Staff Representations of Recovery: Leading Eating Disorder Recovery through Example

Background and Purpose: Patient perspectives in mental health treatment are critical to the integrity of treatment effectiveness. A large body of research considers patient outcomes with focus on clinical modalities, baseline characteristics, and heavy quantitative analysis methods, but rates of recovery are inconsistent, and in particular for eating disorders (EDs), exceptionally low. Methodologies used to understand treatment effectiveness may be incomplete, missing the component of patient lived experiences. The objective of this research was to engage community members for the purpose of improving eating disorder treatment using a person-centered and bottom-up approach. Specifically, the aim was to capture the essence of patient experiences in previous ED treatments by exploring what was helpful or harmful in terms of relationships and engagements with the staff and the program.

Methods: A total of 10 participants were recruited via networking contacts from ED organizations through the researcher. Nine of the participants identified as female and one as nonbinary. Nine of the participants identified as non-Latino White and one as African American/Black. The average participant age was 41. Participants were diagnosed with a range of EDs from binge ED, anorexia nervosa, bulimia nervosa, and other feeding and EDs and attended various levels of ED treatment including residential treatment, partial hospitalization, and intensive outpatient treatment. A semi-structured interview was conducted and recorded via a secure University Zoom account that consisted of prompts such as, “Please tell me about an experience in ED treatment that you felt was helpful.” Interviews were transcribed and iterative coding was performed using heuristic phenomenological qualitative analysis with in-group/out-group perspectives from the researcher. To ensure rigor, an audit trail of the decision-making process of the methodology and step-by-step process that generated findings were checked by research colleagues and verified through member checking with participants.

Results: A meta-theme and four sub-themes emerged from the data. The meta-theme of importance of staff representations of recovery explains the critical nature of how the patients interpreted staff were modeling recovery and relationships to food and body weight during their time in treatment. Sub-themes include staff relationships with bodies, staff relationships with food, staff attitudes and interactions with clients, and staff similarities and differences to clients.

Conclusions and Implications: Engaging the community with patient-centered lived experiences in the research design may provide a missing component to understanding effective ED treatments from the patients’ view. Moreover, relationships and interactions with staff may have been overlooked in previous literature as to the importance in patients’ treatment experiences. Implications of this work are in the critical influence providers may have on their patients within treatment settings for EDs and related symptoms of mental health distress. Possible training programs of recovery oriented values and behaviors designed for providers and staff may improve patient experiences and recovery from EDs and related mental health distress. Future research is needed on the content to be included in the recovery-oriented training programs that include healthy relationships between providers and patients and to food, bodies, and weight.