Recent studies completed in association with North West Centre for Eating Disorders

Research Work in Progress at NWCED

A measure of control: an exploration of the meaning of self-induced vomiting to clients with eating disorders

The therapeutic relationship from an attachment theory perspective

The embodied self: the expression of psychological conflict through the body in clients with eating disorders

Counsellors' conceptualisation of humour in the counselling relationship

Research Work in Progress at NWCED

Putting NICE Guidance for bulimia to work: the clinical effectiveness of guided self-help for bulimia, binge eating disorder and compulsive overeating in a community-based eating disorders service

Caroline Vermes is currently conducting a comparison study of the effectiveness of guided self-help (GSH) versus integrative counselling (IC) for people with mild to moderate bulimia, binge eating disorder and compulsive overeating. The study is taking place in our Stockport community eating disorders clinic. Change in number of episodes of binge eating/overeating over the course of treatment is the primary variable being measured, although a number of other potentially meaningful variables being measured include low mood, low self-esteem, self-directed hostility, perceived external control and anxiety. Client satisfaction with completed treatment will be examined across the two conditions. The cost per client of GSH verses IC will be compared, particularly in light of any findings about the relative effectiveness of these methods of intervention.

In the guided self-help condition, a 12-week CBT programme (comprised of a handbook of selected readings from popular self help manuals with structured homework exercises, plus weekly group therapy, plus three one-to-one counselling sessions spaced over the duration of the course) is offered to newly assessed clients who meet criteria for Step Two therapy. About one in three of these clients opts not to do GSH even though (due to its relatively efficient use of resources) it offers more timely intervention than IC. Clients usually opt for IC over GSH for one of two reasons: either they are not free the evening the group therapy is offered; or they find the idea of joining a therapy group strongly aversive.

A shortcoming of this study is the non-randomized allocation of clients to the two treatment conditions. This is an artefact of the study taking place in a live clinic condition where an effort is made to provide treatment choice. Another is that the waiting list control group will be small as most clients with mild to moderate illness are waiting less than 12 weeks after assessment to start treatment.

This study is undertaken with supervision from The Counselling Studies Department at the School of Education, University of Manchester. It will be finished in Spring 2010 and enquires about its results are welcomed.

A measure of control: an exploration of the meaning of self-induced vomiting to clients with eating disorders.

by Deborah Withers, University of Wolverhampton, September 2008

Abstract

This study involved analysis of the transcripts of three participants who purge by vomiting in the context of an eating disorder. The aim was to explore the meaning of the lived experience of this form of purging. Interpretative Phenomenological Analysis was applied to the primary data from which the following four themes emerged: 1) Gaining and losing control; 2) Focussing on process and measurement; 3) Experiencing conflict and 4) Connectedness. Implications for eating disorder related therapy and training were discussed in light of the emerging themes. Suggestions for further research were made particularly in relation to the apparent need for more effective treatments.

The therapeutic relationship from an attachment theory perspective

by Marina Christina Skourteli, University of Manchester, December 2007.

Abstract

This study examined the notion of the therapist as an attachment figure and the relationship between client adult attachment in close relationships and client attachment to the therapist. Participants (clients in ongoing therapy) were asked to complete measures of adult attachment in close relationships and client attachment to their therapists. In addition, participants were interviewed with regard to their perceptions of their therapist and their therapeutic relationship. Results indicated strong support for the notion that therapists serve as attachment figures for their clients. Further, there was some evidence suggesting that client adult attachment orientation may be activated or re-enacted within the therapeutic relationship and in particular with regard the ways clients relate to their therapist. The importance of the therapeutic relationship and implications for the practice of counselling psychology are discussed.

The embodied self: the expression of psychological conflict through the body in clients with eating disorders

by Heather Sacco, University of Manchester, 2006.

Abstract

This study examined whether, and what kind, of mind-body connection was made by people with eating disorders. 'Mind/body connection' as used in this study meant the connections the participants made between their thoughts, feelings and bodies and the meaning or interpretations they made of their experiences. Four participants were interviewed and Interpretative Phenomenological Analysis (IPA) was used to analyse the data. The literature search spanned several domains: somatisation (Helman, 2002; Kirmayer & Young, 1998), eating disorders literature (Bruch, 1988; Orbach, 2006; Gilbert, 2002; Duker & Slade, 1994) psychology and the body (Stevens, 1997, 1999; MacSween, 1996; Kempen, 1998). Four mail findings were: 1) strong negative feelings and events before or around onset of the eating disorder; 2) a new, negative self-consciousness that developed after a shaming or shunning incident; 3) a circular pattern of mind affecting body and body affecting mind; 4) 'positive' aspects of the eating disorder - what it did for participants. Crucial elements of recovery were: developing a self-identity and keeping their bodies physically strong; and the ability to make meaning of their experiences. Most of the findings of this study corresponded with existing literature. A number of areas for further research were identified.

Counsellors' conceptualisation of humour in the counselling relationship

Jenny Ferguson, University of Manchester, 2009

Abstract

A review of the literature reveals discussion of the (largely anecdotal) uses and misuses of humour in the counselling relationship. Attempts to prove the effectiveness of humorous interventions in counselling relationships are lacking in methodological rigour. There is little research on counsellors' experience of the use of humour in their work. Consequently this study aimed to explore how counsellors encountered the experience and their reflections on the subject. Semi-structured interviews were conducted with eight qualified counsellors (five female, three male). Participants described their views on the development of their personal sense of humour, their experience of humour in practice and their concepts of the effects (if any) on the counselling relationship. The results were analysed using Interpretative Phenomenological Analysis. Five themes emerged from the analysis of the transcripts: 1) Humour as an active technique; 2)Experiencing the encounter of humour; 3) Evolving dynamics; 4) Therapist use of self; and 5) Perception of clients' use of humour. The findings are discussed with reference to existing literature, and extrapolated to include the notion of relational depth (Mearns & Cooper 2005). It is suggested that humorous interactions can play a role in facilitating and enriching the counsellor / client relationship, incorporating the values of 'acceptance' and 'congruence'. A precarious and subjective dimension emerges regarding the appropriateness of the use of humour in the counselling relationship, which argues for a broader understanding within the counselling community. Future research suggestions and implications for training and professional practice are also discussed.