The study utilized a qualitative approach, which evaluated self-reported coping strategies and self-interventions through diary recordings of bingeing and vomiting. This approach was chosen because vomiting is not usually a public act, observations and measurements are impracticable, and self-monitoring can be effective in promoting behaviour change (Nelson 1977). Gilbert (2005) stresses the essentially secretive practice of vomiting so assessment is largely reliant on self-reporting, which by its very nature has varying reliability. Psychotherapy practice diaries are commonly used to provide information for assessments, therapeutic progress and formulation reviews and provide guidance for client progress (Kinsella & Garland 2008, Westbrook et al. 2011). The diary constitutes ‘an intensely personal document, symbolizing the relationship between therapist and patient; it may perhaps be described as a transitional object (providing) control and discipline throughout the week and a constantly available outlet for emotional feelings’ (Lacey 1983, p. 1612).