1. Counseling Skills

2. Components of Effective Brief Risk Reduction Counseling
Communication, both verbal & non-verbal;
Supporting someone in making decisions when their willingness or ability to act is affected by how they feel.
Review.

3. Components of HIV Prevention Counseling
Helping individuals to explore, express, understand and accept how they feel so that they can make decisions about behavior change;
Different than education, although education can be a component;
Good counseling does not = good information giving;
Stress that we used to consider good HIV prevention counseling good information giving, but no longer. It is about help people change their behavior on their own terms. They are viewed as the experts with all the information, we offer tools to help get them where they want to be. Education is a component that is there when elicited, and it can come from both client and counselor. Education is about answering questions and clearing up big misconceptions that are revealed by the client.

4. Components of HIV Prevention Counseling
It is client-centered:
tailored to the behaviors, circumstances and special needs of an individual.
Stress that client-centered does not mean that the session is client-directed, client-driven or revolve around issues that are unrelated to risk.

5. Components of HIV Prevention Counseling
Not solving the client’s problem;
Not giving advice;
The counselor brings a set of skills to help the individual:
reach a better understanding of the issue,
deal with feelings & concerns
assume responsibility for evaluating alternatives and making choices;
Review.

6. Counseling Concepts Concept 1: Focus on Feelings
Concept 2: Manage Your Own Discomfort
Concept 3: Set Boundaries
Review that we will now be covering these concepts.

7. Counseling Concept 1:
Focus on Feelings
In successful helping interactions, the focus is first placed on how an individual feels.
If we do not attend to those feelings, the individual will not hear us.
Again...we’re focusing on the client’s feelings...not OUR feelings!
Dentist example. How does it feel when you go to the dentist and they tell you something isn’t going to hurt and it does? Or when you indicate that something is uncomfortable or painful and they minimize it?

8. Focus on Feelings Counseling Concept 1:
For individuals to engage in honest counseling interactions, we must be willing to bring up, listen to and respond to feeling-level reactions, beliefs and issues.
Have you ever been in a situation where you avoided bringing up difficult issues because you were afraid to upset the other person?
How might that hinder a counseling session?
Review. Throw questions out to large group for individuals to share.

9. Manage Your Own Discomfort
Counseling Concept 2:
Manage Your Own Discomfort
We can’t be expected not to have judgment or uncomfortable reactions.
We are expected to recognize judgment & discomfort so that we can keep it from being a barrier.
Stress that we are human and it is impossible to never have judgment. The trick is to develop way to not let it interfere with the counseling session.

10. Manage Your Own Discomfort
Counseling Concept 2:
Manage Your Own Discomfort
What are some things that might trigger discomfort for counselors?
How might inability to manage discomfort get in the way of effective counseling?
How have you handled this in the past? What suggestions do you have?
Flip-chart or just discuss these with large group.

11. Set Boundaries Individuals must be in charge of their own lives.
Counseling Concept 3:
Set Boundaries
Individuals must be in charge of their own lives.
We need to accept that people may make choices that are not the ones we would want them to make.
Client and counselor have unique roles.
Point out that this may not be the same as how we typically think of setting boundaries. This is more role-centered rather than on specific actions.

12. Set Boundaries CLIENTS
Counseling Concept 3:
Set Boundaries
CLIENTS
Are in charge of making decisions about their lives and carrying out those decisions.
COUNSELORS
Use an empathetic presence in a skillful way to support clients in planning how to reduce risks.
Review. Emphasize as very important distinction.

13. Basic Counseling Skills
Skill 1: Asking Open-ended Questions
Skill 2: Attending
Skill 3: Offering Options, Not Directives
Skill 4: Giving Information Simply
Review that we will be covering these skills.

14. Asking Open-ended Questions
Counseling Skill 1:
Asking Open-ended Questions
Questions that do not elicit “yes” or “no” as responses.
What is the purpose of asking open-ended questions?
Use of silence.
Review. A polite imperative is an open-ended statement like”tell me about your risk in the last month.” It should be considered the same as an open-ended question.

15. Offering Options, Not Directives
Counseling Skill 3:
Offering Options, Not Directives
Have you ever had a doctor or counselor tell you or direct you to make a particular behavior change?
What did you do?
How did you feel when
you went back to see
that person?
Review.

16. Offering Options, Not Directives
Counseling Skill 3:
Offering Options, Not Directives
Buffet Approach
Using this skill, what are some alternatives to the directive:
“You need to use condoms every time you have sex.”
Large group activity.

17. Giving Information Simply
Counseling Skill 4:
Giving Information Simply
Giving information that is too complex or giving too much information can overwhelm people.
Use visual cues to keep you on track.
Give basic information & expand on it with client questions.
Show the visual aids in the back of the manuals for describing the window period and explaining confidential vs. anonymous testing. Encourage them to use these and/or create their own to help them keep information to a minimum unless asked for more.

18. Giving Information Simply
Counseling Skill 4:
Giving Information Simply
Using this skill, share with us a direct answer to this client question:
“Isn’t it mainly homosexuals and drug users who get HIV?”
A good answer is something like “it’s not who you are but what you do that puts anyone at risk for HIV.” Followed by “ So what is it that you do that concerns you about your risk?” Share this with group after they make some suggestions. Validate their suggestions. Point out when their suggestions might be too much information (giving statistics, for example).