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There is such a paucity of good psychoanalytic literature on eating disorders in this country that I look forward to new books from the United States. In the United Kingdom the behaviourist approach still provides the main framework for working with eating disorder patients. It is slowly being supplemented by a mix of cognitive analytic therapy, drug therapy, art therapy, group therapy, family therapy and individual therapy. The particular mix varies from hospital to hospital. It is accepted that eating disorder patients are often highly disturbed and few private therapists are willing to take on low weight anorexics and bulimics because of precariousness of their physical health and the primitive nature of their illness. Harold Boris (1984) Marjorie Sprince (1984) and Diana Birksted Breen (1985) are psychoanalysts who have written about working with anorexics and bulimics. They focus on the narcissistic nature of their patients and their difficulties in negotiating separation from mother. The majority of publications are cognitive/behavioural and systems based and psychodynamic writings in this country are rare.
Many psychotherapists and psychoanalysts in the UK are reluctant to work with eating disorder patients whom they believe to be psychotic. In Psychodynamic Technique in the Treatment of The Eating Disorders, patients are termed psychotic-like but never psychotic. The authors strongly dispute the claim of Bruch (1962, 1965, 1970, 1978), Crisp (1965, 1967, 1968, 1980), Dally (1969) and Palazolli (1978) that working psychoanalytically with these patients is to be avoided. They believe working in the tranference is the only way to achieve long term change They question the helpfulness of