Objective: To synthesise young person and family member perspectives on processes of change in family therapy for anorexia nervosa (AN), including systemic family therapy and manualised family-based treatment, to obtain an understanding of what helps and hinders positive change.
Method: A systematic search of the literature was conducted to identify qualitative studies focussing on experiences of therapeutic change within family therapies for AN from the perspectives of young people and their families. Fourteen studies met inclusion criteria and underwent quality appraisal following which they were synthesised using a meta-synthesis approach.
Results: Six overarching themes were generated: “The psychological underpinnings of AN”; “The therapeutic relationship”; Confinement to a “script”; “A disempowering therapeutic context”; “Externalisation”; and “Family involvement”. Positive change was helped by understanding and support given to the young person’s overall psychological and emotional development and wellbeing, as well as positive therapeutic relationships, relational containment within the family system and externalising conversations in which young people felt seen and heard as individuals beyond an eating disorder. Positive change was hindered by inflexibility in the treatment approach, counter-effects of externalisation, negative experiences of the therapist, a narrow focus on food-intake and weight, as well as the neglect of family difficulties, emotional experiences, and psychological factors.
Conclusions: Positive change regarding the young person’s eating-related difficulties ensued in the context of positive relational changes between the young person, their family members and the therapist, highlighting the significance of secure and trusting relationships. The findings of this review can be utilised by Eating Disorder services to consider how they may adapt to the needs of young people and their families in order to improve treatment satisfaction, treatment outcomes, and in turn reduce risk for chronicity in AN.