Understanding change in young people using a guided self-help intervention for disordered eating

Introduction: This study aimed to explore client and guides experience and views of what factors facilitated and were barriers to change using a guided self-help (GSH) approach for disordered eating in young people.
Method: Four young people and eight Guides were interviewed following GSH treatment within child and adolescent specialist eating disorder services. Young people had prior diagnoses of anorexia nervosa and all were weight restored at the time of GSH. Semi-structured interviews based on an adapted version of the Client Change Index (CCI, Elliott, 1999) were recorded, transcribed and analysed using thematic analysis.
Results: Two main themes emerged in relation to the Guide’s experience of using GSH, the advantages of a GSH approach and considerations for treatment. The main theme for young people was that GSH offers something different.
Both young people and guides saw the Guide, the therapeutic relationship and the system around the young person as important facilitators to change. In addition, Guides mentioned readiness to change and young people described the importance of the skills and techniques of the GSH intervention.
Barriers to change for young people were fear, isolation and wanting a quick fix. For Guides barriers were around client suitability with regards to being stuck, their ED presentation, emotional vulnerability and ability to engage in GSH.
Discussion: This study suggests that the Guide and a positive therapeutic relationship are key elements in facilitating change in young people accessing GSH for eating difficulties. It highlights the importance of understanding a young person’s readiness to change before commencing treatment, the need for early intervention and the training and supervision of guides using the treatment. The findings suggest that the Working to Overcome Eating Difficulties manual is a useful intervention within specialist young people’s eating disorder services and is well received by young people and clinicians. In comparison to other treatment options such as Cognitive Behaviour Therapy (CBT) and Family therapy (FT), it offers a brief intervention that can be offered by a range of clinicians, which young people report as facilitating positive change, even with more complex difficulties such as weight restored anorexia nervosa.