258 Treating Eating Disorders
such as the Women’s Therapy Centers in the UK (see Orbach, 1978, 1986;
Lawrence, 1984, 1987). To date, however, there is very limited evidence of
its effectiveness. One small-scale study involved a randomized control trial
carried out at the Maudsley Hospital in the UK and compared focal psy-
choanalytic psychotherapy with family therapy, cognitive analytic therapy
(CAT), and low-contact “routine” treatment (Dare et al., 2001). Patients
were included in the trial if they were 18 years or older and fulfilled DSM-IV
criteria for anorexia. They were excluded if they fulfilled the criteria for
hospital admission (see section below on inpatient treatment). Of those
recruited into the study (n=84), 54 completed the full year of treatment
(focal =12; family therapy =16; CAT =13; routine =13). The results showed
that most patients had improved at the one-year follow-up, although some
were still severely undernourished. In addition, those who received either
focal psychoanalytic therapy or family therapy fared better than the control
group who received routine care in terms of weight gain and the DSM-IV
criteria for anorexia. This suggests that focal psychoanalytic psychotherapy
can be used for the effective treatment of later-onset anorexics. In 2005,
McIntosh et al. presented the results from a randomized controlled trial (RCT)
exploring the effectiveness of CBT versus interpersonal psychotherapy versus
nonspecific supportive clinical management. The study involved 56 women
with AN, and therapy consisted of 20 sessions over at least a 20-week period.
In terms of patient outcomes, the results were in the opposite direction to
that hypothesized by the researchers as nonspecific supportive clinical
management was found to be more effective than the other two forms of
intervention. In a review of the literature on the effectiveness of psychodynamic
and psychoanalytic therapies across a number of different conditions,
Leichsenring (2005) identified 22 RCTs, of which 2 targeted AN and 3 tar-
geted BN. The conclusion from this analysis was that psychoanalytic therapy
is more effective than no treatment or treatment as usual or than shorter
forms of psychodynamic therapy. To date, therefore, evidence for the effec-
tiveness of psychoanalytic therapy is in its infancy and often contradictory.
Problems with psychoanalytic psychotherapy for eating disordersThe problems with this approach are as follows:
- The treatment of anorexic patients using this approach does not always
match up to the standards set by psychoanalytic psychotherapy. For
example, some patients will have been committed under the Mental Health
Act and therefore have had their freedom to choose the type of therapy