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Is a psychoanalyst the right person to treat patients with eating disorders? Yes, if psychoanalysis is conceptualized not as a method, but as a way of helping patients with a wide range of developmental needs and adaptations. Katherine Zerbe is such a psychoanalyst. The first part of the book's title, Integrated Treatment, refers to George Engel's biopsychosocial model,1 and Zerbe presents much useful information from the biological and social spheres. But the real focus of her book is not the one-third of patients who discontinue treatment after receiving such information, but those who stay for the deep exploration of a relational treatment that is flexible and generous.
The book is divided into three sections, and Zerbe plunges right into treatment in the first section. The approach is relational to the underlying developmental pathology. Central to the task is helping eating disorder patients find not only their own voices, but their true selves. Here the author follows Winnicott's concept, in which the child relinquishes its own needs and wishes and develops a false self in order to maintain a parental tie. As an example, a young patient is not heard by her mother unless she addresses the mother's concerns about her own weight. The young woman turns herself into an anorexic in order to be literally seen by her mother. Beneath this startling compliance, no doubt, lies great need for maternal nurturance, experienced as emptiness and pain leading to self-endangerment.
In the past, many eating disorder patients were admitted to residential centers, a path no longer feasible because of financial constraints. Zerbe urges an outpatient team approach, in part to dilute a savior transference, in part to provide the additional expertise needed because of danger to the body and to demonstrate concern about that condition. The team approach consists of nutritional counseling, family and group therapy, and medication. The latter is also thoroughly discussed. Zerbe