Ultimately, patients need to develop interdependent relationships with their peer group because this is what they are going to need to depend upon in the Anonymous Fellowships for the rest of their lives. Counsellors, as with parents and family and friends, can love and provide an environment of love but cannot do someone else's loving - and it is this feature which is the essence of recovery. When A reaches out to help B anonymously, it is A who gets the benefit every time. B may or may not do so. By taking their minds off themselves and putting them on to other people, sufferers from eating disorders and other forms of addictive behaviour get rid of the self-centredness that has dogged them all their lives and learn to become focused upon the needs of other people. This is a lovely philosophy and it is quite extraordinary that it should at times be criticised so hotly by people who are not even familiar with it, let alone put it into practice in their own lives. Sometimes the Twelve Step programme may be seen as a threat to professional interests.

At PROMIS we are absolutely clear that the counselling staff do not get the patients better: patients learn how to get each other better. It takes considerable maturity for staff to be able to accept that they work hard every day - and deserve the credit for doing just that - but, even so, should not look to their patients for personal rather than professional gratitude.

Once sufferers from eating disorders graduate from PROMIS, they may go on to an extended care facility, a "Halfway House". In these houses patients share the accommodation with each other and may also go to regular outpatient therapeutic sessions but, at the same time, they are exposed to the real outside world in contrast with the sheltered environment of the inpatient treatment centres. The outside world has all the challenges that patients need to learn to deal with on a day-to-day basis - but they know that they can return to the relative shelter of the Halfway House when things are difficult. Ultimately, they have to break completely free and become dependent totally upon the inter-relationship with others in the Anonymous Fellowships. Here, particularly in the case of the eating disorder Fellowships, there can be some significant difficulties because the Fellowships themselves are not strong.

In Overeaters Anonymous there is no specific definition of abstinence other than "to abstain from compulsive overeating". How on earth would one know how to do that if one does not know how to do it? The history of Overeaters Anonymous was that the co-founders, who had a common background in Gamblers Anonymous, wrote down the list of all the foods that they themselves found challenging. The summary was put onto a grey sheet of paper and this list became the "Grey Sheet" recommendations for abstinence. It soon became apparent that this was unworkable: people became obsessed with physical abstinence just as they had previously been obsessed with bingeing. Bulimics Anonymous and Anorexics Anonymous have a similar reluctance to provide specific programmes of abstinence.