Exploring the experience of young people receiving treatment for an eating disorder: family therapy for anorexia nervosa and multi-family therapy in an inpatient setting

Abstract

Background Research indicates that family therapy for anorexia nervosa (FT-AN) and multi-family therapy (MFT) are effective treatments for adolescents experiencing anorexia nervosa (AN). However, less is known about young people’s experiences of these two treatments, as there is limited qualitative research, and to date no qualitative research within an inpatient setting. It is argued that the lack of such insight limits the development of services for young people experiencing AN. Method Five young people were recruited to the study from a specialist inpatient unit who were receiving treatment on the AN pathway which included both FT-AN and MFT. Semi structured interviews were undertaken and analysed using Interpretative Phenomenological Analysis. Results Four superordinate themes and ten subthemes were developed from the data. The four superordinate themes were: ‘Process of Understanding’, ‘Reviving Connection’, ‘Emerging from the Eating Disorder and ‘Development of I’. Conclusions There appeared to be two overarching concepts: the role of the individual and the role of others, that helpfully framed the results. The superordinate themes: ‘Emerging from the Eating Disorder’ and ‘Development of I’ focused on the development of the individual. Conversely, the superordinate themes: ‘The Process of Understanding’ and ‘Reviving Connection’ were centred on the relationships existing within the family system. The results could help inform future service developments regarding inpatient provision and service design. Plain English Summary The most widely used and recognised treatment for anorexia nervosa in young people is family therapy for anorexia nervosa (FT-AN). An alternative treatment is multi-family therapy (MFT). Both treatments are deemed to be effective and usually happen in the community. However, some hospitals provide these treatments while the young people are in-patients. There is no research exploring young people’s experiences of these two treatments while in an in-patient unit. Young people who had received both FT-AN and MFT in an inpatient setting were asked to share their experiences of these two treatments. Their stories were analysed by a researcher. The analysis identified four themes: ‘Process of Understanding’, ‘Reviving Connection’, ‘Emerging from the Eating Disorder and ‘Development of I’. The results highlighted that the young people appeared to place more value on the role of others and perhaps others changing enabled them to change. The research highlighted the benefit in others’ understanding and therefore how improving societal understanding more broadly would be helpful. The young people reflected that both they and their parents benefited from FT-AN and MFT in an in-patient setting and it is proposed that this could help inform future service developments regarding inpatient provision.

Perceived change mechanisms in multi‐family therapy for anorexia nervosa: A qualitative follow‐up study of adolescent and parent experiences

“…As the quantitative evidence base continues to build, less is known about the experience of MFT, particularly from the young person's perspective. Six studies have been published to date that investigate the experience of MFT for adolescent anorexia nervosa (Baumas et al, 2021;Coopey & Johnson, 2022;Engman-Bredvik et al, 2016;Voriadaki et al, 2015;Wiseman et al, 2019aWiseman et al, , 2019b and one for bulimia nervosa (Escoffié et al, 2022), although, only four of these include the young person's voice (Baumas et al, 2021;Coopey & Johnson, 2022;Escoffié et al, 2022;Voriadaki et al, 2015). Of the remaining three qualitative studies, two attempted to recruit young people, but all declined (Wiseman et al, 2019a(Wiseman et al, , 2019b, and one focused on the parent-only experience (Engman-Bredvik et al, 2016).…”

“…The qualitative data available indicate that MFT is perceived to be helpful, intense and challenging (Baudinet, Eisler, Dawson, et al., 2021). Participants report that it promotes new learning and improves family connections (Baumas et al., 2021; Coopey & Johnson, 2022; Wiseman et al., 2019b). Parents often say that MFT provides a new support network that helps to reduce isolation (Engman‐Bredvik et al., 2016; Wiseman et al., 2019b).…”

Perceptions on Healthy Eating Impact the Home Food Environment: A Qualitative Exploration of Perceptions of Indigenous Food Gatekeepers in Urban Fiji

“…Interpretative phenomenological analysis (IPA) was used as a framework for data collection and analysis as it allows for both a detailed exploration of personal perceptions and experiences of iTaukei mothers on healthy eating and an examination of these descriptions and how they impact typical family meals. Due to this two-stage interpretation process, which combines empathetic hermeneutics and questioning hermeneutics [ 41 ] (p. 53), IPA has been especially useful in public health research and psychology, e.g., [ 42 , 43 , 44 ].…”

Processes of change in family therapies for anorexia nervosa: a systematic review and meta-synthesis of qualitative data

“…Findings from a study exploring the effects of FBT illuminated a possible mechanism of change, termed "relational containment" suggesting the importance of relational processes in recovery from AN [22]. Another study highlighted the process of evolving through treatment, for both the individual and their familial system [23]; this involved the repairing of damage through enabling others to improve their understanding of AN. The importance of attending to attachment-related issues has also been emphasised [24,25,26,27,28,29], including the intergenerational transmission of attachment styles, emotional communication and coping styles, as well as attitudes towards eating and weight.…”