Exploring how counselling psychologists and clinical psychologists work therapeutically with patients who fit the criteria for “other specified feeding and eating disorder”
: A reflexive thematic analysis

  • Samantha Russell

Student thesis: PsychD


This study investigates how humanistic counselling psychologists and clinical psychologists practice their therapeutic work with patients who meet the criteria for the diagnosis of other specified feeding or eating disorder (OSFED). Eight humanistic counselling and clinical psychologists were interviewed and the data analysed using reflexive thematic analysis. The findings suggest that practitioners face complex negotiations and power dynamics when working with patients who may fit the criteria for OSFED. Practitioners balance evidence-based practice with their professional experience in service of their patients while managing the expectations of the medical model.
The study highlights five themes related to the experiences of counselling and clinical psychologists working with patients who fit the criteria for OSFED. The first theme emphasises the problematic but powerful nature of the OSFED diagnosis, with concerns expressed about its use in therapy and negotiating its meaning between individualised and standardised care. The second theme focuses on how practitioners negotiate working within the medical system, including minimising damage, escaping, and relying on luck. The third theme discusses the power of the work setting on practitioners' therapeutic decisions. The fourth theme emphasises the situated integration of theory, evidence, and practice-based knowledge in providing therapy. The fifth theme explores how therapists redefine "success" in their therapeutic practices. The study's implications suggest a need for additional exploration and understanding of the OSFED diagnosis and the importance of practitioner input to its development. Clinical implications include the importance of practitioners being aware of the potential negative effects of using the OSFED diagnosis and to be prepared to negotiate its use and meanings with patients in therapy. This highlights the pressures on practitioners to effectively navigate the impact of the work environment and healthcare system on their therapeutic practice.
Date of Award12 Dec 2024
Original languageEnglish
Awarding Institution
  • University of Roehampton
SupervisorPaul Dickerson (Director of Studies) & Lottie Rowe (Co-Supervisor)


  • psychotherapist experiences
  • clinical judgment
  • reflexive thematic analysis
  • therapist behaviours
  • therapist practices
  • medical model
  • system demands

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