Objective
This study examined the reciprocal relationship between alliance and symptoms during treatment for patients with eating disorders (ED).
Methods
Ninety one patients with EDs received inpatient cognitive‐behavioral therapy treatment over 14 weeks. The study used repeated measurements during treatment and collected alliance and symptom measures. The analysis separated the effects of alliance and symptoms into between‐ and within‐patient effects in a multilevel analysis.
Results
The results show a reciprocal relationship with between‐patient alliance predicting ED symptoms and between‐patient ED symptoms predicting alliance the subsequent weeks. However, for within‐patient effects only alliance predicted ED symptoms the subsequent week.
Discussion
The results nuance the effect of the alliance in this patient group, and paint a complex picture of alliance in the psychotherapy process. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:1113–1121).