First Advisor

O'Halloran, M. Séan

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Date Created



The therapeutic working alliance is a vital ingredient to psychotherapy, specifically with clients diagnosed with Anorexia Nervosa (AN) as progress is often slow and treatment difficult. This phenomenological study investigated the experiences of eight clients with AN and seven therapists who work with this population regarding how the working alliance was formed and challenged in the process of individual psychotherapy. Data were gathered through semi-structured interviews. Findings revealed overarching themes among all the participants as well as themes unique to clients and therapists. The findings are discussed in the context of working alliance theory. Implications for therapists when forming the working alliance with clients with AN include remain patient while clients develop trust and motivation, maintain awareness of personal reactions and seek consultation/supervision, be active and directive at the beginning of treatment, use caution when creating therapy goals, collaborate with other treatment providers and family, implement basic counseling skills (e.g., unconditional positive regard, validation, authenticity), utilize appropriate self-disclosure, balance setting boundaries and portraying care, create a warm office environment, and have/gain experience treating this population. Additionally, implications for clients are discussed.

Abstract Format



Working alliance; Anorexia nervosa; Counseling; Eating disorders; Psychotherapy; Therapeutic relationship


402 pages

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