Counselling issues in people with HIV - PowerPoint PPT Presentation

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Counselling issues in people with HIV


Diploma, Body psychotherapy. Diploma, humanistic counselling ... Theoretical models I have found useful. Issues for people with HIV ... – PowerPoint PPT presentation

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Title: Counselling issues in people with HIV

Counselling issues in people with HIV
  • Fergus (Gus) Cairns
  • Diploma, Body psychotherapy
  • Diploma, humanistic counselling

  • Introductions
  • Theoretical models I have found useful
  • Issues for people with HIV
  • Assessment and how to handle certain clients

Introduction to course
  • Aim of training
  • To educate and inform participants about aspects
    of HIV and mental health
  • To help you discuss own experiences of dealing
    with clients with mental health and emotional
    support issues
  • To do some elementary experiential training to
    help volunteers deal with and relate to people
    with specific emotional support needs

Introduction to people!
  • Name
  • Why are you a counsellor?
  • Why you work in HIV
  • One thing you like doing thats nothing to do
    with HIV

Pair exercise
  • My bad day, and what I did about it

Part one some theoretical models I have found
  • Stress and stressors
  • Fight, flight and freeze
  • The Kübler-Ross adaptation model
  • The Gestalt cycle
  • Predispositions the Reichian character

A side-journey into STRESS
  • The state arising when the individual perceives
    that the demands placed on them exceed (or
    threaten to exceed) their capacity to cope, and
    therefore threaten their wellbeing.
  • Stress is not mental illness
  • Stress is a normal part of life
  • Stress has physical effects
  • The result of stress depends on what you do with
    these physical effects
  • To energise you
  • To give you ideas
  • To make you angry
  • To shut you up
  • To make you depressed
  • To make you ill
  • Paul Martin The Sickening Mind Brain,
    Behaviour, Immunity and Disease. ISBN

Stress scale top 10
Stress Event value
Death of spouse 100
Divorce 60
Menopause 60
Separation from living partner 60
Jail term or probation 60
Death of close family member other than spouse 60
Serious personal injury or illness 45
Marriage or establishing life partnership 45
Fired at work 45
Marital or relationship reconciliation 40
Fight, flight or freeze
  • Sympathetic and parasympathetic nervous systems
  • React automatically to stress
  • Sympathetic excitatory, parasympathetic
  • Usually the sympathetic nervous system responds
    to a stressor
  • Adrenaline (epinephrine) mobilises the Fight or
    flight reaction
  • When fight or flight is impossible the
    sympathetic and parasympathetic nervous systems
    both fire at once
  • Acetylcholine (and NO) normally produces
  • In the presence of sympathetic arousal it
    produces dissociation the Freeze reaction
    like an animal playing dead
  • Dissociation lies behind many adjustment
    disorders and stuck states see below

Adaptation to loss and change from On Death and
Dying by Elisabeth Kübler-Ross
The Gestalt Cycle adaptation and moving on
Four primary emotions
  • Happiness
  • Anger
  • Fear
  • Sadness
  • Confusion

Five primary emotions - stuck
  • Happiness stuck ? manic defence, denial
  • Anger stuck ? pathological rage, blame,
    self-harm, suicide
  • Fear stuck ? anxiety disorder, panic attacks,
    phobias, PTSD, OCD
  • Sadness stuck ? depression, dysthymia,
    irritability, physical symptoms
  • Confusion stuck ? more confusion (compound
    dissociation, fugue, DID, amnesia)

Predisposition the Reichian character
structuresDifferent structures vulnerable to
different stress
  • Schizoid child hated or ignored
  • Life means nothing unless I am in control
  • Oral child loved inadequately (e.g. PND)
  • Life means nothing unless I am loved
  • Symbiotic child loved to exclusion of others
  • Life means nothing unless we are in love
  • Narcissistic child used to make parents feel
  • Life means nothing unless I am adored and
  • Masochistic child over-disciplined or
  • Life means nothing unless I do it myself
  • Histrionic child used to create drama and
  • Life means nothing unless it is (sexually,
    emotionally) exciting
  • Rigid child brought up with rigid social
  • Life means nothing unless I am a success

Issues for people with HIV
  • HIV is a chronic stressor youre always aware
    of it
  • It may at certain times also be an acute stressor
    risk encounter, HIV diagnosis, AIDS diagnosis,
    rejection (sexual or family), discrimination,

HIV-specific issues
  • Physical HIV illness, dementia
  • Drug side effects efavirenz, also possibly AZT
  • New diagnosis
  • Stigma and isolation
  • Long term survivors Lazarus effect Im not
    special any more
  • Work and career
  • Loss and bereavement
  • Sex, love, disclosure, rejection
  • Body changes/image
  • Life issues that may have led to HIV depression,
    addictions, abuse

Why mental health is important in HIV
How common I North Carolina
How common II London 2002
Assessment what do you notice?
  • Appearance/behaviour unkempt, restless,
  • Rapport are they with you? Eye contact?
  • Speech slow, fast, easy, reluctant,
  • Mood euphoric, depressed, anxious, irritable,
    labile, blunted, incongruent
  • Thought block, incoherence, delusion, obsession
  • Cognition ability to understand and have
  • Body and perception dizzy, spaced-out, cold
    sweat, heart, headache, noise
  • Insight self-awareness, including the awareness
    that something is wrong (if it is)
  • And most important
  • HOW ARE YOU FEELING ? (countertransference and
    embodied countertransference)

What do you cover?
  • Famous first words (and actions)
  • Presenting problem
  • Family history
  • Relationships
  • Family relationships
  • Current life setting work, money, housing etc
  • Psych. History/medication
  • Medical history including HIV
  • Drink/drug issues/dependency
  • Any suicide history/ideation?
  • Sex risks/dysfunction
  • What are their hopes for counselling?
  • What do they expect counselling to be like?
  • Practical issues e.g. times/frequency/duration/fee
  • If this worked, what would you be like?

Depression and its risk factor, suicide
  • A storyMr Pig
  • Inner experience and meaning of depression
  • Language to watch out for overt/sleep/going
    away/switch off/cant cope
  • Depressed people are helpless, hopelessand
    annoying! Value their anger!
  • How NOT to help a depressed person
  • Dont reassure ?You dont understand
  • Dont reason ?Yes, but
  • Dont sympathise ? You see? Its hopeless
  • Dont get angry ?You see? You hate me too
  • Action and distraction work best

Anxiety and its risk factor, panic
  • A storyTim and my dog
  • Inner meaning and experience of anxiety states
    the adrenalin trap
  • Fight, flight and freeze
  • How NOT to help anxious clients
  • Do NOT reason with the fears
  • Do NOT argue with the irrational
  • Do NOT reassure
  • Physical relaxation techniques usually dont
    work person spaces out
  • Ask If you werent worrying about this, what
    would you be worrying about?

Anger and its risk factor, violence
  • A storyDave C.
  • Inner meaning and experience frustration and
  • Language and behaviour to watch out for
  • How to handle angry clients
  • Stay calm
  • Sit down
  • Match them with energy but not with anger
  • Make sure they can really see you they may be
    in Trauma an angry person is a frightened
  • Understand they need to be heard
  • Pre-set limits if you can no violence/destruction
    /safe words

Knowing who you cant work with
  • A story I am a medical experiment
  • Knowing when you cant work with someone is a
    very personal decision, based not only on your
    professional experience but your life issues
  • Signs no contact/relationship, no insight,
    delusion, extreme countertransference, clients
    issues mirror ones you currently have, client
    triggers trauma/memories
  • Strong reactions arent always bad!
  • Dislike, boredom, annoyance, anxiety, sadness,
    attraction (especially sexual!), urge to touchif
    you feel these then a) You feel what others feel
    b) Youre probably feeling what theyre feeling
    (even if they dont know it).

  • The roles people play
  • and the roles they try to get you to play
  • Projective identification
  • A story autistic Rob and his dreams
  • His therapists always started as rescuers and
    ended as bullies

Boundaries and confidentiality
  • The client who wants to be your friend
  • The client who tells you shocking things
  • When to break confidentiality
  • Imminent harm to self or others
  • Always have a professional contact
  • You are not there to suffer or be punished

Groups and peer groups
  • Isolation is the biggest single predisposing
    factor for mental illness
  • If you are a group facilitator, many of the same
    issues will come up with individuals
    complicated by group dynamics
  • Models directive, non-directive open, closed,
    slow open
  • You are there to interpret the group process, not
    to counsel individuals. The group will do that

Some workshops that could be adapted
  • Prevention/safer sex Healthy Relationships.
  • See
  • Living with HIV The Positive Self Management
    Programme (the Living Well course).
  • See and http//patienteducat
  • Self-confidence and getting more from life The
    AIDS Mastery. See

Any questions?
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