The Eating Disorder Journal — March 2020, Vol. 21, No.3
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Book review by Mary Anne Cohen, LCSW, BCD
A Clinician's Guide to Pathological Ambivalence: How to Be on Your Client's Side Without Taking a Side by Linda Buchanan, Ph.D.
Eating disorder patients seek therapy hoping to resolve their destructive eating behaviors, poor body image, or to lose weight. But hidden in every patient is a secret fear and trepidation about giving up those very behaviors that have also provided comfort, safety, security, and a method of coping.
Clinicians often find themselves in the role of cheerleader as they encourage their patients to adopt healthier habits and build more supportive caring thoughts. But this encouraging position can often backfire when the clinician does not fully respect the vital meaning of the eating disorder symptom or appreciate the patient's mixed feelings about getting better. A power struggle may then develop between client and clinician.
This is where Linda Buchanan comes in with her sophisticated yet accessible book to help therapists "be on your client's side without taking a side." Buchanan points out that underlying resistances, which she terms "pathological ambivalence," occur in all therapy – not just with eating disorder patients. On one hand patients desire to get better, but they can also be compelled to sabotage their success due to fear and anxiety. Dr. Buchanan helps therapists identify, manage, and resolve their patients' ambivalence. She elucidates strategies to help therapists remain neutral while also facilitating progress such as asking clients what percentage of themselves is committed to change and what percentage is fearful, or to help the client arrange a "committee meeting" with different parts of themselves to discuss their confusion, and acknowledging to the client "I see you feel both x and y, so let's focus on BOTH."
By honoring both sides of the patients' ambivalence, and exploring through motivational interviewing with its collaborative stance and open ended questions, patients will feel well understood in their dilemma and better able to tackle their resistance. This excellent book is a must-read for clinicians who will learn to harness and resolve their clients' pathological ambivalence in order to help them achieve a more fruitful enjoyable life.
Dr. Buchanan opened the Atlanta Center for Eating Disorders which grew to three locations in metro Atlanta. She then sold it to Walden Behavioral Care and now serves as its Senior Director of Clinical Services. www.lindapaulkbuchanan.com
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