Therapeutic alliance, anorexia nervosa and the inpatient setting: A mixed methods study

Zugai, Joel; Stein‐Parbury, Jane; Roche, Michael

doi:10.1111/jan.13410

Cited by 13 publications

(14 citation statements)

References 52 publications

(95 reference statements)

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“…The systemic pressure of lack of time seemed to be felt most keenly in primary care, while the surveillance culture and frustrations around communication were predominantly reported in inpatient settings. The greater likelihood that nurses would engage in avoidance and blame, and adopt a maternal stance, may reflect their high level of contact with people with EDs and their involvement in implementing treatment protocols, positioning them both for intimacy with service users and becoming the object of their anger (Ryan et al, ; Zugai et al, , ).…”

Section: Discussionmentioning

confidence: 99%

“…The greater likelihood that nurses would engage in avoidance and blame, and adopt a maternal stance, may reflect their high level of contact with people with EDs and their involvement in implementing treatment protocols, positioning them both for intimacy with service users and becoming the object of their anger (Ryan et al, 2006;Zugai et al, 2018aZugai et al, , 2018b. Fox et al (2012) highlighted the irony that it is generally the least experienced HCPs who spend most time with service users and receive the least containment in the form of space to formulate, process, and reflect.…”

Section: Discussionmentioning

confidence: 99%

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The lived experience of working with people with eating disorders: A meta‐ethnography

Graham

Tierney

Chisholm

et al. 2020

Intl J Eating Disorders

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Objective Working with people with eating disorders (EDs) is known to elicit strong emotional reactions, and the therapeutic alliance has been shown to affect outcomes with this clinical population. As a consequence, it is important to understand healthcare professionals' (HCPs') experiences of working with this client group. Method A meta‐synthesis was conducted of qualitative research on HCPs' lived experiences of working with people with EDs. The results from the identified studies were analyzed using Noblit and Hare's meta‐ethnographic method. Data were synthesized using reciprocal translation, and a line of argument was developed. Results Thirty‐seven studies met the inclusion criteria. Reciprocal translation resulted in a key concept: “Coping with caring without curing.” This was underpinned by the following third‐order concepts: (a) “The dissonance and discomfort of being a helper struggling to help,” (b) “Defending against the dissonance,” and (c) “Accepting the dissonance to provide safe and compassionate care.” These concepts were used to develop a line‐of‐argument synthesis, which was expressed as a new model for understanding HCPs' experiences of working with people who have an ED. Discussion Although the conflict associated with being a helper struggling to help led some HCPs to avoid and blame people with EDs, others adopted a compassionate stance characterized by humanity, humility, balance, and awareness.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The lived experience of working with people with eating disorders: A meta‐ethnography

Graham

Tierney

Chisholm

et al. 2020

Intl J Eating Disorders

View full text Add to dashboard Cite

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“…Consumers’ open opposition towards nurses is likely a manifestation of the distress that consumers experience from re‐feeding and weight gain (Zugai et al . ), and also may be an overt attempt to re‐establish power. Some nurses in this study felt uncomfortable with exercising their authority, due to the opposition that they were liable to receive.…”

Section: Discussionmentioning

confidence: 99%

“…This paper reports on a subset of data from a larger study reported elsewhere (Zugai et al . ,). Data for this study were collected between May 2014 and February 2015.…”

Section: Methodsmentioning

confidence: 99%

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Dynamics of nurses’ authority in the inpatient care of adolescent consumers with anorexia nervosa: A qualitative study of nursing perspectives

Zugai

Stein‐Parbury

Roche

2019

Int J Mental Health Nurs

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Nurses caring for adolescent consumers with anorexia nervosa in the inpatient setting are challenged in a unique way, in that they are caring for people with whom they do not have a mutually held concept of well-being. Their efforts to ensure weight gain are frequently against the wishes of the consumer. This dissonance results in challenging interactions, where nursing care and authority may be undermined. This study investigated the dynamics of nurses' authority within this context. Interviews with nurses (n = 10) were conducted and analysed through thematic analysis. Nurses reported that consumers, compelled by the psychopathology of anorexia nervosa, often sought to challenge or undermine their authority. Some nurses experienced the opposition and conflict as demoralizing, whereas others were able to maintain confidence in the therapeutic merit of their care. Younger, inexperienced nurses in this study were particularly vulnerable to interactions that mitigated their authority, due to their tendency to engage in friendlike relationships. Nurses caring for adolescents with anorexia nervosa should be prepared to be confronted by interactions that overtly and surreptitiously undermine their capacity to exercise professional authority. It is important that nurses recognize the importance of maintaining their authority, and how it can be threatened in subtle and unexpected ways.

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Being a mother with anorexia: A phenomenological study of seeking and receiving professional support for white heterosexual women in the UK

Fitzpatrick

Clarke

Ramsey-Wade

et al. 2023

Couns and Psychother Res

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Mothers are currently under‐represented in the literature on anorexia, including research on treatment, with most research focussed on female adolescents. This raises questions about how adult women and particularly those who are mothers, experience eating disorder treatment. This study provides a phenomenological exploration of lived experiences of seeking and receiving professional help and interactions with health professionals for six white heterosexual mothers who experienced anorexia while raising their children. Four themes are reported that capture the women's diverse experiences of seeking and receiving support for anorexia: (1) conflict between mothering and seeking help; (2) experiences of feeling blamed, poorly treated or misunderstood by health professionals; (3) positive experiences of seeking and receiving support; and (4) the importance of ongoing support. The women's experiences suggest that healthcare professionals should adopt a more holistic approach that acknowledges the subjective reality of the client (including their mother status) when working with mothers experiencing anorexia.

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Therapeutic alliance, anorexia nervosa and the inpatient setting: A mixed methods study

Cited by 13 publications

References 52 publications

The lived experience of working with people with eating disorders: A meta‐ethnography

The lived experience of working with people with eating disorders: A meta‐ethnography

Dynamics of nurses’ authority in the inpatient care of adolescent consumers with anorexia nervosa: A qualitative study of nursing perspectives

Being a mother with anorexia: A phenomenological study of seeking and receiving professional support for white heterosexual women in the UK

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