Letters to anorexia. Narrative tools for working with anorectic patientsin a Dialogical Self context.

Abstract

Deepening understanding of the experience of patients with anorexia nervosa in the light of a narrative-constructivist approach and Dialogic Self Theory. Exploring the phenomenon of internal dialogues, which occur in patients'minds as an interchange between two competing (healthy and disordered) aspects of their Selves. Describing diagnostic and applicative possibilities of narrative stimuli in the form of "Letters to anorexia". As was assumed the process of developing/ regaining a relative detachment from the internal voice of anorexia, which itself is indicative of progressing recovery, can be both diagnosed and fostered with externalisation techniques. Developed for the purpose of the research, a categorisation tool was designed to examine two aspects: Self-positioning (positioning above and below the voice of personified anorexia) and autobiographical narrative patterns used by researched persons. Based on statistical analysis, two different groups of patients were identified: (1) with dominant below-positioning, (2) with dominant above-positioning. Using mixed quantitative-qualitative methodology (including semantic analysis), multidimensional correlations were established within the two homogeneous clusters. Postulated in the Dialogical Self context, supporting internal dialogue in patients with anorexia nervosa seems to co-exist with subsequent stages in the treatment process, which is reflected in the letters to anorexia written during therapy. Areverse correlation can also besurmised, i.e. the positiveeffectof theintentionaltherapeutictriggering of internal dialogue and narrative experience structuring using narrative stimuli such as letters. Authors provide some suggestions for further in-depth research on internal dialogues with regard to application, diagnosis, therapy, and prevention.