Tales of hunger, hope and healing in psychotherapy

(Judith Ruskay Rabinor, Ph.D., Carlsbad, CA: Gürze Books, 2002; 212 pp; $14.95)

If, like me, you enjoy stories, you’ll enjoy this brief, easy to get through, nicely written book. Dr. Rabinor is a compassionate clinician who shares seven tales about her therapy with various eating disorders patients, telling the patients’ stories and the stories of their therapeutic collaborations together, describing her personal reactions to these patients and how these treatment encounters have impacted and changed her. Sometimes the therapies were successful and sometimes they weren’t. Writing about these patients and their treatments may have helped Dr. Rabinor to increase her understanding of what transpired.

Her therapies tend to be eclectically designed for each patient: her work is largely educational, humanistic, and psychodynamically informed. It makes use of supportive and interpretive therapy, suggestion, counseling, and guidance. Where appropriate; she involves the family, assigns homework such as expressive journaling, combines individual and group therapy, and even uses eye movement desensitization and reprocessing (EMDR). A wide variety of clinical situations is presented: anorexia nervosa, bulimia nervosa, compulsive overeating–young adolescents to older women, with a male patient thrown in to boot. Among others, the cast of characters includes a 15-year-old with anorexia nervosa; a 20-year-old woman with binge-purge type anorexia nervosa who reveals a story of sister-brother incest that sort of gets worked through; a self-mutilating, somewhat impulsive woman with bulimia nervosa who takes off to the opposite coast in the middle of treatment; a 58-year-old woman with bulimia nervosa with complex family issues who had never previously sought treatment; and a 65-year-old compulsive overeater treated with EMDR.

A cognitive behavior therapy, interpersonal or family therapy-based treatment manual this isn’t. A revealing description of a therapist’s working style this is. The clinician in me thoroughly resonated with these struggles, both the patients’ and the therapist’s. The scientist in me wished for more understanding of why these clinical approaches were chosen, and for a more thoughtful discussion about treatment selection, e.g., where more evidence-based methods might have been incorporated into these interventions. I’m still skeptical about EMDR, and would really like someone to do a careful study with eating disorders patients before I’d consider endorsing its use. My reading of the most recent discerning research regarding EMDR in the clinical psychology literature suggests that it may not be more successful than other strongly suggestive methods. In any event, these stories smack of clinical authenticity. This casebook can inform clinicians, teachers, patients and their families at several levels, and can warm the hearts of those of us who value humanism in our work.

— J.Y.