Table 4 Treatment needs from the wisdom of SE-AN experience

The therapist sees the person:

▪ as a unique individual

▪ outside the illness

▪ without preconceptions of how AN is for them

▪ struggling to find value in themselves and their life

Therapeutic Relationship

▪ allows time to build trust

▪ recognises relational struggles

▪ instils trust in self-efficacy, helps me to trust myself

▪ accepts me for who I am, especially the bits I ‘disown’ and see as unacceptable

▪ provides security with a boundary of treatment non-negotiables that prioritise my safety, and includes me in the process

▪ recognises that food may be a literal manifestation of being starved, a red herring

Treatment

▪ Helps me to understand my illness before I am expected to give it up

▪ Recognises that my illness really works for me and is the best way I know how to survive^a

▪ Recognises my illness is compatible with the low value I place on myself^a

▪ Helps me to build meaning about what AN is in my life

▪ Allows space in treatment, to address my unique concerns beyond the treatment manual

▪ offers me choices and maximises my autonomy so I can build my own self-efficacy

▪ Measures me not by my weight

▪ Allows me the freedom to create the terms for my life

▪ Helps me to connect to all aspects of my being and offers a variety of treatment adjuncts

▪ If I need to go to hospital, offers me emotional support as well. Recognising when I am terrified and that I may have past trauma from previous admissions too

▪ Recognises the broader context of living with SE-AN, including;

 - Judgement and misunderstanding of my illness

 - Being enslaved to AN, it is the ‘master’

 - Appreciation of my profound losses to SE-AN

 - Helps me to make peace with my life I have made alongside AN

 - Offers me the care that I need in line with my stage of my illness. I’m not an adolescent