Effects of Therapeutic Alliance in Interpersonal Psychotherapy Among Adolescent Girls With Loss-of-Control Eating

Elizabeth B. Ruzicka, Lauren B. Shomaker, Laura Pyle, Jennifer L. Bakalar, Lisa M. Shank, Ross D. Crosby, Denise E. Wilfley, Jami F. Young, Tracy Sbrocco, Sheila M. Brady, Lauren D. Gulley, Jack A. Yanovski, Marian Tanofsky-Kraff

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: Interpersonal psychotherapy (IPT) has been proposed for prevention of excess weight gain among adolescents with loss-of-control (LOC) eating. Mixed findings from a trial testing this conjecture warrant elucidation of potential outcome predictors. The therapeutic alliance (adolescent-facilitator emotional bond and task collaboration) may be important for IPT but has received little attention in weight-related interventions. This study evaluated associations of adolescent-reported therapeutic alliance during IPT with weight- and eating-related outcomes. METHODS: Secondary analyses of a randomized controlled trial were conducted to compare group IPT to health education (HE) for preventing excess weight gain among 113 girls (ages 12-17) with body mass index (BMI) at the 75th to 97th percentile and LOC eating. BMI and LOC eating were measured at baseline, 12 weeks (postintervention), and 1 year. Multilevel modeling was used to test associations between change in therapeutic alliance (from session 1 to session 12) and changes in weight- and eating-related outcomes (from postintervention to 1 year). Analyses were controlled for therapeutic alliance after session 1 and for baseline and postintervention outcome values; group assignment (IPT vs. HE) was a moderator. RESULTS: Increases in emotional bond were associated with decreased weight and with greater decreases in number of LOC eating episodes at 1 year in the IPT group (p<0.05) and with weight gain in the HE group (p<0.05). Greater task collaboration was related to greater weight gain at 1-year follow-up, regardless of group assignment (p<0.05). CONCLUSIONS: The association of therapeutic alliance during IPT with weight and LOC eating outcomes among adolescent girls merits further investigation.

Original languageEnglish
Pages (from-to)7-14
Number of pages8
JournalAmerican Journal of Psychotherapy
Issue number1
StatePublished - 15 Mar 2024
Externally publishedYes


  • Child/adolescent psychiatry
  • Depressive disorders
  • Feeding and eating disorders
  • Interpersonal psychotherapy
  • Loss of control
  • Therapeutic alliance


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