The purpose of this study was to elaborate how clients understand the development of the alliance and to highlight aspects of the process particular to depressed clients working with experienced therapists. Fifteen participants described critical incidents in early therapy that influenced how they understood their working relationships with therapists. All incidents involved clients appraising what their therapists were doing. Through interviewer probing, participants were able to identify the importance of their own activity (disclosing and working with therapist input) as their collaboration in the incidents. Positive emotional responses were woven through the descriptions of the incidents. The research underscores how client understanding of collaboration might be accessed by researchers or clinicians and the potential importance of the interaction of client active exploration with positive emotions in understanding alliance development.

Objective This study examined the feasibility, safety, and potential efficacy of lisdexamfetamine (LDX) as a treatment for adults with bulimia nervosa (BN). Method An open‐label 8‐week feasibility study was conducted in participants with BN. Enrollment rate, dropout rate, safety outcomes, and eating disorder symptom change were examined. Results Eighteen of 23 participants completed the study per protocol. There was no participant‐initiated dropout due to adverse drug reactions and no severe and unexpected adverse drug reactions. An average increase in heart rate of 12.1 beats/min was observed. There was a mean weight reduction of 2.1 kg and one participant was withdrawn for clinically significant weight loss. In the intent‐to‐treat sample, there were reductions in objective binge episodes and compensatory behaviors from Baseline to Post/End‐of‐Treatment (mean difference = −29.83, 95% confidence interval: −43.38 to −16.27; and mean difference = −33.78, 95% confidence interval: −48.74 to −18.82, respectively). Discussion Results of this study indicate that a randomized controlled trial would be feasible with close monitoring of certain safety parameters (especially over a longer time period as long‐term safety is unknown). However, the results should not be used as evidence for clinicians to prescribe LDX to individuals with BN before its efficacy and safety are properly tested. Trial Registration Number NCT03397446.

Outpatient care (e.g., individual, group, or self‐help therapies) and day treatment programs (DTPs) are common and effective treatments for adults with eating disorders. Compared to outpatient care, DTPs have additional expenses and could have unintended iatrogenic effects (e.g., may create an overly protective environment that undermines self‐efficacy). However, these potential downsides may be offset if DTPs are shown to have advantages over outpatient care. To explore this question, our team conducted a scoping review that aimed to synthesize the existing body of adult eating disorder literature (a) comparing outcomes for DTPs to outpatient care, and (b) examining the use of DTPs as a higher level of care in a stepped care model. Only four studies met the predefined search criteria. The limited results suggest that the treatments have similar effects and that outpatient care is more cost‐effective. Furthermore, no studies explored the use of DTPs as a higher level of care in a stepped care model (despite international guidelines recommending this approach). Given the clear dearth of literature on this clinically relevant topic, we have provided specific avenues for further research.