This paper focuses on the integration of Motivational Interviewing (MI) and cognitive behavioral therapy (CBT) in the treatment of eating disorders. Although CBT is regarded as the treatment of choice in this population, it nevertheless has limitations: some patients fail to engage, drop out from treatment prematurely, or simply do not improve. These are common problems in a population characterized by high levels of ambivalence about change. MI strategies can assist clinicians in enhancing readiness for change, tailoring interventions to patient readiness status, and maintaining a therapeutic alliance throughout all stages of treatment. Preliminary research examining the efficacy of adaptations of MI in the treatment of individuals with eating disorders has been promising. This paper presents 4 patient scenarios involving individuals with varying degrees of readiness and in the context of different treatment settings. For each patient scenario, key issues are described and common roadblocks to developing or maintaining a therapeutic alliance are provided. Vignettes illustrate conversations between the patient and therapist for each scenario, highlighting how MI techniques can be integrated into CBT treatment and promote a working therapeutic relationship that enhances long-term treatment outcome.