The Practice of Counselling HIV/AIDS Clients

AIDS/HIV has been described as one of the most pressing medical and social problems of this century. A review of the psychosocial and counselling literature relating to it indicates that the predominant psychotherapeutic approach with clients is symptom-focused and presents psychological problems as being inevitable in the course of illness. A systems approach is considered to have a good fit' with HIV-related problems because of issues relating to unpredictability, relationships, interaction, complexity and secrecy which arise in the course of the illness and its management. Some of the counselling tasks of an AIDS counsellor are set out. Consideration of these can help the system (client, family, health care team, counsellor) both to define problems and to find solutions to them without resorting to prior assumptions about either.     

HIV/AIDS reduces the relevance of the principle of individual medical confidentiality among the Bantu people of Southern Africa

The principle of individual medical confidentiality is one of the moral principles that Africa inherited unquestioningly from the West as part of Western medicine. The HIV/AIDS pandemic in Southern Africa has reduced the relevance of the principle of individual medical confidentiality. Individual medical confidentiality has especially presented challenges for practitioners among the Bantu communities that are well known for their social inter-connectedness and the way they value their extended family relations. Individual confidentiality has raised several unforeseen problems for persons living with HIV/AIDS, ranging from stigma and isolation to feelings of dejection as it drives them away from their families as a way of trying to keep information about their conditions confidential. The involvement of family members in treatment decisions is in line with the philosophy of Ubuntu and serves to respect patients’ and families’ autonomy while at the same time benefiting the individual patient.     

When your face doesn't fit: employment discrimination against people with facial disfigurements

This study aimed to investigate the recruitment prospects of people with facial disfigurement and a contrasting group of wheelchair users, representing a functional impairment with little aesthetic impact. Three applications were made to each of 144 vacancies using three CVs and cover letters rotated around conditions in which one applicant was described as a wheelchair user, another had a noncontagious facial disfigurement, and the third (control condition) had neither. There was evidence of discrimination against people with facial disfigurement in jobs requiring high (but not low) levels of customer contact, and against wheelchair users for jobs entailing high or low‐customer contact. Aesthetic considerations, social norms, and the possibility of stigma by association are discussed as potential underlying factors.     

Stigma by Association Among Family Members of People with a Mental Illness: A Qualitative Analysis

People with mental illness are not the sole recipients of stigmatisation; their immediate family members may be subjected to stigma by association. Through semi‐structured interviews, we investigated experiences of stigma by association among 23 immediate family members of people with mental illness. Participants reported experiencing stigma by association from community members, mental health professionals, and civil servants. Familial relationship, co‐residence, and the gender of participants appeared to play a role in their stigma experiences; parents and spouses reported different manifestations of stigma by association than siblings and children, participants who lived together with their family member with mental illness reported increased experiences of stigma by association, and in contrast to male participants, female participants reported others thinking they are overprotective and as such perpetuated, maintained, or sustained their family members' mental illness. The relevance of these factors points to the need for tailored education and emotional support provision to family members of people with mental illness. Moreover, in‐service training for mental health professionals should include the development of relevant social skills that enable the recognition of familial relationships and roles, and family members' fears, concerns, and problems. Copyright © 2014 John Wiley & Sons, Ltd.     

The Impact of Criminal Record Stigma on Quality of Life: A Test of Theoretical Pathways

Across multiple stigmatized groups, research suggests that stigma may negatively impact individual wellbeing. This impact often occurs through a sequential pathway that includes perceiving societal stigma, a diminished and stereotyped self‐concept (i.e., internalized stigma), experiences of discrimination and rejection, and attempts to cope with stigma (e.g., secrecy or withdrawal). While prior research supports individual links within this pathway, no study has evaluated a model representing the relationships between all of these factors in relation to criminal record stigma. This study utilized cross‐sectional data from an online survey of 198 adults to test the pathways through which criminal record‐related stigma impacts individual quality of life. The results indicated that perceived stigma was a significant predictor of discrimination and rejection experiences, secrecy coping strategies, and decreased quality of life. There was also a significant indirect association between perceived stigma and quality of life through secrecy coping. Consistent with recent criminal record stigma research, internalized stigma was low among respondents. These findings point to the importance of reducing criminal record stigma and discrimination, so that individuals with criminal records have more opportunities to enhance their quality of life without having to withdraw from society or keep their record a secret.     

HIV/AIDS and the family: a review of research in the first decade

Most studies of the psychosocial implications of HIV/AIDS have been focused on the individual. This paper reviews the small but growing body of research into the impact of HIV/AIDS on the family system. Special reference is made to definitions of the family, same-sex relationships and the African family. The impact of HIV/AIDS on the family is discussed in terms of social stigma, isolation and secrecy, stress and coping, social support, communication and disclosure, responses to illness, and changing structure and roles in families. It is anticipated that in the 1990s, the study of the family will become a dominant topic in HIV/AIDS-related research.     

乳晕月牙状切口与传统切口手术治疗男性乳房发育症的比较研究

探讨乳晕月牙状切口切除男性乳房发育症的手术方法及美容效果。回顾性分析5年来在局麻或全麻下,分别采用乳晕月牙状切口（46例）和传统沿乳晕弧形切口或放射状切口（32例）保留乳头乳晕手术治疗男性乳腺发育症,比较两种术式的手术时间、术中出血量、切口隐蔽程度、患者满意度及住院费用等临床资料的差异。乳晕月牙状切口潜行切除增生的乳腺...     

A systematic review of the literature on counselling and psychotherapy for the prevention of suicide: 2. Qualitative studies

Scope of review: The paper reports a meta‐synthesis of 13 qualitative studies of counselling and psychotherapy with people at risk of suicide. Publication time span: The studies considered were reported between 1997 and 2006. Publication origin: Seven studies were conducted in the UK, four in the USA, one in Canada, and one in Sweden. Findings: Themes in clients' and therapists' accounts of the process of counselling or psychotherapy were therapist qualities; therapy components; theoretical framework; and therapy techniques. Themes in their accounts of the effectiveness of counselling and psychotherapy were decrease in self‐destructive behaviour, and quality of life. Themes in clients' views of barriers to effective counselling or psychotherapy were therapist characteristics; therapy components; secrecy; and transferring to the real‐life situation. Secrecy was also identified as a barrier by therapists, as were responsibilities of the profession; training; and the nature of suicide and self‐harm. Facilitators of successful counselling and psychotherapy as identified by clients were responsibility; support; and teaching therapy skills to family members, the latter also being identified by therapists.     

Clients’ perceptions of personal psychotherapy or counselling for therapists

The purpose of this study was to examine clients’ opinions of therapists’ personal use of psychotherapy or counselling. Participants in this study, a nationwide sample of clients recruited through Amazon’s MTurk system, were asked to complete an online survey assessing their attitudes towards treatment use by therapists as well as their general attitudes towards psychological help-seeking and perceptions of stigma (social and self) with psychological treatments. In this study, we found that clients generally had positive views about therapists’ personal use of psychotherapy or counselling. Although overall positive attitudes were found, the results from repeated measures ANOVAs indicated that attitudes depended somewhat on whether the therapist had sought out treatment as part of a training requirement for self-enrichment, or for the treatment of a psychological problem. In addition, participating clients were less supportive of therapists disclosing a treatment use history with their clients. Regression analyses also indicated that attitudes towards treatment use by therapists were significantly predicted by general help-seeking attitudes and perceptions of stigma (social and self), but attitudes towards disclosure were not. The findings from this study have important implications regarding therapist treatment use and disclosure in practice.     

Diversifying counsellor education: a case study of U.S. students of colour

Due to limited research on the experiences of students of colour in counselling programmes, counsellor educators are ill-equipped to implement strategies to promote the graduation of students of colour. In this case study, we explored the protective and risk factors for students of colour enrolled in a counselling programme in the Western U.S. Participants identified three protective factors (diversity, faculty support, and family and friends) and three risk factors (balancing family and school, disconnect from programme, and White dominance) that impacted their post-graduate experience. Implications for the retention of students of colour are discussed.     

Interaction Process Differences between Groups of Paranoid Schizophrenic and Depressed Patients

Group psychoanalytic treatment has special value for helping people form intimate attachments, in particular, for enabling them to resolve lifelong unconscious resistances to closeness. The group serves both as an amphitheater and as an agent for change.

As group therapists, we may break the task down into three stages. First, we bring the character resistances into play; second, we resolve the fears underlying them; and third, we empower our patients to develop mature ways of expressing intimacy.

Our task requires that we establish a contract with our patients so as to study any breach as a possible resistance to intimacy with other members. We study these resistances, which are expressed in words and attitudes. Beneath such resistances lie various fears, which we bring to the surface. As our patients resolve these fears, they begin to act toward each other as they did toward significant figures in their formative years. We work with these vestigial modes of relating, and help our patients turn them into mature modes of expression.     

Silence and Memories of War: An Autoethnographic Exploration of Family Secrecy

A personal journey and a scientific challenge, this is an autoethnographic study about my own family's secrecy. I knew my grandfather had been a German prisoner of war during World War II. We all knew. But nobody talked about it. Then one day I decided I wanted to do systematic research on the issue of family secrecy around my grandfather's war experiences. Researching one's own family can be called autoethnography. It could be said that autoethnography is an approach to research that aims to describe and systemically analyze (graphy) personal experience (auto) to understand social and cultural phenomena (ethno). This scientific approach is quite new in the field of family therapy. This study has been an important personal quest, but it also led to important reflections on silences in families, on my own professional development, and on methodological issues concerning autoethnographical research. For one thing, it highlights some of the positive aspects of family secrecy and silences, and invites us—when confronted with family secrecy in clinical practice—to carefully consider the potential destructive and life‐giving aspects of the silence.     

Evaluation of a counselling skills course for health professionals

A counselling skills course run by a London hospital for 11 health professionals was evaluated. The course covered family counselling skills and child management techniques. Qualitative and quantitative measures were used at five times of testing over a period of 10 months. It was found that participants improved self-perceptions of their counselling ability, increased their knowledge of counselling theories, and considered the course to be helpful in their subsequent work with families. There was no significant change in trainees' self-concept scores. Regular supervision was regarded as helpful in consolidating skills and exploring aspects of practice in a safe environment. Issues relating to evaluation research are discussed.     

'I say what I like': Frank talk(ing) in counselling and psychotherapy

The black consciousness psychology or philosophy of Steve Biko, the political activist who died in police detention in the 1970s in South Africa, is considered. Those aspects of the philosophy relating to empowerment, self-concept development, the internalisation of racism and the racial identity theory of black people are discussed. It is suggested that the 'frank talk' method is a particularly useful tool in counselling and psychotherapy with culturally diverse clients. These ideas and the issue of empowerment of black clients are explored through the examination of a case vignette. In reflecting on the narrative of Jo-Anne, the need for counselling and psychotherapy to accommodate ethnic-minority cultural traditions of healing is affirmed.     

A naturalistic longitudinal evaluation of counselling in primary care

This study evaluated the effectiveness of generic counselling in a primary healthcare setting during three months of counselling and followed up the patients' progress after counselling had finished for the next twenty-one months. Questionnaires were completed by patients within the Dorset Primary Care counselling service on referral to counselling and at set points afterwards. A naturally occurring waiting-list group was compared with patients receiving counselling at baseline and three months. Measurements were taken of patients' psychiatric symptomatology, quality of life (QOL) and self-esteem. Patients who received counselling made highly significant improvements compared with those on the waiting list. These improvements were maintained throughout the long-term follow-up. This would indicate that generic counselling has positive effects that can be maintained for a long period of time after counselling has been completed.     

Understanding the Relationships Among HIV/AIDS-Related Stigma,Health Service Utilization,and HIV Prevalence and Incidence in Sub-Saharan Africa: A Multi-level Theoretical Perspective

HIV-positive individuals often face community-wide discrimination or public shame and humiliation as a result of their HIV-status. In Sub-Saharan Africa, high HIV incidence coupled with unique cultural contexts make HIV-positive individuals particularly likely to experience this kind of HIV/AIDS-related (HAR) stigma. To date, there is a relatively small amount of high-quality empirical literature specific to HAR stigma in this context, supporting the notion that a better understanding of this phenomenon is needed to inform potential interventions. This paper provides a thorough review of the literature specific to HAR stigma in Sub-Saharan Africa, finding (a) qualitative support for the existence of important relationships between HAR stigma and health service utilization and barriers; (b) a need for more quantitative study of stigma and its relationships both to health service utilization and to HIV outcomes directly; and (c) a disconnect between methodological techniques used in this context-specific literature and well-known theories about stigma as a general phenomenon. This paper then draws from its empirical literature review, as well as from well-known theoretical frameworks from multiple disciplines, to propose a theoretical framework for the ecological and multilevel relationships among HAR stigma, health service utilization, and HIV outcomes in this context.     

Making the invisible visible: fear and disclosure of sexual orientation at work

Stigma theory was used to examine the fears underlying the disclosure of a gay identity at work. Using a national sample of 534 gay, lesbian, and bisexual employees, this study examined the antecedents that affect the degree of disclosure of a gay identity at work and, for those who had not disclosed, the factors that influence their fears about full disclosure. Employees reported less fear and more disclosure when they worked in a group that was perceived as supportive and sharing their stigma. Perceptions of past experience with sexual orientation discrimination were related to increased fears but to greater disclosure. For those who had not fully disclosed their stigma, the fears associated with disclosure predicted job attitudes, psychological strain, work environment, and career outcomes. However, actual disclosure was unrelated to these variables. The utility of fear of disclosure for understanding processes underlying the disclosure of gay and other invisible stigmatized identities in the workplace is discussed.     

The Multilevel Relationships of HIV‐Related Stigma to Child and Caregiver Mental Health among HIV‐Affected Households in South Africa

HIV/AIDS‐related (HAR) stigma is still a prevalent problem in Sub‐Saharan Africa, and has been found to be related to mental health of HIV‐positive individuals. However, no studies in the Sub‐Saharan African context have yet examined the relationship between HAR stigma and mental health among HIV‐negative, HIV‐affected adults and families; nor have any studies in this context yet examined stigma as an ecological construct predicting mental health outcomes through supra‐individual (setting level) and individual levels of influence. Multilevel modeling was used to examine multilevel, ecological relationships between HAR stigma and mental health among child and caregiver pairs from a systematic, community‐representative sample of 508 HIV‐affected households nested within 24 communities in KwaZulu‐Natal, South Africa. Two distinct dimensions of HAR stigma were measured: individual stigmatizing attitudes, and perceptions of community normative stigma. Findings suggest that individual‐level HAR stigma significantly predicts individual mental health (depression and anxiety) among HIV‐affected adults; and that community‐level HAR stigma significantly predicts both individual‐level mental health outcomes (anxiety) among HIV‐affected adults, and mental health outcomes (PTSD and externalizing behavior scores) among HIV‐affected children. Differentiated patterns of relationships were found using the two different stigma measures. These findings of unique relationships identified when utilizing two conceptually distinct stigma measures, at two levels of analysis (individual and community) suggest that HAR stigma in this context should be conceptualized as a multilevel, multidimensional construct. These findings have important implications both for mental health interventions and for interventions to reduce HAR stigma in this context.     

Psychological distance reduces the effect of internalized stigma on mental health treatment decisions

Although stigma is a major barrier to treatment for those with mental health concerns, it is poorly understood when stigma is more or less influential in mental health treatment decisions. In the current work, we examined whether psychological distance—the removal of an event from direct experience—reduced the influence of internalized stigma on willingness to seek treatment. Specifically, we tested the hypothesis that psychological distance versus proximity (e.g., seeking treatment in three months vs. in two days, respectively) decreases the negative influence of stigma on willingness to seek treatment. We focused on a population for whom mental health treatment decisions are personally-relevant: individuals who had previously sought mental health treatment. Experiment 1 showed that the extent to which these individuals internalized (i.e., personally endorsed) stigma about mental illness predicted lower intentions to make an appointment with a mental health care provider for themselves (but not another person). Experiment 2 replicated this result using a different measure of psychological distance (temporal distance) and extended this finding to behavior (time spent reading mental health resources). Overall, this research demonstrated that internalized stigma disrupts mental health treatment-seeking intentions and behaviors when they are psychologically proximal, but not when they are distant. Potential applications of these results are discussed.