Therapist Factors Related to the Treatment of Adolescent Eating Disorders

Eating disorders (EDs) are historically complex to treat, and evidence-based recommendations for treating adolescents with EDs need to be improved. The present study is unique and distinctive as it is the first to assess therapists' report of their technique, working alliance, and countertransference with ED adolescents in relation to patient factors of childhood traumatic experiences as well as ED symptomatology. One hundred and four experienced (M = 16.28 years as clinician) therapists from a variety of different theoretical orientations and disciplines currently treating an adolescent patient diagnosed with an ED for at least 8 sessions completed an online survey. These therapists completed measures of therapists' technique, alliance, and countertransference, as well as a DSM-5 ED symptom and childhood trauma questionnaire regarding their patients. Therapists reported experiencing more special/overinvolved countertransference when the patient had greater trauma severity, specifically with patients who experienced more severe traumatic parental upheavals and had been a victim of violence. In addition, therapists used more psychodynamic interpersonal (PI) techniques when treating patients with more severe trauma histories, especially when they were victim to a major parental upheaval, childhood sexual abuse, and serious injury. PI was also significantly related to total ED symptoms, and most specifically with bulimia nervosa and binge ED symptoms. Despite these findings, there was a lack of significance for therapist alliance with ED symptom or trauma variables. Overall, these findings highlight how therapist treatment process may be related to aspects of trauma history and symptomatology when treating an adolescent with an ED. Public Significance Statement The present study suggests that therapists report using psychodynamic-interpersonal techniques and feeling special/overinvolved countertransference with eating disordered adolescents who have a severe childhood trauma history. These findings highlight the importance of being aware of special countertransference and the utility of psychodynamic-interpersonal techniques, both of which were also related to greater therapeutic alliance, when working with eating disordered adolescent patients who have a more severe trauma history.