Cripps Sophie, Pugh Matthew, Serpell Lucy
Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK.
J Eat Disord. 2024 Oct 7;12(1):157. doi: 10.1186/s40337-024-01087-9.
Many individuals perceive Anorexia Nervosa (AN) as a part of their personal identity. Externalisation of the problem is a practice that is often taken up within NICE recommended treatments for AN. Dominant understandings of externalisation are that this practice involves making the "problem" a separate entity, external to the individual. It is an attitude taken by the client and family, stimulated by the therapist to build engagement with treatment and supportive relationships around the individual. However, there is a paucity of research exploring the therapeutic effects of this approach. This research aims to address this gap by exploring the role of externalisation in treatment for AN to elicit an understanding of how this practice is experienced including how it can help and hinder recovery.
Thirteen adults with a current and/or past diagnosis of AN participated in semi-structured interviews. This qualitative study used a reflexive thematic analysis.
Participants described their experience of externalisation as a journey which is depicted by four main themes. 'Separating the AN from the self' reflects the tensions inherent in learning to distinguish between one's perceived sense of "self" and "the AN". 'Making sense of the AN' describes the experience of language forms used to separate the AN from the individual's identity. 'Feeling seen, or unseen as a person beyond the AN' illustrates the helpful and harmful effects of externalising practices on relationships. 'Navigating a complex relationship with the AN' depicts the effects of one-, versus two-way externalisation on the individual's relationship to AN.
The notion of separating one's internal dialogue from one's concept of self may initially be rejected by the individual experiencing AN. However, as the individual develops trust in the therapist and becomes socialised to common forms of externalising language, they may begin to realise two sides within them, a perceived "healthy self" and "the anorexia voice". However, social-cultural discourses around eating contribute to ambiguity during the differentiation between these two voices, thus elucidating the effects of an absence of problem deconstruction alongside externalisation within ED-focussed treatments. Externalising practices were most helpful when led by the individual using their own experience-near language and least helpful when they did not permit the individual to feel seen as a person beyond the AN. Therapists, treatment teams and family members should be cognisant of the emotional effects of language used to externalise AN. Importantly, they should ensure that externalisation is practiced within the spirit of narrative therapy from which it originates.
许多人将神经性厌食症（AN）视为其个人身份的一部分。外化问题是英国国家卫生与临床优化研究所（NICE）推荐的AN治疗方法中经常采用的一种做法。对外化的主流理解是，这种做法涉及将“问题”变成一个独立于个体的实体。这是一种由治疗师激发的客户和家庭所采取的态度，目的是围绕个体建立对治疗的参与度和支持性的关系。然而，探索这种方法治疗效果的研究很少。本研究旨在通过探讨外化在AN治疗中的作用来填补这一空白，以了解这种做法的体验方式，包括它如何有助于和阻碍康复。
13名目前和/或过去被诊断为AN的成年人参与了半结构化访谈。这项定性研究采用了反思性主题分析。
参与者将他们的外化经历描述为一段旅程，由四个主要主题描绘。“将AN与自我分离”反映了在学习区分一个人所感知的“自我”和“AN”时固有的紧张关系。“理解AN”描述了用于将AN与个体身份分离的语言形式的体验。“作为AN之外的人被看见或未被看见的感受”说明了外化做法对关系的有益和有害影响。“与AN建立复杂关系”描绘了单向与双向外化对个体与AN关系的影响。
将一个人的内部对话与自我概念分离的观念最初可能会被患有AN的个体拒绝。然而，随着个体对治疗师产生信任并适应外化语言的常见形式，他们可能开始意识到自己内心的两面，一个被感知的“健康自我”和“厌食症声音”。然而，围绕饮食的社会文化话语在这两种声音的区分过程中造成了模糊性，从而阐明了在以进食障碍为重点的治疗中缺乏问题解构与外化同时存在的影响。当由个体使用贴近自身经历的语言来引导时，外化做法最有帮助；而当它们不允许个体被视为AN之外的人时，帮助最小。治疗师、治疗团队和家庭成员应该意识到用于外化AN的语言的情感影响。重要的是，他们应该确保外化是在其起源的叙事治疗精神内进行的。
