1-to-1 therapeutic change
What is the activity?
Counselling is an in-depth, personalised intervention that aims to help individuals, couples and families achieve greater psychological well-being through reﬂection and discussion. Counsellors may be voluntary or paid, with a minimum qualiﬁcation of a Diploma in Counselling (or equivalent). On-going supervision contributes to counsellors’ professional development, and provides monitoring and support for their ethical judgements and well-being.
Over a period of time (typically 6 to 12 weeks), counsellors and clients build up a trusting relationship. Sessions typically last for 45 to 60 minutes, within which clients are supported in their exploration of feelings, experiences, traumatic life events and goals in order to encourage emotional and behavioural stability. Where families and couples take part in counselling together, aims often include strengthening relationships and communication strategies.
Strengths and limitations
Therapeutic interventions have a signiﬁcant advantage over shorter and elss intense interventions because their duration enables identiﬁcation of personally-relevant issues, reﬂection on these factors, and support in ﬁnding solutions. This means that the potential for behaviour change resulting from therapeutic interventions far exceeds other types of interventions (see the
Participation in a programme of counselling requires that service users commit to a long-term intervention. This requires a signiﬁcant degree of motivation, trust in the service provider, and the resources and social capacity to take part. Attending counselling also requires that participants recognise the potential beneﬁts, including identifying and prioritising their HIV prevention needs. It is possible that those in greatest need of therapeutic interventions may be least able to access them because they may feel alienated from them, or are unsure of their outcomes, making engagement unlikely.
Where does it happen?
In the main, counselling occurs on the premises of a provider agency. This arrangement helps to ensure the security of both clients and counsellors. Counselling requires a private room with few distractions, with phones (including clients’ mobile phones) switched off or silenced for the duration of the session. Some agencies install a panic button in counselling rooms so that other staff members can be alerted in case of physical danger. Counselling staff require the time, space and resources to keep adequate notes on client sessions, and notes must be handled in accordance with the Data Protection Act 1998.
Frequently delivered alongside ...
Information and advice delivered one-to-one
Clinical interventions in the community
Issues to consider
In the context of scarce resources, one-to-one therapeutic interventions should be targeted at those in greatest need of psycho-social support.
Conﬁdentiality and its limits must be clearly communicated with service users.
Keeping coherent, accurate notes of counselling sessions can be a key tool for the counsellor, but raises acute data protection and conﬁdentiality issues. As a result, records kept in relation to counselling sessions should be carefully attended to within each agency’s conﬁdentiality policy, and in accordance with obligations under the Data Protection Act 1998. These record-keeping practices should be subject to regular review.
The use of full-time qualiﬁed staff in the provision of counselling can be prohibitively expensive for some service providers. Many agencies circumvent this problem by recruiting voluntary specialists offering psycho-social support to service users. Of course, this can mean challenges in coordination and commitment.
Social stigma continues to be attached to counselling. Agencies that have successfully offered these services to those who would not usually take them up of their own accord have found innovative means of challenging that stigma, sometimes by enabling familiarity with counselling staff through diverse service provision contexts.
The outcomes from counselling often tend to focus on increased motivation and skills to avoid participating in HIV transmission. The list below offers some examples of outcomes (dependant on the content of the therapeutic intervention) but is not exhaustive. Outcomes among African people participating in therapeutic interventions can include:
- Increased control over HIV transmission in their lives (see the Values section and associated needs).
- Increased confidence to decline any unwanted sexual activity (see associated needs here and the KWP approach section).
- Having the skills to actively manage anxiety and depression (see associated needs).
- Possessing increased conﬁdence and motivation to openly discuss sex, sexuality, and sexual health with sexual partners and in social networks, as modelled and rehearsed in the intervention (see associated needs here, here and here).
- Knowing more about reducing harm when unprotected sex does happen - such as withdrawal and ensuring sero-concordance - while also understanding that there are more effective means of avoiding HIV transmission (see associated needs here and here).
- Increased likelihood of establishing and maintaining sero-concordancy with sexual partners (see associated needs).
- Joint assessment of HIV prevention options for conception in couples where a partner has diagnosed HIV (see associated needs).
Monitoring and evaluation
Therapeutic interventions aim to meet an extensive range of needs tailored to individual service users, but the effects may not be immediately apparent. Questionnaires aimed at those who use and do not use the service can help to assess perceptions about recruitment to the service, access challenges, and to identify key areas for change in delivery. Reviews of anonymised case notes can be used to assess short-term changes noted by practitioners. However, longer-term follow-up - through repeated interviewing - is perhaps the best way to evaluate longer-term beneﬁts to individuals, couples and families.
Page last updated: 17 July 2013
Terrence Higgings Trust (THT) London
THT have altered some routine elements of their counselling service in order to increase accessibility for African people. THT’s Youth Counselling Service devised a street-to-counselling intervention whereby trained counsellors interact with young people in non-therapeutic settings in order to become known and trusted. Where counselling need is identiﬁed, young people can meet with counsellors in more formal settings once trust has been established. In addition, whereas many organisations may be quite strict about missed appointments and locations for adult counselling sessions, THT has found that increased ﬂexibility helps to account for individual needs (such as sporadic employment, sudden changes in housing and childcare responsibilities). They have supplemented their service with an informal drop-in element, which has also increased accessibility.