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Tuesday, 4 January 2011

More Top Tips For Eating Disorders: How Important Is The Working Alliance?

Professor Glenn Waller writing in CBT Today, December 2010 says that a good working alliance is necessary but not sufficient to bring about change in eating disorder symptoms. He says that despite the commonly held belief that this relationship is a key agent of change, the benefit attributed to the working alliance is "relatively small".
I agree. I have met hundreds if not thousands of sufferers who have not recovered despite getting along really well with their therapist. I have met people who are so good at doing therapy that they can deflect the therapist from the real work of change with all kinds of diversion tactics. If we tell a sad enough story we might even find therein reasons why we have an eating disorder but it may not really be the truth.
As a trainer I have suggested that being a good listener while being important, may sometimes deflect from the work that must be done to elicit and change the eating disorder mindset. Everyone needs to tell their story and the story must be heard - but sometimes listening must give way to questioning, guidance and teaching new skills including skills for thinking , or thinking about thinking as well. Some of the techniques of eating disorder treatment are not very person centered at all  (though they can be delivered with respect for the person who can "become").
I hope that therapists can suspend the need to be liked by their clients. The eating disorder client knows how to manipulate and sometimes wants to take a diversion from the issues that need to be faced. It is better to know the skills that eating disorders really respond to - so that respect for the therapist's competency can grow into the client's own self respect and self regard.
As Prof Waller says, there is evidence that when clients do change as a result of proper clinical practice the working alliance is enhanced, not the other way round. If you want to be liked, get a puppy. If you want to be trusted, be congruent.. If you want to help people change, know your stuff. Know nutrition, cognitive therapy, emotional resilience training, body image work, lapse prevention, when to stop listening and interrupt.The rest will follow.

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