Reprinted from Eating Disorders Review
September/October 2011 Volume 22, Number 5
©2011 Gürze Books
(By Simon G. Gowers and Lynne Green. New York: Routledge, 2009, 190 pages; $34.95)
These days, writing a book about psychotherapeutic treatment of children and adolescents that doesn’t focus on family-based treatments and/or other family-focused therapies might be said to require a certain amount of chutzpah. But here it is. Written by a professor of psychiatry at the University of Liverpool and a principal clinical psychologist at a well-regarded eating disorders service for adolescents, this book stakes out and defends a primarily individually oriented cognitive-behavioral approach to treating childhood and adolescent anorexia nervosa and bulimia nervosa.
In their introductory overview, the authors dutifully address the guidelines of Britain’s National Institute for Health and Clinical Excellence (NICE), in order to put what might otherwise seem to be an almost unorthodox treatment focus into perspective. Their reading of the NICE guidelines concludes that there is little robust empirical evidence to recommend any one treatment approach, that randomized controlled trails of family interventions are limited and have produced inconsistent results, and that multiple family group therapy is in the early stages of evaluation but shows promise. At the same time, the authors hold that cognitive behavioral therapy (CBT) provides a sound theoretical model on which to base therapy. In their view, a CBT approach can be suitable for patients ages 11 and up, particularly those with bulimia nervosa depending on the patient. And they clearly acknowledge the lack of systematic evidence to support their perspectives, and invite research on these issues.
The authors also acknowledge that clinical consensus suggests that family interventions should be offered for anorexia nervosa in adolescents, and state that families should be included in the initial assessment and in ongoing treatment and management. The families’ concerns should be addressed, and they should also be involved in support of individual therapy. From this starting point, the book follows a somewhat traditional individually and group-oriented CBT outline, with treatment stages ending in relapse prevention, handouts included.
What’s interesting and potentially helpful about this book are the good ways in which the authors address techniques for talking with, engaging and motivating young eating disorder patients, and for formulating and communicating problems and solutions with them in age and development-level appropriate words and concepts.
But again, we await systematic demonstrations of how well this approach works, with what specific types of patients, and of how it compares to others.