Comparative Treatments for Eating Disorders

Reprinted from Eating Disorders Review
March/April 2001 Volume 12, Number 2
©2001 Gürze Books

(Katherine J. Miller and J. Scott Mizes, eds. Springer series of comparative treatments for psychological disorders. New York: Springer Publishers, 2000; 368 pp; $47.95;ISBN: 0-8261-1358-3)

The unusual pedagogical format of this series successfully engages those of us who enjoy learning in a clinical setting. It’s as if you’re at a clinical grand rounds, where the same patient is presented to a number of authorities, each of whom is an advocate for a particular clinical approach.

After an introductory chapter in which the major problems of eating disorders are overviewed, “Kristin’s” clinical case is presented. The overview chapter summarizes clinical features, course, and a history of the treatments that have been employed for anorexia nervosa and bulimia nervosa, including controlled treatment research on bulimia nervosa (behavioral, cognitive-behavioral, interpersonal and pharmacological).

After the case presentation, authors of subsequent chapters—many of whom are prominent researchers and clinicians familiar to EDR readers—respond to a series of specific questions about this patient posed by the case report. For example, if you were treating this patient, what specific or special techniques (including the use of homework) would be implemented, which other professionals would be brought in, and which significant others would be involved (and how)? How would medical and nutritional issues be handled? What potential pitfalls and types of resistance would be anticipated in the therapy, and how would they be handled? How would termination and relapse prevention be addressed? In addition, the ensuing well-referenced chapters also variably address treatment goals, the nature of the therapeutic relationship, how the case would be conceptualized and formulated, and anticipated time-line and course of treatment.

The specific approaches presented include cognitive behavioral therapy (CBT), psychoanalysis, interpersonal psychotherapy, developmental-systemic-feminist therapy (a specific integration of these three approaches), and self-psychology. In addition, they include an Adlerian approach; the “elementary pragmatic model” (a therapeutic model evolving since the 1960s starting at the University of Bari in Italy, based on the pragmatic communication models of Bateson et al, which posits 16 interactive styles of interpersonal interaction); and the integrative cognitive therapy model being developed and tested at the Universities of North Dakota and Minnesota (which expands traditional CBT by more specifically incorporating attention to cultural, interpersonal and affect regulation issues). And there is more: the cognitive-analytic therapy and transtheoretical framework being grown and tested at the Maudsley and other centers in England (which includes elements of motivational interviewing now widely applied in the treatment of alcoholism and substance abuse).

A final chapter summarizes, contrasts, and compares all these treatments, focusing on the treatment models, the therapist’s skills and attributes, assessment (including the amount of time given to assessment and the specific assessment instruments and tools employed), therapeutic goals, the time-line for therapy, how the case was conceptualized, the therapeutic bond, roles in the therapeutic relationship, techniques and methods of working, and answers to the specific questions posed above. As might be expected, many areas of overlap exist, but there are also significant and deep differences in treatment philosophies, techniques, and anticipated mechanisms of change. It’s a pity that the various authors weren’t given a chance to question and discuss each other’s approaches.

In summary, this recent collection offers a broad, up-to-date, case-based review of a variety of psychotherapeutic approaches. Some have been around for years and have proven useful in clinical trials; some have been around for years but remain untested; and others are theoretically appealing and newly evolving. Every chapter will be informative and many will be thought-provoking, and even experienced clinicians will feel that they’ve been introduced to some new approaches.

— J.Y.

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