"With bulimia or binge eating, the benefits of therapy cannot solely be measured on the basis of changes in the eating disorder itself. Sometimes quick improvements in the eating patterns are short-lived, prompted by a display of "white-knuckle" willpower or a wish to please the therapist. Developing a trusting relationship, expressing feelings, and increasing one's self-esteem have to be established before a more sustained change in the eating can occur. These less observable changes are crucial as a basis of long-term growth."