UCL Psychology and Language Sciences


How does Externalisation of Anorexia Nervosa help, or hinder recovery?

How does Externalisation of Anorexia Nervosa help, or hinder recovery? A qualitative interview study with individuals who have received NICE-recommended psychological treatment for Anorexia Nervosa (DClinPsy thesis; Sophie Cripps, Matthew Pugh)


Externalisation, which consists in making the “problem” a separate entity, external to the individual, is an intervention used in NICE recommended psychological treatments for anorexia nervosa (AN). It is an attitude taken by the client and family that is stimulated by the therapist. While research suggests that externalisation can be helpful (Lock, Epston &  Maisel, 2004), clinical observations are that they can also be counter-therapeutic when used ineffectively. Consequently, externalisation in treatment for AN can have the opposite effects to those intended by the founder of this technique, Michael White (e.g. White, 1988/89; McMahon, 2020).

Aims and method

There is a paucity of research exploring how externalisation can help and hinder the recovery process from the perspective of people who have experienced AN. The aim of this study is to explore people’s experiences of externalisation in treatment for AN to learn how the approach can help and hinder recovery. 10-15 semi-structured interviews will be conducted with individuals above the age of 16 who have completed at least one course of NICE recommended psychological therapy for AN. This research will provide the eating disorders field with important information regarding how best to use externalisation to support recovery from disordered eating.

Research questions

This research does not have a specific hypothesis, but rather aims to generate rich and descriptive insights into people’s experiences of externalisation in relation to recovery from AN. Dominant patterns in participant accounts of externalisation will be identified in a reflexive thematic analysis (Braun & Clarke, 2020). The derived themes will explain how
externalisation can help and hinder recovery.

Our broader research question is:

  • How does externalisation help and hinder people’s recovery from anorexia nervosa?

Under this umbrella, we are interested in exploring the following:

  • How does externalisation effect people’s experiences of treatment for anorexia nervosa?

  • How does externalisation of anorexia nervosa effect peoples’ relationships with sources of support, such as their therapist(s) and wider treatment team, families, and carers?

  • What language/ metaphors are used to externalise anorexia nervosa? What aspects of language/ metaphor are helpful or hindering?

  • What role does externalisation play in relapse and people’s ability to stay well after recovering from AN?