Empirical Researchmentioning

confidence: 99%

Agency via Awareness: A Unifying Meta-Process in Psychotherapy

Gorlin

Békés

2021

Front. Psychol.

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“…Anxiety around readiness for taking this on and excessive worry around motivation to maintain good eating routines was pervasive throughout the transcripts. Kristmannsdottir et al (2019) discuss this idea of agency in their research of people experiencing an ED and claim it is only when a person has a sufficient sense of agency that they can be fully motivated or described as ‘ready for change’. When a person's sense of agency gradually becomes stronger, they can relate to problematic patterns of behaviour in a new way, seeing alternatives and options that are within their means or control agency (Kristmannsdottir et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

An exploration of patient experiences of transitioning to a remote day programme following inpatient treatment in an adult eating disorder service

O'Connor,

Donohue,

Morrissey

et al. 2023

Psychiatric Ment Health Nurs

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Accessible SummaryWhat is known on the subject? Traditionally, treatment for eating disorders (EDs) has been provided on an inpatient or outpatient basis, but more recently other levels of treatment provision to include, day care (DC) and community outreach programmes, have been developed. There is limited research exploring the experience of patients who have transitioned from inpatient ED treatment to a remote DC treatment. This lack of knowledge can impact mental health nurses' understanding of what that experience is like for patients and hence may influence the efficacy of collaboration and inclusion between patients and nurses. What this paper adds to existing knowledge? This research addresses this dearth of knowledge and adds to our understanding of patients' experiences of attending a remote DC programme following a period of inpatient treatment for an ED. This is an important study for nurses and other mental health professionals working with people in ED treatment, as it highlights the specific challenges and anxieties of transitioning from inpatient to a remote DC programme and the individualized supports advisable during this process. What are the implications for practice? This research provides a basis on which nurses can understand and address the challenges experienced by patients after transitioning to a less intensive supportive ED programme. The understanding of these experiences will enhance the therapeutic alliance between the nurse and patient, which will in turn support the patient in increasing agency as they progress through their recovery. This research provides a foundation on which to develop specific supports that need to be in place to help patients manage the anxieties they experience as they transition to a less intense and remote treatment. Findings from these lived experiences can be used to support the development of similar DC programmes for EDs in other settings. AbstractIntroductionDay care (DC) treatment for people with an eating disorder (ED) provides for an easier transition from hospital to home, along with a treatment milieu where patients can maintain occupational and social functioning and allow for the transfer of newly acquired skills to everyday life.AimTo explore patients' experiences of attending a remote day programme following intense inpatient treatment in an adult ED service.MethodA qualitative descriptive methodology informed the study. In‐depth semi‐structured interviews were conducted with 10 consenting patients. A thematic analysis framework was used to guide the process of data analysis.ResultsThree themes reflected participants' experiences: ‘Moving On: Preparing for Change’, ‘Navigating a New Support System’ and ‘Increasing Agency’.DiscussionAn underlying issue for participants was an ongoing but changing experience of anxiety. While anticipatory anxiety is evident in preparing for discharge, this is replaced with a real‐time anxiety as they endeavour to negotiate an effective support network.Implications for PracticeThe findings from this study provide a basis on which mental health nurses can develop timely and effective treatment and support systems with patients who are transitioning from a high support inpatient ED programme to a less intensive ED remote DC programme.

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“…Particularly interesting were the perceptions of what healthy eating meant to the individuals; it was identified as an assertion of “agency” over their lives. “Agency” can be described as how strongly a person believes s/he can impact on experiences and behaviours and has been suggested to influence success of psychotherapeutic treatment for established ED (Kristmannsdottir et al, 2019 ). Our participants described the development of their eating preferences as an attempt to establish independence from their family's food beliefs and a mechanism to assert control over their lives in times of change (e.g., moving to another country).…”

Section: Discussionmentioning

confidence: 99%

Using Behavioural Reasoning Theory to Explore Reasons for Dietary Restriction: A Qualitative Study of Orthorexic Behavioural Tendencies in the UK

et al. 2021

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Orthorexia Nervosa (ON) has gained increased attention in academia since 1997. However, like other “Exia” conditions, there is debate around its inclusion in the Diagnostic and Statistical Manual of Mental Disorders. This study aimed to examine the experiences of those following a diet indicative of ON in the United Kingdom. This information is essential to the development of diagnostic criteria and classification of ON. Behavioural Reasoning Theory was used to explore reasons contributing to the development of ON. Ten individuals (two males and eight females), aged 23–35 years, took part in semi-structured interviews. Inductive thematic analysis was used to analyse the results. Four themes emerged from the data—journey, social, rules/control, and ethical considerations which highlighted contributing factors to the development of ON behaviours, the impact of these behaviours on individuals' social lives, and a strive for control. These findings are the first to suggest that ON involves a more complex set of behaviours than current definitions and proposed diagnostic criteria suggest and highlight the need to consider a variety of reasons for restricted diet when developing diagnostic criteria, screening tools, and classification in the DSM.

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Changes in the sense of agency: Implications for the psychotherapy of bulimia nervosa‐ A case study

Cited by 8 publications

References 24 publications

Agency via Awareness: A Unifying Meta-Process in Psychotherapy

Agency via Awareness: A Unifying Meta-Process in Psychotherapy

An exploration of patient experiences of transitioning to a remote day programme following inpatient treatment in an adult eating disorder service

Using Behavioural Reasoning Theory to Explore Reasons for Dietary Restriction: A Qualitative Study of Orthorexic Behavioural Tendencies in the UK

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