ABSTRACT
This chapter provides ideas for enhancing patients' engagement in treatment, together with ideas for encouraging motivation for change. The chapter recognises that patients with bulimia nervosa often ®nd it dif®cult to proceed with treatment, and that fears about change are common and will need to be tackled for treatment to be successful. Ideas for identifying fears about change, and suggestions for how to manage these, are presented. Six different strategies are described, together with a cost-bene®t analysis examining the advantages and disadvantages of change. Finally, some speci®c fears and issues are brie¯y discussed.
