Understanding anorexia nervosa in males: an integrative approach by Tom Wooldridge. A Review.

Immediately, this text is extremely welcome because there is a dearth of treatment approaches that place men at their core, and this work is badly needed as more males come forward for help and support. The central tenet of the text is that using an integrative approach to talking treatment can lead to better outcomes for the man and his family.

The book gives a concise overview of the limited key research we have on anorexia in males so far and establishes a clear need for male-centric treatment. It introduces the reader to the notion of the ‘patient system’, which is able to account for both the direct influences on the man’s life, as well as the indirect aspects that are being brought to bear. The idea of a problem-maintenance space is proposed and this accounts for the man’s problem-maintaining behaviours. This in turn is viewed using five lenses (Wooldridge refers to these as meta-frameworks). These are: systemic, biological, culture and gender, psychodynamic and spiritual. Once the work of diagnosis and therapeutic alliance are discussed, the remainder of the book takes each of these meta-frameworks in turn and instructs the therapist in what they mean and how to work with them within the patient’s system. The text closes with some discussion of the clinical application of the approach and presents a much needed case study which brings everything together so that the reader can get a feeling for how the integrative approach can work off the page.

There are only two other texts that I’m aware of, that devote the entirety of their content to the treatment of men. Derek Botha’s NO Labels and Richard Bryant-Jefferies’s text Counselling for Eating Disorders in Men. Wooldridge’s book feels very different to the latter. He is determined that the therapist, while being mindful of the need to create a person-centred alliance with the client, can use careful analysis of the man’s meta-frameworks in order to break his problem-maintaining behaviour. He also includes a timely chapter on the phenomenon of pro-anorexia Internet sites and the effects these can have on the anorexic male. Overall, it took me a while to fully appreciate the ‘patient system’ concept, but once I had I found that the text was revelatory. It charts new territory in the treatment of males and is something that novice and skilled counsellors alike would be able to use within their practice.