Integrated Therapy Provides Hope for those with Eating Disorders

Anorexia nervosa (AN) is a difficult issue to treat and many clients who begin therapy to overcome their food issues drop out before they have reached their goals. At the core of any successful therapy is the treatment alliance, the working relationship between the therapist and the client. “Researchers suggest one of the leading reasons for high drop-out in AN treatment trials is the difficulty patients with AN and therapists have in establishing a treatment alliance,” said Dana A. Satir of the Center for Anxiety and Related Disorders (CARD) at Boston University. “Higher quality treatment alliances have been consistently associated with better outcomes across different forms of psychopathology.”

Alliance Focused Treatment (AFT) is a form of Brief Relational Therapy (BRT) is one approach that may offer hope to those who suffer with AN. Because AFT focuses on the alliance between the therapist and the client, the foundation of the treatment is targeted first. To test her theory, Satir administered eight sessions of AFT, eight sessions of cognitive behavioral therapy, and eight more sessions of AFT, to a 26-year-old woman seeking treatment for AN, named Ms. O.  Satir believed that creating a strong alliance in the beginning would set the stage for Ms. O to be more open to behavioral changes later on.

After twenty-four weeks of treatment, Ms. O showed significant improvement. “Importantly, Ms. O’s BMI increased from 18.1 kg/m (i.e., underweight) during the Baseline Phase to 21.0 kg/m (i.e., normal weight), which she maintained for several weeks at the end of the study, representing a total 16% improvement in BMI,” said Satir. “This weight gain (without the development of binge eating and purging) is considered to be the crucial clinical change during early acute treatment for AN, and data suggest it is difficult for adults with AN to achieve and maintain this goal.” In addition, Ms. O was initially diagnosed with depression and no longer met the criteria for clinical levels of depression at the end of the treatment. Satir hopes these findings will be useful to clinicians treating people with eating issues and added, “This study suggests that a low-weight patient can engage in both a process-oriented psychotherapy focused on emotional avoidance, as well as a behavior-change therapy focused on food intake and weight restoration.”

Satir, Dana A., David M. Goodman, Rebecca M. Shingleton, John H. Porcerelli, Bernard S. Gorman, Elizabeth M. Pratt, David H. Barlow, and Heather Thompson-Brenner. “Alliance-focused Therapy for Anorexia Nervosa: Integrative Relational and Behavioral Change Treatments in a Single-case Experimental Design.” Psychotherapy48.4 (2011): 401-20. Print.

© Copyright 2011 by By John Smith, therapist in Bellingham, Washington. All Rights Reserved. Permission to publish granted to

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • addison


    December 28th, 2011 at 4:49 PM

    There are so many eating disordered patients who act like they don’t ever want any help at all that it is no surprise that they have a hard time establishing an alliance with a therapist. They get so combative and act like they do not want any help at all I would find it hard to even try to offer them help, even if they needed it. I do hope that you can find a way to get close to them as so many of these disorders can be deadly, but sometimes it is really hard to help someone who shows little to no interest to helping themselves.

  • Johnna


    December 29th, 2011 at 5:39 AM

    You have to find a way to relate to these low weight patients and give them ways that they can relate to you too. Coming into a session and simply spouting off ways that this is bad for your health is rarely going to do the trick. I would almost think that while the eating would have to be addressed you really have to dig deeper and discover the other things going on in that person’s life that would lead him or her to take such drastic measures with their body.

  • beth


    December 30th, 2011 at 9:11 AM

    addison:really sad to see such people.there are just so many people who cannot afford or get treatment but some others just live in denial and thereby cause themselves a lot of preventable damage.

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