How do adolescents with bulimia nervosa rate the acceptability and therapeutic relationship in family‐based treatment?

Abstract

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

The Role of the Therapeutic Alliance in Eating Disorder Treatment Outcomes: A Systematic Review

“…For example, one study determined that early weight gain in adults with anorexia nervosa enhanced the development of alliance (Brown et al, Downloaded by [University of Otago] at 09:57 24 July 2015 2013), while another found that reductions in urges to restrict eating behaviors both predicted, and were predicted by, a stronger therapeutic alliance (Tasca & Lampard, 2012). The high rates of treatment retention and high ratings of alliance in family-based treatment for adolescents also suggest that an early focus on symptom reduction does not necessarily hinder development of the therapeutic alliance (Pereira et al, 2006;Zaitsoff et al, 2008). It may be that when individuals are able to make changes to their symptoms, they view their therapist as more trustworthy and helpful.…”

“…Despite the fact that the two studies noted above on adult treatment for bulimia nervosa assessed alliance over 19 sessions of treatment, one study assessed early alliance at session 6 (Loeb et al, 2005), whereas the other study measured the same construct at session 4 (Constantino et al, 2005). Assessments of alliance are similarly heterogeneous in studies involving family based treatment for adolescent eating disorders, with measurements of early, middle, and late alliance taking place between sessions 1 to 9, 7 to 13, and 4 to 27, respectively (Isserlin & Couturier, 2012;Pereira et al, 2006;Zaitsoff et al, 2008). These discrepancies in timing of alliance assessment mimics alliance research in non-eating disorder populations (Elvins & Green, 2008;Horvath, Del Re, Fluckiger, & Symonds, 2011).…”

“…With respect to research on the alliance-outcome association for adolescent bulimia nervosa, one study was identified (Zaitsoff, Doyle, Hoste, & le Grange, 2008). Zaitsoff and colleagues (2008) found that reductions in binge and purge behaviors over the course of treatment were not related to alliance in adolescents receiving family-based treatment for bulimia nervosa.…”

Driven exercise among treatment-seeking youth with eating disorders

“…Scores on the EDE have demonstrated high test-retest reliability (Grilo, Masheb, Lozano-Blanco & Barry, 2003; Rizvi, Peterson, Crow, & Agras, 2000) and interrater reliability (Grilo, Masheb, Lozano-Blanco & Barry, 2003). The EDE has been utilized in multiple studies of pediatric samples with diagnoses of AN, BN, or EDNOS (Eddy, Celio Doyle, Rienecke Hoste, Herzog, & Le Grange, 2008; Hoste & Le Grange, 2008). …”

Family-based treatment is overvalued: reply to Lock and Le Grange

“…It is also important that FBT stresses the importance of building a therapeutic relationship with both the adolescent and the family as a whole (Krautter & Lock, 2004). Data collected in several studies suggest that FBT is successful in achieving therapeutic alliances with both patients and parents (Zaitsoff, Doyle, Hostee, & Le Grange, 2008) (Forsberg et al, 2013;Isserlan & Couturier, 2012;Krautter & Lock, 2004;Pereria, Lock, & Oggins, 2006). At the same time, studies suggest that a good therapeutic alliance alone is insufficient to lead to a good outcome or to the maintenance of a good therapeutic alliance (Pereria et al, 2006).…”