A don't-miss contribution to the field! In her newest book, Treating the Eating Disorder Self: A Comprehensive Model for the Social Work Therapist, Mary Anne Cohen takes the clinical reader right into the midst of the intense relational engagement that is at the heart of her clinical approach. Cohen tips us off in her very first sentence that she finds the roots of eating disorders in early relationship wounding: "For many people, trusting food is safer than trusting people."
Cohen elaborates on this relational view in Part 1 of her book, "The Inner world of the Emotional Eater." She describes typical vulnerabilities among her eating disordered clients that follow from early relational wounding, such as the inability to self-regulate, shame-proneness, perfectionism, and a view of one's own needs as a sign of weakness or selfishness that must be hidden from others, or even from oneself. Cohen illustrates each element of the clinical picture with vivid, frequently heartfelt examples from her practice. In these lively vignettes, we find that Cohen's way of understanding what an eating disorder is doing in her client's life is relentlessly non-pathologizing. She tells us, for example, that eating disorders are "misguided attempts at self-repair," that they are "creative solutions for inner turmoil". We get to see in example after example how this deeply human and humane therapist engages with her eating disordered clients, embodying her belief that the therapeutic relationship is the ultimate healing instrument.
In Part 2, Cohen shines a light on aspects of the external world that foster the development of eating disorders in vulnerable people. She devotes an in-depth chapter each to the effects of a client's ethnic culture (especially minority cultures), gender and sexual identity, and involvement with social media. She shows us, again with abundant clinical illustrations, how these environmental features contribute to shaping a sense of self and beliefs about what will gain acceptance and approval in one's social milieu. Cohen is especially strong at involving us in the internal struggles of being "different" in a culture that gives the lion's share of its rewards and approval to people who are white, heterosexual and thin.
This book will be a trusty companion to those who are new to clinical social work or other clinical fields, or who are experienced but new to the treatment of eating disordered clients. For more knowledgeable eating disorder therapists, Treating the Eating Disorder Self provides the simple pleasure of watching and learning from a seasoned clinician as she goes about her work with a career-full of wisdom, a steady hand at the till, and a warm embrace of being simply human that invites and challenges her clients—and her readers— to join in.
"Life," Cohen says, "for all of us is confusing, exuberant, contradictory, hopeful, messy, joyful, hurtful, and disappointing. Sometimes it is hard to be human!" And sometimes we get an expert assist. Treating the Eating Disorder Self is one."
Susan Schulherr, LCSW,
Psychotherapist in NYC, Eating Disorders for Dummies (Wiley, 2008)
My new bible for treating all grief, loss and trauma clients, period.
This book is so good that I'd play a game with myself. Could there be a single page where I'd have nothing to underline, or nothing to write in the margins? The answer has always been: No. Mary Anne Cohen is for me the model therapist. She's bilingual and therefore sophisticated and always appropriately curious about Others, which rubs off on her clients. She brilliantly applies use of self (especially humor and provocation as she treats one of the most serious psychological disorders). She wisely recommends that the client talk freely about their relationships with "Ed" to get the fullest picture of the comfort the behaviors and beliefs provide them before swooping in with a Plan. As she discusses case after case after case, she also weaves in the metaphoric language of eating and digesting to better understand brokenness. Are we "force-feeding" a client solutions? How much "chewing the fat" is ok in sessions? How do we help the client "sink" his teeth into life?
New things I learned from Mary Anne Cohen, which I'll use in sessions? When therapy is successful, beware that change can lead to a period of grieving that the therapist and the client's inner circle may be unprepared for. "We can only heal what we feel." "Our mothers are our first cathedrals." "Tell me what your tears are saying." As a freshly licensed clinical social worker whose background is in grief/loss I can't say enough about Cohen's masterwork. Whether your client's expression of grief/loss/trauma is an eating disorder, or something else, Cohen makes the perfect mentor.
Nancy Gershman, LCSW
Reaching wide and deep, Treating the Disordered Self is the first book to explore both the inner and outer worlds of the emotional eater, providing a clinical perspective and an analysis of how psychodynamics, multicultural issues, sexual identity conflicts, and social media impact clients' relationships with food and their bodies. Both novice and seasoned therapists will feel enlightened and encouraged by the author's nuanced approach to tailoring treatment to the unique fingerprint that every client presents.
Using 200-plus case examples from her practice as the Director of The New York Center for Eating Disorders, Ms. Cohen provides an in-depth view of how abuse, trauma, attachment disorders, and personality traits contribute to dysregulated eating. She examines how factors such as PTSD, cognitive fallacies, and mood and personality disorders impact eating dysfunction as well as treatment approaches such as DBT, Intuitive Eating, HAES, EMDR and medication.
The author illustrates how the client's relationship with the therapist can be a major tool for enabling clients to overcome their primary fear of trusting food more than people. Through case examples, Ms. Cohen describes the therapist's essential work as staying attuned to the tension clients feel throughout therapy as they yearn to give up their eating disorder and fear the emotional pain they will experience when it is gone. To help clients learn to trust the therapist, and subsequently themselves, she stresses the need for authenticity by both parties, from laughter to tears, and their ongoing reflection on and examination of what is happening within the relationship.
What sets this book's approach apart from other "how to" treatment models is its focus on how clients' gender and culture affect their views of their bodies and the meaning of food in their lives. She uses her vast experience working with Black, Hispanic, Asian, Muslim, Orthodox Jewish, and Native American women and men with varying gender identities and problems, to explore how both factors are integral to assessment and treatment and how they bear on an eating disordered client's perception of themselves through their own eyes and those of society. As well, she encourages clinicians to shed their biases and preconceived notions by viewing clients in context and exploring intrapsychic gender and cultural issues along with more traditional "clinical" ones that bear on eating dysregulation.
No book on treating eating disorders would be complete without examining the considerable impact that social media has on clients' experience of themselves and their world. The author takes a neutral stance on social media, explaining how it can harm or help the client. She also addresses issues such as telemental health and the nature and role of therapist-client communications in their relationship, all with an eye toward assessing what works for the client and what doesn't.
In order to heal the eating disorder self of the client, the therapist must "unlock the past, revitalize the present, and create hope for the future." This book teaches therapists how to do all that and more.
Karen R. Koenig, LCSW,
Expert on eating psychology, blogger, speaker and international,
award-winning author of 7 books (with Words to Eat By due out in 2021).
She has been treating dysregulated eaters for more than 30 years.
I am very hopeful that this volume in Mary Anne Cohen's series of books on eating disorders and emotional eating will not be her last. This book is a must read for the social work clinician who is eager to be much better informed about this complex area of clinical work and wants a highly readable guidebook for the difficult endeavor facing all of us who work with this population.
It is hard to imagine that anyone looking for a good book on the subject of eating disorders would not get hooked after reading her excellent introduction. The first two paragraphs of the introduction immediately drew me in and made me eager for more. I got everything I was led to expect and a great deal beyond that.
Her writing really does read like part non-fiction novel, part textbook, and never dull. Her openness and excellent use of her own clinical experiences is invaluable and as such offers a high degree of authenticity. It is truly a mini-encyclopedia that helps the reader understand different approaches to different eating disorders as well as customized applications for different clients.
There were two chapters that I found particularly useful. "Treatment Part 2: Action Strategies in which the author identifies and covers a variety of cognitive and behavioral strategies and discusses ways that DBT and EMDR can be effectively utilized, as well. I especially appreciated her recognition of EMDR as a valuable intervention tool since I have used it successfully with eating disordered clients in my own practice. The other chapter I found outstanding was "The Therapeutic Relationship: Cultivating Hope and Connection." Here she very effectively utilizes a treasure trove of clinical material from her many years of working with clients in her practice and her years of experience as the director of the New York Center for Eating Disorders. She actualizes her long-standing belief that every person's eating disorder is as unique as a fingerprint, and there is no "one size fits all approach" to healing. She tells us that "the goal for the social work therapist is to create an individualized and comprehensive treatment approach in collaboration with clients that will help them break the chains of emotional eating and body image distress."
Thanks to having read Mary Anne Cohen's earlier books, several years ago I added an additional question to my initial consultation with patients: "are you having any difficulties in relation to food and eating behavior." Equally valuable and, similarly, often uncovers material that might not otherwise be offered as soon as the initial hour. This is the moment when I might hear about past or present experience with anorexia, bulimia, binge eating, dieting misery, body shame, and the extent to which matters of food, weight loss, impulse struggles are life consuming. Thanks for that, Mary Anne!
I know I have run the risk of making this book review an exercise in hyperbole, however my appreciation for its value and help in my own practice is boundless. I imagine it could be valuable to you, as well. Try it...you'll like it!
Richard B. Joelson, DSW, LCSW
Clinical social work therapist in private practice in New York City.
Author of "Help Me! A Psychotherapist's Tried and True Techniques
for a Happier Relationship To Yourself and the People You Love."
A sophisticated and heartfelt book for every psychotherapist who treats clients with eating problems or wants to learn more about this field. Not just for social workers! Mary Anne presents an in-depth understanding of the psychodynamics of eating disorders and a comprehensive treatment approach informed by psychoanalytic concepts such as attachment theory, transference and countertransference as well as exploring gender and multicultural issues in the field of eating disorders.
Valerie Frankfeldt, PhD
Faculty, Training, and Supervising Psychoanalyst
Psychoanalytic Psychotherapy Study Center
Mary Anne is a great resource to us all, both experienced clinicians and those entering the field. She brings a wealth of experience and knowledge, weaving clinical case examples and her own personal history. She brings 'life' to the book and keeps readers engaged. What I appreciate most is Mary Anne's emphasis on educating the reader on developing a rich understanding of their client, not just a focus on behavioral intervention.
Ann Saffi Biasetti, PhD, LCSWR, C-IAYT
Psychotherapist, Author, Saratoga Springs, New York