BOOK REVIEWS: Treating Bulimia in Adolescents
Reprinted from Eating Disorders Review
March/April 2007 Volume 18, Number 2
©2007 Gürze Books
Based on the well-regarded Family-Based Treatment (FBT) model first used in the appropriately well-respected studies of individual and family psychotherapy for eating disorders that have emerged from the Maudsley Hospital in London since the 1980s, this volume serves as a companion for the highly popular and useful Treatment Manual for Anorexia Nervosa: A Family-Based Approach (Guilford Press, 2001) by these authors and their Stanford and London-based collaborators. Their thrust has been to develop evidence-based treatments that work, and the treatment manual contained in this book puts their family-focused protocols into the hands of clinicians sensible enough to use them.
The book begins with the required introductions to bulimia nervosa and to the background and rationale of the family-based treatment approach for this disorder. As a premise, families are expected to assume responsibility for seeing that their adolescents adhere to the program and for helping manage the recovery. By chapter three, you're immersed in the clinical work, with detailed instructions for conducting the initial evaluation, the first face-to-face meetings with the family, conducting a family meal, and "action plans." The work is divided into three phases, conducted in approximately 20 sessions. Each phase includes a clear description of the goals, strategies, and tactics to be used and accomplished, and then transcript-segments illustrating details of what it's actually like to put these tasks into action. The descriptive chapters are organized in many helpful paragraphs headed "How" and "Why," and contain numbers of "frequently asked questions" that clinicians are likely to be asking as they proceed through this work.
A recent study conducted at the University of London provided evidence for the effectiveness of a modified form of this treatment in their 18-year-old patients, comparable in efficacy to therapist-guided cognitive behavioral therapy (Schmidt U et al, Am J Psychiatry, April 2007; 164:591). It also showed that many adolescents were not keen to be in family therapy, so that this approach may not work for all teenagers and their families. However, as a clinician I can't imagine not including families in significant ways in my work with adolescent patients with eating disorders. Since the treatment model described and spelled out in this book has been used in several research studies, and provides a state-of-the art approach, clinicians treating these adolescents will definitely want to purchase, study and use many of the ideas contained in this book for many of their patients.