Making recovery conceivable: perspectives from healthcare professionals using psychologically and behaviourally informed approaches to chronic fatigue syndrome

Purpose Healthcare professionals (HCPs) treating patients with chronic fatigue syndrome (CFS) work within a contested field marked by uncertainty. This study explored how HCPs using psychologically and behaviourally informed approaches to CFS understood therapeutic change and their role in facilitating recovery.Methods We used reflexive thematic analysis of two focus groups and three individual interviews with 16 HCPs from five professions, purposively sampled across clinical settings. Participants had at least two years’ experience working with patients with CFS and represented diverse therapeutic and theoretical perspectives.Results The analysis was organised around four interrelated themes: (1) meeting patients in a “no-man’s-land”, (2) offering a new explanatory “map”, (3) navigating by the map, and (4) maintaining trust in a contested field. HCPs described offering frameworks integrating biological, psychological, and social processes. Two overlapping orientations emphasised either stress, overload, and impaired regulation or maladaptive learning, perception, and self-sustaining symptom processes. Across orientations, validation and fostering agency were central. Embodied experiences of improvement were considered important for strengthening trust and confidence that change was possible. Competing illness narratives challenged trust.Conclusions Participating HCPs described explanatory frameworks, their application in practice, therapeutic relationships, and patients’ embodied experiences of improvement as interacting to make recovery conceivable.