• service allocation;
  • stepped care;
  • secondary treatment program


The main objective of this commentary is to stimulate a debate on service allocation and the implications for clinical practice and research. Although efficacious treatments for patients with ED have been developed over the past decades, nonetheless many patients do not benefit substantially during treatment and many fail to maintain treatment gains after termination. Specific stepped care strategies have been suggested to improve this situation. These include secondary level treatments for those who do not respond to primary treatment and maintenance treatments for those who do respond. Usually, the primary as well as the secondary treatment are standardized and thus, follow an implicit service allocation strategy that is independent of the individual patient. This scenario is similar to the general situation in psychotherapy service provision. We therefore look to the psychotherapy service provision literature for guidance and propose an alternative strategy that aims for a better match between individual patient's needs and treatment duration. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association.