Beyond Measure: A Counselling Psychology approach to mental healthcare Natasha Leandra Sutherland Portfolio submitted in fulfilment of the requirements for the Professional Doctorate in Psychology (DPsych) City University London Department of Psychology October 2019 1 C2 General Table of Contents Table of Contents .................................................................................................................................... 2 List of Tables and Figures ........................................................................................................................ 6 Acknowledgements ................................................................................................................................. 7 Declaration of Powers of Discretion ........................................................................................................ 8 Introduction to The Portfolio .................................................................................................................. 9 Sections of The Portfolio ....................................................................................................................... 12 References ............................................................................................................................................. 14 PART A: Doctoral Research .................................................................................................................... 15 Abstract ................................................................................................................................................. 16 Chapter 1. Introduction ........................................................................................................................ 17 1.1 Rationale for the Study .......................................................................................................... 17 1.2 Contribution to Counselling Psychology ............................................................................... 18 1.3 Clarification of Some Key Terms ........................................................................................... 19 Chapter 2. Literature Review ................................................................................................................ 21 2.1 A Brief History of Anorexia Nervosa ...................................................................................... 21 2.2 Contemporary Anorexia Nervosa and its Diagnosis .............................................................. 22 2.3 Factors Contributing to Anorexia Nervosa ............................................................................ 24 2.3.1 Biological factors ........................................................................................................... 25 2.3.2 Psychological factors ..................................................................................................... 25 2.3.3 Environmental Factors .................................................................................................. 27 2.3.4 Sociocultural Factors ..................................................................................................... 29 2.4 Treatment of Anorexia Nervosa ............................................................................................ 31 2.4.1 Evidence-Based Treatment ........................................................................................... 32 2.4.2 Current Treatment Provision within the UK .................................................................. 35 2.4.3 Qualitative Investigations into Treatment Experiences ................................................ 37 2.5 Dropout ................................................................................................................................. 39 2.5.1 Defining Dropout ........................................................................................................... 39 2.5.1.1 Dropout as ‘Resistance’ to Change ............................................................................ 41 2.5.2 Predictors of Dropout .................................................................................................... 42 2.5.2.1 Patient Factors ........................................................................................................... 43 2.5.2.2 Treatment and Treatment-Patient Factors ............................................................... 44 2 C2 General 2.5.3 Qualitative Investigations into Dropout Experiences .................................................... 46 2.6 Summary of debates and implications for the current study ............................................... 47 Chapter 3. Methodology and Method .................................................................................................. 50 3.1 Research Aims and Research Question ................................................................................. 50 3.2 Locating the Philosophical Position of the Research............................................................. 50 3.2.1 A Qualitative Design ...................................................................................................... 52 3.2.2 Epistemological Framework and Research Paradigm ................................................... 53 3.3 An Interpretative Phenomenological Analysis ...................................................................... 55 3.3.1 Phenomenology............................................................................................................. 55 3.3.2 Hermeneutics ................................................................................................................ 57 3.3.3 IPA Characteristics ......................................................................................................... 58 3.3.4 Rationale for IPA ............................................................................................................ 58 3.3.5 Why Alternative Qualitative Methodologies Were Rejected ........................................ 59 3.3.6 Challenges and Limitations of IPA ................................................................................. 61 3.4 Method .................................................................................................................................. 61 3.4.1 Sample Selection, Size and Recruitment ....................................................................... 61 3.4.2 The Participants ............................................................................................................. 65 3.4.3 Data Collection .............................................................................................................. 67 3.4.3.1 Interview Schedule ........................................................................................................ 67 3.4.3.2 Pilot Interview ............................................................................................................... 68 3.4.3.3 Interview procedure ...................................................................................................... 68 3.4.3.4 Post-Interview Notes ..................................................................................................... 69 3.4.3.5 Transcribing the Interviews ........................................................................................... 70 3.4.4 Data Analysis ................................................................................................................. 71 3.5 Ethical Considerations ........................................................................................................... 75 3.5.1 Conception of The Study ............................................................................................... 75 3.5.2 Design and Implementation of The Study ..................................................................... 76 3.5.3 Write up of The Study ................................................................................................... 77 3.6 Quality criteria in Qualitative Research................................................................................. 77 3.7 Reflexivity .............................................................................................................................. 78 3.8 Summary ............................................................................................................................... 80 Chapter 4. Analysis ................................................................................................................................ 81 4.1 Overview of Themes .............................................................................................................. 81 4.2 Becoming ‘The Anorexic’: Identity and Belonging ................................................................ 83 4.2.1 Identity and the Anorexic Diagnosis .............................................................................. 83 4.2.2 Social Acceptance and Belonging .................................................................................. 87 3 C2 General 4.2.3 Summary........................................................................................................................ 90 4.3 More Than Meets The Eye: The Unseen Subjective Experience .......................................... 91 4.3.1 Professionals Lack Psychological Awareness ................................................................ 91 4.3.2 Standardised Symptom-Focused