The therapeutic alliance in the early part of cognitive-behavioral therapy for the eating disorders

Vincent Square Eating Disorders Clinic, Central and North West London NHS Foundation Trust, London, United Kingdom.
International Journal of Eating Disorders (Impact Factor: 3.13). 01/2012; 45(1):63-9. DOI: 10.1002/eat.20914
Source: PubMed


This study examined the strength of the therapeutic alliance in the early stages of cognitive-behavioral therapy (CBT) for the eating disorders, and whether the strength of that alliance is associated with early eating characteristics, comorbid Axis 1 and 2 features.
Forty-four eating-disordered patients completed measures of eating and Axis 1 and 2 characteristics at the start of therapy, and measures of the therapeutic alliance and eating characteristics at the sixth session of CBT.
The therapeutic alliance was strong, including in the domain of attachment. It was unrelated to initial eating pathology and early changes in eating cognitions and behaviors. However, there were links between initial emotional and interpersonal features and therapeutic alliance by the sixth session.
The findings counter suggestions that CBT for eating disorders is characterized by a poor therapeutic relationship. The therapeutic alliance is likely to be enhanced by addressing high levels of emotional distress and difficulties in interpersonal function where appropriate. This research needs to be extended to other therapies, other domains of function and different time points in therapy, to build a fuller picture of the role of the therapeutic relationship in working with the eating disorders.

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Available from: Glenn Waller, Jan 08, 2014
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    • "Therapists ' own justifications for not weighing patients include ( but are not limited to ) : a ) " It would ruin the therapeutic relationship " . This justification fails at two different levels , which clinicians should be aware of . First , patients ' perceptions of the working alliance are strong in CBT , where weight is taken routinely ( Waller , Evans , et al . , 2012 ) . Second , the assumption that the therapeutic alliance is a driver of change in the eating disorders is highly questionable ( e . g . , Brown , Mountford , & Waller , 2013 ; Raykos et al . , 2014 ) . b ) " The patient is weighed by another professional " . This is a very common excuse for not weighing the patient e that they are weig"
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    Behaviour Research and Therapy 04/2015; 70. DOI:10.1016/j.brat.2015.04.004 · 3.85 Impact Factor
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    • "A. Brown et al. / Behaviour Research and Therapy 51 (2013) 216e220 219 weakened. However, there are ways in which the current research could be strengthened, including the collection of baseline patient characteristics in order to identify factors that moderate the patient's treatment response (e.g., Lockwood, Serpell, & Waller, 2012), the use of a larger sample, and the use of more objective measures of therapeutic alliance. Notwithstanding these potential improvements, this study provides evidence that it is possible to develop a strong therapeutic alliance within CBT for anorexia nervosa, even when the clinician and patient work on the goal of weight gain from early on. "
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