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BOOK REVIEWS

Fam Syst & Health 21: 435-440, 2003

A s you no doubt recall from Psych 101,X x o u r identity gradually expands from ourbody and our pull-toys to include our clothes,our car, and perforce o ur job. (I migh t ha veskipped a few things.) Reading the reviewsof these thre e books highlighted for me t heextraordinary value as well as privilegecontained for us in our profess ions inhealth care. Difficult as the challenges are,we get to be where it really matters to be.The books described here are reso urces forprofessionals, but for some re aso n-pro bab lybecause of the compassion and thoughtfulwriting of our reviewersI found myselfreading the reviews a s one who might needthose professionals. From that position, theirsignificance really stands out.

Sometime I might need a professional whoknows how to help me care for a relative withAlzheimer's. If I do, I hope Counseling theAlzheimer's Caregiver is at h a n d . Mycounselor would be the be tter for it. Authoredby Mittelman, Epstein, and Pierzchala, the

Thelma Jean Goodrich, Ph.D., Department ofFamily Practice and Communi ty Medicine, 6431Fannin, JJL 308S, Hous ton, TX 77030; (713) 500-7617;ThelmaJean.Goodrich@uth.tmc.edu

book gives an excellent evidence-basedapproach developed at New York University.Sometime I migh t need a professional whoknows how to help a family close to me hitby dep ression . If I do, I hope to find one w hohas taken to heart Beardslee 's Out of aDarkened Room. I could count on a balanceof individual as well as family atten tion .For sure I will need a doctor sometime,and for sure I wan t th at doctor to hav e rea dSavett 's The Human Side of Medicine. Thebook compi l es a l i f e t ime of wisdomsystem atically chronicled by Dr. Savett. Thereview makes it sound like the kind ofwisdom you w ant your doctor to star t w ith,not end w ith. So Save tt offers a great gift.

Thelma Jean Goodrich, Ph.D.Book Review Editor

Counseling the Alzheimer's Caregiver:A Resource for Healthcare Pro-fessionalsBy Mary S. Mittelman, Cynthia Epstein, andAlicia Pierzchala

American Medical Association PressChicago, 2003, 346 pagesThis impressive book is a comprehensivee v i d e n c e - b a s e d g u i d e for c o u n s e l i n gAlzheimer 's caregivers . It descr ibes anapproach developed by the staff of New York

435Families, Systems & Health, Vol. 21 , No. 4, 2003 F SH, Inc.

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4 3 6 / FAMILIES, SYSTEMS & HEALTHUn ivers ity School of Me dicine's Alzheim er'sDisease C enter, which ha s been the subjectof a 15-year efficacy trial. The outcome ofthe stud y shows clearly th at counseling andsupport can help families keep Alzheimer'sdisease patien ts at home and tha t competentemotional support an d referral resources canreduce t he negative impact of caregiving onthe caregivers.The book is designed to share the three-stage protocol developed a t the Alzheime r'sDisease Center for addressing the needs ofc a r e g i v e r s . Th e a u t h o r s k e e p t h e i rprofessional audience clearly in mind as the yaddress the sub jec t . They beg in wi thbackground i s sues on the d i sease , i t sdiagnosis, the stages of progression, andelements of the assessment. The GlobalDeterioration Scale is particularly helpful.It lists the symptoms and behaviors of theseven stages of the disease, as well as theapproximate duration of each stage. Theauthors then walk the reader through thestag es of Alzh eim er 's d isease an d thechallenges that come up for caregivers fromthe initial diagnosis through managementof difficult behaviors, relationship changes,choosing living arrangements, and finallydealing with death.

The counseling protocol is presented inthre e cha pters : counseling the caregiver fortwo sessions, counseling the family for foursessions, an d ad hoc counseling. The ad hoccounseling is a particularly unique aspect ofthe pro gram . This pa r t of the protocoladd resse s the ongoing needs of the caregiverby providing te lephone counsel ing foremotional support, crisis situations, andre fe r r a l i n fo rmat ion . Th i s suppor t i savailable for the dura tion of the illness.Although a program description soundsl i k e d r y r e a d i n g , t h e p r e s e n t a t i o n i sin t e r es t ing and engag ing . The au thor saccomplish this by including stories aboutc a r e g i v e r s , c o u n s e l o r s , a n d p a t i e n t s ,highlighted in gray through out th e text. Thereader follows the story of Millie and herhus ban d, Ted, and the ir family from the first

subtle signs of Ted's behavior changesthrou gh th e various challenges of the diseaseover a ten-year period. The ad hoc counselingprovided by the program me ets a vital needby making professional s uppo rt available toMillie and her family a s issues a rise. Th eirstory gives the book continuity and engage sthe re ade r in the progressive unfolding of thedisease for one family. In addition to Millie'sand Ted's story, every chapter is filled withengaging clinical vign ettes which h ighlightand reinforce the teach ing points.The book has many p rac t i ca l , andsometimes unique, ideas and suggestionswhich healthcare professionals can offercaregivers to help them adjust to their roleand manage the sometimes overwhelmingstress es. One section deals with add ressingthe reluctance and apprehension caregiversmay have about participating in supportg r o u p s . U n d e r l y i n g c o n c e r n s m a y b eexposing perso nal issues , feeling pre ssu re tocon tribute, or fear of w ha t will be discusse d.The chapter on relationships brings upthe challenge of building a life apart fromcaregiving. It even addresses the sensitiveissues relate d to developing a new rom anticrelation ship to help ease the loneliness andsadn ess of a partn er's prog ressive decline.The chap ter concerning the challenges ofmanaging the pat ient ' s behaviora l andpsychological symptoms not only hassuggestions for creating a safe env ironment,but also deals with the resistance thatcaregivers can have toward making thesechang es. The auth ors define "environment"very broadly to include the neighborhood aperson lives in, the layout of the home, thepeople that make up his or her socialnetwork, and the interactions they share.Ano ther chap te r o f f e r s p r ac t i ca lsuggestions for the caregiver during thepatien t's hospitalization. These suggestionsinclude ways to simplify the environment,reduce patient agitation, and communicatewith hospital staff. The auth ors recommendthat the caregiver stay involved with thehospitalized patient, instead of thinking of

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BOOK R EVIEWS /437the hospitalization as respite tim e. Ways tofind respite are creatively dealt with inanother section.The chapter on residentia l care providessound and balanced guidance rega rding th edifficult decision to place a relative in ares ident ia l fac i l i ty . The a u t h o r s w a r ncaregivers that the first visit to a facilitymight be distressing. They suggest that byvisiting a number of nursing homes, andtaking time to compare them , caregivers willform a realistic view of w ha t the se facilitiescan provide. This chapter also includes acom prehensive list of w ha t to look for w henvisiting an assis ted- l iv ing se t t ing or anursing home.Each cha pter conveniently concludes witha checklist, which summarizes the mainpoints of the cha pter. This tool can be use das a quick guide for counselors or h ealt hca reproviders who are working w ith a caregiver.The chapters are arrange d so that counselorscan tur n to the section addressing the issuesat hand and find a list to guide them in thecounseling proc ess.

Although the authors descr ibe thei rapproach as applicable for developing acounseling pro gram in a physician's office,it is left to the reader to organize the ma terialand imagine its application in a prim ary c aresetting. Prim ary care counseling is more likethe ad hoc part of the counseling protocol. Itis well known that caregivers will turn totheir doctors, often with somatic co mplaints,when the s t resses of caregiving becomeo v e r w h e l m i n g . P h y s i c i a n s , and t h o s eteaching physicians, would clearly benefitfrom a succinct sum ma ry of issue s to considerwhen assisting a caregiver in th e con text ofa brief primary care counseling visit . Awelcome addition to the book would have beena chapter for prim ary care counseling. Thischapter could have pulled togethe r the gemsscattered throughout book and t ake thephysician beyond the usual self-care advicefrequently offered to caregivers.

This book is a well-written and clearmanual that accomplishes what it sets out

to do. It is a practical resource book filledwith vivid vignettes a nd specific strate giesfor helping healthc are professionals m eet th edaily and long-term challenges of assistingfamilies caring for Alzheimer's patients atevery stage of this de vas tating disease. Thecumulat ive knowledge presented by theauthors f i l ls a gap by providing a r ichresource for anyone in a position of counselingor supporting a caregiver.Mary Anne Carling, M.A., C.S.W.

Department of Family PracticeBronx-Lebanon Hospital CenterBronx, New York

Out of a Darkened Room: When aParent is Depressed, Protecting theChildren and Strengthening the FamilyBy William R. BeardsleeLittle, Brown, and CompanyBoston, 2002, 294 pagesOne possible critique of family th era py istha t, in its efforts to contextuahze prese nting

problems in children and bring abo ut second-order changes to the family as a whole, itminimizes the t r a u m a e x p e r i e n c e d byindividuals and the demands and effortinvo lved in m o r e p e r s o n a l f o r m s oft r ans fo rmat ion . Wi l l i am R. Beards lee ,Psychiatrist-in-Chief and the Chairman ofthe Depar tmen t of Psychiatry at BostonChildren's Hospital , presents a model oftherapy for families when the t hre at to thefamily and the challenge to the the rap ist issevere and deb ilitating paren tal depression.Dr. Beardslee's model aims to prevent theintensification of problems in children bycombating pa ren tal depression in the familycontext.A series of steps comprise the model: 1)holding a family meeting so that silenceabout the illness can be broken and familydialogue can begin, 2) developing knowledgea b o u t the i l l n e s s and c l e a r i n g up

misconcept ions , 3) fac i l i ta t ing medicalt r e a t m e n t and i n d i v i d u a l t h e r a p y toFamilies, System s & He alth, Vol. 21, No. 4, 2003 FSH, Inc.