COUNSELLING SPECIAL GROUPS

CHILD AND ADOLESCENT COUNSELLING

Child and adolescent counselling is a process between a child or adolescent and
a counsellor in a trusting relationship to help that child or adolescent explore
and make sense of a traumatic experience that has happened to them (e.g.
death of a parent, abusive situations).
The aims of child and adolescent counselling Child and adolescent
counselling focuses on supporting the behavioural, emotional and social growth
of children and adolescents. Child and adolescent counselling aims to assist
children and adolescents recover their self-esteem and confidence. It helps them
understand that the trauma was not their fault and to address any fear or anger
they are feeling.
Trauma is when a child feels strongly threatened by one or repeated events s/he
is involved in or has witnessed. Incidents that cause trauma can happen abruptly
or unexpectedly, like accidents, violence, rape or death. In other cases children
might experience a series of traumatic events, such as abuse, the chronic illness
of a parent or multiple deaths in a household.
Reactions to trauma after being exposed include:
 Anxiety and fear  Sadness and loss  Sleeping difficulties  Unruly
behaviour, anger and aggression  Guilt, feeling that they are to blame. 
Withdrawal and isolation  Difficulty concentrating in class and poor
performance  Poor health

Resilience is the ability to recover quite quickly from severe traumatic events.
All children are born with the potential to be resilient, but this can vary greatly
between children. Resilience has to be promoted and developed. Resilient
children take strength from their own character and can cope with difficult
situations. It is important to support children and adolescents who are building
up their resilience Talking with the child can increase their chances of recovery
– the negative effects of trauma can become greater if they don‘t have the
chance to talk through their experiences. Talking about traumatic events allows
people‘s thoughts to become clearer and less confusing. It can also help a child
make sense of strong and frightening emotions and feelings, such as guilt, anger
or fear. Other ways of promoting resilience in children and adolescents might
include encouraging them to keep in touch with their friends who can provide

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support and/or join other peer support networks; providing accurate information
about any physical symptoms they might be experiencing.
Coping can be taught and learned. Raising a child is not just a matter of taking
care of that child, but supporting the child‘s efforts to take care of him/herself.
Some coping mechanisms include:  Having a friend or trusted adult to talk to. 
Asking a neighbour or teacher for help.  Praying  Hoping for and working
towards a better future  Finding ways of becoming self-reliant.

COUNSELLING PLWHIV AND AIDS

Patients may present for testing for any number of reasons, ranging from a
generalised anxiety about health to the presence of HIV related physical
symptoms. For patients at minimal risk of HIV infection, pre-test discussion
provides a valuable opportunity for health education and for safer sex messages
to be made relevant to the individual. For patients who are at risk of HIV
infection, pre-test discussion is an essential part of post-test management. These
patients may be particularly appropriate to refer for specialist counselling
expertise.

The importance of undertaking a sensitive and accurate sexual/and or injecting

drug risk history of both the patient and their sexual partners cannot be
overstated. If patients feel they cannot share this information with the physician
or counsellor then the risk assessment becomes meaningless; patients may be
inappropriately reassured, for example, and be unable to disclose the real reason
for testing. Counselling skills are clearly an essential part of establishing an
early picture of the patient and his/her history and of how much intervention is
needed to prepare him or her for a positive result, and to further reinforce
prevention messages. It is at this stage that potential partners at risk are
identified which will become an important part of the patient's management if
HIV positive.

Post-test counselling

HIV results should be given simply, and in person. For HIV negative patients
this may be a time where the information about risk reduction can be “heard”
and further reinforced. With some patients it may be appropriate to consider
referral for further work on personal strategies to reduce risks—for example one
to one or group interventions. The window period of 12 weeks should be
checked again and the decision taken about whether further tests for other
sexually transmitted infections are appropriate.

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HIV positive patients should be allowed time to adjust to their diagnosis.
Coping procedures rehearsed at the pre-test discussion stage will need to be
reviewed in the context of the here and now; what plans does the patient have
for today, who can they be with this evening? Direct questions should be
answered but the focus is on plans for the immediate few days, when further
review by the counsellor should then take place. Practical arrangements
including medical follow up should be written down. Overloading the patient
with information about HIV should be avoided at this stage. Sometimes this
may happen because of the health professional's own anxiety rather than the
patient's needs. Counselling support should be available to the patient in the
weeks and months following the positive test results.

Counselling during combination antiretroviral therapy

Significant developments in combination antiretroviral therapy have led to a

surge of optimism about long term medical management of HIV infection, and
people are now living much longer with HIV. Patient adherence is an important
factor in the efficacy of drug regimens. However, taking a complicated drug
regimen—often taking large numbers of tablets several times a day—is a
constant reminder of HIV infection. The presence of side effects can often make
patients feel more unwell than did the HIV and some may be unable to cope
with the side effects. Counselling may be an important tool in determining a
realistic assessment of individual adherence and in supporting the complex
adjustment to a daily routine of medication.

Coping strategies
 Using counselling
 Problem solving
 Participation in discussions about treatment
 Using social and family networks
 Use of alternative therapies, for example relaxation techniques, massage
 Exploring individual potential for control over manageable issues
 Disclosure of HIV status and using support options

Psychological responses to an HIV positive result

Many reactions to an HIV positive diagnosis are part of the normal and
expected range of responses to news of a chronic, potentially life threatening
medical condition. Many patients adjust extremely well with minimal
intervention. Some will exhibit prolonged periods of distress, hostility, or other
behaviours which are difficult to manage in a clinical setting. It should be noted
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that serious psychological maladjustment may indicate pre-existing morbidity
and will require psychological/psychiatric assessment and treatment. Depressed
patients should always be assessed for suicidal ideation.

Effective management requires allowing time for the shock of the news to sink
in; there may be a period of emotional “ventilation”, including overt distress.
The counsellor should provide an assurance of strict confidentiality and
rehearse, over time, the solutions to practical problems such as who to tell, what
needs to be said, discussion around safer sex practices and adherence to drug
therapies. Clear information about medical and counselling follow up should be
given. Counselling may be of help for the patient's partner and other family
members.

Psychological issues in HIV/AIDS counselling

Shock
 of diagnosis
 recognition of mortality
 of loss of hope for the future

Fear and anxiety

 uncertain prognosis
 effects of medication and treatment/treatment failure
 of isolation and abandonment and social/sexual rejection
 of infecting others and being infected by them
 of partner's reaction

Depression
 in adjustment to living with a chronic viral condition
 over absence of a cure
 over limits imposed by possible ill health
 possible social, occupational, and sexual rejection
 if treatment fails

Anger and frustration

 over becoming infected
 over new and involuntary health/lifestyle restrictions
 over incorporating demanding drug regimens, and possible side effects,
into daily life

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Guilt
 interpreting HIV as a punishment; for example, for being gay or using
drugs
 over anxiety caused to partner/family
COUNSELLING THE ELDERLY.

Aging includes life changes and transitions, like retirement, that may warrant
counselling.

The elderly might want to go to therapy if they

 Spend an hour or more each day worrying about a particular issue

 Are embarrassed or ashamed about something in their life
 Have developed unhealthy habits to cope with big life changes
 Feel overwhelmed, anxious, or disinterested in things they used to enjoy

 Transitioning to retirement. For some people, retirement is an exciting

time to travel, immerse yourself in a hobby, or spend extra time with the
family. Others may feel less enthusiastic and wonder what to do with
their time. Even if you are excited to retire and have plans for how to
spend your time, the transition can still be a shock to the system.
 Talking to a counselor can help them consider their choices and reflect on
their career. It can also give them a better sense of what they want to
focus on during retirement.
 Dealing with medical issues. As they age, they may have health issues
that change the way you do things. There are many conditions linked to
getting older that may change their daily routines and abilities. Even if
they haven’t been diagnosed with a condition, as they get older their,
vision, hearing, memory and physical strength will likely decline.