• eating disorders;
  • therapeutic alliance;
  • cognitive-behavioral therapy



This study examined the strength of the therapeutic alliance in the early stages of cognitive-behavioral therapy (CBT) for the eating disorders, and whether the strength of that allianceis associated with early eating characteristics, comorbid Axis 1 and 2 features.


Forty-four eating-disordered patients completed measures of eating and Axis 1 and 2 characteristics at the start of therapy, and measures of the therapeutic alliance and eating characteristics at the sixth session of CBT.


The therapeutic alliance was strong, including in the domain of attachment. It was unrelated to initial eating pathology and early changes in eating cognitions and behaviors. However, there were links between initial emotional and interpersonal features and therapeutic alliance by the sixth session.


The findings counter suggestions that CBT for eating disorders is characterized by a poor therapeutic relationship. The therapeutic alliance is likely to be enhanced by addressing high levels of emotional distress and difficulties in interpersonal function where appropriate. This research needs to be extended to other therapies, other domains of function and different time points in therapy, to build a fuller picture of the role of the therapeutic relationship in working with the eating disorders. © 2011 by Wiley Periodicals, Inc. (Int J Eat Disord 2012)