An exploration of body confidence and recovery in relation to the client with an eating disorder: meaning and importance for therapeutic alliance

Rodgers, Emma R. (2015) An exploration of body confidence and recovery in relation to the client with an eating disorder: meaning and importance for therapeutic alliance. DClinPsy thesis, University of Nottingham.

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Purpose and Background

This mixed methods study explored the importance of therapist body-confidence and gender upon the Eating Disordered client and recovery. Examination of previous literature highlighted a lack of research exploring negative treatment experiences from the perspective of individuals who have an Eating Disorder. With reference to socio-cultural theoretical models, initial findings in the literature indicate that aspects of therapist appearance may be an important factor in treatment experience. The potential sensitivity of exploring therapist appearance is considered as one reason that this topic remains largely unexplored in the literature.


143 males and females with self-reported current or historical experience of an Eating Disorder completed an anonymous, online survey which was designed by the authors for the purpose of the study. Questions exploring body-confidence and recovery were analysed using Thematic Analysis incorporating Saliency Analysis. Questions pertaining to therapist gender and body-confidence were analysed using statistical tests. Rationale is provided for the epistemological stance, methodological approach and design of the current study.


Thematic Analysis revealed three overarching themes about body-confidence and three overarching themes about recovery. The body-confidence themes suggested that individuals who have an ED progress along a continuum of beliefs about body-confidence, initially believing that it is linked to body-size, before acknowledging that their Eating Disorder is unrelated to body-confidence and finally realising that body-confidence is possible regardless of size. The recovery themes indicated that individuals who have an ED go through a cycle where they feel restricted, begin to reconcile self and culture and achieve resilience on the path to recovery. Statistical analysis revealed that participants rated therapist body-confidence as highly important and showed a strong preference for a gender-same therapist. There was also some indication that participants judged the body-confidence of male and female therapists differently, although the effect size of this finding was small. The results are discussed within the context of previous literature and in keeping with the epistemological position of the current study.


These findings offer further support for the continued investigation of therapist appearance, in particular body-confidence and gender, and how it might impact upon the therapeutic experience of Eating Disordered clients. Further contribution is the addition of the perspective of individuals who have an Eating Disorder to the literature about recovery from an Eating Disorder. There are important implications for services, how they are organised and how therapists are trained to work with this population. Future research should further explore the ways in which aspects of therapist appearance impact upon therapeutic experience for Eating Disorder clients and whether there are mediating factors. Finally, the principle researcher’s critical reflection about theoretical, scientific and ethical aspects of the research process is provided.

Item Type: Thesis (University of Nottingham only) (DClinPsy)
Supervisors: Braham, Louise
De Boos, Danielle
Keywords: Therapist body confidence, Therapist gender, Eating Disorder, Recovery
Subjects: W Medicine and related subjects (NLM Classification) > WM Psychiatry
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID: 29981
Depositing User: Rodgers, Emma
Date Deposited: 20 Apr 2016 09:57
Last Modified: 15 Sep 2016 20:13

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