Journey of acculturation: developing a therapeutic alliance with Chinese adolescents suffering from eating disorders in Shenzhen, China

Abstract

Adolescents suffering from eating disorders (ED) including anorexia nervosa (AN) and bulimia nervosa (BN) are typically ambivalent towards change, and often have low motivation in seeking help and participating in treatment (Bruch, 1973; Selvini Palazzoli, 1981; Ward et al., 1996). Developing a therapeutic alliance and engaging them in treatment are often insurmountable tasks for clinicians and psychotherapists. The challenge will be even greater for family therapists who have to relate to both the emaciated adolescents and their parents at the same time. The family therapist faces a dilemma to support the emaciated adolescents on the one hand, and to collaborate with the parents to combat the disorder on the other. Winning the trust of both parties is an ideal goal, but in reality there is the risk of losing the trust of either the afflicted adolescent or the parents, and if the situation is not handled appropriately, the resistance of both parties may be heightened, resulting in premature termination of treatment. Therapeutic alliance can be defined as the joint product of the therapist and client(s) together focusing on the work of therapy (Sprenkle and Blow, 2004). Maintaining a strong therapeutic alliance in family therapy has been identified as one of the common factors accounting for treatment success. There are three groups of factors affecting the therapeutic alliance in family therapy: the therapist characteristics (such as accurate empathy, non-possessive warmth), the client characteristics (such as treatment expectation, motivation and personal strengths) and the therapist–client interaction. As cultural background shapes a person’s experience and influences his or her worldview and behaviours, family therapists and r The Association for Family Therapy 2007. Published by Blackwell Publishing, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA. Journal of Family Therapy (2007) 29: 389–402 0163-4445 (print); 1467-6427 (online)