Therapeutic alliance, expressed emotion, and treatment outcome for anorexia nervosa in a family-based partial hospitalization program

•Maternal therapeutic alliance (TA) was higher than patient TA.•Parental TA was not associated with treatment dropout.•Maternal hostility was associated with lower maternal TA.

Adolescent therapeutic alliance has been found to be associated with improvements in eating disorder cognitions and with early weight gain. The current study assessed patient and parent therapeutic alliance, correlates of parent alliance, and relationship between alliance and treatment outcome. Fifty-six patients with anorexia nervosa completed measures of therapeutic alliance and eating disorder symptoms. Patients' parents completed measures of therapeutic alliance, expressed emotion, and psychopathology. Patients' alliance predicted cognitive and behavioral symptomatology at end of treatment (β = − 0.39, p = 0.001), though it was not related to changes in weight (β = 0.12, p = 0.377). Maternal hostility was associated with lower maternal alliance (r = − 0.34, p = 0.05). Findings suggest that maternal hostility should be addressed in treatment, and that patient alliance may be important in achieving psychological recovery from disordered eating.