Rescripting: A Grounded Theory study of the contribution that fathers make to Family Based Treatment when a young person has anorexia nervosa

Abstract

Anorexia nervosa (AN) is a serious eating disorder that most commonly develops during adolescence. Across Scotland, child and adolescent mental health (CAMH) clinicians have been trained in the delivery of manualised Family Based Treatment (FBT) for AN. FBT is an approach that requires the involvement of all family members. The limited evidence available is indicative of fathers initially attending FBT but disengaging during the treatment process. Parental alignment and empowerment have been associated with improved treatment outcomes. As such the absence of fathers during the treatment process represents cause for concern. The aim of this study was to develop an understanding of the experience of fathers and the contribution that they made to FBT when a young person had anorexia nervosa. Grounded Theory was chosen because it is a valuable methodology where little is known about an area of human experience and because it supports the development of a substantive theory. Fifteen fathers with previous involvement in FBT took part in individual interviews. Data was collected and analysed simultaneously, utilising the process of constant comparative analysis. Field notes and memos informed and guided the construction and generation of analytic categories from the data. Four categories emerged from the data: Being on the Outside, Finding a Way In, Finding a Way to Be and Finding a Way to Let Go. The core category of Repositioning reflects the way that FBT changes the father’s position within the family. The substantive theory of Rescripting describes how fathers, in the context of AN in the family, redefine themselves and their role for the duration of FBT; it identifies the challenges fathers face within this new and different role. This study addresses a gap in knowledge regarding the paternal experience of and contribution to FBT. It informs CAMH clinicians practice in relation to supporting and involving fathers in treatment.