Patients' characteristics and the quality of the therapeutic alliance in family‐based treatment and individual therapy for adolescents with anorexia nervosa

Abstract

This study examines the relationship between patients' characteristics and the therapeutic alliance in family-based therapy (FBT) and adolescent focused therapy (AFT) for adolescents with anorexia nervosa (AN). Independent observers rated audiotapes of therapy sessions using the working alliance inventory-observer version (WAI-o). Patients' characteristics examined to predict the development of the therapeutic alliance included their socioeconomic characteristics, markers of eating disorder psychopathology and expectancy of their treatment. Baseline scores on the eating disorder examination (EDE) were positively correlated with the alliance early in treatment in FBT but no patients' characteristics were correlated with the alliance in AFT. EDE was a moderator of alliance, with higher baseline EDE scores predicting higher alliance scores in the FBT group than in the AFT group. The results suggest that the therapeutic alliance can be successfully developed with adolescents with AN, even those initially reporting high levels of symptomatology. Adolescents' acknowledgement of their symptoms may be an important factor in their ability to develop an alliance with the therapist.Practitioner points • Despite common clinical impressions, it is possible to form a strong therapeutic alliance with adolescents with AN in both family and individual therapy. • Adolescents' own reports and perceptions of their eating disorder may be an important factor in their ability to build the therapeutic alliance. • Clinical strategies hypothesized to promote a strong therapeutic alliance include the externalization of AN, decreasing blame and a focus on adolescent developmental issues.

Telehealth Cognitive Behavior Therapy for Co‐Occurring Insomnia and Depression Symptoms in Older Adults

“…Overall and subscale WAI‐O scores were comparable to those typically obtained in other clinical trials (LoTempio et al., ). The total score for early session alliance was mean ( M ) = 182.0 (standard deviation [ SD] = 10.7) and late session alliance was M = 175.8 ( SD = 28.4).…”

Just One More Bite: A Qualitative Analysis of the Family Meal in Family‐based Treatment for Anorexia Nervosa

“…Moreover, the parents and therapists may have placed greater value on challenging the AN during the family meal given these patients' heightened illness severity. LoTempio et al () found that EDE scores at baseline were positively associated with the therapeutic alliance at session four of Maudsley FBT. The authors suggested that higher EDE scores could represent a greater acknowledgement of symptoms and an increased willingness to obtain help, which may contribute to patient–therapist collaboration during treatment.…”

Thematic review of family therapy journals in 2013

“…There was a special issue of the Journal of Family Therapy (volume 35, issue supplement 1) on adolescent eating disorders with a review of the evidence base (Downs and Blow, ) and articles on the therapeutic alliance (LoTempio et al . ), multiple family therapy (Hollesen et al . ; Mehl et al .…”

“…There was a special issue of the Journal of Family Therapy (volume 35, issue supplement 1) on adolescent eating disorders with a review of the evidence base (Downs and Blow, 2013) and articles on the therapeutic alliance (LoTempio et al 2013), multiple family therapy (Hollesen et al 2013;Mehl et al 2013), a family admission programme (Wallis et al 2013) and a day hospital programme (Girz et al 2013). These articles highlight the value of family therapy in the treatment of adolescent eating disorders.…”