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A meta-analysis of the relation between therapeutic alliance and treatment outcome in eating disorders

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Author Graves Tiffany A., Tabri Nassim, Thompson-Brenner Heather, Franko Debra L., Eddy Kamryn T., Bourion-Bedes Stephanie, Brown Amy, Constantino Michael J., Flückiger Christoph, Forsberg Sarah, Isserlin Leanna, Couturier Jennifer, Paulson Karlsson Gunilla, Mander Johannes, Teufel Martin, Mitchell James E., Crosby Ross D., Prestano Claudia, Satir Dana A., Simpson Susan, Sly Richard, Lacey J. Hubert, Stiles-Shields Colleen, Tasca Giorgio A., et al. ,
Project Design development in randomized clinical trials - Psychological treatment in generalized anxiety
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Original article (peer-reviewed)

Journal International Journal of Eating Disorders
Volume (Issue) 50(4)
Page(s) 323 - 340
Title of proceedings International Journal of Eating Disorders
DOI 10.1002/eat.v50.4

Open Access

Type of Open Access Repository (Green Open Access)


The therapeutic alliance has demonstrated an association with favorable psychotherapeutic outcomes in the treatment of eating disorders (EDs). However, questions remain about the inter‐relationships 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, βs = 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.