One size doesn't fit all: the nature and context of the therapeutic relationship in the treatment of adults with anorexia nervosa: a grounded theory study

Anorexia nervosa is a serious, life threatening mental disorder that is difficult to treat. Research suggests that the therapeutic relationship is an aspect of therapy that is valued by recipients of eating disorder services and viewed as essential in the quality of any treatment undertaken. Establishing a helpful therapeutic relationship can be equally challenging for both the therapist and the client. Additionally, what the nature of the therapeutic relationship needs to be is often unclear and there is limited research into this aspect of the therapeutic relationship from the perspective of adults with anorexia nervosa specifically. Therefore, the aim of this study set out to answer the research question: • What is the nature and context of the therapeutic relationship from the perspective of adults with anorexia nervosa? Following a constructivist grounded theory methodology, elicited written data were gathered from adults with anorexia nervosa using asynchronous online research methods via a bespoke confidential website. The participants were recruited through the eating disorder charity Beat. Additional existing autobiographical material including books and online blogs were also used as supplementary data. Data collection and analysis was carried out over three phases. Three theoretical categories were constructed that explicate the significant aspects of a positive therapeutic relationship: Balancing control in the therapeutic relationship; Developing trust; and “They just got me” - feeling understood by the therapist. The central category of individuality or “one size doesn’t fit all” underpins these categories, hence requiring a therapist to tailor the therapeutic relationship to the individual. In conclusion, this study offers a substantive theoretical understanding of the critical aspects of the therapeutic relationship as described by adults with anorexia nervosa. These factors have utility across a range of recommended psychological therapies for anorexia nervosa and could be usefully deployed by any health, social care or education professional