ABSTRACT
Our aim here is to consider the role of the therapeutic alliance within cognitive behaviour therapy (CBT) for treatment of eating disorders (part of the ‘how it is done’ element of therapy). It is not our intention to go into much detail regarding the technology of CBT itself (the ‘what is done’ element), as that is well detailed elsewhere (e.g. Fairburn 2008; Waller et al. 2007). However, we do provide a brief introduction to the topic, in order to make the rest of this chapter meaningful to those who work in other modalities. CBT is a psychotherapy which is based on the principle that unhealthy patterns of cognition/thinking can result in emotional, behavioural and physiological problems that will maintain the negative thinking pattern, creating a vicious cycle. For example, an individual who thinks ‘I am only worthwhile if I am slim’ is likely to feel anxious and depressed and to restrict her or his food intake, resulting in starvation. In turn, that restrictive behaviour can lead to less stable mood, more concrete beliefs about the importance of body size, and bulimic behaviours. Evidence-based approaches (e.g. Fairburn 2008) focus initially (and often mainly) on the role of these maintaining factors and how to modify them in order to escape from the eating disorder. As with CBT for other disorders, this approach to the eating disorders stresses the importance of early behavioural change (e.g. exposure to feared foods; behavioural experiments) and biological stabilization, followed by a greater emphasis on cognitive and emotional factors (e.g. cognitive challenges; surveys).
