HIV/AIDS Counselling: Bereavement & Crisis Counselling

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BEREAVEMENT/GRIEF COUNSELLING

Bereavement is a term that can be used to describe any event that includes loss, so this could mean losing a job or the death of someone you know. Bereavement can also be termed as grief.

Bereavement in relation to HIV/AIDS could be grief over the loss of a dear one or grief upon learning one or a partner or a friend is HIV positive. Grief is multidimensional it can be experienced on all levels of the person, in the heart (feelings and emotions), the mind (thoughts), the spirit (meaning of life), the body (physical manifestations). It is a time of transition, beginning with period of diagnosis to death, shock of an anticipated loss, of trying to prepare for the inevitable.

When death follows a terminal illness (like AIDS) even though the family and friends know that the death is inevitable and have watched the person slip away during the illness, they are still left with a sense of loss. People grieve not only for the deceased, but also for the unfulfilled dreams and plans for the future that they hoped to share with them.

There is no right way of coping with a death; people respond to a loss in their own individual way. The way a person responds is partly dependent on their relationship with the deceased, but it also depends on their own personality and upbringing.

Goals of Bereavement Counselling

The main goal of bereavement counselling is to increase the reality of the loss to the mourners and help provide psychosocial and emotional support to them. Bereavement counselling also helps:

• To help the person deal with spoken and unspoken feelings which he/she is experiencing about the loss of loved one or the HIV diagnosis
• To help the person overcome difficulties of readjustment to everyday life after the loss or diagnosis
• To encourage the person to say an appropriate goodbye and to feel comfortable reinvesting in life after the loss of the loved one without feelings of guilt
• To help the person to be able to adjust to life after an HIV diagnosis.

CRISIS COUNSELLING

Crisis counselling is a short term intervention which focuses on dealing with the immediate situation. It involves helping clients to understand the crisis situation, express their feelings about it, and outlines an action plan and getting referrals. Crisis counselling in relation to HIV/AIDS is defined as a confidential dialogue between a PLWHA and a counsellor aimed at enabling the client to cope with the crisis which is being experienced. The crisis could be:

• · Diagnosis of HIV infection
• · Unexpected death in family
• · Breakup of a relationship
• · Death of another PLWHA
• · Emergence of new symptom
• · Treatment failure or anything that an individual perceives as a severe life event

The role of the counsellor in crisis counselling

One of the counsellors’ major roles during crisis counselling is to help the client define the problem and help restore a sense of control. Sometimes the crisis is so overwhelming for the client that he/she is unable to identify what the major problem of the crisis is, is it the HIV diagnosis itself or is it the need to disclose HIV status to a spouse that is causing the crisis and if both are regarded as a problem, which is the more serious of the two to the client. The counsellor must “Begin where the client is” and be reassuring and supportive as the client discusses the crisis. The counsellor must listen carefully and patiently because the client may sound incoherent initially but with adequate support will calm down and start communicating in a more coherent manner.

Counsellors should never offer false assurances to clients such as statements like “all will be well” because the counsellor really does not know if all will be well and cannot guarantee the client that his HIV diagnosis status will decline rapidly to AIDS or that if client was raped that the rapist is probably not HIV positive. This sort of false reassurance may temporarily help in calming the patient but on the long term I f the client does test HIV positive or declines rapidly from HIV to AIDS, the client will lose trust in the counsellor and feel that the counsellor lied to him/her.

The counsellor should help break the problem into smaller parts and help client prioritize different aspects of the problem. The counsellor should repeat certain information repeatedly to ensure that the client understands the situation and is not in denial. But the counsellor should not overstate the issue and annoy the client who is already emotionally overwrought. The counsellor should also help client set realistic goals for problems and identify which ones he can do something about and which one the client will just have to accept as a part of life.