Alcohol & Alcoholism Vol. 40, No. 2 © Medical Council on Alcohol 2005; all rights reserved
BOOK REVIEW
Shame, Guilt and Alcoholism Treatment Issues in Clinical Practice, 2nd edn. By Ronald Potter-Efron, The Haworth Press, New York. £12.88. 237 pgs. ISBN 0 7890 1517 X
The book's content is very much what it says on the cover. The author explores the two emotions of guilt and shame, suggesting theoretical models on how these are produced and maintained and then examines how the therapist can assist clients to face these issues and recover.The first chapter differentiates between guilt and shame, showing that essentially guilt is about what people ‘do’ whereas shame is more about ‘being’ and how people perceive themselves. It is this difference that makes the book more comprehensive in examining shame, as changing long-held beliefs about self is a more profound challenge to the therapist, than the behavioural changes necessary to alleviate guilt.
The link is made between guilt, shame and addiction and the author continues to expand on this throughout the book. Interestingly, the author demonstrates how guilt and shame are tackled in the steps and traditions of Alcoholics Anonymous, as well as within individual and group clinical practice.
The next chapters explore, first, shame and then guilt. The author is careful to distinguish between the adaptive and maladaptive features of each emotion and acknowledges that a degree of each is necessary for humans to regulate their behaviour appropriately. He provides guidance on how the therapist can diagnose excess or inappropriate elements of shame and guilt and gives examples of probes that the therapist can use to delve deeper into the issues. He describes case studies and scenarios from his own experience to illustrate points.
The last chapters tie together all the items explored and focus on specifics associated with addiction including substance abuse within families, Alcoholics Anonymous and helping the adult children of alcoholics.
The book is well collated and thorough, incorporating up-to-date references from a range of experts in the field. It balances the theoretical with the practical in an easily understandable way and provides a useful tool for any clinician.
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