Therapist Ratings of Technique and Alliance Among AdultsWith Eating Disorders: Support for Integrative Treatment

Abstract

The prevalence of eating disorders (EDs) has persistently increased over time, yet research on ED treatment is scarce. This study is the first to explore the relationship between specific therapeutic techniques and therapist alliance in the treatment of adult ED patients. Data were collected in 2022 via an online survey from 126 licensed therapists treating an adult with an ED. Therapists averaged 15 years of clinical experience in various theoretical orientations (e.g., cognitive–behavioral [CB] = 50%, psychodynamic= 20.6%, interpersonal = 11.1%, family systems = 7.1%, humanistic–existential = 4.8%, other = 6.3%). Therapists rated the use of CB, psychodynamic–interpersonal (PI), and adjunctive (AT) ED interventions in their treatment of, as well as their alliance with, a randomly selected patient. Patients reported on had diagnoses of anorexia (n = 55), bulimia (n = 21), binge eating (n= 24), unspecified ED (n = 5), and other specified ED (n= 20). There was a significant, positive correlation between therapists’ reported use of CB interventions and rating of therapist alliance, r(124) =.182, p=.04. Furthermore, a forward stepwise regression yielded a three-step model predicting therapist alliance, R =.400, r2 =.160, F(125) = 7.73, p,.001. This regression model revealed that psychoeducation (CB) and exploring uncomfortable emotions (PI) were positive predictors of therapist alliance, whereas simultaneous inpatient or day treatment (AT) was a negative predictor of therapist alliance. Findings highlight how specific integrative treatment interventions strengthen or weaken therapist alliance, with implications for improved treatment of adults with EDs.