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10
Book Reviews
Given that the aims of this book are to encourage clinicians to try cognitive and behavioural
methods with depressed clients, it is understandable that the author has concentrated almost
exclusively on the literature surrounding these areas. Although in one way a strength, such a
narrow focusing can also be frustrating, as links with other therapeutic orientations are passed
over. The more eclectically-minded, for instance, might have liked to have seen reference to the
process research examining the impact of specific events within therapy, or of attempts to
integrate cognitive techniques with more psychodynamic therapies (e.g. Cognitive Analytic
Therapy). These, however, are relatively minor points and the achievement of this book in
lucidly setting out a range of models, assessment and treatment techniques should not be
under-estimated.
RIK CHESTON
Scliool of Social Sciences, University of Bath
Mulleady, G., Counselling Drug Users about HIP‘ und AIDS. xiii + 204; No price given
paperback. Black Scientific Publications, Oxford (1992).
A subtitle of this book could have been ‘HIV, IVDU and Health Education’. Intravenous drug
users (IVDUs) constitute the second largest group of persons with acquired immunodeficiency
syndrome (AIDS) in several countries in the world and serve as a major conductor of the human
immunodeficiency virus (HIV) to other groups, including non-drug-using sex partners and their
children (Centers for Disease Control, 1990).
Mulleady’s stated aim is to draw together the literature on ‘the broad overview of how human
immune deficiency syndrome AIDS epidemic is regarded as a disease state arising as a result of
infection with the human immunodeficiency virus (HIV)’ (p. 1). Because of her emphasis on the
significance of information about the AIDS syndrome, the treatment currently available and the
concerns of drug users, Mulleady has excluded topics such as psychotherapeutic principles and
AIDS counselling for drug injectors, the multicultural experience with HIV disease, moral
development and HIV prevention and HIV Cofactors.
The standard of the chapters is uniformly high and illustrates well the broad range of expertise
that is currently contributing to advancement of HIV, IVDU, and Health Education.
Mulleady’s introductory chapters explore the immune system, disease spectrum and the
diagnosis of AIDS; working and coping with behaviour change in drug injectors by health
professionals; pre- and post-test counselling and sexual behaviour counselling. The succeeding
chapters discuss current and future dimensions of HIV virus among women and children at high
risk in the African continent; and drug addiction in pregnancy and the neonate, resulting in utero
opiate dependence and sudden infant death syndrome. There is focus also on the HIV risk
behaviour of drug injecting and syringe sharing in the community. The final chapters explore the
issues of clinical management of intravenous drug users with AIDS. They include coping with
dying and bereavement and a concluding overview of AIDS groups psychotherapy and relapse
prevention.
Mulleady’s thorough treatment of her chosen subject matter provide the book with three main
strengths: her discussion of the best use of services in the assessment, diagnosis and intervention
with drug-injecting clients; a rigorous exploration of the range of interventions which promote
harm minimisation and AIDS-risk reduction; and a logical presentation and examinations of
these accounts. By painstakingly providing a series of biopsychological theories and issues,
Mulleady has produced a very useful introduction to the growing area of ‘AIDS, IVDU and
Health Education’. However, the brevity of these reviews, while making the volume manageable
as an introduction, might limit its suitability as an undergraduate or primer text. The volume
assumes a fair amount of background knowledge, and constitute a remarkable biopsychosocial
overview and evaluation of ‘the state of the art’. As a text, it would need to be supplemented by
considerable additional references.
While the choice and treatment of subject matter make the volume, a book with ‘its heart in the
right place’, it is arguable that as an ‘AIDS, IVDU and Health Education’ text it provides too
narrow a coverage of the field. Readers with no knowledge of psychotherapeutic principles and
AIDS counselling will not have a proper grip of the subject matter. There are some deficiencies.
First, there is no mention of the general principles of psychotherapy that can be usefully applied,
Book Reviews
71
depending on the type of counselling and setting, to HIV risk reduction counselling. These
principles, according to Grace et a]., 1992, relate to the ‘process’ or patterns of clientcounsellor interaction, rather than the ‘content’ or informational components of the interaction.
The author’s neglect of multi-level interventions is most clearly shown in her approach to
evaluation. Similarly the author offers little evidence to suggest that any changes may be
longlasting or effective in reducing the risk of future drug use.
An HIV cofactor is a behaviour, substance, infection or other agent that affect the course of
HIV, either by influencing the transmission of the virus or the progression of the disease. Agents
that have been considered as possible cofactors for HIV transmission or disease progression
include alcohol and other drugs, a range of sexually transmitted diseases (STD’s), psychological
stress, smoking and nutrition. Whether or not a single module can do justice to all areas of HIV,
IVDU and Health Education is a separate issue; however, a book that purports to be a HIV text
should tackle all fundamental areas of the field. Also the author needs to highlight the shortcoming of the quasi-experimental design (pretest-treatment-post-test) she has advocated.
Findings suggest that many addicts act in a rational fashion when faced with important choices
regarding behaviours which are directly AIDS-related. It appears that the educational intervention was successful because it sensitized subjects to the realities of AIDS, established AIDS as
a real threat to them, and then immediately armed them with knowledge and materials (bleach,
condoms and assorted literature) to assist them in their own risk-reduction efforts. ‘When faced
with the prospect of disease and death from AIDS, many addicts seemed willing to modify their
behaviour-particularly the way in which needles and related paraphernalia are used-in order
to minimize the chance of infections’ (Stephen et al., 1991, p. 571). Finally, in common with most
AIDS/HIV texts, relatively little space is devoted to the effect of AIDS on work (Akande, 1993).
These minor discrepancies do not detract from the value of this substantial, thought-provoking thesis. This book is intended primarily as a book for practitioners, who are faced with the
hard task of trying to keep abreast of latest developments while also coping with heavy
workloads. It should be read not only by all those working with or encountering drug users in the
health-care field, but it would also be helpful for psychologists, social workers and psychiatrists
commencing work with youth and adolescents, health planners, medical anthropologists, sociologists, health economists, rural sociologists and development experts. My smart guess is that
anyone who takes an interest in the introduction will want to go on and read the whole piece.
ADEBOWALE
AKANDE
Department of’ Psychology, University of the Western Cape, Republic of South Africa
References
Akande, A. (1993). AIDSlHIV training in the workplace, Journal of European Industrial
Training, (forthcoming).
Centers for Disease Control (1990). AIDS update, Morbidity and Mortality Weekly Report, 39,
259-289.
Grace, W. C., Genger, S. G. and Coslett, R. N. (1992). ‘Psychotherapeutic principles and AIDS
counselling for drug injectors’, Focus, 7(2), 1-3.
Stephen, R. C., Feucht, T. E. and Roman, S. W. (1991). ‘Effects of an intervention program on
AIDS-related drug and needle behaviour among intravenous drug users’. American Journal of’
Public Health, 18(5), 568-657.
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