Counselling for eating disorders in men.

Bryant-Jefferies R. Radcliffe Publishing, Oxford, 2005, 200 pages, 19.95 pounds, ISBN 1-85775-758-0 When approaching this book, it is important to understand what the text is and what it is not. Counselling for Eating Disorders in Men is one of a series of 'person-centred dialogues' by the author called the Living Therapy Series. Each of these books portrays what counselling sessions using a person-centred approach (i.e. non-directive and based on Carl Rogers) might look like. The bulk of this latest text includes two fictional case studies in which a female therapist conducts person-centred therapy with a male client who has an eating problem and comments are interspersed pertaining to the counselling process.

The author of the text is primarily a person-centred counsellor, rather than an expert on eating disorders. He is a practitioner who has specialised in counselling related to alcohol and substance misuse and has written a range of books applying person-centred counselling to a variety of contexts.

Well-researched evidence-based treatments for eating disorders, such as cognitive behavioural therapy and interpersonal therapy, are not discussed in the text. Furthermore, the author takes a non-diagnosis approach (preferring to discuss constellations of symptoms) to the extent that the definitions given of the various eating disorders depart from standard practice (e.g. they are not from the Diagnostic and Statistical Manual of Mental Disorders).

The book starts with a very brief introduction explaining the eating disorder context and the fact that a substantial number of men wish to change their body shape and some do have eating disorders. The introduction then quickly moves to an overview and description of person-centred therapy, which was originally formulated by Carl Rogers. As described in the book, the approach starts with the fundamental concept of two people (a therapist and a client) being in psychological contact. Key elements of therapy include unconditional positive regard for the client; empathic understanding of the client's experience; and communication to the client of that unconditional positive regard and empathic understanding. Rogerian therapy is fundamentally non-directive, so the therapist does not generally make suggestions or problem solve with the client. Instead, the process is focused on reflecting back what the client communicates in a genuine way, thus allowing the client to become more authentic and congruent (experiencing and expressing himself or herself more genuinely) over time. The author also briefly refers to the 'Cycle of change' model of Prochaska and DiClemente, which he has integrated into his approach.

Most of the book then consists of dialogues between therapist and client in the context of two fictional cases. The first 'case' follows 'Keith' who has a problem with compulsive eating, and the second 'case' is a client, 'Terry', who it is discovered at session six of counselling, has anorexic characteristics. In the context of these dialogues, the author includes boxes in which key elements of the therapeutic approach and relevant issues are discussed. These discussions focus on process points related to person-centred therapy (e.g. the importance of appropriate empathy the issue of being non-directive, pointing out how the therapist allows the client to come to clarity about an issue), rather than on eating disorder treatment per se. At the end of each chapter, 'points for discussion' are offered, which ask about issues such as whether the therapist was able to be non-directive, what feelings were evoked in the reader, or what the reader might discuss in supervision if he or she were the therapist.

In summary, this book would be of interest to those who take a client-centred approach or would like to know what a non-directive Rogerian style might be like. It is not a text that will inform readers about current research into issues related to males with eating disorder. Nor does the book describe or discuss findings related to evidence-based treatments that exist for eating disorders, such as cognitive behavioural therapy and interpersonal therapy. It also does not offer nutritional information related to treatment for eating disorders.

For readers who are interested in learning about research into males with eating disorders, the following references might be of use:

Andersen AE, ed. Males with Eating Disorders. Philadelphia, PA: Brunner Mazel, 1990.

Andersen AE, Cohn L, Holbrook T. Making Weight: Healing Men's Conflicts with Food, Weight, and Shape. Carlsbad, CA: Gurze Publishing, 2000.

Weltzin TE, Weisensel N, Franczyk D, Burnett K, Klitz C, Bean P. Eating disorders in men: update. J Men's Health Gend 2002; 2: 186-93.

Eleanor H. Wertheim, PhD

Professor, School of Psychological Science

La Trobe University 

Bundoora, Victoria, Australia