Abstract:
Anorexia Nervosa is a widely researched and discussed phenomenon with opinion on best approaches to treatment diverse. As a therapist working in the field I observed a difference in the way therapists and clients understand therapy. To investigate this observation two research studies were undertaken: In the first study 12 women who had experienced therapy for anorexia were interviewed about their experiences. Their talk was analysed using a discourse analytic approach. Four interpretative repertoires were identified: a violence repertoire, an illness repertoire, a game repertoire and a parent-child repertoire. Within each repertoire women's positioning of themselves and therapists was examined. The women positioned themselves and therapists variously in their talk. Positions specific to the women included 'good girl' and ‘victim, and their talk largely positioned therapists as critical, authoritarian, and nurturing parents. Women also commonly positioned self and therapists respectively as winner and loser, professional and client, expert and fool. Whilst such positioning frequently functioned to disempower clients, analysis revealed a range of strategies the women used to resist disempowerment and create agency.
In the second study four therapists who had worked with clients with anorexia were interviewed about their responses to concerns raised in the first study. The key strand in analysis of therapists talk was how they appropriated dominant discourses to construct therapy. Analysis of therapist's talk revealed therapists commonly appropriated a scientific-medical discourse with therapy variously constructed as; empathetic caring, punishment, power, and a forced act.
Differing constructions of anorexic identity strongly influenced how both groups understood the role of therapy. Therapists were more likely to construct anorexia as a total identity and therefore recommend programmes that immersed clients completely. Conversely, the women were more likely to construct anorexia as a small part of their identity and wanted treatment programmes that enabled maintaining other life activities. The women commonly perceived therapy as punishing and unhelpful whilst the therapists framed therapy as altruistic and helpful. These findings confirm that therapists and clients construct therapy differently and hold important implications for professional practice. Firstly training and supervision for therapists need to emphasise clients' perspectives. Secondly changes to therapeutic practice need to be directed towards developing a holistic approach to therapy that recognises clients' strengths and areas in which they are functioning in their lives. Thirdly therapists need to actively consider how therapy can enable clients to feel more empowered by and positive about their therapeutic experience.
