The therapeutic alliance has demonstrated an association with favorable psychotherapeutic outcomes in the treatment of eating disorders (EDs). However, questions remain about the interrelationships 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, bs 5 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.Resumen: Objetivo: La alianza terap eutica entre paciente y terapeuta ha demostrado ser una relaci on con resultados psicoterap euticos favorables en el tratamiento de los trastornos de la conducta alimentaria (TCA). Sin embargo, quedan preguntas acerca de la inter-relaci on entre alianza temprana, mejoría temprana de síntomas y resultados del tratamiento. Hicimos un meta-an alisis de la relaci on entre estos constructos y los posibles moderadores de estas relaciones en los tratamientos psicosociales para TCA. M etodo: Veinti un estudios reunieron los criterios de inclusi on y aportaron suficientes datos suplementarios. Resultados: los resultados revelaron un efecto de la talla pequeño a moderado, b 5 0.13 a 0.22 (p < .05), encontrando que la mejoría temprana de los síntomas estuvo relacionada con la subsecuente calidad de la alianza y las calificaciones de la alianza tambi en estuvieron relacionadas con la subsecuente reducci on de los síntomas. La relaci on entre alianza temprana y resultados de tratamiento fue parcialmente explicada por la temprana mejoría de los síntomas. Con relaci on a los moderadores, la alianza temprana mostr o d ebiles asociaciones con el resultado en terapias con un fuerte componente conductual relativo a terapias no conductuales. Sin embargo, la alianza mostr o m as fuerte relaci on con los resultados para pacientes m as j ovenes (versus mayores), por encima y sobre la varianza compartida con la temprana mejoría de síntomas. Discusi on: En resumen, la reducci on temprana de los síntomas refuerza la alianza terap eutica y los resultados del tratamiento en TCA, pero la alianza temprana puede reque...

The therapeutic alliance has proven to be an important construct in psychotherapy outcomes research for numerous psychiatric disorders. Given that dropout rates from treatment are especially high for individuals with eating disorders, it is critical to clarify the role that the therapeutic alliance plays in predicting treatment outcomes for this specific population. MEDLINE, CINAHL, and PsycINFO databases were systematically reviewed for studies that formally measured the therapeutic alliance construct and at least one other treatment variable in the context of eating disorder treatment. We identified 19 studies that indicate the therapeutic alliance may be an important factor in eating disorder treatment, yet reflect on the paucity of research on this topic in the context of treatment outcomes for both adult and adolescent populations. Current trends and limitations in the literature are highlighted to guide future research and ultimately improve clinical outcomes for patients with eating disorders.

Objective: This study examined the extent to which inhibited expression of negative feelings and an interpersonal style that focuses on others' needs and expectations are related to eating disorder symptoms in adolescent females. Method: Female high school adolescents (N 235) completed the Anger Expression Scale, the Silencing the Self Scale, and measures of eating disorder symptoms, self-esteem, and psychological adjustment. Results: Adolescents with higher eating disorder symptom scores had signi®cantly higher levels of anger inhibition and silencing the self scores. In regression analyses, the Silencing the Self and Anger Expression Scales contributed statistically signi®cant unique variance to cognitive and behavioural eating disorder symptoms scores after controlling for shape-and weight-based self-esteem. A similar, though weaker, pattern of results was found after controlling for global self-esteem. Discussion: These results partially replicate relationships found between inhibited self-expression and eating disorder symptoms in adult clinical samples. Implications for the development of eating disorder symptoms are addressed.

Contrary to expectations of FBT-BN, adolescents receiving both treatments develop a strong alliance with the therapist.