COUNSELLING

Counselling is one of the approaches most frequently used in health education to help individuals
and families.

The purpose of counselling

According to the District Health Management Operations Mannual of the Ministry of Health
(1999), individuals are encouraged to think about their problems and thus come to a greater
understanding of the basis of their problems through counseling. Because of this understanding it
is hopped people would commit themselves to taking actions that will solve the problems. The
kind of action taken will be the person’s own decision, although it may be guided, if necessary
by the counsellor.
Counselling means choice, but not force, or advice. A health worker may think that his or her
advice seems reasonable, but it may not be appropriate to the particular circumstances of the
person receiving the assisstance. With counselling, it is the person concerned who takes
decisions so that the solutions adopted are more likely to be appropriate. An appropriate solution
will be one that the person can follow with successful results.

Rules for Counselling

Relationships
Counsellors show concern and a caring attitude. They pay attention to building a good
relationship from the beginning with the person they are trying to help. People are more likely to
talk about their problems with someone they trust.

Identifying needs
Counsellors seek to understand a problem as the person with the problem sees it. People must be
assisted to identify their problems. Counsellors do not name the problems for them. The use of
questions that lead to open comments will help here.

Feelings
Counsellors develop empathy (understanding and acceptance) for a person’s feelings, and not
sympathy (sorrow or pity). A counsellor would never say ‘you should not worry so much about
that’. It is natural for people to have worries and fears about their problems. A good counsellor
helps people to become aware of their feelings and to cope with them.

Participation
Counsellors never persuade people to accept their advice. If the advice turns out to be wrong, the
person will be angry and no longer trust the counsellor. If the advice is right, the person may
become dependent on the counsellor for solving all problems.
Counsellors help people to think about the factors involve in their problems, and encourage
people to choose the solutions that are best in their particular solution.

Secrecy
Counsellors will be told about many personal and possibly embarrassing problems. The
information must be kept secret from all other people, even from the client’s relatives. If people
you are counselling discover that you have told others about what transpires during the
counselling, that person will no longer trust you and will avoid you. A client may even get into
trouble because of what a counsellor has told others. Counsellors always respect the privacy of
the people they are helping. They never reveal information without specific permission.

Information and resources

Although counsellors do not give advice, they should share information and ideas on resources
available which the client needs, in order to make a sound decision. Many people do not realize
the connection between their behaviour and their health. Counsellors do not lecture, but should
provide simple facts during discussion to help people have a clearer view of their problems.

DIFFERENT TYPES OF COUNSELLING

Counselling with families
People may need the help of their families to solve a problem. Counselling skills are useful
whether the counsellor is working with one person or with a whole family. When working with a
family, we are dealing with more than one person, therefore, there may be more than one
problem, more than one need, and probably more than one solution. Also, be aware that in
families different people have different responsibilities and powers. The father, for example, may
have the major say on how money is spent by the family. The mother may make most of the
decisions about types of food to be eaten. Grandparents influence the degree to which families
follow traditional customs. Give information that would be appropriate to the right person for
each problem.

Counselling with children

In a clinic, or the community, you find children with health, emotional, or other problems.
Counselling can be provided for them if they are old enough to talk.
It is better to talk to the child alone. Background information can be obtained from the parents
first, and then they may be politely asked to excuse the party. Sometimes parents want to answer
the entire question, they do not give a child a chance to speak. The child may be afraid of saying
certain things in front of parents. The counsellor should explain to the parents that the child
might speak more freely without others around.

Begin by talking about interesting things. Ask the child about his or her favourite games, for
example. Once the child is relaxed, begin talking about the problem. Let the child know that
everything said will be kept in secret. In this way, the child will trust you and speak freely.
Always keep your promise of secrecy. If parents, teachers, or others find out what has been said,
the child will be afraid, and never let the counsellor help again.
Follow the counselling rule with a child as you would with an adult. The child will be able to
learn much about health from a good counsellor.
Counseling during Home visits
Counselling can be done in the clinic or at school, but home visit are also helpful. The
community health nurse should visit all homes in the community regularly. If a community is
small with about 10-25 houses, home visits can be made at least once a fortnight. In larger
communities or neighbourhoods, visits can be made monthly
If you approach people with understanding, they will welcome you into their homes to give
opportunities for health education.

Educational methods used in counselling

There are various educational methods that can be used to help individuals and families solve
their problems. Some of them help people understand the cause of their problems. Some help
them see possible solutions, while other methods help them reach decisions for action.

We have seen in other chapters how it is important is for us to place ourselves in the position of
other people to understand why they behave as they do. However, the people themselves also
need to see why there is a problem. Our role therefore, is first to understand the problem, and
then to help people understand it themselves. Next, we need to work together with them to find
solutions that are appropriate to their situations.

Sometimes people may be reluctant to take the action necessary to solve their problems. They
may not feel that it is worth the time and effort. Encourage them to examine their values in order
to take some decisions with regards the importance they place on their health and welfare.
Another way to help people decide to act is the use of self-reward. People should decide on the
reward they would give themselves if they follow through the necessary action.
It is important to help people choose solutions that will fit in their ways of doing things, and with
their beliefs. Try to help them avoid solutions that are uncomfortable, and help find workable
alternatives.
Always remember that counselling calls essentially for personal approach and for skills in
listening, in providing information, and in helping people themselves determine what is best for
them.
Demonstrating and displaying real objects are educational methods that can be used to counsel
an individual.

Facilitating decisions and follow- through

What are the things we value most
Values are standards and beliefs that are very important to us and therefore affect our behaviour.
Some of the things people value includes progress, happiness, friendship, security, and comfort.
If asked, most people would say they value health, but too often they do not value their health
until they have lost it.

Although people feel strongly about their values, they do not always seem to behave in ways that
match them. People often do not even realize their behaviour is not consistent with their values.
The examples below show this clearly.

People value their children very highly. They consider it an honour to be a parent. Caring for
children is a special duty not to be taken lightly. However, sometimes you see family spending
their money on new clothing cigarettes, or alcohol, even though the expence of children who are
underweight and sickly. It may be that the family wants new clothing so that they can match up
with societal celebrations. Maybe they drink alcohol because their friends do or because it seems
a way to mix easily with other people. Maybe they believe cigarette will help them concentrate
better to their work. Perhaps the family does not know that children need to eat certain foods to
be healthy. You can probably think of other reasons for the family’s behaviour. It is unlikely that
the mother and father want to hurt their children. They probably do not realize that their
behaviour is out of way with the value they place on their children.
Adjusting behaviour to values
It is our role to help people to see clearly how their values may not be match by their behaviour.
Then perhaps, they will try to change. If they are to do so, they will need to help them find out
what matters most in their lives. This is best done with individuals, although it can be done in
small groups. Values are very personal. People are unlikely to talk in front of others about their
values and contradictions in their behaviour.

Once the people are clear about the things they value most in life, ask them if they always act in
a way that are in harmony with their values. If they say ‘No’, ask them why. Find out what
makes it difficult for them to live always according to their values. Likewise, if you have noticed
any differences in the values a person holds and the person’s actions, gently point them out .The
realization of such differences is a very important step towards the decision to change one’s
behaviour. However, once a person has decided to modify certain habits that decision has to be
kept day after day, until the changes in behaviour have become part of a way of life, which is
very difficult. We will see now how people can be strengthened in their decision to adopt healthy
practices.

Using self –rewards

If people receive a benefit for an action, they will be encourage or motivated to repeat that
action. Rewards can encourage good health behaviour. However, they must be used with caution.
First, they should be used only when a form of behaviour is very difficult to change (for
example, alcoholism)
Secondly, a community health nurse should be aware that it is quite possible to mislead someone
by using rewards and thus cause many problems. To avoid this, always make sure people choose
the kind of healthy behaviour they want to achieve, and ensure they choose their own desired
rewards.

JOURNEY OF HOPE - AN HIV/AIDS EDUCATIONAL TOOL

What is Journey of Hope?
Given the magnitude of the rate of HIV/AIDS infections in Ghana and the feared devastating
effects of it on the lives of people, a wide array of interventions and tools are required to fight
this disease for a long and lasting impact.

According to the John Hopkins University Centre for Communication Programmes (2001),
Journey of Hope is an innovative package of tools developed to assist organisations and
individuals to more effectively adopt participatory approaches in communicating messages on
the prevention and management of the disease.

As a strategic tool, Journey of Hope aims at enhancing the impact of the efforts being made by
various organisations and individuals in Ghana towards the realisation of an HIV/AIDS free
society. It offers new tools and approaches to help all people in the country, particularly the
youth contribute in reversing the rising tide of HIV infections, currently estimated at 200 new
infections each day.

Main Features
Journey of Hope is a tool for promoting participatory forms of HIV prevention and forms part of
the Stop Aids – Love Life slogan of the HIV/AIDS Campaign in Ghana. It uses an analogy of
floodwaters for the rising tide of the HIV epidemic. It is a behaviour change methodology. The
main features of the Journey of Hope analogy are:
 Crocodiles in water representing the HIV virus and other Sexually Transmitted
Infections (STIs);
 Boats and Bridges-the prevention methods of Abstinence, Faithfulness and condom use
portrayed as narrow bridges and three boats; and
 Future Islands – representing the individual’s future goals in life; the goals that are
being threatened by the HIV pandemic.

Overall Aims of Journey of Hope

The overall aims of the Journey of Hope are

 To help people acquire life skills for making positive life

choices in the time of the HIV/AIDS pandemic; and
 To enable people make a choice of the type of relationships
they desire in a way that keeps them safe from HIV
infection.

How the Overall Aims are to be Achieved

In achieving the overall, aim Journey of Hope:
 Promote open discussions about sexual behaviour and HIV/AIDS issues.
 Involves people in fun and interesting ways, using participatory story telling with
interactive visual aids and symbols;
 Clarifies the choices and builds skills that empower people to protect themselves from
HIV infection (Abstinence, mutual Faithfulness and Condom use);
 Encouraging people to plot their own course to a safer lifestyle, linked to achieving
outcomes they really want, and value in life;
 Applies a range of powerful; and practical concepts and tools for behaviour change;
 Enables people to develop skills in negotiating what they want in a relationship;
 Clarifies issues around voluntary counselling and testing; and
 Promotes support and compassion for those living with HIV/AIDS.

Components of the Journey of Hope

The Journey of Hope kit comprises the following tools:
 Narrow Bridges, which introduces HIV prevention and enables participants visually,
physically and symbolically experience the three ways of avoiding HIV/AIDS –
abstinence, faithfulness and or condom use.
 The Fleet of Hope; which explores issues around HIV prevention and enables participants
to discuss the HIV prevention measures as they relate to specific situations in Ghana and
examine their own personal positions on the Fleet of Hope.
  Future Islands; which has the theme ‘Love Life’ and helps people, no matter the situation
in which they are to envisage a future they really want and would feel very happy to
have, by avoiding being infected by HIV.
 Trigger Sketches, which provide situational studies in a dramatic way for dealing with
practical issues on the way to each individual’s future island – the attainment of ones life
goals.

The Journey of Hope Tested and Proven

Since March 2000, various individuals, groups and organizations, including in school children,
youth, drivers, and work place groups, People Living with HIV/AIDS (PLWHA), students of
tertiary institutions and religious organisations amon others, have helped in the trial and
feasibility of Journey of Hope in Ghana. The feedback from these trials has been very positive;
showing that these tools are easy to use and have strong impact on enabling people to develop
the required life skills to enable them avoid HIV infections, manage HIV/AIDS cases that may
confront them and develop compassion for relatives and friends who may be living with the
disease.
Journey of Hope is therefore an educational tool with a tested and proven efficacy for helping
people make the right decisions in the fight against the spread of HIV/AIDS in Ghana (Ghana
Users’ Guide, 2001).