1. Counseling Principles, Skills and Techniques
Module 0
Counseling Principles, Skills and Techniques

2. Learning Objectives (1)
By the end of this unit, participants will be able to:
Explain how personal beliefs and feelings can affect interactions with clients
Identify psychosocial issues in lay counseling
Define counselling
Describe the 3 Rs of counseling
Describe counseling ethics and values
REVIEW learning objectives.
ASK participants if they have questions before continuing.

3. Learning Objectives (2)
Explain the IMB model and how it apples to patient adherence
Describe the importance of Egan’s 3 Stage model in lay counselling
Define communication
List basic communication skills for lay counselors
Explain 2 common pitfalls in lay counselling

4. Understanding yourself: Self awareness
INTRODUCE this unit by explaining that one of the things the lay counselor will become aware of quite early on in their training is that learning about counselling is not a theoretical exercise. In fact, there is a substantial element of self-awareness and personal development! This means that a great deal of what you learn throughout this course will be experiential. From the very beginning you will probably think much more about yourself, the experiences you have had, the opinions you hold, prejudices that you may not have been aware of, your relationships, and any other significant factors of your personal and professional life. This experience is both rewarding and challenging. This unit will help you to explore, acknowledge and understand yourselves and others.
ALLOW 1 hour for this section.

5. Values survey A sense of accomplishment A comfortable life Freedom
Happiness
Social recognition and leadership
An exciting life
Self-respect
Health
Affection from immediate friends and family
Inner harmony
ASK: Think of your future and what you would like to have in it. List the points from the slide in order of priority for you, with 1 as the top priority and 10 as the lowest.
ALLOW participants 5 minutes to complete the exercise.
ASK 3-4 participants to share their list (no need to take a response from each person in the group).
DISCUSS by asking the following questions:
Why did you rank these ideas in the order that you did?
Each of us completed this activity differently. What do these differences tell us?
What do the similarities tell us?
SUMMARIZE by saying that the ideas or principles listed here reflect our “world view” what we find most important when we look around us. This may also be reflected in the things and people we find most important. All these issues are important to all of us but we will rank them differently at different times in our lives. Our clients may have different priorities from us.
ALLOW 20 min for this activity.

6. Values, Attitudes and Prejudices
Values: the importance we attach to a particular belief, practice, idea or object
Attitudes: a tendency to respond or behave in certain ways.
Prejudices: pre-judgments learned from our community
Animated slide—click to reveal the definitions.
ASK participants to brainstorm and discuss the meanings of values, attitudes and prejudices. WRITE participant ideas on a flipchart.
REVEAL the definition of values, attitudes and prejudices printed on the slide.
ASK: How are these values, attitudes and prejudices important to our work as HTC providers?
SUMMARIZE by saying that the way we see the world will always affect how we treat others in our lives. It is important that we be aware of our own values, attitudes and prejudices, so that we can have an open mind to our clients. This is key to treating each client fairly and with respect.
ALLOW 10 minutes for this activity.

7. Self Concept Self concept self-image ideal self self-esteem body image
EXPLAIN that there are different ways we can describe ourselves based on our body image, self-image, ideal self and self-esteem. For example:
Body image, e.g., “I am dark, tall, big, short…”
Self-image, e.g., "I am a mother, teacher, sister, Malawian…”
Ideal self, e.g., “I want to be a good mother, good swimmer, excellent HTC provider…”
Self- esteem, e.g., “I am proud to be a good HTC provider, I am ashamed to be lazy…”
EXPLAIN to the participants that:
Body image – can mostly be seen by anyone (public domain)
Self-image – some can be seen by others, but not all (public and private domain)
Ideal self – many things unknown to others (private and hidden domain
Self-esteem – mostly hidden from the public (private and hidden domain)
When we feel good, all the domains are more or less equal. But when there is a trauma in our life, our images of ourselves will change. This will always be the case for people who learn of their HIV status.
ASK participants to draw the table of self-concept pictured on the slide. Fill in each quadrant with a statement about yourself. [Do not ask participants to share what they wrote in the large group, as statements may be too personal to share.]
In group discussion, ASK:
What have you learnt about yourself?
How might these domains affect your counselling?
SUMMARIZE by saying that we can describe ourselves in many different ways. HTC providers should be aware that the clients also have self-concept, which should be taken into account during the counselling process.
ALLOW 25 minutes for this activity.

8. Understanding Your Client: Common Psychosocial Issues
ALLOW 1 hour 40 minutes for this section.
EXPLAIN that learning about how HIV works in the body is only half of the story when it comes to preventing the spread of HIV. Plenty of people who know all the facts about HIV still become infected with the virus. Why?
Our behaviour is a reflection of the social, cultural, political and religious environment we are surrounded by. We make changes—or don’t make changes—largely as a result of the support we get from people around us. In this way, if we are to prevent the spread of HIV, we need to look at the psychological and social environment around us.

9. Reproductive Organs: Activity
I am a ___.
I am used for ____.
Advance preparation: Prepare pieces of paper—one for each participant and trainer—with the name of a sexual or reproductive body part on each. Fold each piece of paper and place it in a box. [Suggested body parts include: foreskin, uterus, urethra, cervix, vagina, testicle, clitoris, anus, breast, fallopian tube, pubic hair, penis, ovaries, prostate gland, vaginal lips, rectum.]
EXPLAIN to participants that this exercise is to help them, as lay counselors, talk openly about the human body and to understand the use of different genital parts. Each piece of paper has a name of a body part written on it.
ASK each participant to pick one piece of paper from the box.
INSTRUCT each participant to stand and read the name of their body part, and complete the following statements (participants should feel free to call out the body part in their own language):
“I am a ____.
I am used for _____.”
NOTE that each participant should take a minute or less in their description. To speed things along, walk around the room and select the person to go next. Participants should stand at their place to speak, not go to the front of the room.
After everyone has finished, ASK: What have you learned from this exercise? [Take 2-3 responses]
SUMMARIZE by telling participants that it is important to learn about parts of the body, to practice talking openly about them, to think about language used. It is also important to recognize how the embarrassment caused by talking about the might affect our clients.
THANK participants for their openness and willingness to participate. This is a sign that they will make very good lay counselors!
ALLOW 25 minutes for this activity.

10. Why do some people adopt safer sex strategies and others don’t?
Why do people have sex?
Why do some people adopt safer sex strategies and others don’t?
CONTINUE by saying “We have talked about the “equipment” needed to have sex. Now let’s look at the reasons. Tell me: Why do people have sex?”
[Take 2-3 responses. Some of the reasons may include: procreation, partner’s expectation, pleasure, guilt, expressing love, making up after a quarrel, exploration, habit, expression of power, lust, duty].
ASK: Why do some people adopt safer sex strategies and others don’t?
[Take 2-3 responses. Some answers may include: some don’t understand the risks, some say it feels better without a condom, some value particular sexual activities, some don’t feel vulnerable to HIV and STIs, some may receive pressure from a partner].
ASK: Why is it important to discuss sexual issues with your partner at all?
SUMMARIZE by saying that people are different. We all have sex for different reasons at different times. We may value certain types of sexual activity while disliking other types, even if they are safer. People must choose for themselves what behaviours they are willing to adopt. The lay counselor can only give information and help the client explore the issues.
ALLOW 15 minutes for this discussion.

11. Quality Sex Group one (women only) Group two (men only)
What makes good sex for you? How can women introduce the concept of quality sex to their partners? How might men react?
Group two (men only)
What makes good sex for you? How can men introduce the concept of quality sex to their partners? How might women react?
EXPLAIN that recent research has shown that ‘quality sex’ or ‘satisfying sex’ between couples minimizes the frequency of partner change among men and women. Reducing the number of partners is one way to reduce the incidence of STIs and HIV.
REMIND participants of Unit 1.1 when we discussed factors associated with risk (which fluid, dose, number of exposures, health of HIV infected person, health of exposed person).
ASK: Which of these factors is addressed when we encourage our clients to stay with one partner? [Answer: number of exposures]
EMPHASIZE that promoting quality sex is an important way to curb the spread of HIV.
DIVIDE participants into two groups--men in one group and women in the other.
ALLOW 10 minutes to discuss the following questions:
Group one (women only): What makes good sex for you? How can women introduce the concept of quality sex to their sex partners? How might their male partners react?
Group two (men only): What makes good sex for you? How can men introduce the concepts of quality sex to their sex partners? How might their female partners react?
When the groups have finished, ASK each group to present its findings to the whole group. ALLOW 5 minutes each for the presentations.
USE the following questions to guide the discussion:
What did you think about the vision for “quality sex” from the other group?
What do these different visions for quality sex mean for a male-female couple? How do couples achieve quality sex?
How might promoting quality sex reduce the spread of HIV?
ALLOW 30 minutes total for this activity.

12. Quality Sex: Definition
Quality sex is when both partners want sex. It happens between people old enough to know what they are doing, and it is pleasurable for both partners as well as free from the risk of infection or unwanted pregnancy.
SUMMARIZE the activity on the previous slide by having a volunteer read the definition on the slide.
EXPLAIN that while safer sex is often thought to be less enjoyable sex, it can be more enjoyable and fun because it can allow both partners to relax and reduce worry about HIV or STIs.

13. Gender and HIV Women 2X as likely to have HIV Biological factors
Design of a woman’s body
Cells in the cervix allow easy entry
More likely to have undiagnosed STIs
Social and Cultural factors
Tend to have less information about sex and less control in a sexual relationship
May have relationships w/older men
EXPLAIN that both men and women are vulnerable to HIV infection, and in every country of the world, HIV affects both. However, women are about twice as likely to be infected with HIV than men. In Malawi, women between the ages of 15 and 24 are 2.2 times more likely to be HIV-infected than their male counterparts in the same age group. In simple terms, this means that for every 100 men infected with HIV in Malawi, there will be 220 women infected. Why do you think this so? There are a lot of reasons that women are more vulnerable to HIV. Some are biological factors; some are social factors; some are cultural factors.
Biological
The design of a woman’s body (her organs are internal) facilitates transmission
The particular cells in the cervix allow HIV a way to get in the body
Women are more likely to have undiagnosed STIs and may not notice symptoms as easily
Social and Cultural
Women tend to have lower levels of education and less information about sex
Women may have less control in a sexual relationship
Women may experience trauma or bleeding during sex
May have relationships with older men (who may be more sexually experienced, therefore at greater risk for HIV)
EMPHASIZE that given what we discussed in Unit 1.1 about prevention of mother-to-child transmission, it is critical to be mindful of these issues when counselling women.

14. Stigma and Discrimination
What are some ways that you see people with HIV experiencing discrimination? What groups tend to get stigmatized because of their HIV infection?
EXPLAIN that stigma is something that occurs when a person is labelled by a society. That person may experience negative effects from that labelling—they may be rejected, threatened, isolated or generally treated badly. This can result in feelings of shame. Discrimination happens when someone treats a person differently from others. Discrimination is an action that is taken biased against a particular person or type of person.
ASK: What are some ways that you see people with HIV experiencing discrimination? What groups tend to get stigmatised because of their HIV infection?
Possible answers include:
Women: seen as “loose”
Men: sometimes assumed that they got HIV from another man
Homosexual men: treated as if they deserve HIV because of their desires, difficult for them to find support
Drug users: not respected as human beings who deserve help and compassion to break their addiction
CONTINUE the discussion by asking:
What is the effect of that discrimination for someone who is HIV infected?
What is the effect of that discrimination for someone who is NOT HIV infected?
EMPHASIZE that stigma and discrimination of people who have HIV—or are suspected to have HIV—is still very common worldwide. Everyone has a role in stopping stigma and discrimination. What can we do TODAY to reduce stigma and discrimination?
RECORD answers on a flipchart.
Be aware of own prejudices.
Have an HIV test yourself and be open about your status
Challenge discrimination when we see it happening
Wear a red ribbon to promote awareness and sensitivity for people who are HIV infected
SUMMARIZE by saying that stigma affects us all. At different times in our lives we will all have been stigmatised and stigmatising. Reducing stigma will help people talk more openly about HIV/AIDS and so help to reduce HIV transmission
ALLOW 20 minutes for this discussion.
END OF DAY ONE.

15. Counseling theories ALLOW 2 hours 15 minutes for this section.
EXPLAIN that counselling is both an art and science. The “science of counselling” refers to its underlying principles. The “art” is the blend of the lay counselor’s personality, techniques and skills. In this section we will learn about the theories of counselling.

16. What is Counselling? Lay counselors aim to help others:
Understand their situation more clearly
Identify a range of options for improving the situation
Make choices that fit their values, feelings and needs
Make their own decisions and act
Develop life skills
ASK participants the question on the slide and allow time for them to respond before clicking through to show the answers.
EXPLAIN that people have different ideas about what counselling is—in fact, there are many models for counselling out there. At its root, counselling is just a structured conversation. It may take place between 2 or more people. The lay counselor assists the client or clients in working though one or more particular problems they may face. The lay counselor and client work together to find ways to resolve or cope with the problems. Lay counselors encourage people to recognize and develop their own coping capacity.
The main goals of counselling are to help the client:
Understand their situation more clearly
Identify a range of options for improving the situation
Make choices that fit the client’s values, feelings and needs
Make their own decisions and act on them
Cope better with a problem
Develop life skills, such as talking about sex with a partner
Provide support for others while preserving their own strength

17. The 3 Rs of Counseling Be Respectful Be Responsive Be Real
EXPLAIN that person-centred philosophy towards counseling views all clients as
normal people who are experiencing problems in the here-and-now, and that
helping them involves Respecting their humanity, by being Real and Responsive to them.
Be respectful
It means that you regard another person as unique, and you respect their ability to make decisions
and solve their own problems. In such an atmosphere trust can develop, and the person can feel
safe to open up to their own experiences and their own feelings.
Be responsive
Being warm and empathic is a way of being responsive. Warmth is the non-verbal expression
of understanding and caring, i.e. through facial expressions, voice tone, posture
and gestures. Empathy means getting inside the world of the person who comes
for counselling and verbally communicating this understanding to the person.
Be real
Genuineness refers to a genuine integration of our feelings, words and actions; and
communicating this realness to the person. ‘Professional’ or superficial communication
often builds a barrier in counselling. If empathy is about listening to the client, genuineness
is about listening to oneself as a counsellor. Genuineness or being real is sometimes
more difficult that being empathic because it implies that the counsellor has got
to have a good sense of self-knowledge.

18. Counselling Ethics & Values
Acknowledge that clients are unique
Allow clients to freely express feelings
Be aware of the client/counselor relationship
Show clients acceptance
Show a non-judgmental attitude
Acknowledge that clients are responsible for themselves
Be aware of your own limitations as a counselor
Ensure that confidentiality is maintained
EXPLAIN in counselling we are often dealing with the most hidden part of a person’s
being, and clients often feel vulnerable and open. Thus, it’s important that we explore and follow
various values and ethical behaviours in counseling. These are as follows:

19. Information-Motivation-Behavioral Skills Model
EXPLAIN that the ‘Information-Motivation-Behavioral Skills Model’ is a simple model to guide looking at complex health behaviors. The model assumes that if an individual is well informed, highly motivated and possesses the necessary behavioural skills, then they are likely to initiate and maintain preventive behaviours. This model is associated with patient adherence in that:
Information is the basic knowledge about a medical condition that might include how the disease develops, its expected course and effective strategies for its management.
- Motivation encompasses personal attitudes towards the adherence behaviour, perceived social support for such behaviour, and the patients' subjective norm or perception of how others with this medical condition might behave.
- Behavioural skills include ensuring that the patient has the specific behavioural tools or strategies necessary to perform the adherence behaviour such as enlisting social support and other self-regulation strategies.

20. Behavioural Counselling Theory
Everything we have learned, we learn from early experiences with others
Behaviour can be learned and unlearned
Helps clients identify specific actions to change their lives
Deals with current behaviour, past is insignificant
Emphasis put on clients responsibility for their own behaviour
USE the following examples/activities to demonstrate how this theory can be applied in an HIV counselling session. NOTE that you can choose to do all the activities or just some, depending on the needs of your participants. If short on time, simply choose one activity/example per theory.
EXPLAIN that while psychoanalytic theory looks at the past, behavioural theory looks at the present.
Promoting Change Discussion:
ASK the group:
What changes might clients who come for HIV testing want to make?
What might help each change?
RECORD responses on a flipchart.
Then ASK, what might help them make these changes?
ALLOW 25 minutes for this activity.
SUMMARIZE by saying that it can be very hard to change the way we are, but small steps can lead to change if we want. We need to help clients make changes if they wish to.
Belief Systems and Behaviours Discussion:
EXPLAIN that there are many myths and misconceptions about HIV.
ASK, what are some that you have heard? [Write 3 or 4 responses on a flipchart. If participants have difficulty coming up with responses, offer the statements below]
Some people are immune to HIV infection.
A man can be cured of AIDS by having sex with a virgin.
You can tell when someone has HIV just by looking at them.
AIDS is a disease that scientists created to control the global population.
ASK participants: How might people behave if they believe the statements made were true?
SUMMARIZE by saying that as a result of these beliefs people may put themselves at risk of HIV infection, or that if diagnosed HIV+, they may give up all hope. It is the role of the lay counselor to challenge these beliefs.
REVIEW key points on slide

21. Egan’s 3 Stage Model Goals should be SMART Stage 1: Exploration
Understanding
Stage 3:
Action
Goals should be SMART
EXPLAIN to participants that Egan devised a map to guide the counselling process. The map has three stages.
Exploration – To enable the client to explore her/his problems; to develop a warm relationship; to help the client tell his/her story; the lay counselor needs to be non-judgmental.
Understanding – To help the client to probe deeper into his/her problem; to identify options; and to identify resources.
Action – To help the client to make choices; to help the client understand the implications of her/his choices; to help the client plan action for the future.
NOTE that Egan's model also helps lay counselors bring together all counselling theories
Exploration – Psychoanalytic
Understanding: Behavioural and cognitive behavioural
Action: Behavioural and cognitive as well as humanistic
EMPHASIZE that action planning needs to be SMART. SMART is an acronym and stands for specific, measurable, achievable, realistic, time-bound.
NOTE if needed that it is sometimes referred to as the EUA.
ALLOW 20 minutes for this slide.

22. Communication with the client
ALLOW 1 hour 40 minutes for this section.

23. Counselling Skills and Techniques
Facilitator note: Be sure to check participants’ knowledge of these techniques before going into great detail, as many (particularly the health care workers), will likely already have been trained on many of these topics (eg. Open vs. closed-ended questions)
INTRODUCE this section by saying “Now that we have discussed a number of theories that drive our HIV counselling, it is time to take a closer look at specific counselling skills and techniques.”
EXPLAIN that counselling theory is like the frame of a house, it gives our sessions shape and structure. The skills and techniques in this unit are like the bricks, tiles, paint and boards that close-in the house. These are the particular tools that help a lay counselor conduct an effective counselling session. As we go through the training, we will be referring back to these skills and techniques.

24. Communication There are 2 types: verbal and non-verbal RECEIVER SENDER
message
channel
Animated slide—click to reveal the text and graphic on the slide.
ASK participants to define communication.
ALLOW participants time to respond before revealing the definition below. Note that this definition is in the Participant Handbook on Page x.
Definition of Communication
Communication is a process through which information messages, thoughts, ideas, feelings are transmitted from one person to another.
Effective communication is important because it enhances interactive processes to take place. Therefore a good and effective lay counselor MUST possess good communication skills.
Two Types of Communication
1--Verbal Use of Words—what is actually being said.
2--Non-verbal use of signs—this includes things like eye contact, touch, body movement, facial expression. Non-verbal communication includes mainly body language and good listening.
The HTC provider should be aware of what his/her body is saying (i.e. gestures like crossing of arms and legs)
All forms of communication, verbal and non-verbal, should be clear, understandable and culturally acceptable.
The Communication Process
This is a two way process (interaction) which involves:
The Sender—this is a person from whom information has originated
Message—the idea that is being passed on either verbally or non-verbally
Channel—the means by which the message is transmitted from source to receiver.
Receiver—this refers to the person talked to who in turn interprets the message being transmitted
Feedback—a response from the receiver of a message he/she received
feedback

25. What are some common barriers to effective communication?
ASK the question on the slide and generate a list of ideas from participants.
ASK them to focus on methods that would prevent rather than facilitate effective communication between HTC provider and client/patient.

26. Barriers to Communication (1)
Moralizing
Arguing
Preaching
Storytelling
Blocking Communication
SUMMARIZE the discussion using the information on this slide and the next.
EXPLAIN that the methods on this slide:
focus on YOU (the lay counselor) and what you think or believe
are not focused on what the patient/client says
ASK participants to provide an example of one or two of these.
ASK the group “How would that make you feel?” based upon the example given.
Background Information
Moralizing
Making judgments about a cllient/patient’s behaviour – calling it “right” or “wrong” or telling them what they “should” or “shouldn’t” do
Arguing
You may disagree but try to encourage rather than argue
Preaching
Telling the client/patient what to do in a self-righteous way
Storytelling
Relating long-winded narratives about YOU that are not really relevant or helpful to the client/patient
Blocking communication
If an HTC provider is blocking communication by:
Speaking without listening to the answers
Using an aggressive voice
Showing impatience
Showing annoyance when interrupted
Having an authoritative manner
Then the patient may:
Feel down, humiliated, scared, insecure
Remain passive, not ask questions
Not trust the lay counselor not keep his/her recommendations
Not return to the health facility

27. Barriers to Communication (2)
Shuffling papers
Not looking directly at someone when (s)he is talking
Looking out through the window
Looking at your watch
Dirty office
Interruptions or distractions

28. Communication Skills SOLER Active listening Questioning Paraphrasing
Focusing
Challenging
Summarizing
Working silence
EXPLAIN that in this unit, you will be introduced to a number of counselling skills. These counselling skills are like your “lay counselor’s tool box”. As you sit with clients, you will draw upon these skills to help the client discover what he or she needs from the counselling session.
NOTE that there are 8 counselling skills discussed in this unit:
SOLER, Active Listening, Questioning, Paraphrasing, Focusing, Challenging, Summarizing and Working Silence

29. SOLER S - sitting squarely O - open posture L - leaning forward
E - eye contact
R - relatively relaxed
WRITE the words in bold on the flipchart paper as you talk through the subject. SOLER is a technique for demonstrating interest and attention non-verbally.
S—sit squarely to communicate presence and availability.
O—open posture to signify that you are open to the client and to what the client is saying. Others see this as a non-defensive posture.
L—leaning forward towards the client is a natural sign of involvement.
E—eye contact. There should be eye contact but this should not be confused with staring. It is a way of communicating your presence and interest and that you want to hear what the other person wants to say.
R—being relaxed and natural when doing all the above is important. It means becoming comfortable with your body and the situation.
EMPHASIZE that SOLER needs to be followed in all counselling sessions.
DEMONSTRATE SOLER with a volunteer in the front of the room.

30. Active Listening Actions that show you are listening
These are important because:
It feels great when someone is listening
It feels humiliating when someone is not listening
If your client thinks you are not listening, he/she may stop talking or think you disapprove
Activity: listening and not listening
ASK participants to pair up with the person next to them. Ask them to face on another.
EXPLAIN that each will have an opportunity to talk while the other listens. One person in the pair talks for 2 minutes about something they have done or experienced recently, which they enjoyed or were interested in. The other person listens intently for 1 minute, showing a listening attitude in every way possible. After a minute, the listener stops listening. They should not leave their seat but in every way show that they are not listening. Then swap roles.
Back in the main group, ASK participants:
How did it feel as a speaker to be listened to? To NOT be listened to?
What did you do as a listener to show you listened? What did you do to show you weren’t listening?
Possible answers include:
Some of the actions that show one is listening: leaning forward, sitting close, making eye contact, nodding, smiling, staying still, asking questions, staying quiet, and so on.
Some of the actions that show one isn’t listening: fidgeting, looking around the room, sitting back, not looking at the person, not asking questions, looking bored, and so on.

31. Questioning Open-ended questions: Closed-ended questions:
Encourage choice: How? What? When?
Closed-ended questions:
Restrict choice, yes/no answers
Leading questions
Lead to lay counselor-decided answers
“Why” questions
Can sound interrogative, causes defensiveness
EXPLAIN that questioning is a skill used to help lay counselor and client explore and understand more fully the issues being discussed.
NOTE that questioning, probing and prompting have the same objectives—to help clients name, take notice of, explore, clarify, or further define issues.
EXPLAIN that there are many types of questions as listed on the slide:
Open-ended questions give clients choice in how to respond and are aimed at leading into a discussion. Examples are the ‘how’, ‘what’, and ‘when’ questions.
Closed questions restrict choice and lead to single-word or yes/no answers.
Leading questions lead to yes/no answers and make assumptions.
‘ Why’ questions often sound interrogative in nature and tend to put people on the defensive.
Those most commonly used in counselling are open-ended questions.
EMPHASIZE that questions should not be asked simply to satisfy the lay counselor’s curiosity.

32. Paraphrasing
Restating the content of the message in similar, but fewer, words
Shows understanding
Provides reflection that is clearer than the original statements
Begins with feelings, ends with facts
SHARE or ENCOURAGE participants to share examples of each of the skills presented on this and the next 4 slides.
EXPLAIN that paraphrasing is when an lay counselor reflects what the client is feeling and what a client has said using the HTC provider’s words. It shows understanding and allows the lay counselor to check that s/he has understood. It is not about interpreting. Always start with the feelings and then the words. Only reflect what you have heard.
READ the client statements below and ask participants to respond briefly with a paraphrase, particularly picking up the feelings. If needed, use the answers below to assist participants if they are struggling with this exercise.
Client: I’m exhausted. I have to work incredibly long hours.
Lay counselor: It sounds as if you are very tired and you are working very hard too.
Client: When I get home my husband has done nothing. I’m so fed up.
Lay counselor: You say you are really annoyed with the situation. Your husband isn’t helping you.
Client: I’m fed up. I can never do anything right at work
Lay counselor: You say that you are feeling very low, you are finding work very hard at the moment because you don’t seem to get things right.
EXPLAIN that a paraphrase can also help bring together the key points from a counselling session or a part of a counselling session. This type of paraphrase is sometimes also called summarizing

33. Summarizing
Making a brief statement bringing together the key points from a counselling session or a part of a counselling session
EXPLAIN that its purpose is to ensure that lay counselor and client understand each other correctly and can move forward in the session.
NOTE that it can be used at any stage of a counselling session.

34. Focusing Enables client to understand their issues in greater depth
Helps move the client from the general to the specific
EXPLAIN that enabling clients to focus allows them to understand their issues at greater depth. It helps move from the general to the specific.
READ the following client statements and have participants ask the questions. PROVIDE the answers below if needed.
Client: I hate my husband.
Lay counselor: What in particular do you dislike?
Client: I feel scared all the time.
Lay counselor: What is it that scares you?

35. Challenging
Helpful in identifying contradictions in client’s behaviour
Self-perception and behaviour
Verbal and non-verbal messages
Two verbal messages
EXPLAIN that challenging is used to help a client examine beliefs or behaviours that seems to be self-defeating or harmful to the self and to others. It can be useful to challenge mixed messages such as discrepancies between vocal and body messages, verbal messages, words and actions, and between past and present statements. It can be used when clients are focusing on other people rather than themselves, when there seems to be a lack of reality, or when the client is not acknowledging choice.
PROVIDE the following examples:
Lay counselor to client:
You say you are fine, yet your tone of voice is sad.
You say you fear HIV/AIDS yet you don’t want to use condoms or give up your multiple sex partners.
I am aware that you have only talked about your partner; I wonder how you are feeling yourself.
ASK one participant to give an additional example of challenging.
SUMMARIZE by saying that by challenging, you can develop better understanding of your client. It might feel as if you do not believe your client and seem judgmental. Because of this, challenging needs to be done carefully.

36. Working silence
Maintaining silence as you allow a client to process and reflect on information
Communicate presence in the session using minimal prompts such as nodding, maintaining eye contact, leaning forward
EXPLAIN that this skill is commonly used after giving test results.

37. Empty chair
Used to explore client’s relationships with themselves, with aspects of their personality, or other people in their lives
Involves the client addressing the empty chair as if another person, or aspects of their personality, was in it
Source:

38. Too much self-disclosure
2 Common Pitfalls
it's happened
to me...
I think...
My personal
advice is...
My point
of view is...
Note that this slide is animated
CLICK once and ASK: What is happening during this counseling session? What do you see in this picture?
ASK: And how do you think this makes the client feel? (click)
ASK: What are the 2 common pitfalls?
(click) Too much self-disclosure and giving advice
Too much self-disclosure
Giving advice

39. Too much self-disclosure
Lay counselor talks about his/her experiences, distracts from client’s issues
How might lay counselor self-disclosure harm clients?
Under what circumstances do you think self-disclosure would be ok?
DISCUSS the two most common “pitfalls”, places where lay counselors often go wrong.
First, self-disclosure. This is when the lay counselor talks about his/her experiences. It can be seen as distracting and shifts focus away from the client’s issues.
ASK: How might lay counselor self-disclosure harm clients?
The disadvantages:
It might take attention away from the client and shift it to the lay counselor
The lay counselor might assume that because both have experienced the same thing, they both respond to the experience in the same way
The client might want more information than the lay counselor is willing to give
The client is not bound to protect the lay counselor’s confidentiality
The lay counselor might use this self disclosure for personal therapy: a problem shared is a problem half solved
EMPHASIZE that the lay counselor needs to remember the client is not bound by confidentiality and that self disclosure needs to be done very carefully if at all.
ASK: Under what circumstances do you think self-disclosure would be ok? How do think it could benefit the client?
The benefits
It might help clients develop a new perspective on their problems.
It might reduce a sense of isolation
Might increase the bond and trust between the client and lay counselor

40. Giving advice You should always have safe sex You must eat a good diet
Now you are HIV positive, you have to use condoms
You need to tell your wife about your test result
You should reduce the number of your partners
Animated slide—click to reveal statements one by one.
INTRODUCE the activity by saying that lay counselors might be tempted to give advice to clients.
READ the first statement on the slide and ask a volunteer to think of another way to make the statement, turning the advice into information.
If needed use the first statement to demonstrate:
Advice: You should always have safe sex
Information: Safer sex can protect a person from getting HIV infection or from passing it on.
CONTINUE with the rest of the statements [choose a new volunteer for each statement)
SUMMARIZE the activity by saying: “Advice directs the client. Information allows the client choice. By generalizing the information, clients will not feel judged or directed.”
ALLOW 10 minutes for this activity.

41. What would you say if one of your clients asked if you are HIV positive?
EXPLAIN that as lay counselors, we have a set of skills that we will use to counsel clients effectively. We have looked at 2 main pitfalls (self-disclosure and advice) that can interfere with effective counselling. But sometimes, very personal issues may arise that create difficulties for lay counselors.
For example, what would you say if one of your clients asked if you are HIV positive?
What would be the benefits and the disadvantages of telling them?
What might you say?
ASK participants to brainstorm (out loud) the advantages of lay counselors going through HTC/disclosing their status.
The participants may raise the following:
The lay counselor will understand what it feels like to go through the testing process.
lay counselor will know their own HIV status.
An HIV positive lay counselor is proof that people can live well and continue working when they are HIV positive.
The lay counselor will have more credibility in talking to others.
The individual benefits or disadvantages would be the same as for anyone testing negative or positive.
CONCLUDE the unit by emphasizing that lay counselor need to be genuine and respectful. How can lay counselor promote testing when they do not believe in it themselves? The advantages of having a test for clients are the same as for lay counselors. Going for a test, whatever the result, gives an lay counselor good knowledge of the experience. It is important to consider our own HIV status and what the issues are for us in going for HCT. Having the test may give us real advantages in our lives and our work, but the testing needs to be safe for us as individuals.
ALLOW 10 minutes for this discussion

42. Key points (1)
It is important that we be aware of our own values, attitudes and prejudices so that we can have an open mind with our clients
We make changes—or don’t make changes—largely as a result of the support we get from people around us
REVIEW key points and answer any additional questions.

43. Key points (2) Lay counselors aim to help others:
Understand their situation more clearly
Identify a range of options for improving the situation
Make choices that fit their values, feelings and needs
Make their own decisions and act
Develop life skills
2 common pitfalls of lay counselors include too much self-disclosure and giving advice