Body mass index and its impact on the therapeutic alliance in the work with eating disorder patients

In the present study we examined the hypothesis that in bulimic patients the body mass index (BMI) has an important impact on the therapeutic relationship. For each of 18 patients with differing BMIs, two therapists were each interviewed separately about their experiences of working with the patient. Transcriptions of the interviews were rated by two independent raters on a catalogue of nine criteria concerning feelings and attitudes of therapists toward patients. Factor analysis showed two main components: 'close-protective' and 'distant-confrontative'. The heavier the patient, the higher was the probability of the emotional atmosphere being rated as 'distant-confrontative'. With thinner patients the atmosphere was more often rated as 'close-protective'. Age also had some influence on the characteristics of the therapeutic relationship: with older patients, the therapeutic relationship tended towards 'distant confrontative'. Whether and in which way these differences have an impact on treatment and outcome has not been examined by the presented study and needs further investigations. Copyright (C) 2002 John Wiley & Sons, Ltd and Eating Disorders Association.