Teoría de la equidad

This research study gained ethical approval from the LMU Ethics Review Panel and an NHS REC. It was also approved by Beat. I was then able to recruit participants through Beat’s website and volunteer database.

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The research advertisement and the participant information sheet explained that participants could withdraw their consent at any point up to or during the interview and that after the interview they would have four weeks to withdraw their consent. Debriefing took place at the end of each interview to ensure that the participants had understood their rights regarding withdrawing from the study.

3.9.2 Confidentiality.

In line with the recommendations by the BPS (2009), participants’ right to confidentiality were respected throughout the study. Participants were informed of their rights both verbally before the interview commenced and in writing on the participant information sheet. This included reassuring participants that their anonymity was protected in any verbal or written reports or presentations from the project, including any direct quotations from the interview. This was done by removing any identifying data from the transcripts and providing each participant with a pseudonym. The original interview data were kept securely in accordance with the Data Protection Act 1998 and any forms containing personal information, interview recordings and transcripts were held separately from each other in locked filing cabinets.

3.9.3 Potential distress.

The topic of this research study was considered sensitive under the guidance of the BPS guidelines on human research (2014), as it was likely to involve more than a minimal degree of risk to participants due to potentially causing discomfort, stress or psychological harm to the participants. This was also in line with the recommendations provided by the NHS REC applications telephone support service. A distress protocol was utilised to ensure that any participant discomfort or distress was addressed appropriately.

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CHAPTER 4: ANALYSIS 4.1 Overview

This chapter presents the findings of this study in detail. The results were derived from four semi-structured interviews. Three master themes and nine subordinate themes were identified. They are presented in Table 2. All four master themes and seven of the subordinate themes were present in each interview. These are presented in Table 2. The themes will be expanded into narrative form in the chapter. The original transcript for Sarah (Participant 3) is located in Appendix XVI, a sample of the analysed transcript in Appendix XVII, and the individual themes in Appendix XVIII.

The themes and the narrative offer one possible account of how women experience CBT for bulimia and it is recognised that the account is subjective to the researcher. There were considerable similarities and differences between the participants’ accounts and these are reflected in the material presented in each theme.

Short utterance, such as ‘um’ were removed from the transcripts unless they were considered to be important to the process of interpretation. Empty square brackets indicate that some material of the original transcript has been omitted. Square brackets containing a description refer to non-verbal gestures and communications. Three dots signify a brief pause.

The concept of ‘control’ and concerns regarding its loss and maintenance were central to all the women taking part in the study. They occurred at various points of the interview and the analysis in relation to other people, their eating difficulties and the therapy experience, for example. Temporally these concerns seemed to have a consistent presence in these women’s lives from the early beginnings of their difficulties until the present day. During the analytical process, and arranging and rearranging of the themes, the concept of control was broken into smaller segments: master themes and consequent subthemes. Although not all themes explicitly discuss and name control, it is notable that the shadow of the concept was present throughout the process. The analysis begins by presenting ‘Loss of control’ as the first master theme. The latter themes, namely ‘Staying on the surface’ and ‘Holding onto power’ relate to the various actions that the women seemed to take to avoid losing control, and the impact of this on them.

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Theme

Quote Frequency

of

Subtheme Loss of Control Reaching a Crisis

Point

“And he said, he said “You’ve got to, you’ve got to go.” I told him I was being sick and that was when he said “If you don’t tell someone, I will.”” (Amber, 27-28)

All

participants

Rejection “And ‘cause they were saying “Well, you don’t meet the criteria, you don’t have an eating disorder, because you might be making yourself sick ten times a day, but you’re not, like, you’re not whatever size.”” (Laura, 80- 82)

All

participants

Exposure “As soon as she saw that I was allowing myself to be more relaxed or exposed, she would like bore into the whole, like tear it open [participant laughs] to try and get me to be less kind of constructed and less kind of whole, I suppose, and more kind of fluid in my approach to the sessions, ‘cause I think I’m quite like business-like about therapy, ‘cause it’s very intimidating.” (Emma, 1000-1006)

All

participants

Staying on the Surface

Rational Therapy “It wouldn’t require me to talk about... like my childhood or you know, she made it sound very practical. And that it deals kind of really with what you’re doing right now and how to stop it, I guess. As opposed to... you know, looking back and kind of why I’d got here. I think, y-y-you know, she explained there would be certain amount of that, but not to the extent that the psychotherapy. And that had freaked me out.” (Sarah, 284-289)

All

participants

Keeping Others Happy

“I was just worried that the treatment would stop and I wouldn’t have support anymore, because I knew how hard it was to get support in the first place. So I was just worried that it would come across that I was non-compliant and I would get discharged.” (Laura, 584- 586) Laura, Sarah, Amber The Core Remains Untouched

“I’m always scared to lose weight, because I’m scared to get obsessed again. [ ]I’ve been on hundreds of diets over the years, properly done Slimming World, Weight Watchers, that kind of stuff. But the problem is I get fully obsessed and I, I get, I get competitive, [ ] and I, I know it’s just under surface. You know, it’s like it’s just like scratching the surface.” (Sarah, 660-664)

Emma, Laura, Sarah

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Power

Hiding “Neither to my GP, nor to my psychiatrist, nor to my therapist did I ever mention food. But I knew that I wasn’t mentioning it. It wasn’t a kind of a, it wasn’t an issue and therefore it didn’t come up. I, I decided it was something that I didn’t want to have to. And I think that was part of the, I really didn’t wanna have to have an eating disorder.” (Emma, 615-621)

All

participants

Letting Others in – The Therapy Relationship

“The lady, she was younger, so she was closer to my age so more kind of relatable as well. [ ] She, she was more like a friend, whereas the second one had a much more kind of dominant… position over me. [ ] Like a sort of teacher or parent sort of thing. Whereas my first one, she was like sitting with a friend and telling her about it.” (Amber, 439-443)

All

participants

Loss of a Safe Place, Struggling to Hold on

“I found it quite terrifying at the time, to be honest. Just because I wasn’t expecting it, I guess. And she said that you know, I mean we’d been thinking about things anyway and I felt as though I hadn’t had that conversation with her. Like I hadn’t been thinking about ending things with her, like I hadn’t been thinking that things were gonna end, because we hadn’t spoken about things been going to end.” (Laura, 744-748)

All

participants