Book Review

Therapists on the Front Line: Psychotherapy with Gay Men in the Age of AIDS

N Engl J Med 1994; 331:619-620September 1, 1994

Article

Therapists on the Front Line: Psychotherapy with Gay Men in the Age of AIDS
Edited by Steven A. Cadwell, Robert A. Burnham, Jr., and Marshall Forstein. 576 pp. Washington, D.C., American Psychiatric Press, 1994. $55. ISBN: 0-88048-558-2

This book is a useful source of information for therapists, physicians, nurses, and other health care professionals who care for people at risk for, or living with, HIV or AIDS. That includes virtually all medical and mental health professionals who are in practice or in training during the current burgeoning pandemic. The editors have assembled an extremely well informed and articulate group of authors, who have comprehensively covered a complex and disquieting set of issues. The book stands on its own as an extremely useful tool for understanding how best to deal with the people most likely to be infected with HIV and to die of AIDS. It also offers wonderful lessons for understanding the social context of homosexuality in relation to and independent of AIDS, the complexities of delivering therapy to patients with a chronic fatal disease, and the need for health care professionals to deal with their own personal issues regarding sexuality, morality, and empathy.

The first section of this well-organized book develops several key themes, including the stigmatization of homosexuals, the effects of living with HIV, suicidal ideation, and neuropsychiatric dysfunction. It concludes with two well-written chapters on diagnostic methods.

The sections that follow include chapters based on diverse psychotherapeutic approaches, ranging from psychoanalysis to group therapy. The humanism of the therapists who have written the chapters pervades the entire book, whether they are describing the role of childhood sexual abuse in the origins of risk-taking behavior or the survivor guilt experienced by men whose partners have AIDS. The book is culturally specific, with chapters on working with African Americans and Latinos, as well as rural gay men.

The book also evaluates issues faced by therapists that relate to the care of people with AIDS or HIV, such as countertransference and peer supervision, and the challenges faced by gay therapists who may be HIV-seronegative while working with clients who are HIV-infected. The authors also confront the difficult issues faced by therapists who become infected and how they disclose this information to their HIV-infected and uninfected clients. In short, the book is a tour de force; it contains a great deal of new information. I found it extremely enlightening and highly recommend it to primary medical providers, clinical researchers, and mental health professionals. The book exemplifies the optimal response to new challenges, such as the complex and depressing ones posed by this unremitting epidemic.

Kenneth H. Mayer, M.D.
Brown University School of Medicine, Providence, RI 02912