The perceived influence of emotions on clinical decisions and practices in child and adolescent eating disorders

Abstract

Recently, two theoretical models (the Iatrogenic Maintenance Model for Eating Disorders and the Therapist Drift Model) have identified clinician emotion as a factor that may negatively influence the treatment of eating disorders (ED). However, the role of clinician emotion in the delivery of treatment remains largely unstudied. The present article-based thesis sought to examine clinicians’ perceptions of the negative influence of emotions (clinicians’ own emotions and those of others) on clinical decisions and practices with respect to child and adolescent eating disorders. Two studies were conducted to examine clinicians’ perceptions of whether, and in what ways, emotions play a role in clinical decisions and practices. Overall, clinicians endorsed some degree of negative influence of emotions on clinical decisions. Specific treatment decisions were identified as being perceived to be more vulnerable to the negative influence of emotions (e.g., decisions related to the involvement of a critical or dismissive parent in treatment), and particular client/parent emotional states (anger, flat affect, hopelessness or helplessness) were identified as being perceived to be more likely to lead to a negative influence of emotions on clinical decisions. Clinicians also endorsed specific concerns that they perceive to drive emotion-based decisions, as well as several emotion-driven practices. Finally, clinician characteristics related to the perceived occurrence of this phenomenon were examined. Emotional drain and work setting were factors predictive of the perception of negative emotional influence on decisions and practices. The results are discussed in terms of the implications for clinical practice and future directions.