Aradas Jessica, Sales Diana, Rhodes Paul, Conti Janet
1University of Western Sydney, Locked Bag 1797, Penrith, 2751 Australia.
2University of Sydney, Penrith, Australia.
J Eat Disord. 2019 Aug 1;7:26. doi: 10.1186/s40337-019-0255-1. eCollection 2019.
Maudsley Family Therapy and its manualised version Family-Based Therapy for Anorexia Nervosa (FBT-AN) have accrued the most significant research evidence-base for the treatment of adolescent Anorexia Nervosa (AN). A tradition of seeking augmentations for this treatment has also been established to enhance efficacy. There exists, however, a gap in the uptake of this form of manualised treatment into the "real world" of clinicians who work with adolescent AN.
This research study investigated the key experiences and identity negotiations of a group of nine Australian clinicians who were interested in contributing to research into ways that Maudsley and FBT-AN might be improved.
Nine clinicians, who at the time of the interview practised or had previously practised, FBT-AN participated in a semi-structured interview. A critical discursive analysis of interview transcripts generated a thematic map of these therapists' experiences and identity negotiations in their practice of FBT-AN.
These therapists experienced the structure of FBT-AN as both a secure map for therapy, yet also constraining at times, in their work with adolescents and their families. Additionally, their professional identities were both invested and troubled by the identity position of themselves as evidence-based practitioners, particularly where evidence-based practice (EBP) meant strict fidelity to the manual and restrained them from tailoring a broader range of therapeutic interventions to an individual adolescent and their family. Within their narratives, these therapists refashioned alternative identity positions around what it meant to be an evidence-based practitioner through listening to and drawing on their clinical expertise of what works in therapeutic practice with an individual adolescent and their family.
These therapists narratives highlight the power of the dominant discourse of EBP that works to privilege the research evidence over other forms of evidence that include clinician expertise and client preferences. The dilemmas faced by these therapists questioned not only the strict application of FBT-AN for adolescent AN across diverse therapeutic contexts, but also the effects of supervisory practices that paralleled this strict fidelity to the model. Further research is needed into therapeutic interventions and supervisory practices that give greater scope for clinicians to draw on their expertise in the flexible tailoring of treatments to the unique needs and preferences of the individual adolescent and their family.
莫兹利家庭治疗法及其手册化版本神经性厌食症家庭治疗法（FBT - AN）在治疗青少年神经性厌食症（AN）方面积累了最为重要的研究证据基础。为提高疗效，也已形成了寻求增强这种治疗方法的传统。然而，在将这种手册化治疗形式应用于治疗青少年AN的临床医生的“现实世界”方面，存在着差距。
本研究调查了一组九名澳大利亚临床医生的关键经历和身份协商情况，这些医生有意为研究如何改进莫兹利治疗法和FBT - AN做出贡献。
九名在接受访谈时正在或曾经实践FBT - AN的临床医生参与了半结构化访谈。对访谈记录进行批判性话语分析，生成了这些治疗师在实践FBT - AN过程中的经历和身份协商的主题图。
这些治疗师体验到FBT - AN的结构既是治疗的可靠指南，但在与青少年及其家庭合作时有时也具有局限性。此外，他们作为循证从业者的身份定位既投入其中又感到困扰，特别是在循证实践（EBP）意味着严格遵循手册，限制他们为个别青少年及其家庭量身定制更广泛治疗干预措施的情况下。在他们的叙述中，这些治疗师通过倾听并借鉴他们在与个别青少年及其家庭的治疗实践中有效的临床专业知识，重塑了关于成为循证从业者意味着什么的替代身份定位。
这些治疗师的叙述突出了EBP主导话语的力量，这种话语将研究证据置于包括临床医生专业知识和患者偏好在内的其他证据形式之上。这些治疗师面临的困境不仅质疑了FBT - AN在不同治疗背景下对青少年AN的严格应用，还质疑了与严格遵循该模型并行的督导实践的效果。需要进一步研究治疗干预措施和督导实践，以便为临床医生提供更大空间，使其能够利用专业知识灵活地根据个别青少年及其家庭的独特需求和偏好量身定制治疗方案。
