26. Working with Severe and Enduring Eating Disorders: Enhancing Engagement and Matching Treatment to Client Readiness

  1. John R. E. Fox3 and
  2. Ken P. Goss4
  1. Josie Geller1,
  2. Suja Srikameswaran1,
  3. Joanna Zelichowska1 and
  4. Kim D. Williams2

Published Online: 3 OCT 2012

DOI: 10.1002/9781118328910.ch26

Eating and its Disorders

Eating and its Disorders

How to Cite

Geller, J., Srikameswaran, S., Zelichowska, J. and Williams, K. D. (2012) Working with Severe and Enduring Eating Disorders: Enhancing Engagement and Matching Treatment to Client Readiness, in Eating and its Disorders (eds J. R. E. Fox and K. P. Goss), John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/9781118328910.ch26

Editor Information

  1. 3

    Division of Clinical Psychology, University of Manchester, UK

  2. 4

    Coventry Eating Disorders Service, United Kingdom

Author Information

  1. 1

    University of British Columbia, Canada

  2. 2

    St Paul's Hospital, Vancouver, Canada

Publication History

  1. Published Online: 3 OCT 2012
  2. Published Print: 9 OCT 2012

ISBN Information

Print ISBN: 9780470683545

Online ISBN: 9781118328910



  • alternative model of care;
  • client readiness;
  • eating disorders (EDs);
  • quality of life;
  • therapeutic styles;
  • treatment


This chapter on working with severe and enduring eating disorders (EDs) is organized into four sections. In the first section, a review of research conducted on readiness and motivation for change in the EDs is provided. The empirical literature on barriers to recovery and improving client readiness is described. The second section outlines an alternative model of care for individuals with enduring EDs that is informed by this empirical literature. This model of care emphasizes a ruthless focus on tailoring treatment to client readiness and focusing on quality of life as opposed to recovery. The next section addresses care provider stance, and describes how four care provider styles, or habitual patterns, can negatively impact on the therapeutic alliance. The final section provides an illustration of how to capitalize upon the strength of each style, and a discussion of how care providers working with this group maintain resilience and hope.