“I wish that I hadn't compared…my body to…theirs” : exploring female clients' experience of their female therapist's body during Anorexia Nervosa treatment : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Psychology at Massey University, Albany, New Zealand

Abstract

Anorexia nervosa (AN) is a type of mental distress with particularly high rates of treatment attrition. Given AN’s high mortality rate, identifying factors that influence treatment engagement is critical. Clients with AN are known to observe and assess body-related stimuli, paying significant attention to their own appearance as well as the bodies of those around them (Daly, 2016; Fairburn, 2008; Kaplan & Garfinkel, 1999; Lowell & Meader, 2005; Rance et al., 2014). As the therapist is a salient figure in treatment, their body is likely to be a significant part of the client’s experience. Despite this, there is little research on how clients with eating disorders experience their therapist’s body. However, existing studies suggest that clients form assumptions and judgments about their therapist’s body, which can impact their engagement in treatment. This research aims to build on this underexplored area by investigating how female clients with AN experience and make sense of their female-identifying therapist’s body during treatment. Using an interpretative phenomenological approach, semi-structured interviews were conducted with three female participants who identified as recovered and had received AN treatment in New Zealand with a female therapist. Findings revealed that the therapist’s body played a key role in the client’s treatment experience. Most notably, participants compared their bodies to their therapist’s, which created a sense of similarity or difference. This comparison, in combination with their stage of recovery, led to assumptions and judgments about their therapist that influenced their willingness to engage in treatment. Specifically, at the early stages of recovery, when their anorexia nervosa was most severe, participants interpreted body comparisons through the lens of their distress, making assumptions and judgments that reduced their willingness to engage in treatment. In contrast, participants at later stages of recovery, who were motivated to recover, formed different assumptions and judgements, fostering a greater willingness to engage. The therapeutic alliance underpinned the participants' treatment engagement, meaning that the participants’ sense of trust and feeling understood were also crucial to treatment engagement. Participants strongly recommended that therapists acknowledge and discuss their bodies with clients and adopt a transparent approach. These findings provide preliminary evidence that the therapist’s body influences the client’s experience and engagement in treatment. Therefore, therapists should consider and address these reactions to support client engagement effectively.