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Beyond measure: A counselling psychology approach to mental healthcare

Sutherland, N. L. (2019). Beyond measure: A counselling psychology approach to mental healthcare. (Unpublished Doctoral thesis, City, University of London)


This study sets out to explore the experience of anorexia nervosa (AN) treatment from the perspective of those who choose to dropout. Dropout rates are particularly high in the treatment of AN but the reasons for this remain unclear. There have been calls to facilitate patient-led explorations of the reasons behind dropout, believing it may further our understanding, as the focus of most research to date has been on trying to locate predictive patient characteristics, with little attention paid to patients’ subjective experience. Adopting a critical realist epistemology, this study aims to explore the perspectives of those who dropped out from AN treatment in order to enrichen current understandings of the treatment experience and to gain a better insight into the meaning of dropping out. This study will describe participants’ AN treatment experiences and the sense they made of their decision to dropout. Semi-structured interviews were carried out with five women, age 19-44, who had dropped out from AN treatment within the National Health Service. Their data was examined using Interpretative Phenomenological Analysis and four major, interconnected themes emerged. Becoming ‘The Anorexic’: Identity and Belonging describes their experience of having become increasingly focused on their ‘anorexic’ identity within treatment and on achieving acceptance and belonging through fulfilment of an ‘anorexic’ social role. More Than Meets The Eye: The Unseen Subjective Experience describes their perception that their subjective experience went unacknowledged, be that due to individual clinicians lacking psychological awareness or due to the standardised, symptom-focused approach of the program itself. Disempowering Forces: Control and Chaos Within The System describes participants’ perceptions that the treatment environment was, variously, controlling and chaotic, both which created an experience of disempowerment and lost control. While these first three superordinate themes describe prominent aspects of participants’ treatment experience, Protest and Protection: Dropping Out from Getting ‘Worse’ describes the meaning they gave to their eventual decision to dropout, framing it as a consequence of the harmful treatment experiences recorded within the preceding themes. The findings from this study provide Counselling Psychologists, as well as other clinicians working with eating disorders, a valuable insight into the meaning sufferers give to their decision to dropout from treatment, and identify opportunities to reduce clinical factors that might contribute while maximising those factors which protect against it.

Publication Type: Thesis (Doctoral)
Subjects: B Philosophy. Psychology. Religion > BF Psychology
Departments: Doctoral Theses
School of Health & Psychological Sciences > Psychology
School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses
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