Rudi Dallos

Disgust and eating disorders

Two studies are described which investigated the relationship between disgust sensitivity and eating disorders. In a normal sample, Study 1 found a significant correlation between measures of eating disorder and measures of disgust sensitivity, but only in female subjects. This relationship was not mediated by existing levels of anxiety or depression. Study 2 found that subjects who had clinically-diagnosed eating disorders exhibited significantly higher levels of disgust than matched normal control subjects. Both studies indicated that elevated disgust in relation to eating disorders appeared to be confined primarily to disgust of food, the body and body products, and did not extend to disgusting stimuli which are not associated with food or the body.

Attachment Research and Eating Disorders: A Review of the Literature

The aim of this article is to review the clinical literature which examines the association between attachment patterns and eating disorders with a focus on anorexia nervosa, and to examine the varieties of methods and measures employed in attachment research. A literature review was carried out and the relevant articles are examined in terms of their contribution to this area. The literature indicates a number of important considerations when working with this group, including extreme separation anxiety and unresolved loss and trauma, and discusses the implications of these findings for treatment. The results also indicate conflicting evidence regarding associations between attachment style and eating disorder subgroup suggesting that severity of disorder matters more than eating disorder subtype. The different ways of investigating attachment patterns and experiences are explored in this paper. It is suggested that the attachment classification system runs the risk of reducing complex human experience to typologies and that qualitative research might help to address this problem.

Children's and Adolescent's Views on Family Therapy

Family therapy has made a considerable contribution to our understanding of the experiences of children and families and especially how various symptoms can be understood as their response to distressing family dynamics. Though family therapy has found ways of alleviating children’s distress we still know relatively little about how children experience the process of family therapy. Such knowledge is important for ethical as well as pragmatic reasons – to be able to offer a more sensitive and effective experience. This paper reports a study employing qualitative methods whereby children were interviewed about their experience of family therapy. Semi-structured interviews were conducted after family therapy sessions, and children were invited to recall what they perceived to be helpful and unhelpful. Helpful events or moments were then identified and replayed on the videotape of the sessions to assist children’s memory. The results suggest a diversity of experiences according to the children’s ages, gender and role in the family. Some common assumptions were challenged by the findings, for example, that some children preferred more directive and focused aspects of the therapy, rather than systemic questions which could inspire feelings of confusion and inadequacy.

All in the family: integrating attachment and family systems theories.

This article brings together ideas from attachment and systemic family therapy. There is both growing interest among systemic practitioners in the conceptual and empirical base of attachment theory and also the need for attachment theory to expand dyadic patterning to include its context in family functioning. We propose the Dynamic-Maturational Model (DMM) as being the most compatible and useful variant of attachment theory. With its emphasis on the functional nature of behavior, a dynamic view of development and change, and a focus on multiple attachments and representational systems, the DMM fits systemic concepts well. We propose that many apparent discrepancies between the theories will disappear if careful distinctions are made between observed behavior, functional explanations, and attributions. We conclude with theory-based recommendations for selecting treatment strategies. Several case examples that are theory based, counterintuitive, and tied to disorders that are difficult to treat are offered to give substance to our ideas.

Attachment and adolescent depression: The impact of early attachment experiences

Abstract Bowlbys (1969/1982) ideas of attachment as an interactional system provide the basis for an understanding of the development of adaptive and maladaptive working models of the self and other. More specifically, attachment theory can offer an in-depth understanding into the development of a depressotypic self-schema. Attachment theory is set alongside research into adolescent depression in order to illustrate the importance of the primary attachment relationship in protecting adolescents in our society from developing depressive symptomatology. Therefore, current research in adolescent depression is viewed through the lens of attachment theory. This view is complemented by an exploration of the role of culture in the production of gender differences in depression. Thus, a tripartite model of adolescent depression, including the individual, family relationships, and socio-cultural factors is offered as being of potential value for clinicians and researchers in this area.

The experience of the impact of divorce on sibling relationships: A qualitative study

This article examines the impact of divorce on relationships between siblings. It is argued that despite the massive number of children who go through this experience few studies have invited children to talk about their experiences. An exploratory qualitative study is reported with eight young women who talk about the effects of the divorce of their parents on their relationships with their siblings. The study employed a form of interpretative theme analysis and used sociograms to illustrate perceived changes in family and sibling relationships. Three metathemes emerged: changes over time, emotional impacts of the divorce and systemic processes. Overall, the findings indicated that siblings experienced increased closeness as a result of the shared experience of going through the divorce of their parents together. The young women also reported turning to each other for support as a result of the emotional unavailability of their parents during the divorce. Some implications for clinical practice are discussed, especially working together with siblings as well as with their families.

Abandoning our parents and grandparents: does social construction mean the end of systemic family therapy?

This paper explores how ideas from first- and second-order cybernetics may be incorporated into the contemporary interest in social constructionist perspectives. We argue that it is possible to contemplate a third-order cybernetics which incorporates ideas from systems theory and social constructionism and that this may capture the reality of the ‘hands-on’ integration of ideas that many practitioners are currently exploring. A framework consisting of eight connecting threads is proposed as a way of helping us to clarify the continuities and discontinuities between the original and contemporary ideas. It is argued that this is an important and potentially useful endeavour, since many practitioners use a mixture of ideas and techniques in an eclectic way but are wary of potential criticisms of being ‘linear’, ‘expert’, ‘manipulative’ and ‘non-collaborative’. A case study is offered to illustrate a ‘hands-on’ integration of contemporary and pioneering ideas and to invite discussion of how concepts and techniques from first- , second- and the new ‘third-order’ cybernetics influenced by social constructionism might be further integrated.

Young People’s Experience of Mentoring: Building Trust and Attachments:

The study was conducted in the context of PROMISE - a voluntary scheme, in the southwest of England which provides mentors for a young person for a period of up to 2 years. Predominantly these youngsters had experienced a range of difficulties in their lives including periods in care, severe problems in their families, trouble with the police and mental health problems. Each young person is allocated a mentor who has regular contact with them offering activities, support and informal counselling. Although the general response to the scheme has been positive it was felt that there was a gap of understanding about how the young people experienced the scheme. An exploratory qualitative study was commissioned to explore how a sample of the young people, who had been involved in the mentoring scheme for a substantial period, experienced the process of mentoring. The study involved interviews with six young people and group discussions with mentors and staff. Generally, the experience was reported by the young people to be highly favourable with the development of a positive, consistent, available, trusting and caring relationship cited as key ingredients. These findings were supported by discussion with the mentors. The study suggests that attachment theory is helpful in explaining the mentoring process and in promoting ideas for future developments.

The Meaning and Impact of Head and Neck Cancer: An Interpretative Phenomenological and Repertory Grid Analysis

This study explores the personal meaning of head and neck cancer for individuals, with particular reference to the impact on the self. It employs interpretative phenomenological and repertory grid analysis with 10 people, all of whom have undergone surgical treatment for head and ceck cancer. Four themes emerged: namely, destruction of self, altered relations with the body, disenfranchised self, and conservation of self. Repertory grid analysis validated and enriched understanding of these findings. Participants described how head and neck cancer inflicted a fundamental attack on their sense of self. Nonetheless, participants were dynamic in their self-management and detailed an active process to retain a positive sense of self.

Young people's stories of self-harm: a narrative study.

This study explores the way in which adolescents who have engaged in self-harm make sense of their self-harm and its relationship to the events that have occurred in their lives. The six adolescents (aged between 13 and 18 years) who had been engaging in self-harm were invited to tell their life stories. The analysis explored both the content and the structure of these narratives in order to identify what they regarded to be key events in their lives and also what appeared to have been defended and less fully integrated features of their lives. A primary finding was that the adolescents perceive a severe lack of understanding from others about self-harm, which appeared to inhibit them from developing coherent narratives. They also found it difficult to discuss and integrate the difficulties behind their self-harm, giving narratives that were poorly integrated with little true resolution. One prominent story shared by this group was a story of self–harm as a way of directing their anger inwards. The findings highlight the importance for adolescents of access to conversations where difficult past events can be processed and understood within the context of a life story, and the implications for identity formation.