CP Research Corner: Therapeutic Alliance and Treatment Outcome

A meta-analysis of the relationship between therapeutic alliance and treatment outcome in eating disorders

While the therapeutic alliance has long been identified as an important factor in favorable psychotherapeutic outcomes, the effects of the therapeutic alliance relative to the presence of early symptom change in ED treatment remains undefined. The relationship between early alliance formation and early symptom reduction may be moderated by factors such as the age of the client, patient diagnosis, and type of therapeutic intervention (behavioral vs. non-behavioral).

In addition to these moderators, clinicians question the extent to which a quality alliance may result from versus promote the observed change. In a research review published in the International Journal of Eating Disorders in 2016, twenty studies were reviewed that examine this very relationship. Results demonstrated that “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 non-behaviorally oriented treatments.” Interestingly, further analyses of the aforementioned moderators supported the role of early alliance in predicting later symptom-change for individual-focused therapies (e.g., IPT, FBT) and multiple therapies; but not for CBT. Read more here.



Graves TA, Tabri N, Thompson-Brenner H., Franko DL, Eddy KT, Bourion-Bedes S, Brown A, Constantino MJ, Fluckiger C, Forsberg S, Isserlin L, Couturier J, Paulson, Karlsson G, Mander J, Teufel M, Mitchell JE, Crosby RD, Prestano C, Satir DA, Simpson S, Sly R, Lacey JH, Stiles-Shields C,Tasca GA, Waller G, Zaitsoff SL,Rienecke R, Le Grange D,Thomas JJ. A meta-analysis of the relation between therapeutic alliance and treatment outcome in eating disorders. Int J Eat Disord. 2017;00:000–000. doi:10.1002/eat.22672.