"Invented medicine"? Alliance building in first encounters between clinicians and adolescents with anorexia nervosa: a qualitative study.

BACKGROUND

Caring for adolescents with anorexia nervosa (AN) involves gaining patients' and families' trust in a condition fraught with ambivalence. While essential for subsequent care and the development of a therapeutic alliance, the first clinical encounter is also known to be emotionally challenging both for frontline professionals and for families. There are few studies investigating the experience of clinicians working in specialized care settings. Our study aims to explore the challenges experienced by specialized professionals during the initial encounter with patients presenting with AN and their families.

METHODS

A qualitative study was conducted at the Maison des Adolescents, Cochin Hospital, Paris, a facility specialized in holistic care for adolescents, based on semi-structured interviews using Interpretative Phenomenological Analysis (IPA).

RESULTS

Sixteen clinicians with various professional profiles were interviewed between March 15th 2024 and August 5th 2025. Verbatim analysis identified four superordinate themes: (1) The first encounter: a daunting experience. (2) Balancing two divergent clinical postures: empathy and suasion. (3) Strategies for building a therapeutic alliance in the face of reluctance. (4) Building professional legitimacy through experience.

CONCLUSIONS

The emotional impact of these initial encounters can remain significant and complex, requiring introspective work and adaptability from professionals in order to promote therapeutic alliance. Developing of a formalized structure for initial interviews could be a possible avenue for improving these encounters.