BOOK REVIEWS: Effective Clinical Practice in the Treatment of Eating Disorders
Reprinted from Eating Disorders Review
January/February 2009 Volume 20, Number 2
©2009 Gürze Books
Margo Maine, William N. Davis, and Jane Shure, an experienced trio of eating disorders clinicians and theorists, have engaged a large number of highly qualified eating disorders therapists to contribute reflective essays, offering their perspectives on what transpires at the core of their therapeutic work. Most of the contributors practice individual psychotherapies with adult clients informed by various versions of psychodynamic, humanistic, existential, feminist, holistic, and spiritual perspectives. To give you a further sense of this collection, of the 16 contributors, only one is an MD, and none of the chapters deals with cognitive behavioral therapy.
What we have here is a thoughtful group of practiced clinicians offering insights into their extensive consulting room experiences, with accompanying vignettes, describing what they and their clients take to be key aspects of the genesis and psychological effects of and healing interventions for eating disorders.
Dr. Maine sets the stage in her opening chapter, "Beyond the Medical Model: A feminist frame for eating disorders." Subsequent chapters deal with many of these issues and extend the frames as well. A non-complete list of topics you will encounter includes psycho-spiritual perspectives, body trust, and a "body-positive" approach, holistic integrative psychiatry, sacred circles employing feminist group therapy, guided imagery, and body-mind treatment. Psychodynamic psychotherapy and family therapy receive good consideration. Particular attention is paid to issues of shame in the evolution and treatment of women with eating disorders, all manner of countertransference reactions in therapists, and the use of the self in therapy.
Readers who expect the word "effective" in the book's title to mean that treatments are backed up by research studies showing good outcomes will be disappointed and might feel misled. The evidence for effectiveness in these presentations is largely limited to anecdotal descriptions. What we're given here are, for the most part heartfelt, compassionate and personal beliefs and discussions based on the connections and practices that these therapists and their clients have found to be experientially and intuitively satisfying. These practices have worked well for these therapist-client dyads, groups and families in clinical settings and, evidently have contributed to good outcomes.
Unfortunately, at this point, evidence-based treatments only go so far, so in practice therapists require a wide array of clinical skills. Since huge differences in individual clinical characteristics and personal preferences will also guide patient-oriented treatments, clinicians require a large clinical toolbox from which to select what is likely to work best for and best fit each client. Think variations on a theme around evidence-based practices, or improvisations around evidence-based practices, or for good cause and judicious reasoning, in some instances clinical approaches that have not yet been tested in research settings in lieu of evidence-based practices. From that perspective, the approaches described in this book undoubtedly have much to offer.