Abstract
This study examines the impeding role of self-critical perfectionism at onset of treatment on therapeutic alliance during treatment and eating disorder symptoms at follow-up in patients with an eating disorder. Participants were 53 female patients with a mean age of 21.1 years treated for an eating disorder in a specialized inpatient treatment unit. Self-critical perfectionism was assessed at admission, therapeutic alliance was assessed during treatment (after three months of treatment), and eating disorder symptoms were assessed at admission, after three months and one year later. Self-critical perfectionism negatively related to treatment alliance with the therapist. Although self-critical perfectionism was not directly predictive of subsequent changes in eating disorder symptoms, it was indirectly related to less reduction in body dissatisfaction through the therapeutic alliance. These results point to the importance of self-critical perfectionism in the therapeutic alliance and in changes in body image problems. Treatment implications are discussed.
Highlights
Many studies have shown that patients’ selfcritical (SC) perfectionism interferes with the treatment of depression (Blatt & Zuroff, 2005), as it impedes therapeutic alliance
It has not been directly tested, it has been suggested (e.g., Shahar et al, 2004) that the van der Kaap-Deeder et al: Self-Criticism and Therapeutic Alliance difficulties that individuals with high levels of SC perfectionism experience in engaging in a therapeutic alliance, might be because they project their own self-criticism onto the therapist and might be less likely to trust the therapist and to disclose themselves in treatment
Preliminary Analyses One-way ANOVA’s revealed that there were no differences between diagnostic categories in terms of SC perfectionism at T1 [F(3,49) = .58, p > .05], drive for thinness at T1 [F(3,49) = .56, p > .05], T2 [F(3,49) = .22, p > .05] and T3 [F(3,49) = .67, p > .05], body dissatisfaction at T1 [F(3,49) = 1.76, p > .05], T2 [F(3,49) = .29, p > .05] and T3 [F(3,49) = .47, p > .05], and therapeutic alliance at T2 [F(3,49) = .47, p > .05]
Summary
Many studies have shown that patients’ selfcritical (SC) perfectionism interferes with the treatment of depression (Blatt & Zuroff, 2005), as it impedes therapeutic alliance. Patients with high levels of self-criticism are characterized by a negative representation of the self as they engage in constant and harsh self-scrutiny and self-evaluation, and have a negative representation of others as they are chronically concerned about others’ criticism or evaluation (Blatt, 2008; Dunkley & Kyparissis, 2008) It has not been directly tested, it has been suggested (e.g., Shahar et al, 2004) that the van der Kaap-Deeder et al: Self-Criticism and Therapeutic Alliance difficulties that individuals with high levels of SC perfectionism experience in engaging in a therapeutic alliance, might be because they project their own self-criticism onto the therapist and might be less likely to trust the therapist and to disclose themselves in treatment. We aimed to test a mediating model in which therapeutic alliance during treatment mediates the relation between patients’ SC perfectionism at onset of treatment and changes in ED symptoms over time
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