Riva Miller

The meaning of bad news in HIV disease: Counselling about dreaded issues revisited

Abstract HIV disease is a slow, progressive immunological disorder. As there is neither a cure nor a vaccine, morbidity and mortality arising from HIV infection will continue to challenge health care providers, including those who counsel these patients. Psychological preparation for ‘bad news’ and support for those whose health is deteriorating is an important task in HIV counselling. This paper describes what may be considered bad news for people living with HIV, how to prepare them for unwelcome changes in their medical condition and how to give bad news, should the need arise.

Selective disclosure : a pilot investigation into changes in family relationships since HIV diagnosis

The aim of this research was (1) to determine the impact of HIV infection on the family as experienced by a sample of HIV infected males and females attending a London hospital HIV/AIDS service, and (2) to examine the feasibility of conducting this investigation in a clinical setting. Fifty patients (predominantly gay males and heterosexual females) attending an HIV outpatient clinic were assessed using a self-administered questionnaire covering family relationships and disclosure of HIV. The results showed a similarity for gay males and heterosexual females in the definition of ‘close family’, yet a difference in the disclosure of HIV status to their family of origin. We conclude that the impact of HIV on the family can be examined in a clinical setting, although the question of validation must be addressed.

Doing therapy briefly

Acknowledgements About the Authors Introduction and Overview of Time Sensitive Therapy Exploring Brief and Time Sensitive Therapy Emancipating Therapy Therapy as Conversation How Have You Managed To Cope So Well? Preparing For The First Therapy Session: Some Parameters To Consider Outline of The First Therapy Session: A Map For Practise Working Positively and Briefly With a Teenager With a Serious Medical Condition: A Case Study Getting Unstuck in Therapy: Adversity as Opportunity Cognitive-Behavioural Interventions: Briefly Focused Endings and Closure in Therapy Brief Therapy in Managed Care References

Counselling in health care settings

Introduction to counselling in health care settings theoretical concepts beliefs about illness and counselling language use and stereotyping of gender specific disease counselling tasks in health care exploring and defining problems in counselling genograms principles and aims of counselling, and the structure of the session confidentiality giving information in counselling giving bad news reframing and creating balance in patient beliefs counselling for loss and terminal care bereavement counselling moving on from feeling stuck in counselling counselling the worried-well and those with intractable health worries counselling for the prevention of ill-health models of consultation and collaboration staff support and burnout.

Social care services for patients with HIV at a London teaching hospital; an evaluation.

OBJECTIVE--To investigate outpatients use of, and satisfaction with social care services in an HIV unit. DESIGN--Survey of patients with HIV infection using self administered questionnaire. SETTING--Outpatient HIV clinics at the Royal Free Hospital, London, March-April 1991. MAIN OUTCOME MEASURES--Patients social circumstances, use or intended use of social care services and satisfaction with social care services. RESULTS--The greatest demand was for counselling about coping with HIV (38% of respondents), available medical treatment (24%), counselling for the HIV test (33%), psychological support for emotional (24%) or relationship problems (16%), advice about housing (24%) and financial matters (20%). In general, the use of social care services by men and women was similar. Twice as many men, however, sought help with payment of domestic bills, compared with women. Women were more likely to seek advice about financial benefits, obtaining sterile injecting equipment and discuss sleep and relationship problems. Thirty eight percent of patients were unemployed. Overall, 84% thought the service was good or excellent. Although less than 40% of patients currently used any one service, 60% thought they would use these services in the future. CONCLUSION--The greatest demand for social care services was for coping with HIV, housing and financial matters, and HIV test counselling. More than half the patients stated that they would probably need social care services in future.

Changing patterns in the workload of a district HIV/AIDS counselling unit 1987-90.

OBJECTIVES--To describe the changing workload of an HIV/AIDS counselling unit between 1987 and 1990. DESIGN--Retrospective examination of data collected by the HIV/AIDS counselling unit between 1987-90 on the number of counselling sessions with patients, family members and staff. SETTING--An HIV/AIDS counselling unit established in 1987 in a London teaching hospital. MAIN OUTCOME MEASURES--Number of new referrals to the HIV/AIDS counselling unit and the number of follow-up sessions. Number of counselling sessions with family members, hospital staff and people making telephone contact with the unit. RESULTS--New referrals to the HIV/AIDS counselling unit increased from 117 (1987-88) to 926 (1989-90). Follow-up appointments increased from 403 to 2016 in the same period. Telephone counselling sessions increased five-fold, and counselling sessions with family members nearly ten-fold over the three year period. Staff consultations doubled. CONCLUSION--The increase in the HIV/AIDS counselling units workload may be partly attributable to the rising incidence of AIDS in the community, reflecting earlier patterns of HIV infection. In addition, new HIV/AIDS services were developed in the hospital between 1987 and 1990. These included the establishment of a same-day HIV test and result clinic; integrated management of patients with HIV/AIDS, with an emphasis on early intervention in HIV infection; specialist services for families, antenatal clinic attenders and others affected by HIV; and the appointment of a designated HIV/AIDS consultant. New approaches to counselling and training health care providers in counselling skills will assume increasing importance in meeting future demand for HIV/AIDS counselling.

Workload of a new district AIDS counselling unit, April 1987 to March 1988.

The Hampstead district AIDS counselling unit in London was opened in January 1987. It is staffed by a clinical psychologist, a social worker, and an administrator. From April 1987 to March 1988, 141 new patients and their relatives were referred from a range of clinical departments and 544 counselling sessions were provided. In addition, 666 staff consultations were organised to help colleagues manage some of the psychosocial problems of patients. An increase in demand during 1988-89 and a need for additional resources are anticipated. A strong case is seen for training other members of health care teams so that they may counsel patients with AIDS without referring them to the unit.

Preparing for the First Therapy Session: What to Consider

When meeting a client for the first time, many factors come together that influence the encounter and its outcome as described in Chapters 1–3. In this chapter, some concepts and parameters that are pertinent to doing therapy briefly will be considered in more detail. These include the contexts of therapy, the pace of therapy, a framework for practice, guiding practice principles and finally some challenges and dilemmas that face the therapist, using a brief approach to therapy.

Outline of the First Therapy Session: a ‘Map’ for Practice

Whatever the context or theoretical stance, some basic concepts and steps can guide the first interview. The first interview always has the potential for being the last session as understood in the terms of the approach outlined in this book. All sessions have a beginning, middle part and ending. As the session develops, the exact order and timing of the steps depend upon the flow of conversation, guided by the questions chosen by the therapist. These questions are fashioned in response to signs and symbols from the client that are the shorthand clues which guide the therapist to collaborate with the client in resolving or lessening his concerns. Clients, like travellers, are vulnerable to the elements in their surroundings. It is incumbent on the therapist to take the lead and set the tone for the session. The therapist picks up the signs and symbols to help the client reach his desired destination.

How have you Managed to Cope so Well

Traditional models of psychotherapy are hierarchical and expert oriented. Expertise and competence are assigned to the professional. The implications of assigning competence to the professional means that the professional takes charge of the therapeutic process and assumes responsibility for the client and his problem. As such, the client adopts a position of incompetence and passivity. Likewise, the client assigns responsibility for the resolution of his problem to the professional. This position of the therapist arises from the traditionally held view of the client and the professional that is deeply embedded in the western modern culture and typified in the medical model. The medical model as such has been found to be both valuable and appropriate. If a bone is fractured, the client wants it to be fixed by a competent professional skilled in orthopaedics. Roles are clear and defined. The underlying assumption is that if the client places himself in the hands of the professional, his pain can be ended. Out of this rigidity of thought emanates a whole protocol of professional practice which has had a powerful influence on traditional psychotherapeutic training and practice.