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Objectives. This study aimed to explore how guidance contributes to the outcome of self-help for disordered eating.

Method. A sample of guides and clients with a range of disordered eating was interviewed on completion of a randomized control trial and analysed using thematic framework analysis.

Results. Four themes emerged; the necessity of having a guide as a facilitator, features of the therapeutic relationship in clients with positive outcomes, features of the therapeutic relationship in clients with poor outcomes, and client suitability.

Conclusions. These findings have implications for the delivery of guided self-help interventions for disordered eating. They suggest the value of assessing clients’ readiness to change, working with clients with less severe and complex conditions, and the importance of guide qualities and skills.

Practitioner Points

  • • 
    Guidance is a necessary adjunct to self-help approaches for the effective treatment of a range of disordered eating and can be delivered by trained non-eating disorder specialists.
  • • 
    Guided self-help appears most appropriate for less severe, binge-related eating disorders, including eating disorders not otherwise specified (EDNOS), further work is needed for use with anorexic-type presentations.
  • • 
    While it is important to establish and maintain a strong, open, and collaborative therapeutic relationship, client ‘readiness’ appears fundamental in the relationship and consequent treatment outcome.