MODULE NAME: COUNSELLING
CMT: 05206
NTA LEVEL 5, SEMESTER 2
QUALIFICATION: TECHNICIAN CERTIFICATE IN
CLINICAL MEDICINE
FACILITATOR’S NAME: G. MINJA
DATE: 2ND MAY 2019
PRINCIPAL OUTCOME:
1. Apply basic principles of clinical examination and
diagnostic procedures to reach proper diagnosis
Enabling Outcome:
2.3 Apply effective counselling skills in managing
clients
Sub enabling out comes:
2.3.1. Use effective counselling skills
2.3.2. Describe various types of HIV counselling to
general and Key Population
Cont....
 2.3.3. Demonstrate counselling skills in
providing health care services to HIV clients
2.3.4.Demonstrate HIV counselling and testing
skills
2.3.5. Provide counselling to patients with
other chronic illnesses
2.3.6. Provide counselling to PWUDs and
PWIDs
MODULE SESSIONS
Session 1: Counselling skills in managing
clients
Session 2: Overview of HIV Testing and
Counselling Approaches in Tanzania
Session 3:Pre-Test Counselling in Voluntary
Counselling & Testing (VCT)
Session 4: Post-Test Counselling in Voluntary
Counselling &Testing (VCT)
Session 5:Provider Initiated Testing and
Counselling (PITC)
Cont....
Session 6: Family Counselling
Session 7: Couples Counselling
Session 8: Crisis Counselling
Session 9: Counselling in providing health
care services to HIV clients
Session 10: Chronic illness counselling
Session 11: PWUD (People who use drugs) and
PWIDs (People who inject drugs) counselling
SESSION 1: EFFECTIVE COUNSELLING SKILLS IN
MANAGING CLIENTS
Related Tasks
By the end of this session, students are expected
to be able to:
1. Define terms used in counselling
2. Identify types of HIV counselling
3. Identify guiding principles used in counselling
4. Explain characteristics of a good counselor
5. State general approach to counselling
DEFINITION OF TERMS
Counselling; is an activity that help client/
patients to gain the information, motivation
and skills to deal with their problems.
OR
Counselling; is an interpersonal relationship
between someone actively seeking help from
someone trained and willing to give help
Cont....
Pre – testing counselling: is a dialogue
between a client and a counsellor before
the HIV test is performed
Post-Test Counselling
• Is a dialogue between a client and
counsellor when the HIV test results are
ready and are about to be given to the
client
Cont.....
PITC (Provider-Initiated Testing and
Counselling)
• Refers to HIV Testing and Counselling which is
recommended by health care providers (HCPs)
to persons attending healthcare facilities.
(CITC) Client Initiated HIV Testing and
Counselling
In this approach, also known as Voluntary Counselling
and Testing (VCT), client(s) voluntarily make the
decision to learn their HIV status
GOALS OF COUNSELLING
The goal of counselling is to help patients discover their
own thoughts and feelings
In addition, counselling can help clients/patients
manage their situations by:
• Providing emotional support and safety in times of
crisis
• Helping people to explore their emotions
• Helping people make informed choices and change
their behaviours based on accurate information
THE OUTCOMES OF COUNSELLING
The results or decision of a counselling process
aim to enable the patient to:
Make some of the changes that he/she wants
in life
Develop positive relationships and explore his
or her potential
Cope with painful situations, like death,
terminal illness and disability
TYPES OF COUNSELLING
There are three (3) types of Counselling
 Individual counselling
 Group counselling
 Couple counselling
1. INDIVIDUAL COUNSELLING:
• Individual counselling is a one-to-one helping
relationship in which the counsellor helps the
client to accept, solve or cope with the
problem.
Cont....
Features of individual counselling includes client
comes on his/her own or he/she is referred
from another counsellor/source.
Client coming for counselling may be an adult,
youth or child who is:
Able to talk rationally
Mentally distraught – unable to think/talk
rationally
With varied life experience
Duration of individual counselling
A helping relationship may be one, a few or
many sessions.
The setting in which the relationship occurs
whether it is a counselling centre, VCT
centre/hospital.
The nature and duration of individual
counselling cannot be determined until the
nature of the problem is clarified.
Cont....
• In most cases the initial session begins in
a similar way of staying with a client for
45 minutes to 60 minutes per session.
• Counselling relationship may terminate
when a counsellor and client conclude a
successful counselling relationship or
client referral is made
2. GROUP COUNSELLING:
• Group counselling is a one-to-group helping
relationship in which the counsellor works
with the group in seeking a solution to their
common problem. Example couples is
considered as group
• Group Counselling is designed to help clients
in a group to achieve increased understanding
integration, and acceptance of reality,
socialization, realistic goals, adaptability and
responsibility for self.
Cont....
• The general aim is to help members appraise
themselves so that they may gain
understanding, and broad perceptive of
themselves in relation to others
Features of Group Counselling:
A group of clients must have the following
features;
• Clients in the group must have a common problem.
• There must be active integration among members.
COUPLE COUNSELLING
Couple refers to two people, usually of opposite sex,
who may be:
 Married
 Cohabiting (not married but a man and woman are
staying together)
 Friends
 Couple counselling occurs when two individuals who
have had or who intend to have sexual relations wish
to discuss issues concerning HIV together and look
for ways to cope with the situation.
Cont....
Usually two people come in for couple
counselling if:
They intend to get married
One or both member/s is/are sick
They intend to have children
They are having conflicts in the home around
being honest about sexual practices and safer
sex
Cont....
The couple has a sick child; or the child dies of AIDS
related complex
They have been referred to the clinic by a doctor
• Homosexual male and homosexual female
couples are also at risk of transmitting HIV to
one another.
• Couple counselling can also be offered to
them just as to heterosexual couples.
GUIDING PRINCIPLES OF COUNSELLING
• A counselor must observe the 3 C’s which are
the guiding principles for HIV counselling
testing:
– Confidentiality
– Counselling
– Informed Consent
GUIDING PRINCIPLES IN PITC
1. CONSENT
• Informed consent, one of the three guiding
principles of testing and counselling, it is the
process during which clients receive clear and
accurate information about HIV testing in order
to make an informed decision about whether to
accept or decline testing. Informed consent can
be written or verbal in certain situations by the
caretaker.
• It is the responsibility of the healthcare provider
obtaining informed consent to make certain that
the following elements of informed consent are
addressed:
Cont….
– Clarify the purpose and benefits of testing, counselling
– Ensure an understanding of the testing and counselling
process
– Respect the client’s testing decision
• Remember, the client can decline the HIV test, but that
should not affect their medical attention.
2. COUNSELLING: Patient will receive pre-test and posttest counselling
• The result of HIV testing should always be offered in
person as part of an individual (or couple) post-test
counselling session. Along with the result, appropriate
post-test information, counselling, and referral should
also be offered
Cont….
 HIV test results and post-test counselling must be
given to all people who are tested. HIV-negative
persons need test results and counselling which
includes prevention messages, and information
about safer sex practices.
 Always Provide HIV test results in person
 Offer counselling or referral
 Healthcare providers should ensure privacy when
providing HIV test results
 Whenever possible, test results should be
provided in a private area or room
Cont…..
– Healthcare providers should reassure the client that
the post-test conversation and the test results will be
kept confidential.
– During the post-test counselling session, healthcare
providers should inform the client that follow-up
treatment, care, and support are available, including
support for disclosure when needed.
3. CONFIDENTIALITY
• Maintaining confidentiality is an important responsibility of
all healthcare providers and is essential to establishing and
maintaining client trust. Test result will not be shared with
others except healthcare providers providing services to
the patient
Cont….
• It means:
– All client information is kept private
– Information is shared only on a ‘need to know’ basis
– All medical records and registers are kept in secure
place
• Clients should be informed that personal and
medical information, including HIV test results,
may only be disclosed to other healthcare
providers in order to ensure that the client
receives the appropriate medical care.
Cont….
– Healthcare providers should emphasize; however, only
those health care providers who are directly involved
in the client's care will have access to the medical
records—and only on a ‘need-to-know’ basis.
– Anyone not directly involved in a client’s care, for
example, a receptionist, should not have access to
client medical records because they do not need to
know a client’s HIV status in order to perform their
job.
• All medical records and registers, whether or not
they include HIV-related information, should be
kept confidential and stored in a safe, secure
place.
CHARACTERISTICS OF A GOOD COUNSELOR
Consider what kinds of most important qualities or
character, one needs to be an effective counsellor,
what it looks like to be an effective counselor and
what skills are needed to be an effective counselor
Characteristics of an effective counsellor
are:
 Competence
 Maintains confidentiality
 Trustworthiness
 Demonstrate self awareness and understanding
Cont….
Good psychological health
Can build good rapport
Show warmth and sensitivity
Show empathy
Remain objective and open minded
Active listener
Be able to reflect and clarify their needs
Patience
Be non-judgmental
BARRIERS IN COUNSELLING
• It is important to note that the counselling
process is not always smooth.
• Sometimes the process is blocked or hindered
by various factors.
• Counsellors should recognize those factors
and handle them effectively
• In counselling you may find also resistance
RESISTANCE
Resistance is the conscious or unconscious
defence that prevents material in the
unconscious from coming into awareness.
Resistance is a defence mechanism where
information is suppressed knowingly or
unknowingly.
- For example, a girl who has difficulty
remembering the details of being raped.
Resistance can occur at any time in the
helping relationship.
Cont….
Resistance is often a response by the client who is
feeling threatened by the counselling
relationship.
It protects against fear, anxiety, anger, depression
and embarrassment.
Resistance can also result from inappropriate
counsellor behaviour.
Counsellors may also bring resistance and
unfairness to their work.
Visible fatigue or burnout on counsellor’s side can
also encourage client to be resistant.
TWO LEVELS OF RESISTANCE
A).Client’s resistance in allowing thoughts and
memories to be known to the counsellor.
B).Client’s refusal in disclosing painful, frightening
and embarrassing issues, feelings, behaviour and
materials to a counsellor.
SIGNS OF RESISTANCE
• Resistance becomes visible when the client:
– Begins to come late to appointments or forgets them
altogether.
– Questions counsellor’s ability/competence
– Is not assured of confidentiality
Cont….
Does not know how to begin
• For example, teenagers failing to start telling their
stories
Talks non-stop on the same issue while avoiding
others
Is unable to speak
DEALING WITH RESISTANCE
• Resistance should be dealt with from a client’s
point of view.
• Resistance is usually a defence mechanism, and
when the client recognizes that the resistance is
not needed, it will be dropped.
Cont….
• Defence mechanisms are usually unconscious and
people do not even know that they are using
them.
• A well-timed interpretation of the client’s
feelings, situation, etc. that helps the client see
what is happening.
• The client should never be blamed of being
purposely closed.
• It takes time to work on resistance.
• Resistance is unconsciously dropped when the
client feels more comfortable with the counsellor.
Note:
• Sometimes, once a good environment has been
created by the counsellor, if the client still seems
resistant, it might be because the client does not
even recognize that they are being so.
• If the counsellor at this time gently helps the client
recognize that they are being resistant by pointing
out behaviours that suggest so and explains that
these behaviours will be a barrier in the counselling
process, the client might be able to overcome
resistance and start being more open and free with
the counsellor.
TRANSFERENCE
• Transference is the process by which emotions
associated with one person, such as a parent,
unconsciously shift to another, especially to
the counsellor.
• Effective counselling is a very close process in
which a client is exposed to the counsellor’s
behaviour, communication style, gestures,
sense of joking, expression of interests, caring,
support and argumentative style.
Cont….
• Transference occurs when a client identifies the
counsellor as being similar to an important
person in their past such as a parent, lover or any
significant other.
• Positive transference includes feelings of love,
respect, friendliness and dependence toward the
counsellor.
• Negative transference expresses unfriendly,
mistrusting and fearful feelings towards the
counsellor.
Cont….
• When transference is diagnosed it must be
dealt with adequately in order to facilitate
healthy growth during counselling.
• Positive transference is often helpful in
lowering client’s resistance.
OVERCOMING BARRIERS TO COUNSELLING
• It is important for a counsellor to step back and
be attentive to the process of counselling while
encouraging progress in sessions.
• Counsellors should seek help from supervisors
when required.
• For supportive supervision, the counsellor should
seek assistance from the immediate counsellor
supervisor at the site, and there should also be
regular supervision from the Council Health
Management Team (CHMT) and the Regional
Health Management Team (RHMT) to adequately
support counsellors.
Cont.…..
• Regular meetings with supervisors are
important to share experiences and avoid
burnout.
• Simple techniques such as good listening skills
and body language demonstrating the
counsellor’s attention can be helpful while
overcoming barriers in counselling.
ACTIVE LISTENING AND SILENCE
Tips for Active Listening
Give space and time for people to say how
they feel.
Do not be afraid of silences; give time to think
and reflect.
Do not show your judgement.
Listeners are human! Of course they have
opinions; the important point is their opinions
do not prevent them from listening.
Cont....
 Acknowledge that other people’s thoughts, opinions
and feelings are valid and don’t try to argue other
people out of their feelings.
 Listen actively -- watch out for messages sent and
RESPOND to them.
 Ask for clarification or explanation when you do not
understand something.
- For example: ‘I don't quite understand what you
mean; could you help me by saying some more
about this?’
-Do not state emotions, thoughts and feelings, but
offer space to explore them.
EXAMPLES OF NON-VERBAL GESTURES
Feature
Body position
Eyes
Eye contact
Body posture
Examples
Tense, relaxed, leaning
toward or away from
Teary, open, closed,
excessive blinking,
twitching
Steady, avoiding, shifty
Stooped shoulders,
drooping body, legs
crossed, rigid, relaxed
Cont....
Body movement
Mouth
Knee jerks, taps, hand
and leg gestures, head
nodding pointing fingers,
dependence on arms and
hands for expressing
message, touching
Smiling, lip biting, licking lips, tight
lips, loose lips, shaking lips, grinding
jaws
Cont....
Facial expression
Skin
General appearance
Voice
Animated, bland,
frowning, puckers,
grimaces
Perspiration, paleness and
colour change
Clean, neat, sloppy, well
groomed.
Fast, slow, jerky, high
pitched, whispers
KEY POINTS
There are three types of Counselling
 Individual counselling
 Group counselling
 Couple counselling
• A counselor must observe the 3 C’s which are
the guiding principles for HIV counselling
testing:
– Confidentiality
– Counselling
– Informed Consent
Evaluation
• What bare types of counselling?
• What are the guiding principles of
counselling?
• Mention characteristics of a good counsellor
References
• NACP (2008). HIV and AIDS Voluntary Counselling and
Testing: Participant’s Manual. Dar es Salaam, Tanzania:
Ministry of Health and Social Welfare, National AIDS
Control Programme.
• NACP (2008). HIV and AIDS Voluntary Counselling and
Testing: Trainer’s Guide. Dar es Salaam, Tanzania:
Ministry of Health and Social Welfare, National AIDS
Control Programme.
• NACP (2009). National Training on Provider Initiated
HIV Testing and Counselling. Dar es Salaam, Tanzania:
Ministry of Health and Social Welfare, National AIDS
Control Programme.
END OF SESSION
THANK YOU FOR
LISTERNING
AND
PARTICIPATION