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Birksted-Breen, D. (1987). Handbook of Psychotherapy for Anorexia Nervosa and Bulimia. Edited by Garner D. Garfïnkel E. Guilfordand Press. Pp. 592. £35.. Psychoanal. Psychother., 3(1):93-95.

(1987). Psychoanalytic Psychotherapy, 3(1):93-95

Handbook of Psychotherapy for Anorexia Nervosa and Bulimia. Edited by Garner D. Garfïnkel E. Guilfordand Press. Pp. 592. £35.

Review by:
Dana Birksted-Breen

As the title suggests, this book is a collection of papers covering a range of psychotherapies used in the treatment of anorexia nervosa and bulimia. The book deals almost exclusively with these disturbances in women. The term psychotherapy is here used to include not only psychodynamically oriented psychotherapy but such radically different approaches as cognitive and behavioural methods and even self-help groups. Group and family therapy also each form a section. To complete the picture some authors advocate a “multicomponent treatment program because of the need for change at intrapsychic, family and peer group levels” (Strober & Yager, p. 367).

So here we have a book about disorders which a number of authors stress are multidetermined and heterogeneous in nature; and we have a multiplicity of treatment approaches, the outcome of which many of the authors are cautious about. What is one really comparing? Can one compare the efficacy of one method versus another when premises and ideologies are so different? Weight gain is usually the criterion used. It is a simple and objective criterion and that makes life easy. But can the “result” of the said “psychotherapy” really be measured purely in terms of weight gain? Is that not using the same currency as the anorexic or bulimic person is using?

Of course a dangerously emaciated person needs to be helped out of the immediate impasse she is in, but can one really consider that putting on weight over a period of a few weeks is in itself anything more than a cure of the immediate physical condition? It is “first aid”, not psychotherapy. It is not because the anorexic woman says she wants little that she should be offered little. On the contrary I believe that because the anorexic woman can only allow herself little she needs to be offered plenty — plenty of time and plenty of space (which is an altogether different matter to force-feeding).

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