Eating disorders can have an enormous impact on families, friends and professionals and are often poorly understood given their complex nature. For those who have a role as ‘carer’ knowing how to best help can be daunting and it is easy to slip into patterns of relating to someone with an eating disorder that serves to exacerbate what is already a stressful and emotionally painful situation.

Help is at hand from a team of experts; Professor Janet Treasure has joined forces with Gráìnne Smith who had personal experience of caring for a loved one with anorexia nervosa and Anne Crane who recovered from her own eating disorder to write this pioneering book based on clinical approaches developed at the Maudsley Eating Disorder Service. Skills-based learning is a manual that equips both health professionals and carer's with knowledge and skills to effectively support and encourage an individual with an eating disorder. The authors use a phrase that captures the essence of this manual, ‘you alone can do it, but you cannot do it alone’, which implies that although the individual with an eating disorder is responsible for themselves, the process of making changes is best achieved with the support and encouragement of others. The manual is packed full of information and tips that would help most people who have little knowledge of eating disorders develop a greater understanding of this complex psychological disorder. The authors have skilfully brought together a manual that successfully combines knowledge of eating disorders with skills training. The thrust of the book is about developing and enhancing good communication skills that are presented in a straightforward and interesting style, illustrated with animal metaphors. On a continuum of communication style are you predominately a rhinoceros, charging in and taking control, or a kangaroo, over-protective with too much sympathy? Learning to reflect on your own communication style and changing the way in which you relate to someone with an eating disorder is essential if you are to be an effective carer, not to mention managing your own stress response.

The book has 14 chapters; following the introduction in chapter 1, chapter 2 focuses on learning to recognize signs of an eating disorder, especially when the person may not have accepted they have a problem themselves. The question of how to broach the delicate subject having an eating disorder is discussed and tips, useful phrases and questions that can facilitate understanding and exploration of the problem are provided. Chapter 3 is educational and focuses on the basic facts about eating disorders; there is a useful section on dispelling myths about eating disorders that, hopefully, will help the carer develop a positive attitude that demonstrates understanding. In chapter 4 carers are asked to identify typically what kind of care-giving they fall into; kangaroo care or the rhinoceros response? The metaphor of the dolphin as a coach, moving side by side, encouraging every step of the way is introduced as a preferred way of caring. The animal metaphors of the ostrich with too little emotion and the jellyfish with too much emotional response are introduced with the St Bernard in the middle displaying warmth and kindness. Chapter 5 concentrates on helping the carer develop resilience in dealing with the stress of caring for someone with an eating disorder whilst caring for one's own needs and those of the whole family. Chapter 6 addresses the consequences of being underweight and discusses BMI, weight monitoring and when to seek medical help. In chapter 7 understanding the stages of change model in eating disorders is described and strategies for enhancing motivation are presented. In chapter 8 skills that are essential for good communication are demonstrated; there is a useful dos and don'ts section in addition to dealing with conversation traps. Chapter 9 discusses interpersonal relationships and problem-solving skills. Chapter 11 focuses on managing under-eating while chapter 12 concentrates on binge eating and over-eating. In chapter 13 managing difficult behaviours are discussed including, binge eating and compensatory behaviours, isolation, perfectionism, negative rumination, self-harm and obsessive compulsions and rituals. And finally the authors reflect on and summarize the treatment programme.

I would highly recommend that health professionals buy this manual and in turn recommend it to anyone involved in the care of someone with an eating disorder. It is the type of book the whole family can benefit from.