From failed fixes to feeling seen: client and clinician experiences of temperament-informed schema therapy for binge eating disorder

Objective This exploratory qualitative study examined how clients and clinicians experienced a temperament‑informed schema therapy intervention for binge eating disorder (ST-BED-TI), with particular attention to perceived change processes and contextual factors shaping treatment experience in a small subgroup of chronic, complex presentations.Method Semi‑structured interviews were conducted with three adult women with longstanding, clinically complex binge eating disorder (BED) who received 25–35 sessions of outpatient ST-BED-TI, and four clinical psychologists who delivered the intervention. Interviews were conducted online, transcribed verbatim, and analysed using reflexive thematic analysis. This trial was pre-registered on the Australian New Zealand Clinical Trials Register (ID: ACTRN12623001259639).Results Three overarching themes with eight subthemes were generated. Participants described moving from symptom‑focused “failed fixes” experienced as unhelpful, invalidating or insufficient towards feeling deeply understood within a formulation that reconceptualised binge eating as a survival‑based coping mode. Corrective attachment experiences, inner child work, grief for unmet childhood needs, and interoceptive awareness were described as central therapeutic processes to reducing binge eating. Trauma‑informed and neuro‑affirming flexibility, a strong therapeutic alliance, and sufficient time emerged as key facilitating factors for change.Conclusions Findings suggest that ST-BED-TI may provide a relational, developmental, and embodied adaptation to unmet needs in longstanding and complex BED presentations. ST-BED-TI may be a useful treatment pathway for these populations by prioritising attachment repair, embodied safety, and neurodiversity‑sensitive flexibility. Interpretation should remain cautious given the small sample of treatment recipients and a lack of systematic neurodivergence assessment.