Zerbe on Integrated Treatment of Eating Disorders: Beyond the Body Betrayed

This book seems to contain all of human life, from the scientific details through the full range of emotions, including the extremes of love and hate. And it emanates a sense that although we all get shaken sometimes, and life is dangerous, every feeling is expressible and every situation is workable.

Rating: 5

Integrated Treatment of Eating Disorders: Beyond the Body Betrayed

By , 2008. ISBN 9780393704426. W.W. Norton. 358 pages.

This is a masterpiece, pulling off the feat of being both a wide and deep treatment of the subject in question; covering a great breadth of research data, medical and theoretical concerns; and keeping a practical focus on the therapeutic endeavour and a personal tone which is engaging, generous and wise.

I am aware that I often use the term “comprehensive references” when reviewing books, but this volume includes 35 pages of references (in pretty small type!) along with an annotated bibliography of especially recommended resources mainly for people with eating disorders, including self-help books and first person accounts.

The book as a whole, however, is aimed at therapists, and as the title suggests, its approach is an integrative one. While it seemed to me to be grounded in a psychoanalytic approach, it presents a synthesis of diverse perspectives on the eating disorders themselves and their treatment, with special emphasis given to the “opposing” poles of psychoanalytic and cognitive behavioural treatment, drawing out underlying common values and exploring how they can enhance each other in practice. The third major contributor to the synthesis is contemporary neuroscience, which is intriguingly presented, in some detail.

Integrated Treatment of Eating Disorders is divided into three sections. Part One leads the reader through the “Stages of Treatment of Eating Disorders”: namely, opening, middle and termination. While the material and case examples are obviously directly relevant to clients with eating disorders, I found the discussion of the therapy process to be highly relevant to all client populations. Zerbe stresses that the goal of therapy is not reducible to symptom reduction, but ultimately involves the client discovering their “true self” — which is not an ideal self but a “good-enough” one, which feels authentically satisfied by how they choose to live.

Part Two deals with “Treatment of Eating Disorders over the Life Cycle”: that is, adolescence, adulthood and middle and later life. I also found this section insightful as a guide to life goals, losses and transitions inherent in these stages, whether an eating disorder is involved or not. It is also extremely useful in teasing out the differences in the experiences of those with eating disorders and hence working out more appropriate treatments. For example, wishing to be exceptionally thin is a very different goal for a teenager and a middle aged woman, and cultural values further complicate the matter, in requiring eternal youth.

Part Three covers “Special Issues in the Treatment of Eating Disorders”: the first one, maybe often too hastily overlooked as an aspect of eating disorders, being sexuality, the second, “Managing Transference and Countertransference” and the last, ‘Assessing Outcome and Resiliency.” This last section is stuffed full of research findings, and Zerbe skillfully draws what is of use out of many studies which are either inconclusive or have particular methodological limitations.

Throughout the book Zerbe skillfully and engagingly interweaves quotes from literature — be it the founders of psychoanalysis (who seem to be sitting in the room with her), Tolkien, Martin Buber’s poetry, or a Joni Mitchell song — with the biological, cultural, sociological and developmental aspects of human life and how they play out in anorexia, bulimia, over-eating and other eating disorders. She mixes in the complexities (never, ever, underestimated) of the therapist/patient relationship, a willingness to share her own wide clinical experience in all its imperfection, and her own tone of voice, with its humour and occasional nifty turn of phrase.

In fact, as a good therapist should, the book seems to contain all of human life, from the scientific details through the full range of emotions, including the extremes of love and hate. And it emanates a sense that although we all get shaken sometimes, and life is dangerous (the relatively high mortality rates of eating disorders, the extensive medical complications that can arise and the difficulties in curing them are detailed and stressed throughout the book), every feeling is expressible and every situation is workable.

For this I feel very grateful to the author, and I heartily recommend the book.

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