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

Summary

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.