Learning Objective
After reading this article, you should be able to...
Analyze the impact of the therapeutic alliance on outcomes in Interpersonal Psychotherapy (IPT) for adolescent girls with loss-of-control (LOC) eating.

REVIEW OF: Ruzicka EB et al, Am J Psychother 2024;77:7-14.
STUDY TYPE: Randomized double-blind controlled trial

Background
Interpersonal Psychotherapy (IPT) has shown promise in preventing excessive weight gain and mitigating eating disorders among adolescents. This study delves into the role of the therapeutic alliance—emotional connections and task collaboration between therapists and participants—in enhancing the efficacy of IPT for adolescent girls experiencing loss-of-control (LOC) eating. LOC eating, characterized by episodes where one feels unable to stop eating, is recognized in the DSM-5 as a significant component of binge-eating disorder and bulimia nervosa, predicting the development of these disorders.

Research Methodology
Over the course of a year, researchers randomly assigned 113 girls aged 12-17 to either IPT (55) or health education (HE) (58). All had BMIs between the 75th and 97th percentiles and had experienced at least one LOC eating episode in the previous month. Participants were strategically paired with therapists to ensure that each group received comparable levels of time, attention, and expertise. The IPT program, adapted from established protocols for depression and binge eating, included 12 weekly sessions of 90 minutes each. The HE program avoided any discussions that linked emotional or social issues with eating behaviors. After the first and twelfth sessions, researchers measured how well the adolescents connected emotionally with their therapists.

Results
The analysis found that when IPT participants felt closer to their therapists, they experienced a reduction (-0.34 kg/m^2) in BMI and no change in the number of LOC eating incidents. Conversely, in the HE group, feeling closer to a therapist was associated with an increase (+1.31 kg/m^2) in BMI and 0.66 more episodes of LOC eating.

An unexpected finding of the study was that higher task collaboration was linked to increased BMI across both groups. “Task collaboration” refers to the extent to which the therapist and client agree on and are engaged in the therapeutic activities aimed at reaching the treatment goals. The mixed results suggest that while task collaboration typically supports therapeutic goals, its role in weight-related outcomes needs further exploration.

CARLAT TAKE
The bottom line is that improved bonding with an IPT therapist may improves outcomes in eating disorders—which makes sense, given that IPT explicity focuses on interpersonal relationships. However, closer bonding with teachers in a didactic health education setting seemed to be counterproductive. Perhaps those participants who bonded more with their teachers were hoping for more emotional support than they could receive in that setting. For therapists, the message may be that you should foster the therapeutic alliance only when you are prepared to actually use that alliance productively in your therapeutic work.

Reference 
Ruzicka, E. B., Shomaker, L. B., Pyle, L., Bakalar, J. L., Shank, L. M., Crosby, R. D., Wilfley, D. E., Young, J. F., Sbrocco, T., Brady, S. M., Gulley, L. D., Yanovski, J. A., & Tanofsky-Kraff, M. (2024). Effects of Therapeutic Alliance in Interpersonal Psychotherapy Among Adolescent Girls With Loss-of-Control Eating. American journal of psychotherapy, 77(1), 7–14. https://doi.org/10.1176/appi.psychotherapy.20230011