Recommendations for improving the responsiveness of private practitioners are provided, with an emphasis on enhancing clinical training and increasing the availability and accessibility of mental health resources.

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This study is the 1st to explore specific therapeutic techniques clinicians find helpful in establishing and maintaining alliance with adolescents with eating disorders. Data was collected from 107 experienced therapists (M years ϭ 16) currently treating an eatingdisordered adolescent. Therapists held degrees in various disciplines in mental health (MA, MS, MSW, MHC, PhD, PsyD) or in medicine (MD), who came from various theoretical orientations (cognitive-behavioral [CB] ϭ 46.7%, psychodynamic ϭ 13.1%, interpersonal ϭ 13.1%, family ϭ 7.5%, humanistic ϭ 3.7%, and other ϭ 15.9%). Therapists rated the utility of various psychodynamicϪinterpersonal, CB, and adjunctive eating disorder interventions, as well as their alliance with that patient. The majority of the patients (N ϭ 107) reported on were female (n ϭ 102) and diagnosed with anorexia (n ϭ 70), bulimia (n ϭ 14), binge eating (n ϭ 9), or other specified feeding or eating disorders (n ϭ 14). Therapists reported a constellation of integrative treatment interventions related to alliance. Specifically, a forward stepwise regression yielded a final, 7-step model predicting therapist alliance (R ϭ .704, r 2 ϭ .495), F(102) ϭ 4.599, p ϭ .035. The final regression model revealed specific items from each treatment approach to be significantly related to alliance, with the most important item being an in-session focus on the therapeutic relationship. Findings highlight how an integrative model of treatment interventions, with emphasis on the focus of the therapistϪpatient relationship in session, might be explored in future work to help facilitate the alliance in the treatment of adolescents with eating disorders.

Eating disorders (EDs) are historically complex to treat, and evidence-based recommendations for treating adolescents with EDs need to be improved. The present study is unique and distinctive as it is the first to assess therapists' report of their technique, working alliance, and countertransference with ED adolescents in relation to patient factors of childhood traumatic experiences as well as ED symptomatology. One hundred and four experienced (M ϭ 16.28 years as clinician) therapists from a variety of different theoretical orientations and disciplines currently treating an adolescent patient diagnosed with an ED for at least 8 sessions completed an online survey. These therapists completed measures of therapists' technique, alliance, and countertransference, as well as a DSM-5 ED symptom and childhood trauma questionnaire regarding their patients. Therapists reported experiencing more special/ overinvolved countertransference when the patient had greater trauma severity, specifically with patients who experienced more severe traumatic parental upheavals and had been a victim of violence. In addition, therapists used more psychodynamic interpersonal (PI) techniques when treating patients with more severe trauma histories, especially when they were victim to a major parental upheaval, childhood sexual abuse, and serious injury. PI was also significantly related to total ED symptoms, and most specifically with bulimia nervosa and binge ED symptoms. Despite these findings, there was a lack of significance for therapist alliance with ED symptom or trauma variables. Overall, these findings highlight how therapist treatment process may be related to aspects of trauma history and symptomatology when treating an adolescent with an ED. Public Significance StatementThe present study suggests that therapists report using psychodynamic-interpersonal techniques and feeling special/overinvolved countertransference with eating disordered adolescents who have a severe childhood trauma history. These findings highlight the importance of being aware of special countertransference and the utility of psychodynamic-interpersonal techniques, both of which were also related to greater therapeutic alliance, when working with eating disordered adolescent patients who have a more severe trauma history.

This study examined the use of therapeutic skills by different, well-known experts in psychology who have published extensively on the treatment of borderline personality disorder to ascertain areas of technique similarity, difference, and integration. Initial videotaped sessions from these expert therapists working with the same patient were independently rated, using an established measure, on cognitivebehavioral and psychodynamic-interpersonal techniques by 6 trained clinicians. These raters also independently identified what they believed were the most clinically significant segments of each session. The 6 raters demonstrated excellent levels of reliability. Results of this empirically based comparative process analysis suggest significant similarity, integration, and common focus across these 7 expert therapists in the specific techniques they used and in the themes and issues explored during the most clinically significant segments. All therapists took an active stance in exploring areas of clinical focus and initiating topics of discussion in this first meeting. Therapists tended to focus on the patient's pattern of romantic relationships ending abruptly and his lack of understanding why they ended, or his role in them ending. Almost all these segments included the therapist providing the patient with an alternative way to understand his experiences not previously recognized. Moreover, several of the therapists tended to both explore his irrational thoughts (e.g., all-or-nothing thinking, being incomplete without a partner) and relate perceptions of these relationships (e.g., being a victim, minimizing his anger/violence) to his interpersonal difficulties. Likewise, therapists often used the information gained from this process to provide psychoeducation regarding treatment approach and rationale. Finally, therapists would often return to key specific themes and issues that were clinically significant within the session in order to further explore and work through their meaning with the patient. Clinical Impact StatementQuestion: How do expert therapists from various theoretical orientations approach treatment of borderline personality disorder? What are the differences and commonalities, and are they integrative? Findings: Several techniques may be helpful in the treatment of borderline personality disorder, such as taking an active stance and initiating clinical focus as well as offering alternative perspectives to understand experiences not previously recognized and exploring irrational thoughts. Meaning: Across the various theoretical orientations, there were many similarities across the work of the expert therapists, suggesting the clinical utility of integration when treating borderline personality disorder. Next Steps: Future steps include examining how integrative and traditional therapies differ at the level of technique with various types of patients at different points across the treatment process.

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