Therapists’ experiences of supporting adults with longstanding anorexia in specialist community eating disorder services

As we learn more, it is becoming apparent that longstanding anorexia nervosa presents a unique challenge to society. The impact of longstanding anorexia nervosa in the UK is considerable, and approximately 20% of individuals with anorexia nervosa experience the chronic form and recovery rates are low. There is also evidence that living with anorexia nervosa for any length of time comes with considerable risks to the client's quality of life. Ultimately, longstanding anorexia nervosa has the highest mortality rate of any psychiatric condition. Despite wide acknowledgement of the severity of longstanding anorexia nervosa, there is minimal consensus about how best to support adults experiencing longstanding anorexia nervosa. This research aimed to explore therapists' experience working with longstanding anorexia nervosa and generate much-needed information on how best to help therapists with this complex presentation.

Participants comprised therapists who had worked with long-standing anorexia nervosa in NHS specialist adult community eating disorder services over the past five years. Eight therapists participated in the research. Data was gathered through semi-structured interviews and analysed using reflexive thematic analysis within a critical realist framework. From this, five themes were identified: (1) Managing the severity of the illness, (2) Sitting with the therapist's feelings, (3) The need for a bespoke approach, (4) Negotiating the relationship with the service, and (5) Recognising the need for therapist self-care.
The data revealed the need for bespoke support for clients and therapists in this complex area. The findings highlight the need to incorporate more tailored treatment plans based on client presentation and the use of broader theoretical frameworks to improve understanding of implicit and relational complexity. They also draw attention to the critical area of therapist self-care. Understanding therapists' experience in supporting longstanding anorexia nervosa may help inform future treatment pathways that could improve the quality of the experience for both therapists and clients.