Change Processes During Intensive Day Treatment for Anorexia: A Dyadic Interview Analysis of the Views of Adolescents and Parents

Background. Day programmes for severe adolescent anorexia nervosa offer an alternative to inpatient admission for some cases, but there is only one service of this kind in the UK. Processes of change during treatment for anorexia are currently poorly understood. Aim. Explore how adolescents with anorexia and their parents understood the helpful and unhelpful factors and processes that impacted them during day hospital treatment for the adolescent’s anorexia. Methodology. A critical realist paradigm was used to qualitatively explore the views of 16 participants. Participants were recruited from the Intensive Treatment Programme at the Maudsley Hospital at the end of treatment. Dyadic Interviews Analysis (DIA) was used to compare and contrast the narratives of the seven adolescent-parent pairs after two inductive reflexive thematic analyses were conducted for the group of eight adolescents and the group of eight parents separately. Findings. The author’s DIA created sixteen subthemes across five themes: "It was kind of like ... last hope" - Families have experienced prior treatment failure and its impact; "She got with the programme very quickly" – Programme structure and authority enable eatingand safety; "Like me she didn’t feel so alone anymore" – Moving from isolated distress to a shared or supported struggle; "Just sort of gone over the bridge a little bit." - Progress made in the programme and progress still to be made; "I think there's positives and negatives to them all." (Evie-A) – what helps progress can also hinder it. Conclusions. The findings can be conceptualised within Fonagy’s ideas regarding therapeutic change, including epistemic trust and mentalisation. Anorexia-specific factors and processes are equally important to consider, namely control and collaboration, externalisation of anorexia, the role of peer support, and the potential for family members to experience the impact of the adolescent’s anorexia and treatment non-response as traumatic.