Originally published: . Volume 5, No. 9. Source pages: 12, 13.
Dr. Laura Choate 2013 American Counselors Association
Dr. Laura Choate, Louisiana State University Associate Professor, and Licensed Professional Counselor, has added an extremely useful and practical book to her growing repertoire of works that focus on the interventions with girls and women, college student wellness, and preparation of those in the counseling and psychotherapy fields.
In Eating Disorders and Obesity, Choate has gathered an impressive group of contributors who lay out the foundational knowledge, techniques, and practical applications needed for practitioners working with those who struggle with eating disorders.
The book is not just for those working directly with those who have disordered eating patterns, but Choate provides critical information and insights for anyone in health services, education, or community health. She and contributors show the problems are embedded in our culture, including the family, schools, and media. In this, the authors point to the pervasive and unavoidable push toward disordered eating in our culture, especially for girls and women, but also for boys and men.
While Choate and contributors realize the need for understanding this complex problem from the mixture of biology, environment, and individual psychology––that all must be taken into account by the insightful therapist––this volume focuses on the practical techniques and perspectives that a therapist or counselor needs to work competently and ethically within a comprehensive framework.
“I am not alone in acknowledging the pervasiveness of cultural pressures regarding eating, weight, and shape that leave very few individuals unscathed,” Choate writes in her introduction. “These pressures influence individuals to varying degrees depending on the genetic vulnerability and their exposure to environmental risks.”
Pointing to these pressures and their results, such as the fact that 46 percent of all 9th to 12th graders are actively trying to lose weight, she writes in her introduction of the reason for the text.
“Because I want my children and all others to be equipped with the skills they need to stay healthy and resilient in the face of the cultural pressures surrounding eating, weight, and shape, this book is dedicated to assisting counselors and their clients to become empowered to effect positive change in this area within the multiple systems (family, school, community) in which they are embedded.”
“Eating disorders and obesity are a preventable public health concern,” she concludes, “and considerable efforts are necessary to prevent their initial onset and progression. Counselors are in a position to provide effective prevention programs in school, mental health, and college and university settings, and it is my hope that this book will provide them with essential resources for putting these programs into practice.”
Eating Disorders and Obesity is logically divided in to four sections. The first, “Foundations,” includes key information about the sociocultural context for eating disorders, about how effective interventions must include information about media, family, peers, and about gender differences and issues of race and ethnicity.
Section two is “ Assessment and Practice Frameworks for Eating Disorders and Obesity.” This section includes chapters that outline how the concerns of clients are linked into treatment planning, assessment, and where a client falls on the continuum of care, which can range from prevention to intensive treatment. A focus on school counselors, who are involved at a critical period of the emergence of eating disorders and how they play an important role in early detection, is explained. School based interventions are also included in this section.
The next part, “Effective Prevention and Early Intervention for Eating Disorders and Obesity,” lays out essential information about prevention and public health. Included is a description of prevention programs for children, for young adults and college students, and also a “culturally adapted guided self-help program…”
The final section outlines the approaches for those who need more intensive therapy, “Effective Treatments for Eating Disorders and Obesity.” In this part, contributors lay out the evidenced-based programs and psychosocial outpatient treatments for eating disorders and obesity which fall within the counselors scope of practice. Authors clarify the overlap between major approaches, but also set out some of the distinct approaches, including enhanced cognitive-behavioral therapy. One of the major benefits of the text, here the contributors provide research about which particular treatments work with which subpopulation of clients.
The writing is consistent across the chapters but maintains the authors’ voice, a real plus because so many of these authors are high-level theorists and practitioners of international recognition.
The chapters are also balanced between research information, insight for the reader, and practical, usable information to help technical expertise for treatment. One of the benefits of the book is that readers are helped to be aware of pitfalls in this complex area of work, with its multiple slippery slopes.
Each chapter is nicely summarized at the end with chapter highlights, a well-stated conclusion, references, and in many of the chapters, recommended readings or resources.
All toll, 42 contributors help make this book a comprehensive review with strong practical help for the counselor or psychotherapist working in any setting.
One of most engaging chapters, co-authored by Choate, is “Ethical and Legal Issues in counseling Clients With Eating Disorders.” Choate and coauthors explore the serious and ethically complex issues for those assisting this population.
“Eating disorders (EDs) are serious biopsycholsocial issues with severe consequences, including a range of potentially lethal medical complications. The rate of mortality in clients with anorexia nervosa (AN) is among the highest of all psychiatric conditions.” … “In additional, suicidality has been correlated with both AN and bulimia nervosa.”
She points out that despite the lethal risks, people with these disorders are often not motivated to seek treatment, a set of conditions that present “… several legal and ethical dilemmas for the counselor.”
The writers point to numerous challenges, such counselors reporting they felt their appearance was monitored by the clients, that power struggles were common with this population, and how difficult it is for some counselors to understand the “ego-syntonic nature of the client’s symptoms, how they prefer their emaciated state.” The authors point specificity to issues with scope of competence in this complex area and how important it is to have a depth of real understanding into the complicated social systems involved.
The edited Eating Disorders and Obesity offers some of the most respected names in the field. This is just a sampling of the board base of experience that goes into the work includes the following experts.
Dr. Linda Smolak, Emerita Professor of Psychology at Kenyon College, coeditor of Body Image, Eating Disorders, and Obesity in Youth: Assessment, Prevention, and Treatment (American Psychological Association), and author of Body Image: A Handbook of Science, Practice, and Prevention, (Guilford Press) helps launch the work with chapter one “Sociocultural Influences on the Development of Eating Disorders and Obesity.”
Dr. Margo Maine, clinical psychologist working in the field for 30 years, coeditor of Treatment of Eating Disorders: Bridging the Research-Practice Gap, (Elsevier), Effective Clinical Practice in the Treatment of Eating Disorders: The Heart of the Matter (Routledge), and The Body Myth: Adult Women and the Pressure to be Perfect (Wiley), and Father Hunger: Fathers, Daughters and the Pursuit of Thinness (Gurze), and Body Wars: Making Peace With Women’ Bodies (Gurze), coauthors the chapter two in this volume, “Gendered Considerations in the Treatment and Prevention of Eating Disorders.”
Dr. Niva Piran, professor of counseling psychology at the University of Toronto, and recipient of the Florence Denmark Distinguished mentorship Award from the Association of Women in Psychology, author and researcher, provides the chapter, “Prevention of Eating Disorders in Children: The Role of the Counselor.”
Other authors include those from Centre for Clinical Interventions Eating Disorder Programme in Perth, West Australia, Dr. Anthea Fursland, clinical psychologist, and Dr. Hunna Watson, research psychologist, at the Princess Margaret Hospital for Children in Perth, both who serve on the streering committee of the National Eating Disorders Collaboration in Australia.
This work adds to Choate growing list of contributions in this area. She authored the 2008 book, Girls' and Women’s Wellness: Contemporary Counseling Issues and Interventions, and the 2013 work, Adolescent Girls in Distress: A Guide for Mental Health Treatment and Prevention. She has published over 20 articles in peer-refereed journals including the Journal of Counseling and Development, Counselor Education and Supervision, and the Journal of Mental Health Counseling. She was the 2004- 2006 editor of the Journal of College Counseling, and an editorial board member of the Journal of Counseling and Development.
Dr. Choate currently serves on Louisiana Licensed Professional Counselors Board of Examiners, and is a National Board Certified Counselor and a Board Approved Supervisor in Louisiana. She was the 2009-2010 chair of the American Counseling Association Publications Committee.
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