A meta-analysis of the relation between therapeutic alliance and treatment outcome in eating disorders.
The therapeutic alliance has demonstrated an association with favorable psychotherapeutic outcomes in the treatment of eating disorders (EDs). However, questions remain about the inter-relationships between early alliance, early symptom improvement, and treatment outcome. We conducted a meta-analysis on the relations among these constructs, and possible moderators of these relations, in psychosocial treatments for EDs. Twenty studies met inclusion criteria and supplied sufficient supplementary data. Results revealed small-to-moderate effect sizes, βs = 0.13 to 0.22 (p < .05), indicating that early symptom improvement was related to subsequent alliance quality and that alliance ratings also were related to subsequent symptom reduction. The relationship between early alliance and treatment outcome was partially accounted for by early symptom improvement. With regard to moderators, early alliance showed weaker associations with outcome in therapies with a strong behavioral component relative to nonbehavioral therapies. However, alliance showed stronger relations to outcome for younger (vs. older) patients, over and above the variance shared with early symptom improvement. In sum, early symptom reduction enhances therapeutic alliance and treatment outcome in EDs, but early alliance may require specific attention for younger patients and for those receiving nonbehaviorally oriented treatments.
Eating Disorders Clinical and Research Program (EDCRP), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States.
Tiffany A
TA
Graves
Eating Disorders Clinical and Research Program (EDCRP), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States.
Nassim
N
Tabri
Eating Disorders Clinical and Research Program (EDCRP), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States.
Heather
H
Thompson-Brenner
Eating Disorders Clinical and Research Program (EDCRP), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States.
Debra L
DL
Franko
Eating Disorders Clinical and Research Program (EDCRP), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States.
Kamryn T
KT
Eddy
Centre Hospitalier Lorquin, Lorquin, France.
Stephanie
S
Bourion-Bedes
Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, England, United Kingdom.
Amy
A
Brown
Department of Psychological and Brain Sciences, University of Massachusetts-Amherst, Amherst, Massachusetts, United States.
Michael J
MJ
Constantino
Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin, United States and Institute fur Psychologie, University of Bern, Bern, Switzerland.
Christoph
C
Flückiger
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, United States.
Sarah
S
Forsberg
Division of Child & Adolescent Psychiatry, University of Ottawa, Ottawa, Ontario, Canada.
Leanna
L
Isserlin
Pediatric Eating Disorders Program, McMaster Children's Hospital, Hamilton, Ontario, Canada.
Jennifer
J
Couturier
Anorexia-Bulimia Eating Disorder Unit, The Sahlgrenska University Hospital, Gothenburg, Sweden.
Gunilla
G
Paulson Karlsson
ZZP Center for Psychological Psychotherapy, University of Heidelberg, Heidelberg, Germany.
Johannes
J
Mander
Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany and Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, Essen, Germany.
Martin
M
Teufel
Neuropsychiatric Research Institute, Fargo, North Dakota, United States and University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, United States.
James E
JE
Mitchell
Neuropsychiatric Research Institute, Fargo, North Dakota, United States and University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, United States.
Ross D
RD
Crosby
Niccolò Cusano University, Roma, Italy.
Claudia
C
Prestano
Department of Psychiatry, University of Colorado Denver, Denver, Colorado, United States.
Dana A
DA
Satir
School of Psychology, Social Work, and Social Policy, University of South Australia, South Australia, Australia.
Susan
S
Simpson
School of Nursing Science, University of East Anglia, Norwich, Norfolk, United Kingdom.
Richard
R
Sly
Department of Health and Social Care Sciences, St. George's, University of London, London, England, United Kingdom.
J Hubert
JH
Lacey
Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine and The School of Social Service Administration, University of Chicago, Chicago, Illinois, United States.
Colleen
C
Stiles-Shields
Brain and Mind Research Institute, University of Ottawa and the Ottawa Hospital, Ottawa, Ontario, Canada.
Giorgio A
GA
Tasca
Department of Psychology, University of Sheffield, Sheffield, United Kingdom.
Glenn
G
Waller
Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada.
Shannon L
SL
Zaitsoff
The University of Michigan Comprehensive Eating Disorders Program, Ann Arbor, Michigan, United States.
Renee
R
Rienecke
Department of Psychiatry, University of California, San Francisco, California, United States.
Daniel
D
Le Grange
Eating Disorders Clinical and Research Program (EDCRP), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States.
Jennifer J
0000-0003-2601-581X
JJ
Thomas
D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003299:Cooperative Behavior; D001068:Feeding and Eating Disorders / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D011369:Professional-Patient Relations; D016896:Treatment Outcome
eating disorder; meta-analysis; therapeutic alliance; treatment outcome