This chapter outlines the historical and clinical evolution of intensive enhanced cognitive behaviour therapy (CBT-E) for adolescents at Villa Garda Hospital, the first specialized unit in Italy dedicated to the intensive treatment of eating disorders. Established in 1984, the service initially adopted an eclectic disease-oriented model combining different psychological treatments with medical management. While partially effective in the short term, this model lacked theoretical consistency, undermined patient autonomy, and produced high relapse rates after discharge. In response to these limitations, the unit transitioned to a unified, evidence-based framework rooted in CBT-E. The turning point came in 2002 following a workshop by Christopher Fairburn, where the CBT-E model was introduced. Its flexible, collaborative, and transdiagnostic structure, along with its focus on personalized formulation, proved highly compatible with the needs of adolescent patients. The adaptation of CBT-E for inpatient rehabilitation use followed a three-step process: (i) designing a high-intensity programme aligned with CBT-E principles, (ii) implementing it with whole team engagement and external supervision, and (iii) evaluating its clinical effectiveness through a randomized controlled trial. Key adaptations included the use of a multidisciplinary team fully trained in CBT-E, assisted eating procedures, group interventions, and team-patient review weekly meetings. Further development led to the creation of CBT-E protocols explicitly tailored for adolescents, recognizing their unique developmental, motivational, and cognitive profiles.