Treatment failure in cognitive-behavioural therapy: Therapeutic alliance as a precondition for an adherent and competent implementation of techniques

AbstractCognitive-behavioural therapy (CBT) can be effective for anorexia nervosa. However, there is evidence that the delivery of treatments for the eating disorders is inconsistent. This study examined evidence that clinician characteristics and practice can influence the effective implementation of CBT. The participants were 100 qualified clinicians who routinely offered outpatient CBT to adults with anorexia nervosa. They completed a survey of their demographic characteristics, level of anxiety, clinical practice in CBT for anorexia nervosa, and beliefs about the relationship between weight gain and therapeutic alliance in the early part of such treatment. Greater reported levels of weight gain were associated with the use of manuals, early focus on weight gain as a target, structured eating, and a belief that weight gain precedes a good working alliance. Clinician anxiety and early focus on the therapeutic alliance rather than structured eating were associated with poorer outcomes. These conclusions need to be tested within clinical and research settings. However, they suggest that clinicians should be encouraged to use manual-based approaches when treating anorexia nervosa using CBT, as focusing on techniques might result in the best possible outcome in this early part of treatment.

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Therapeutic alliance in Enhanced Cognitive Behavioural Therapy for bulimia nervosa: Probably necessary but definitely insufficient

Behaviour Research and Therapy ◽

10.1016/j.brat.2014.04.004 ◽

2014 ◽

Vol 57 ◽

pp. 65-71 ◽

Cited By ~ 16

Author(s):

Bronwyn C. Raykos ◽

Peter M. McEvoy ◽

David Erceg-Hurn ◽

Susan M. Byrne ◽

Anthea Fursland ◽

...

Keyword(s):

Bulimia Nervosa ◽

Therapeutic Alliance ◽

Cognitive Behavioural Therapy ◽

Behavioural Therapy ◽

Cognitive Behavioural

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The Effects of Bug-in-the-Eye Supervision on Therapeutic Alliance and Therapist Competence in Cognitive-Behavioural Therapy: A Randomized Controlled Trial

Clinical Psychology & Psychotherapy ◽

10.1002/cpp.1968 ◽

2016 ◽

Vol 23 (5) ◽

pp. 386-396 ◽

Cited By ~ 14

Author(s):

Florian Weck ◽

Marion Jakob ◽

Julia M. B. Neng ◽

Volkmar Höfling ◽

Florian Grikscheit ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Therapeutic Alliance ◽

Cognitive Behavioural Therapy ◽

Controlled Trial ◽

Behavioural Therapy ◽

Therapist Competence ◽

Randomized Controlled ◽

Cognitive Behavioural

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When Cognitive Behavioural Therapy for Obsessive Compulsive Disorder Fails: Service User Perspectives

10.31234/osf.io/b7uqs ◽

2020 ◽

Author(s):

Josie Frances Adeline Millar ◽

Sarah Halligan ◽

James Gregory ◽

Paul M. Salkovskis

Keyword(s):

Treatment Failure ◽

Obsessive Compulsive Disorder ◽

Cognitive Behavioural Therapy ◽

Psychological Treatment ◽

Qualitative Interviews ◽

Behavioural Therapy ◽

Service Users ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Cognitive Behavioural

Background: Cognitive Behavioural Therapy (CBT) is an effective psychological treatment for Obsessive Compulsive Disorder (OCD), but not all service users’ benefit from treatment. The factors involved in non-optimal response have been largely examined from the perspective of therapists. The current study explored the reasons for treatment failure from the perspective of service users. Method: Twelve participants were recruited, six with OCD and six with Panic Disorder (PD), with the latter being included as a comparison group. All participants had undertaken > 2 unsuccessful courses of CBT. The Treatment History Questionnaire (THQ) was used to determine the adequacy of participants’ previous treatment. Qualitative interviews were conducted, and reflexive thematic analysis was used to analyse interview data.Results: The THQ indicated that most participants had undertaken a technically adequate previous course of CBT, meaning that inadequate therapy was unlikely to be the sole reason for treatment failure in the study sample. The qualitative findings indicated three overarching themes capturing participants’ experiences of treatment and its failure: 1) Invalidating and Disempowering Experiences; 2) Factors Relevant to Formulation and Socialisation; and 3) Wider Barriers to Recovery. The first two themes were shared by both OCD and PD participants and the third was specific to OCD. Conclusion: The majority of factors underpinning therapy failure related to the therapeutic interaction and were pertinent to both participants with OCD and PD. In addition, OCD participants described a wider set of socio-contextual obstacles to their benefitting from treatment. Clinical implications are discussed.

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