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 Noah Rubinstein, LMFT, LMHC, therapist in Olympia, Washington. All Rights Reserved. Permission to publish granted to GoodTherapy.org.
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