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Title: Client non-disclosure in treatment for eating disorders and its relationship with current symptoms : the roles of shame, the therapeutic alliance,and therapist self-disclosure
Author: Spokes, Naomi
Awarding Body: University of Surrey
Current Institution: University of Surrey
Date of Award: 2012
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Background Opinion is divided with regards to the extent to which client disclosure in therapy advantages clients. Furthermore, inconsistent research findings suggest the ease with which an individual discloses is a function of multiple influences. Objectives To explore the relationship between client non-disclosure in therapy and current eating disorder (ED) symptoms in individuals who had received treatment for an EO. A second aim was to investigate factors facilitating and inhibiting client self- disclosure; in particular client shame, the therapeutic alliance, and therapist self- disclosure. Method Participants (n=120) completed an online survey comprising questionnaires and open-ended questions assessing ED symptoms, shame-proneness, non-disclosure in therapy, perceived therapist disclosure, and the therapeutic alliance. Results Shame and the therapeutic alliance were significantly related to current ED symptoms (r=.46 and r= -.19 respectively) and total client non-disclosure (r=.41 and r= -.43 respectively). Total client non-disclosure was significantly related to current ED symptoms (r=.31) and fully mediated the relationship between the therapeutic alliance and current ED symptoms. Client non-disclosure did not mediate the relationship between shame and current ED symptoms. Only therapist disclosure of 'negative feelings towards a client' was significantly related to client non-disclosure (r=.28). This relationship was partially mediated by the therapeutic alliance. Thematic analysis of open-ended questions revealed substantial variability across participants regarding the perceived helpfulness of therapist disclosure and the overall factors perceived to facilitate and inhibit client self-disclosure. Conclusions The hypothesised model whereby client non-disclosure mediated the relationship between the therapeutic alliance and current ED symptoms was supported. Furthermore, the therapeutic alliance partially mediated the relationship between therapist disclosure of negative feelings towards a client and client non- disclosure. Results suggest the strength of the therapeutic relationship, influenced by therapist disclosure, has important implications for a client's willingness to disclose and current ED symptoms.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Psych.D) Qualification Level: Doctoral
EThOS ID:  DOI: Not available