The Predictive Ability of High Quality Therapeutic Alliance on Outcome for Adolescents Undergoing Treatment for Anorexia Nervosa. A Systematic Review.

Aim of Review. The therapeutic alliance stands out as a quantifiable phenomenon with a consistent effect on treatment outcome in psychotherapy. However, little is known about the predictability of high quality therapeutic... [ view full abstract ]

Aim of Review. The therapeutic alliance stands out as a quantifiable phenomenon with a consistent effect on treatment outcome in psychotherapy. However, little is known about the predictability of high quality therapeutic alliance in the treatment of adolescents with anorexia nervosa. The main aim of the study was to determine the predictive ability of high quality therapeutic alliance on improved eating pathology and weight in adolescents with anorexia nervosa to provide a scientific evidence base for or against efforts for the provision of interventions for adolescents with anorexia nervosa with a strong therapeutic alliance at the core.

Search and Review Methodology. A systematic search of pertinent databases and other resources retrieved relevant literature based on specified PEO criteria. Two independent reviewers screened the retrieved records based on predefined inclusion criteria. The selected articles were then assessed for quality of methodology, result analysis and clinical applicability using the Newcastle-Ottawa-Scale. Data were extracted from the final selected studies using a pre-defined data collection form, and their results were analysed statistically.

Findings. The findings of this review indicate that the therapeutic alliance is of importance in achieving successful treatment outcome in the treatment of adolescents with anorexia nervosa – irrespective of the treatment approach employed. However, findings also indicate that the therapeutic alliance is not sufficient on its own to achieve recovery. The review could not report conclusive findings on the main aim of the study in the format of a meta-analysis.

Conclusions and Implications. The therapeutic alliance is not sufficient on its own to achieve successful outcome, but it does contribute towards better recovery. The findings highlight a lack of homogeneity in the identified studies and therefore the need for agreement on the key concepts in this field. There is also a necessity for research to establish whether different methods to develop and maintain the therapeutic alliance depending on treatment type need to be identified. Further research is also needed in the area of how certain therapist and client characteristics can influence the development of the alliance, as well as the causal direction between symptom improvement and alliance score.