By Catherine Cook-Cottone
Dr. Catherine Cook-Cottone’s Embodiment and the Treatment of Eating Disorders: The Body as a Resource in Recovery provides a well-researched, organized, and easy-to-read guide to her Embodied Approach to Treating Eating Disorders (EAT-ED). Clients suffering from eating disorders frequently consider the body an enemy. Embodiment works within the war zone to help clients heal holistically. She refers to embodiment as a “basic human right” throughout the book, emphasizing its importance.
Cook-Cottone developed the four pillars of embodied practice: (a) mindful self-care, (b) being with and working with what is present in the current moment, (c) honoring effort and struggle (i.e., self-compassion), and (d) cultivating a mission and purpose in life. The approach focuses on the now and what is ahead while learning from the past.
Treatment of eating disorders is, at best, moderately effective. Cook-Cottone posits a new approach, incorporating body-based elements to help clients heal from eating disorders. Over 350 references provide the reader with a broad-based research library, connecting theoretical underpinnings of the approach and its basis. It also compiles Cook-Cottone’s experience of over 20 years working with clients healing from eating disorders and her research, including 20 publications. The author uses personal and professional experiences to deepen content, sharing her history of suffering with an eating disorder and using vignettes of clients to illustrate points.
Part 1 makes the case for embodiment, citing relevant theories and how embodiment relates to symptoms of eating disorders. Cook-Cottone discusses the bodily felt sensations of emotions and discusses how emotions provide information for survival. She discusses the existential basis for embodiment and the need of clients with eating disorders to make meaning out of their lives and to replace meaning that the disorder may have held for them.
The second part of the book provides clinical steps to implement the EAT-ED process. Throughout Part 2, Cook-Cottone provides detailed practice guides and scripts to help clinicians implement EAT-ED. She covers the empirically backed treatment methods for the eating disorder diagnoses of anorexia nervosa, bulimia nervosa, and binge eating disorders, and recommends implementing the EAT-ED approach in conjunction with existing best practices.
She also discusses mindful self-care, one of the four pillars of her EAT-ED approach, and asserts that the ability to practice mindful self-care is necessary for healthy engagement with the world. The EAT-ED pillar of cultivating a mission and a purpose in life is discussed in terms of embodied meaning. Living with intention—understanding values, meaning, and purpose—helps the client focus on what is important to them, replacing their focus on calories, inches, and pounds.
The EAT-ED pillar of being with and working with what is present in the current moment is described as embodied wisdom. Being mindful allows the client to experience the body and learn to understand their own needs, wants, and joy through the body. Cook-Cottone refers to our bodies as our main source of “wisdom, connection, calming and self-soothing” (p. 153). She discusses the four cornerstones of being with and working with what is present in the current moment, which are the clients’ understanding of (a) their level of arousal, (b) sensations in the body, (c) sensory input, and (d) feelings; these cornerstones help clients understand that the body has wisdom and help them learn how to listen to that wisdom.
Although Cook-Cottone discusses the four pillars of embodied practice as the structure of the EAT-ED approach, the book does not follow the structure. As discussed above, she describes three of the four pillars in chapters titled with other terms, forcing the reader to tie the pillars to the concepts. Additionally, she does not detail the pillar of honoring effort and struggle (i.e., self-compassion) in the same manner as the others. Noting that the pillar exists should help clinicians recognize its value, but the book does not provide specific information or guides related to this pillar.
Cook-Cottone relates several practices helpful for clients with eating disorders, including yoga and equestrian therapy, as well as time in nature and relaxation. These practices can help clients develop their sense of embodiment and learn to enjoy the experience their bodies. As a dance/movement therapist, I found her discussion of dance/movement therapy (DMT) disappointing; she refers to movement-based therapies as “practices” rather than “therapeutic interventions” (p. 216). DMT, an embodied form of therapy and a profession for over 50 years, has been used effectively to treat clients with eating disorders. For example, restricted eating can be reflected in restricted movement and DMT can help clients expand their movement repertoire and, therefore, expand their opportunities.
Dr. Catherine Cook-Cottone ends with wisdom, asserting that the therapist using these tools with clients should practice embodiment themselves. Overall, this book provides an insightful approach for clinicians that can enhance their effectiveness in their work with clients recovering from eating disorders.
Cook-Cottone, C. (2020). Embodiment and the treatment of eating disorders: The body as a resource in recovery. W.W. Norton.
Reviewed by: Melissa Meade, MS, NCC, LPC/MHSP-T, R-DMT
The Professional Counselor