Patient interpersonal factors and the therapeutic alliance in two treatments for bulimia nervosa

Constantino, Michael J.; Smith-Hansen, Lotte

doi:10.1080/10503300802183702

Cited by 59 publications

(65 citation statements)

References 55 publications

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“…For example, there is some evidence that the therapeutic alliance grows slightly more across the course of interpersonal psychotherapy than across the course of CBT for bulimia nervosa. 41 The time point in therapy where the alliance is measured also has clinical relevance. 19 For example, a deterioration in the working alliance is associated with drop-out from therapy for anorexia nervosa, while a longer-term increase in that alliance is associated with completing the treatment.…”

Section: Discussionmentioning

confidence: 99%

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

Waller

Evans

Stringer

2011

Intl J Eating Disorders

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Objective: 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.Method: 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.Results: 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.Discussion: 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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Section: Discussionmentioning

confidence: 99%

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

Waller

Evans

Stringer

2011

Intl J Eating Disorders

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“…When aligned with the defined patient and therapist roles, friendly-submissive patient behaviors can complement friendly-dominant therapist behavior and foster a good therapeutic alliance, whereas hostile-dominant patient behaviors are likely to be perceived by the therapist as mismatching the patient role (Kiesler, 1983;Kiesler & Watkins, 1989;Renner et al, 2012;Tracey, 1993). Accordingly in most studies, friendlysubmissive patient problems reported at intake related to a better therapeutic alliance (Constantino & Smith-Hansen, 2008;Muran, Segal, Samstag, & Crawford, 1994;Puschner, Bauer, Horowitz, & Kordy, 2005), whereas hostile-dominant problems predicted poorer relationship ratings (Connolly Gibbons et al, 2009;Muran et al, 1994;Puschner et al, 2005). More generally, high patient friendliness indicated a good therapeutic alliance and patient coldness a worse relationship, whereas too dominant interpersonal problems showed heterogeneous or even no association with the therapeutic alliance in these studies (e.g., Dinger, Strack, Leichsenring, & Schauenburg, 2007;Hersoug, Monsen, Havik, & Høglend, 2002).…”

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confidence: 90%

Interpersonal differentiation within depression diagnosis: Relating interpersonal subgroups to symptom load and the quality of the early therapeutic alliance

Holtforth

Altenstein

Krieger

et al. 2013

Psychotherapy Research

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We examined interpersonal problems in psychotherapy outpatients with a principal diagnosis of a depressive disorder in routine care (n=361). These patients were compared to a normative non-clinical sample and to outpatients with other principal diagnoses (n=959). Furthermore, these patients were statistically assigned to interpersonally defined subgroups that were compared regarding symptoms and the quality of the early alliance. The sample of depressive patients reported higher levels of interpersonal problems than the normative sample and the sample of outpatients without a principal diagnosis of depression. Latent Class Analysis identified eight distinct interpersonal subgroups, which differed regarding self-reported symptom load and the quality of the early alliance. However, therapists' alliance ratings did not differentiate between the groups. This interpersonal differentiation within the group of patients with a principal diagnosis of depression may add to a personalized psychotherapy based on interpersonal profiles.

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“…Moreover, IIP-C general distress factor has been associated with poor working alliance (Constantino and Smith-Hansen, 2008), whereas interpersonal problems in the friendly-submissive domain (i.e., low agency, high communion) have been associated with better alliance (Constantino and Smith-Hansen, 2008; Muran et al, 1994; Puschner et al, 2005). In contrast, Paivio & Bahr (1998) found that the IIP-C octant scales social avoidance and non-assertiveness, reflecting low agency and high communion, related negatively to working alliance.…”

Section: Introductionmentioning

confidence: 99%

Interpersonal problems as predictors of therapeutic alliance and symptom improvement in cognitive therapy for depression

Renner

Jarrett

Vittengl

et al. 2012

Journal of Affective Disorders

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Background The degree to which interpersonal problems of depressed patients improve over the course of cognitive therapy (CT) and relate to the quality of the therapeutic alliance and to symptom improvement, remain unclear. Methods We analyzed data of adult outpatients (N = 523) with major depressive disorder participating in a clinical trial to determine the factor structure of the Inventory of Interpersonal Problems-Circumplex (IIP-C) and to relate the observed factor scores to the quality of the therapeutic alliance and symptom improvement over the course of CT. Patients received 16–20 sessions protocol (50–60 minutes each) of individual CT according to the treatment manual by Beck et al. (1979). Results We found a three-factor structure (interpersonal distress, agency, and communion) of interpersonal problems. Interpersonal distress decreased (d = .90), but interpersonal style did not change substantively during CT (communion d = .03; agency d = .14). High initial agency scores related negatively to the therapeutic alliance (β = −.12), whereas high initial communion scores related positively to the therapeutic alliance (β = .15). Elevated pre-treatment interpersonal distress scores were related to both weaker therapeutic alliances (β = .13) and higher symptom levels throughout treatment (β = .10). Limitations All patients in this study had recurrent MDD and it is therefore uncertain whether the results would generalize to patients with other psychiatric disorders. Conclusions This study supports the use of the IIP-C as a comprehensive measure of patients' interpersonal style and interpersonal distress. The IIP-C measured before CT showed some predictive validity with respect to therapeutic alliance measured at the midpoint and therapy outcome. The clinical importance of these findings is discussed.

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Patient interpersonal factors and the therapeutic alliance in two treatments for bulimia nervosa

Cited by 59 publications

References 55 publications

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

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

Interpersonal differentiation within depression diagnosis: Relating interpersonal subgroups to symptom load and the quality of the early therapeutic alliance

Interpersonal problems as predictors of therapeutic alliance and symptom improvement in cognitive therapy for depression

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