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This paper focuses on the integration of Motivational Interviewing (MI) and cognitive behavioral therapy (CBT) in the treatment of eating disorders. Although CBT is regarded as the treatment of choice in this population, it nevertheless has limitations: some patients fail to engage, drop out from treatment prematurely, or simply do not improve. These are common problems in a population characterized by high levels of ambivalence about change. MI strategies can assist clinicians in enhancing readiness for change, tailoring interventions to patient readiness status, and maintaining a therapeutic alliance throughout all stages of treatment. Preliminary research examining the efficacy of adaptations of MI in the treatment of individuals with eating disorders has been promising. This paper presents 4 patient scenarios involving individuals with varying degrees of readiness and in the context of different treatment settings. For each patient scenario, key issues are described and common roadblocks to developing or maintaining a therapeutic alliance are provided. Vignettes illustrate conversations between the patient and therapist for each scenario, highlighting how MI techniques can be integrated into CBT treatment and promote a working therapeutic relationship that enhances long-term treatment outcome.

The Readiness and Motivation Interview (RMI) is a semistructured interview measure of readiness and motivation to change that can be used for all eating disorder diagnoses. The RMI has demonstrated excellent psychometric properties and has both clinical and predictive utility in adult samples. This study examined the psychometric properties of the RMI in a younger population, namely, 12- to 18-year-old girls with eating disorders. Study participants (N = 65) completed the RMI and measures of convergent, discriminant, and criterion validity. Adolescents with eating disorders were able to conceptualize and articulate their readiness for change and to report the extent to which change efforts were for themselves versus for others. RMI readiness profiles across eating disorder symptom domains in adolescents were comparable to those in adults, with higher reported readiness to change binge eating than to change dietary restriction or compensatory strategies. Differences in internal consistency between adult and adolescent samples are discussed. Interviewing adolescents early in treatment about readiness may assist clinicians in forming an alliance with this difficult-to-engage population, while also providing valuable information for treatment planning.

Examined parents' awareness of their daughters' attitudes, beliefs, and feelings about their bodies. Sixty-six adolescent daughters completed an eating disorder scale, a body figure rating scale, and made ratings of their shape and weight. Greater discrepancies between parents' estimates of daughters' body esteem and daughters' self-reported body esteem were associated with greater body dissatisfaction in daughters. (SLD)

The efficacy of highly active antiretroviral therapy (HAART) has been well documented, particularly among HIV-infected individuals with CD4 cell counts below 200/[mm.sup.3]. Despite this, eligible individuals may continue to show some reluctance to use HAART. The present study explored the factors influencing patients' decision not to take HAART even though it was medically indicated according to current treatment guidelines and available at no cost to the individual. Fifteen eligible patients at an urban HIV clinic were interviewed regarding the barriers that affected their decision to decline HAART. Most participants had previous experience with antiretroviral therapy and though most believed that HAART was beneficial and felt confident that they could adhere to treatment, they did not feel HAART was the right choice for them at the present time. The Critical Incident Technique was used to identify and classify incidents participants identified as influencing their decision not to take HAART. A total of four categories emerged from the data: Medication Factors, Mood, Lack of Support, and Outcome Expectancies. The results of this study highlight the ambivalence individuals may feel when faced with the prospect of taking HAART. The extent to which each of these factors influenced their decision differed substantially among participants. Suggestions for possible clinical interventions that can be used to address these concerns are offered.

Highly active antiretroviral therapy (HAART) adherence research has focused predominantly on individuals with less than optimal clinical outcomes; therefore, little is known about the experiences of individuals who sustain undetectable viral loads. The present study used a qualitative method to explore how individuals who have sustained undetectable viral loads account for their success, and to identify challenges, as well as possible needs, for continued success. Participants were 20 patients at an outpatient infectious disease clinic in an urban center. Participants completed two 60-minute interviews. The Critical Incident Technique was used to identify and classify critical incidents linked with sustaining treatment success. Of the 438 critical incidents collected, 316 were identified as helpful and 122 were identified as unhelpful. Helpful categories included resolving ambivalence, using personal strengths, and fostering helpful relationships. Unhelpful categories were mood, lack of social support, financial difficulties, and medication factors. Doing well on antiretroviral therapy is a dynamic process that requires ongoing attention from both the patient and care provider. The results of this study highlight the efforts of patients to maintain their health and remind care providers not to assume that patients are not facing continuous challenges. Findings from the present study suggest that psychosocial factors do contribute to improved clinical outcomes in patients taking HAART.

Residential eating disorder treatment involves emotional, financial, and time commitments from clients, staff, and the health care system. At discharge, most clients have made substantial nutritional, social, and psychological changes. However, maintaining these changes when intensive support is no longer available represents a significant challenge, and it is common for individuals to slip back into previous eating disorder patterns. Interviews with 32 individuals were conducted 6 months after discharge. Qualitative analyses revealed a pattern of factors that facilitated and hindered recovery. These factors were integrated with past research findings to develop a conceptual model about how changes are maintained. Recommendations regarding ways that health care professionals can assist with the transition from intensive treatment to community living are discussed.

Given that individuals with eating disorders are typically ambivalent about changing their eating patterns, what approach is most helpful in working with this challenging group? This research compared the responses of clients with eating disorders and those of care providers to written clinical vignettes. All participants rated collaborative interventions as more acceptable and more likely to produce positive clinical outcomes than directive interventions. In addition, clients who were least ready for change rated directive interventions as less acceptable and less likely to produce adherence than did clients who were more ready. Despite participants' clear preference for collaborative interventions, directive interventions were rated as equally likely to occur. The implications of participant preferences and reasons that these preferences may not be reflected in actual clinical practice are addressed.

Research indicates that ratings from research assessors are the only predictor of behavioral task completion and intensive treatment acceptance for clients who are anorexic. Questionnaire recovery activities were predicted by both research assessor and client ratings. Clinician ratings did not correlate with either questionnaire or behavioral measures.