目的:综合年轻人和家庭成员对神经性厌食症(AN)家庭治疗变化过程的看法,包括系统的家庭治疗和以家庭为基础的手动治疗,了解什么有助于和阻碍积极的变化。
方法:对文献进行了系统的搜索,以确定定性研究,从年轻人及其家庭的角度关注AN家庭治疗中的治疗变化经验。15项研究符合纳入标准,并接受质量评估,随后使用荟萃合成方法进行合成。
结果:产生了六个总体主题:\“全面关注年轻人的整体发展\”;\“治疗关系作为变革的载体\”;\“治疗师对脚本的限制及其对情绪调节的影响\”;\“令人沮丧的治疗背景\”;\“饮食失调的外部化(ED)\”和\”的重要性。积极的变化是由理解和支持给予年轻人的全面发展,包括他们的心理,情感,社会和身体健康,积极的治疗关系,家庭系统内的关系遏制和外化的对话,让年轻人感觉到和听到。积极的变化受到治疗方法缺乏灵活性的阻碍,外部化的反作用,治疗师的负面经历,狭隘地关注食物摄入和体重,以及对家庭困难的忽视,情感体验,和心理因素。
结论:在年轻人之间的积极关系变化的背景下,年轻人与饮食相关的困难发生了积极变化,他们的家庭成员,治疗师和治疗团队,强调安全和信任关系的重要性。ED服务可利用这项检讨的结果,考虑他们如何适应年轻人及其家庭的需求,以提高治疗满意度,治疗结果,进而降低AN慢性化的风险。
这篇综述综合了年轻人及其家庭成员对神经性厌食症(AN)家庭疗法中治疗变化的看法。包括以饮食失调为重点的家庭治疗模式(以家庭为基础的治疗;以FBT和以AN为重点的家庭治疗;FT-AN),以及系统性家庭治疗(SyFT),了解这些治疗方法的哪些方面是有帮助的,而不是阻碍从进食障碍(ED)中恢复。父母的参与对于促进恢复身体健康至关重要,因为父母对年轻人的饮食行为承担临时责任,直到他们能够再次养活自己。然而,治疗往往未能承认和解决使年轻人容易发展为AN的心理和情感困难,以及增加食物摄入量和体重引起的心理困扰。在家庭紧张和不稳定时期,家庭感到得到治疗师的良好支持的积极治疗关系对于提供遏制很重要,然而,在以ED为重点的手动家庭治疗方法中,需要更大的灵活性和个性化,尤其是FBT。研究结果强调了激发年轻人声音以增强其个人治疗能力的重要性,以及治疗空间对改善家庭功能和增强家庭团结的价值。最后,他们阐明了对以ED为重点的手动家庭治疗模型的需求,以便为治疗师提供空间,使其能够与年轻人和家庭进行情感协调,以遏制他们的痛苦经历。
OBJECTIVE: To synthesise young person and family member perspectives on processes of change in family therapy for anorexia nervosa (AN), including systemic family therapy and manualised family-based treatments, to obtain an understanding of what helps and hinders positive change.
METHODS: A systematic search of the literature was conducted to identify qualitative studies focussing on experiences of therapeutic change within family therapies for AN from the perspectives of young people and their families. Fifteen studies met inclusion criteria and underwent quality appraisal following which they were synthesised using a meta-synthesis approach.
RESULTS: Six overarching themes were generated: \"A holistic focus on the young person\'s overall development\"; \"The therapeutic relationship as a vehicle for change\"; \"The therapist\'s confinement to a script and its impact on emotional attunement\"; \"A disempowering therapeutic context\"; \"Externalisation of the eating disorder (ED)\"; and \"The importance of family involvement\". Positive change was helped by understanding and support given to the young person\'s overall development including their psychological, emotional, social and physical wellbeing, positive therapeutic relationships, relational containment within the family system and externalising conversations in which young people felt seen and heard. Positive change was hindered by inflexibility in the treatment approach, counter-effects of externalisation, negative experiences of the therapist, a narrow focus on food-intake and weight, as well as the neglect of family difficulties, emotional experiences, and psychological factors.
CONCLUSIONS: Positive change regarding the young person\'s eating-related difficulties ensued in the context of positive relational changes between the young person, their family members, the therapist and treatment team, highlighting the significance of secure and trusting relationships. The findings of this review can be utilised by ED services to consider how they may adapt to the needs of young people and their families in order to improve treatment satisfaction, treatment outcomes, and in turn reduce risk for chronicity in AN.
This review synthesises the views of young people and their family members regarding their perspectives of therapeutic change within family therapies for Anorexia Nervosa (AN), including both manualised eating disorder-focussed family therapy models (family-based treatment; FBT and AN-focussed family therapy; FT-AN), as well as systemic family therapy (SyFT), to understand which aspects of these treatment approaches are helpful versus hindering to recovery from an eating disorder (ED). Parental involvement was crucial in facilitating the restoration of physical health through the process of parents taking temporary responsibility for the young person’s eating behaviours until they can feed themselves again. However, treatment often failed to acknowledge and address the psychological and emotional difficulties that made the young person vulnerable to developing AN, as well as the psychological distress caused by increasing food-intake and weight. A positive therapeutic relationship in which families felt well supported by their therapist was important in providing containment during a time of familial strain and instability, yet there was a need for greater flexibility and individualisation within manualised ED-focussed family therapy approaches, particularly FBT. The findings highlight the importance of eliciting the young person’s voice to enhance their personal agency in treatment and the value of therapeutic space to improve family functioning and enhance family unity. Lastly, they illuminate the need for manualised ED-focussed family therapy models to allow space for the therapist to emotionally attune to young people and families in order to contain their experience of distress.