Wow, great question. I can only speak from personal experience. My therapist once asked what my "aha" moment was since many patients point to an event that triggered their recovery. However, I think it is a series of events and that the bulk of the work is just getting to the point where you are fully comitted to recovery.
That said, I failed at therapy a couple times before finding a therapist that really helped me. The best thing she did was to balance being honest with me and letting me steer my own recovery. I resisted a lot of her suggestions and she allowed me to disagree but she kept going back to the facts. I could argue that "I" didn't want to do something and she allowed me that but I couldn't argue when she told me "what works for most people." Sometimes, her suggestion wasn't appropriate for me-for example, I never kept a food journal because it made me obsess over food. But most of the time, I was only resisting because I didn't want to give up my disorder. And once her little fact was in my head, I would mull it over and finally try it. But I never felt like she was telling me what to do.
To summarize, for me the best thing a therapist can do is tell it to me straight. Whatever she thinks, tell me. But she should never tell me what to do or control my decisions (that's why I had an eating disorder)-instead she should tell me what normally works and give me options.
Finally, I've spoken to lots of eating disorder patients and the thing they complain the most about is that their therapist doesn't listen to them. Of course, this is usually because the patient doesn't want to listen. But what could help, is always explicitely asking the patient how they are feeling about therapy. It is almost never asked. You need to reinforce that you are on the same team and ready to modify the therapy for the patient.
Hope this helps,
Sammie
