The lived experience of young people with obesity: A thematic synthesis, and a thematic analysis of client experiences of the therapeutic relationship in hindsight

Jefferys-Higgs, Georgina 2024. The lived experience of young people with obesity: A thematic synthesis, and a thematic analysis of client experiences of the therapeutic relationship in hindsight. ClinPsy Thesis, Cardiff University. Item availability restricted.

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Abstract

The present thesis includes two projects looking into the lived experiences of potentially vulnerable populations: a systematic review focusing on young people with obesity, and an empirical paper looking at clients’ retrospective opinions around the therapeutic relationship. Paper 1: Systematic Review The first paper attempted to synthesise the lived experiences of young people with obesity. The origin of this review topic is based largely on a personal long-standing interest in understanding and supporting those who experience obesity, and the social implications that come with it. This interest stems from previous work in an adult bariatric service, where most clients would discuss events and experiences that happened in childhood which contributed to difficulties in making health-based behavioural changes and low self-worth. There is extensive qualitative literature around the experiences of adults with obesity, which harnesses their voices to delve deeply into the nuance of their experiences, but markedly less so around youth populations, from their perspective specifically. The voices in these populations can become overshadowed by statistics and clinical outcomes, and the person behind these figures can be lost. It was my intention, with this study, to platform their perspectives on the experience of obesity; causes, consequences and everything in between, to contribute to the growing body of literature which emphasises empathy and holistic care in health and governing settings. To achieve this, scientific and medical databases were searched for applicable qualitative literature. 14 papers met the inclusion criteria, presenting the experiences of 206 young people with obesity, with a variety of locations, ages, and biological sexes represented. From these data, thematic synthesis was used to identify three overarching themes, plus subthemes, across the papers: navigating the social experience of peers, the mixed experience of adults, and the complex internal experience. With their peers, of whom respondents appeared to have limited choice about due to school settings, there was consistent discussion of bullying and exclusion, and avoidance used as a tactic to minimise this. These negative socialisations could be mitigated or buffered through having friends, however even these experiences were influenced by respondent’s weight, be it through feeling the need to construct an identity around the obesity, a fear of being vulnerable and misunderstood, or a feeling of being outside even within their social circle. Adults were often identified as acting in ways that harmed the young people, through shame, scrutiny and ‘othering’ them from healthy-weight peers, which had potential emotional, psychological and physical consequences, such as the contribution to disordered eating. Adults could also support young people with obesity, by focusing on achievements outside of their weight, and encouraging activities which they enjoyed partaking in rather than framed as weight-management. External experiences could contribute to lowered self-confidence and increased self-consciousness, and complex emotional and psychological outcomes. This could then hinder weight management, which most participants reported attempting. The findings of this review highlight how complex the experience of being a young person with obesity can be, and how psychological consequences of these experiences are entwined with the ability to engage with healthy behaviours. The clinical implications of this were explored, specifically around policy and guideline generation, and intervening with individual young people with obesity directly. Paper 2: Empirical Project The second paper is a qualitative study exploring client perspectives in retrospect around the therapeutic relationship. The therapeutic relationship is a well-explored topic, with extensive history and conceptualisation, largely generated by clinicians. Within all psychological frameworks that this author is aware of, it is considered a key aspect of the process of therapy. Through my position from the therapist chair, I became aware that feedback of working with a therapist was often very positive, and also captured directly after the final session, or in the proximity of it. Discharge from service often happens when a client has started to achieve goals or make therapeutic progress, and so feelings of positivity may be especially heightened at this time. A brief scoping review suggested that these insights were reflected in much of the literature – that the therapeutic relationship from the client perspective, rather than the clinician, was captured mid or immediately after sessions. I was interested in what these perspectives would look like after the metaphorical dust had settled, whether the therapeutic relationship would still be considered important to the whole experience, and what it was about the relationship that stuck with the client once there was ample time and space away from the sessions, if indeed any of it remained in hindsight. Semi-structured interviews were held with 14 clients, recruited through social media, who represented a variety of social demographics, psychological presentations at the point of seeking therapy, and therapeutic models accessed. The conversations identified that the therapeutic relationship, for all participants, was absolutely key for therapeutic progress, and for many the main aspect that remained of the process at all. The framework outlined in Braun and Clarke’s (2006; 2021a) Thematic Analysis was used to capture recurrent and prominent themes within these interviews. Three main themes were constructed: perceived safety as a foundation for the therapeutic relationship, the client feels deeply understood and still valued, and the therapeutic relationship enhances intervention. Participants reflected the vulnerability they felt in entering therapy, and both professional and personal attributes of the therapist helped them to feel safe and therefore more at ease. Many described feeling misunderstood or dismissed by those outside of therapy, and so the therapeutic relationship was supported, and became more healing, if the therapist took time to know the client through questioning and allowing for correction, and then accepting them regardless of what was discovered through this process. Participants here identified that the interventions tools felt more effective if they felt the therapist knew them accurately enough to tailor techniques to them and trusted the therapist to have their best interest at heart. Discussed is how these findings add nuance and depth to existing concepts of the therapeutic relationship, clinical implications, limitations of the study, and future directions for research.

Item Type:	Thesis (DClinPsy)
Date Type:	Completion
Status:	Unpublished
Schools:	Schools > Psychology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Date of First Compliant Deposit:	7 July 2025
Last Modified:	10 Jul 2025 10:46
URI:	https://orca.cardiff.ac.uk/id/eprint/179611

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