Table 3 Themes and sample quotations based on written feedback

Treatment aspects

 1.Use of manual

  Positive (n = 10)

M3 “Many of the exercises that we went through in the sessions made me really think about why I felt and acted the way I did and what I really want from life.”

  Negative (n = 2)

M23 “I found the workbook didn’t help me as I wasn’t learning anything new.”

 2.Treatment focus

  Positive (n = 4)

M19 “Not too focused on solely the eating disorder per se, but on the many different factors/difficulties that encourage and maintain the eating problems (and other difficulties).”

  Negative (n = 2)

M43 “Did not find it that helpful. I did not feel that [the therapist] dealt with either the root of the problem, why I lack confidence, or how to deal with it.”

Treatment outcomes and recovery

 1.Positive outcomes

  Effect on understanding AN symptoms and their impact on behavior (n = 8)

M16 “[The treatment] was great in helping me to see it as a disease with symptoms as opposed to something wrong with me as a person.”

M32 “I feel that the therapy has given me a much greater understanding of why I keep this illness and what the illness gives me. I strongly believe that I needed this insight to be able to work on recovery.”

  Effect on feelings and thought processes (n = 13)

M7 “I found it beneficial as I was able to start to question the [anorexic] voices and thoughts I had regarding food – whereas before I was unable to challenge them and simply accepted them as fact.”

M41 “By no means have I completely let go of anorexia but I’ve taken so many more steps than I felt capable of before. I have reappraised myself, my eating, and my illness and feel more hopeful than I have in years.”

  Effect on eating habits and weight (n = 7)

M3 “The food plans we made also helped me to learn how to eat normally and I now rarely worry about what I eat.”

M33 “I think strategies… help me to manage my anxiousness around food and have increased my self-management of my food intake.”

  Effect on communication (n = 3)

M1 “[Expressing my feelings to others] has been really beneficial as I can tell people when I am struggling, instead of letting the eating disorder do the talking.”

 2.Negative outcomes (n = 1)

M24 “I do not feel [the therapy] has necessarily AIDED recovery.”

 3.Stage of recovery (n = 9)

M25 “I still have my fears about gaining weight, weighing myself and find it very difficult to change. Maybe I was/am expecting too much and there is no magic/instant cure or solution to my problems with ED.”

M42 “I consider myself to be almost completely recovered at this point and very excited about moving forward.”

Treatment aspects

 1.Lack of structure

  Positive (n = 1)

S34 “I was pleased to have been given the freedom and time to find a lot of answers and strength for myself, but having the security of monitoring and treatment behind me.”

  Negative (n = 2)

S23 “I did not feel like there was a secure plan in place for that there were set goals or targets, which I would have found helpful.”

S33 “Didn’t like the unstructured approach of SSCM, would have preferred more tailored one like MANTRA to ensure lots of aspects of anorexia… were covered.”

 2.Focus on Nutrition

  Positive (n = 1)

S9 “We talked a lot about food and meal plans and provided me with all the material to work out what I needed to eat and open my eyes to what healthy eating and nutrients really mean.”

  Negative (n = 4)

S11 “The fact that I got weighed each week terrified me… [The therapist] started talking about 2500 calorie diet, this is when I said no I can’t do it.”

S31 “I also found the therapy too focused on food (encouragement to eat) as opposed to exploring feeling and behaviors. I would have liked to explore why I do this to myself. I am still struggling to understand this.”

Treatment outcomes and recovery

 1.Positive outcomes

  Effect on understanding AN symptoms and their impact on behavior (n = 4)

S7 “I do feel that the therapy has given me a better foundation and understanding of my behavior to work from.”

S31 “During the therapy I became aware of my issues and realized that most of my physical problems are due to the same issue.”

  Effect on feelings and thought processes (n = 1)

S26 “I hope it has set me up with the right mental tools to be able to analyze situations better (both related and unrelated to food).”

  Effect on eating habits and weight (n = 2)

S27 “I still have a lot of negative eating disordered thoughts but I’m at a healthy weight so I suppose that is a positive.”

  Effect on communication (n = 2)

S30 “Felt that I could be very open and honest even when I knew what I was feeling or saying would expose my underlying desire to keep my eating disorder.”

 2.Negative outcomes (n = 2)

S1 “Anything new I have tried I have not tried more than once or made a permanent part of my diet… And sometimes I feel I say or agree to things just to please my therapist.”

S33 “Ended up being admitted as an inpatient due to low mood and then daycare treatment for [eating disorders].”

 3.Stage of recovery (n = 4)

S17 “I felt like the therapy did not get very far… I don’t know if any therapy can ever stop [the illness].”

S26 “I hope with carrying on the therapy for a bit I will be able to return to eating healthily.”

 1.Duration, frequency and disruptions of therapy (n = 11)

M12 “I do not feel that it was long enough and I have definitely regressed.”

S14 “I found it difficult to maintain changes to my diet only seeing the therapist once a week, perhaps more regular appointments would help people continue their recovery independently.”

S12 “Unfortunately, my therapist was away for quite a few weeks during my weekly sessions and this did set me back a bit, and feel I still have quite a way to go.”

 2.External social support (n = 9)

S31 “It was very useful to have my family involved in the therapy.”

S21 “I would have liked to have group sessions so I didn’t feel so abnormal about thoughts I was having.”

 3.Pacing and individualization of treatment (n = 8)

M27 “I appreciated the way it was individualized and went at the pace that suited me.”

S11 “I think a slower pace, I was not at all ready mentally to increase food.”

 4.Therapist (n = 31)

M7 “My psychologist was fantastic with me. I feel I learned a lot from her and even though I have now stopped seeing her, I still remember a lot of what we covered and can use it to continue challenging my thoughts.”

S7 “After developing a therapist/patient relationship… I was able to feel as though I could trust her advice over my thoughts.”

M48 “The therapist I was given I believe failed to deliver this treatment in an acceptable and appropriate manner.”

 5.Concerns about ending therapy (n = 9)

M44 “I notice an immediate change back to some old behaviors within two weeks of ceasing weekly sessions.”

S27 “I am scared of getting ill again.”