Academic journal article Indo - Pacific Journal of Phenomenology

An Interpretative Phenomenological Analysis of Schema Modes in a Single Case of Anorexia Nervosa: Part 2: Coping Modes, Healthy Adult Mode, Superordinate Themes, and Implications for Research and Practice

Academic journal article Indo - Pacific Journal of Phenomenology

An Interpretative Phenomenological Analysis of Schema Modes in a Single Case of Anorexia Nervosa: Part 2: Coping Modes, Healthy Adult Mode, Superordinate Themes, and Implications for Research and Practice

Article excerpt

This is the second of a sequence of two papers that examine the schema modes of Linda (20), who had presented with anorexia nervosa and major depression, based on the interpretative phenomenological analysis (IPA) of transcripts of several sessions of psychotherapy. This paper presents the analysis of Linda's Coping and Healthy Adult modes, and also examines superordinate themes that reflect the nature of, and the relationship between, modes. It concludes with an examination of the implications for further research and clinical practice.

Linda's Coping Modes

Linda's coping modes were congruent with the three categories used in schema therapy: overcompensatory, avoidant, and surrender (Farrell, Reiss, & Shaw, 2015; Young, Klosko, & Weishaar, 2003), as defined in Part I of this case study (Edwards, 2017).

Overcompensatory Coping

The Anorexic Overcontroller

Notably prominent was an overcompensatory Anorexic Overcontroller (A-OC) mode in which Linda's main focus was on losing weight and enforcing on herself detailed rules about her diet. Exercising rigid control over management of her body mass and eating offered Linda a sense of stability and control that was in marked contrast to the experience of her Vulnerable Child (VCh), which it effectively shut down. The A-OC is vividly portrayed in two images. The first is the scale on which she and her cousin weighed themselves in the dream reported in S28 (see Part I). "It was a little black scale", she said, "and then it just turned into ... a computery thing ... with like blue lights". A voice announced her body mass and gave instructions about which parts of her body were too fat and needed to be reduced. The complex system of rules, instructions and processes portrayed here is implicit in a second image that Linda experienced in S30. Asked to picture her Healthy Adult (HA) side and the A-OC, she saw the A-OC as a woman who "is thin, and always scowling and frowning and with long fingers able to pinpoint, and... scolding and - sometimes she even has a whip. And she's often dressed in black, with high heels... and very professional and classy,... like a polished look but untouchable".

Linda was aware that this "dictator side" had developed in childhood to cope with her "fear of not doing stuff right and getting into trouble all the time and getting scolded". Initially its focus was on doing everything perfectly and in an orderly manner - a Perfectionist Overcontroller (PerfOC) (Lobbestael, van Vreeswijk, & Arntz, 2007). However, particularly after she was diagnosed with diabetes, it had developed the specialized focus on body mass and weight loss to become the AOC. This had not replaced the broader perfectionism: in session 40 she described how, in times of stress, both these aspects are activated: "Sometimes during exams I almost kick into like this restricting type frame of mind or want to have my life so ordered ...".

Drawing on these images, the A-OC can be seen to be a complex, multifaceted system. Its first feature is the promise of a happier life. This is made explicit in S30, where, after describing the classy woman dressed in black, Linda says, "She says that if you look ... thin and if you can get everything under control and be strict enough on yourself, then you will be pretty or beautiful or acceptable ... [and] you will have more fun and ... other people will want to spend more time with you ...". A further benefit is made explicit in S40: "Your life will be more controlled and more disciplined and you will be a success". The second feature follows from this: Linda's set of private rules about goal weight and what she is permitted to eat, and a third feature, her consequent impulse to restrict her eating in order to lose weight. In S30, she mentions how this "side of me that wants to lose weight" leads her to ignore the diet given her in hospital. In S33, although her body mass is equivalent to a BMI of 22.6, she says, "I don't want to be that weight. …

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