title: The therapeutic alliance in the early part of cognitive-behavioral therapy for the eating disorders.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Vincent Square Eating Disorders Clinic, Central and North West London NHS Foundation Trust, London, United Kingdom. glenn.waller@kcl.ac.uk
authors.forename: Glenn
authors.initials: G
authors.lastname: Waller
authors.forename: Jane
authors.initials: J
authors.lastname: Evans
authors.forename: Hannah
authors.initials: H
authors.lastname: Stringer
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy; D003299:Cooperative Behavior; D001068:Feeding and Eating Disorders / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D011369:Professional-Patient Relations; D014167:Transference, Psychology