The Impact of the Therapeutic Alliance on Treatment Adherence: A Case Study of a Patient with Anorexia Nervosa

The aim of this study was to address a significant gap in the literature by highlighting the impact of the therapeutic alliance on reducing dropout rates in psychotherapeutic treatment for patients diagnosed with anorexia nervosa within the framework of brief strategic psychotherapy. This case report focuses on a clinical case analysis conducted within a specialized therapeutic setting at the Center for Strategic Intervention Specialists (MIP Center Chile) in 2020. The selected case involves a 20-year-old female patient with restrictive anorexia nervosa, diagnosed according to DSM-5 criteria, who had previously experienced difficulties adhering to psychological treatments. This study is unique in its use of the "Session Rating Scale" (SRS), a structured feedback tool employed during therapy sessions to evaluate and actively enhance the therapeutic alliance. The SRS provided valuable insights into the patient’s perception of the therapeutic relationship, focusing on dimensions such as trust, alignment on therapeutic goals, and the therapist’s responsiveness to specific needs. The findings demonstrated that fostering a trustworthy and validating therapeutic environment significantly enhanced the patient’s engagement, ultimately improving treatment adherence and reducing the likelihood of dropout. This case report contributes to the literature by addressing the lack of evidence on the role of the therapeutic alliance in the context of brief strategic psychotherapy for anorexia nervosa. It underscores the importance of structured feedback tools, such as the SRS, and offers clinicians practical guidance on leveraging the therapeutic alliance to optimize treatment outcomes in this population.