Exploring Therapists Reflective Experiences of Working with British Ethnic Minorities with Eating Disorders

Research highlights that ethnic minority females are less likely to receive a diagnosis or treatment for an eating disorder (ED). The other half of the therapeutic alliance is therapists, and their role and input should not be understated when aiming for positive outcomes for this group. This research explores therapists perspectives in terms of their experiences; what working with this group means to the therapists themselves; and their experience of working with cultural concepts.
Semi-structured interviews were conducted with 12 therapists in the UK, London and thematic analysis was used to analyse the data. Shame was often cited as a barrier to accessing help. This had different influences on their therapeutic work, such as not questioning shame or linking this to a negative interpretation of parents. There was also the concept that ethnic minorities were more likely to present with emotional and interpersonal factors fuelling the ED, although this conflicted with the notion of the Western body ideal being an influence. Participants also revealed a feeling of being restricted by service management, having a limited time to reflect on cultural issues, and the worry about being offensive or doing something wrong.
Subtle steps can be taken to encourage new and creative ways of addressing the issues highlighted. Services and guidelines should support therapists through regular reflective practice on cultural issues. Hierarchy in teams could be addressed by encouraging diversity in decision making. To break down the perceived barrier of shame, the use of cultural genograms and cultural scripts could be encouraged to understand the ED context. Referral guides could be developed to inform primary care of the warning signs of EDs that may not feature in the diagnostic criteria. Recommendations should aim to balance the nuances of the individual, alongside a systematic rollout to address unmet needs.