Jordan Sibeoni1,2, Laurence Verneuil2, Léa Poulmarc'h1, Massimiliano Orri3,4, Elise Jean1, Marc-Antoine Podlipski5, Priscille Gérardin5, Anne Révah-Lévy1,2. 1. Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, France. 2. ECSTRRA Team, UMR-1153, Inserm, Université de Paris, France. 3. McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Canada. 4. Bordeaux Population Health Research Center, INSERM U1219, University of Bordeaux, France. 5. Centre Hospitalier du Rouvray, Fédération Hospitalo-Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Rouen - CH du Rouvray, France.
Abstract
BACKGROUND: Therapeutic alliance is one of the most important aspects of treatment of adolescents with anorexia nervosa. Little is known about the facilitators and obstacles of its process in this situation. We aimed to explore the experience of therapeutic alliance in inpatient treatment among adolescents with anorexia nervosa, their parents and their psychiatrists. METHODS: This qualitative study, using semi-structured interviews, took place in France. Data collection by purposive sampling continued until we reached theoretical sufficiency. Data analysis was thematic. RESULTS: Forty-one participants were included, 15 teenaged girls, 18 parents and 8 psychiatrists. Analysis showed two themes: (1) what facilitates an alliance in treatment - with four facilitators: (a) human qualities, (b) an active role in the treatment, (c) taking time and (d) taking care of the entire family and (2) what impedes an alliance in treatment with four obstacles: (a) being too close or too distant, (b) focusing on weight, (c) control and constraints and (d) psychiatrization. CONCLUSION: Collaborative work between paediatricians and psychiatrists could facilitate therapeutic alliance with parents. Definition of therapeutic alliance in this situation should be enlarged to include the adolescent-parent relationship. It is necessary to construct specific items to integrate these specific aspects to existing scales.
BACKGROUND: Therapeutic alliance is one of the most important aspects of treatment of adolescents with anorexia nervosa. Little is known about the facilitators and obstacles of its process in this situation. We aimed to explore the experience of therapeutic alliance in inpatient treatment among adolescents with anorexia nervosa, their parents and their psychiatrists. METHODS: This qualitative study, using semi-structured interviews, took place in France. Data collection by purposive sampling continued until we reached theoretical sufficiency. Data analysis was thematic. RESULTS: Forty-one participants were included, 15 teenaged girls, 18 parents and 8 psychiatrists. Analysis showed two themes: (1) what facilitates an alliance in treatment - with four facilitators: (a) human qualities, (b) an active role in the treatment, (c) taking time and (d) taking care of the entire family and (2) what impedes an alliance in treatment with four obstacles: (a) being too close or too distant, (b) focusing on weight, (c) control and constraints and (d) psychiatrization. CONCLUSION: Collaborative work between paediatricians and psychiatrists could facilitate therapeutic alliance with parents. Definition of therapeutic alliance in this situation should be enlarged to include the adolescent-parent relationship. It is necessary to construct specific items to integrate these specific aspects to existing scales.
Authors: Markita Suttle; Mark W Hall; Murray M Pollack; Robert A Berg; Patrick S McQuillen; Peter M Mourani; Anil Sapru; Joseph A Carcillo; Emily Startup; Richard Holubkov; J Michael Dean; Daniel A Notterman; Kathleen L Meert Journal: Pediatr Crit Care Med Date: 2021-04-01 Impact factor: 3.971