Race, Ethnicity and Culture: what happens to these contexts when Family Therapists work with Childhood Eating Disorders?

Race, ethnicity and culture (REC) influence the meaning of food and eating. This research examines how attention and reflexivity of family therapists towards REC are influenced by the NICE guidelines (manualised, family-based treatment- FBT) when working in childhood eating disorders services. The guidelines position clinicians to focus on psycho-education and weight gain. Hence, the opportunity to reflect on differences and similarities when meeting families is often deemed unnecessary in the initial phase of treatment. This sets up a dilemma between saving life and being reflexive. The study employs a qualitative, exploratory, multi-method approach based on online, semi-structured interviews with six individuals and two small focus groups of family therapists. Narrative Analysis (Dialogical/ Performance Analysis) was used to interpret the data from which structure, themes, identities, and contexts were drawn to address the research questions. The analysis illuminated the participants’ internal contexts and their connections with cultural practice. It also highlighted their external contexts such as team dynamics, FBT adherence, cost and efficiency. Wider societal influences were identified: the control of bodies, food and eating; the conceptualisation of risk and blame in modern society and in the NHS. Some unexpected narratives were elicited which showed the complexity of racism and the challenges present when addressing race, ethnicity and culture in this clinical context. My findings show that the degree of adherence to FBT by family therapists, depends on their personal experience, resonance to emotional distress, confidence, team priority and team support. Some participants demonstrated that therapists can save lives and be reflexive. Those who did not adapt FBT prefer the authority and certainty of the medical discourse. Nevertheless, as a systemic therapist, I believe FBT would benefit from adaptation in order for attention to reflexivity and inclusion of REC to be encouraged throughout the treatment process.