Therapist factors related to the treatment of adolescent eating disorders.

Abstract

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.

Personality Assessment Inventory Clinical Scales in Relation to Patient and Therapist Rated Alliance Early in Treatment

“…Additionally, our study’s finding that therapists rated early session alliance higher with patients reporting anxiety, specifically trauma-related stress, is also consistent with extant literature on working with patients with a trauma history. For example, in a study by Groth et al (2020) therapists reported experiencing more special and involved personal feelings with patients of greater trauma severity. In work by Reynolds et al (2017), researchers found that in a chronic, complex trauma sample, patients’ adaptive coping strategies were significant predictors of positive therapist ratings of alliance.…”

Facilitators and obstacles to therapeutic alliance among patients with anorexia nervosa: A qualitative dyadic research

“…Substantial evidence highlights the alliance–outcome association (Graves et al, 2017; Zaitsoff et al, 2015), but far less is known about factors contributing to (or hindering) the development of a strong alliance among patients with EDs (Constantino et al, 2005; Groth et al, 2020; Katznelson et al, 2020; Waller et al, 2012; Zaitsoff et al, 2008). By identifying such factors, therapists can better predict potential relationship ruptures and tailor their interventions to prevent them (Safran et al, 2011).…”

The Mediator Effect of Personality on the Relationship Between Symptomatic Impairment and Treatment Outcome in Eating Disorders

“…With respect to the latter point, future studies should evaluate more comprehensive and reliable outcome indices. Such investigations might explore changes in personality functioning, as well as the potential indirect effects of the therapeutic alliance or therapist effects on ED treatment outcome (e.g., Colli et al, 2016;Lingiardi et al, 2018;Tanzilli et al, 2018;Groth et al, 2020). Lastly, some authors (e.g., Lilenfeld et al, 2006) have noted that it is difficult to differentiate the pathoplasty model from the so-called predispositional model.…”