Patient baseline interpersonal problems as moderators of outcome in two psychotherapies for bulimia nervosa.

Objective: We tested an aptitude by treatment interaction; namely, whether patients' baseline interpersonal problems moderated the comparative efficacy of cognitive-behavioral therapy (CBT) vs. interpersonal psychotherapy (IPT) for bulimia nervosa (BN). Method: Data derived from a randomized-controlled trial. Patients reported on their interpersonal problems at baseline; purge frequency at baseline, midtreatment, and posttreatment; and global eating disorder severity at baseline and posttreatment. We estimated the rate of change in purge frequency across therapy, and the likelihood of attaining clinically meaningful improvement (recovery) in global eating disorder severity by posttreatment. We then tested the interpersonal problem by treatment interactions as predictors of both outcomes. Results: Patients with more baseline overly communal/friendly problems showed steeper reduction in likelihood of purging when treated with CBT vs. IPT. Patients with more problems of being under communal/cold had similar reductions in likelihood of purging across both treatments. Patients with more baseline problems of being overly agentic were more likely to recover when treated with IPT vs. CBT, whereas patients with more problems of being under agentic were more likely to recover when treated with CBT vs. IPT. Conclusions: Interpersonal problems related to communion and agency may inform treatment fit among two empirically supported therapies for BN.

Patient interpersonal factors and the therapeutic alliance in two treatments for bulimia nervosa.

Although the therapeutic alliance is robustly associated with psychotherapy outcomes, less is known about factors that influence its development. This study examined the association between baseline patient interpersonal factors and patient-rated alliance in a randomized trial comparing cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) for bulimia nervosa. Using hierarchical linear modeling, early and middle alliance were negatively associated with interpersonal distress and positively associated with interpersonal affiliation. Middle alliance was also related to treatment group interactions with rigidity, affiliation, and control. Overall, alliance growth was higher in IPT than CBT. Using group-based trajectory analysis, three divergent alliance trajectories emerged (high and improving, low and improving, and low and stable), with group mean differences between two of them in terms of interpersonal distress and hostile-submissiveness.

Preliminary results of a video-assisted psychotherapist workshop in alliance strategies.

This study examined the preliminary results of an integrative, video-assisted training workshop aimed at helping psychotherapists build strong therapeutic relationships with their clients. Participants were 57 clinicians across five community mental health clinics, who were randomly assigned to the brief alliance-training workshop (in which they participated prior to starting treatment with a new client) or to a delayed-training control condition. Outcomes assessed included therapist-reported use of alliance strategies during Session 1, therapist-rated alliance quality after Session 1, and client engagement across the first 4 weeks. In contrast to hypotheses, one-way analyses of variance and chi-square analyses revealed no statistically significant differences between the training and the delayed-training conditions. However, the therapist-reported impact of using the workshop's alliance strategies was positively correlated with therapist-rated alliance quality (r = .30, p = .03) and marginally correlated with number of sessions attended (r = .25, p = .06) across the two conditions. The findings hold promise for the utility of a brief alliance-focused workshop, and for collaborations between researchers and clinicians seeking to bridge science and practice.