BOOK REVIEWS

book gives an excellent evidence-based approach developed at New York University. Sometime I might need a professional who A s you no doubt recall from Psych 101, knows how to help a family close to me hit Xxour identity gradually expands from our by depression. If I do, I hope to find one who body and our pull-toys to include our clothes, has taken to heart Beardslee's Out of a our car, and perforce our job. (I might have Darkened Room. I could count on a balance skipped a few things.) Reading the reviews of individual as well as family attention. of these three books highlighted for me the For sure I will need a doctor sometime, extraordinary value as well as privilege and for sure I want that doctor to have read contained for us in our professions in Savett's The Human Side of Medicine. The healthcare. Difficult as the challenges are, book compiles a lifetime of wisdom we get to be where it really matters to be. systematically chronicled by Dr. Savett. The The books described here are resources for review makes it sound like the kind of professionals, but for some reason-probably wisdom you want your doctor to start with, because of the compassion and thoughtful not end with. So Savett offers a great gift. writing of our reviewersI found myself reading the reviews as one who might need Thelma Jean Goodrich, Ph.D. those professionals. From that position, their Book Review Editor significance really stands out. Sometime I might need a professional who knows how to help me care for a relative with Counseling the Alzheimer's Caregiver: Alzheimer's. If I do, I hope Counseling the A Resource for Healthcare ProAlzheimer's Caregiver is at hand. My fessionals counselor would be the better for it. Authored By Mary S. Mittelman, Cynthia Epstein, and by Mittelman, Epstein, and Pierzchala, the Fam Syst & Health 21: 435-440, 2003
Alicia Pierzchala American Medical Association Press Chicago, 2003, 346 pages

Thelma Jean Goodrich, Ph.D., Department of Family Practice and Community Medicine, 6431 Fannin, JJL 308S, Houston, TX 77030; (713) 500-7617; ThelmaJean.Goodrich@uth.tmc.edu

This impressive book is a comprehensive evidence-based guide for counseling Alzheimer's caregivers. It describes an approach developed by the staff of New York

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University School of Medicine's Alzheimer's Disease Center, which has been the subject of a 15-year efficacy trial. The outcome of the study shows clearly that counseling and support can help families keep Alzheimer's disease patients at home and that competent emotional support and referral resources can reduce the negative impact of caregiving on the caregivers. The book is designed to share the threestage protocol developed at the Alzheimer's Disease Center for addressing the needs of caregivers. The authors keep their professional audience clearly in mind as they address the subject. They begin with background issues on the disease, its diagnosis, the stages of progression, and elements of the assessment. The Global Deterioration Scale is particularly helpful. It lists the symptoms and behaviors of the seven stages of the disease, as well as the approximate duration of each stage. The authors then walk the reader through the stages of Alzheimer's disease and the challenges that come up for caregivers from the initial diagnosis through management of difficult behaviors, relationship changes, choosing living arrangements, and finally dealing with death. The counseling protocol is presented in three chapters: counseling the caregiver for two sessions, counseling the family for four sessions, and ad hoc counseling. The ad hoc counseling is a particularly unique aspect of the program. This part of the protocol addresses the ongoing needs of the caregiver by providing telephone counseling for emotional support, crisis situations, and referral information. This support is available for the duration of the illness. Although a program description sounds like dry reading, the presentation is interesting and engaging. The authors accomplish this by including stories about caregivers, counselors, and patients, highlighted in gray throughout the text. The reader follows the story of Millie and her husband, Ted, and their family from the first

subtle signs of Ted's behavior changes through the various challenges of the disease over a ten-year period. The ad hoc counseling provided by the program meets a vital need by making professional support available to Millie and her family as issues arise. Their story gives the book continuity and engages the reader in the progressive unfolding of the disease for one family. In addition to Millie's and Ted's story, every chapter is filled with engaging clinical vignettes which highlight and reinforce the teaching points. The book has many practical, and sometimes unique, ideas and suggestions which healthcare professionals can offer caregivers to help them adjust to their role and manage the sometimes overwhelming stresses. One section deals with addressing the reluctance and apprehension caregivers may have about participating in support groups. Underlying concerns may be exposing personal issues, feeling pressure to contribute, or fear of what will be discussed. The chapter on relationships brings up the challenge of building a life apart from caregiving. It even addresses the sensitive issues related to developing a new romantic relationship to help ease the loneliness and sadness of a partner's progressive decline. The chapter concerning the challenges of managing the patient's behavioral and psychological symptoms not only has suggestions for creating a safe environment, but also deals with the resistance that caregivers can have toward making these changes. The authors define "environment" very broadly to include the neighborhood a person lives in, the layout of the home, the people that make up his or her social network, and the interactions they share. Another chapter offers practical suggestions for the caregiver during the patient's hospitalization. These suggestions include ways to simplify the environment, reduce patient agitation, and communicate with hospital staff. The authors recommend that the caregiver stay involved with the hospitalized patient, instead of thinking of

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the hospitalization as respite time. Ways to find respite are creatively dealt with in another section. The chapter on residential care provides sound and balanced guidance regarding the difficult decision to place a relative in a residential facility. The authors warn caregivers that the first visit to a facility might be distressing. They suggest that by visiting a number of nursing homes, and taking time to compare them, caregivers will form a realistic view of what these facilities can provide. This chapter also includes a comprehensive list of what to look for when visiting an assisted-living setting or a nursing home. Each chapter conveniently concludes with a checklist, which summarizes the main points of the chapter. This tool can be used as a quick guide for counselors or healthcare providers who are working with a caregiver. The chapters are arranged so that counselors can turn to the section addressing the issues at hand and find a list to guide them in the counseling process. Although the authors describe their approach as applicable for developing a counseling program in a physician's office, it is left to the reader to organize the material and imagine its application in a primary care setting. Primary care counseling is more like the ad hoc part of the counseling protocol. It is well known that caregivers will turn to their doctors, often with somatic complaints, when the stresses of caregiving become overwhelming. Physicians, and those teaching physicians, would clearly benefit from a succinct summary of issues to consider when assisting a caregiver in the context of a brief primary care counseling visit. A welcome addition to the book would have been a chapter for primary care counseling. This chapter could have pulled together the gems scattered throughout book and take the physician beyond the usual self-care advice frequently offered to caregivers. This book is a well-written and clear manual that accomplishes what it sets out

to do. It is a practical resource book filled with vivid vignettes and specific strategies for helping healthcare professionals meet the daily and long-term challenges of assisting families caring for Alzheimer's patients at every stage of this devastating disease. The cumulative knowledge presented by the authors fills a gap by providing a rich resource for anyone in a position of counseling or supporting a caregiver. Mary Anne Carling, M.A., C.S.W.
Department of Family Practice Bronx-Lebanon Hospital Center Bronx, New York

Out of a Darkened Room: When a Parent is Depressed, Protecting the Children and Strengthening the Family
By William R. Beardslee Little, Brown, and Company Boston, 2002, 294 pages

One possible critique of family therapy is that, in its efforts to contextuahze presenting problems in children and bring about secondorder changes to the family as a whole, it minimizes the trauma experienced by individuals and the demands and effort involved in more personal forms of transformation. William R. Beardslee, Psychiatrist-in-Chief and the Chairman of the Department of Psychiatry at Boston Children's Hospital, presents a model of therapy for families when the threat to the family and the challenge to the therapist is severe and debilitating parental depression. Dr. Beardslee's model aims to prevent the intensification of problems in children by combating parental depression in the family context. A series of steps comprise the model: 1) holding a family meeting so that silence about the illness can be broken and family dialogue can begin, 2) developing knowledge about the illness and clearing up misconceptions, 3) facilitating medical treatment and individual therapy to

Families, Systems & Health, Vol. 21, No. 4, 2003 FSH, Inc.