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Therapeutic interaction in anorexia nervosa treatment

Bellair (nee Dunn), Rachael (2009) Therapeutic interaction in anorexia nervosa treatment. PhD thesis, Murdoch University.

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Anorexia nervosa (AN) is a chronic and complex psychosomatic condition, characterised by a primary drive to be thin and a refusal to maintain normal body weight. Only a minority of people diagnosed with AN ever become asymptomatic and more research has been called for to address high drop-out rates and lack of engagement in AN treatment services, in particular psychotherapeutic treatment. Prior studies have generally examined this problem in terms of patient mediated variables, such as attitudes and behaviours, with little focus on contextual factors. Research that has studied therapeutic engagement in the area of AN has yet to examine psychotherapeutic treatments-in-practice. Guided by this gap in the literature this thesis examines ways in which therapists engage with adolescents diagnosed with AN in naturally occurring psychotherapeutic interactions. A secondary and concurrent focus is to look at how the therapists’ underlying theoretical models are reflected in in situ practice. The data corpus comprises twenty-four therapy sessions recorded in an eating disorders programme based in a children’s hospital. In contrast to eating disorders treatment statistics reported in the literature, the programme has a low drop-out rate, zero mortality rate and good long-term patient outcomes, making it an especially suitable setting to examine engagement.

Drawing on methods from discursive psychology (DP) and conversation analysis (CA), a number of interactional practices are found which show how the key principles of engagement and neutrality are brought off, or achieved as such in turn-by-turn interaction. Central to the analysis, is the recurrent production of patients’ bodily states and conduct as delicate items. As these topics are also the primary focus of the institutional setting, the analysis shows how practices such as perspective display series and dispositional management allow delicately marked institutional tasks to be carried out. The analysis also examines how patients’ bodies and conduct are embedded in, and constituted as problematic in the interactions. Regularities, such as agentic repositioning in accounts, demonstrate the co-production of patients as psychologically compliant with treatment while physically non-compliant.

This thesis contributes to work in applied CA concerning links between theoretical models and interactional practices by demonstrating naturally occurring regularities that describe key guiding principles of the eating disorders programme. It also builds on work in DP concerning examinations of the body and embodiment, by showing how patients’ physical bodies are an integrated feature of the interactions. Finally, this thesis has implications for a clinical audience in terms of extending therapists’ awareness of how engagement with patients is constituted interactionally, which also contributes to wider AN literature on ‘resistance’ to therapy.

Item Type: Thesis (PhD)
Murdoch Affiliation(s): School of Psychology
Supervisor(s): Donaghue, Ngaire
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