Counselors were also critical of the TASO model as a sexual risk reduction counseling model. In 1999, Weinhardt, Carey, Johnson, and Bickham published a meta-analysis of the effects of HIV counseling and testing.
MODELS OF VCT IN SOUTH AFRICA Introduction
The TASO model uses Egan's (1986) client-centered 3-step Problem Management Process, which promotes the idea that people are responsible for and capable of making their own decisions. The client-centred approach emphasizes the centrality of the counselor-counselee relationship and aims to develop counselors who respect the views of those they counsel without imposing their own values.
THE PRESENT
THE PREFERRED
THE ACTION
MOTIVATION FOR FOCUSING ON THE COGNITIVE BEHAVIOURAL MODEL TO COUNSELLING (ARRM)
The review of VCT counselor training in the South African context revealed that the dominant approach is client-centred. As this approach has recently been introduced in South Africa and there has been little evaluation of this model, this research focuses on investigating the counsellors' experiences and perceptions of this model in relation to its applicability for sexual risk reduction counseling in the South -African context.
LIMITATIONS OF INDIVIDUAL BASED APPROACHES TO SEXUAL RISK REDUCTION
Thus, Campbell and Cornish (2003) argue that our understanding of the mechanisms through which community-level processes influence the likelihood of behavior change is still in its infancy. This study sought to address the challenges outlined above by examining how structural inequalities played out at the local community level in ways that undermined the possibility of behavior change. He suggests that an understanding of the rule-defined nature of institutions is needed to understand how behavior change can be sustained.
It also leads to an understanding of the role of the environment in creating contexts for change. But turning to the context of experience, there has also been little understanding of our society's place in understanding behavior (Airhinnbuwa & Obregon, 2000). Kelly (200 I) argues that relatively little work has been done at the level of explanation and intervention, and that there is relatively little understanding of the psychological and social dynamics associated with risk exposure and intervention.
He argues that there must be an understanding of the emotional and symbolic universes that span space.
CONCLUSION TO LITERATURE REVIEW
CHAPTERTHREE:METHODOLOGY
Qualitative Approach
The case study method was therefore used in this study to provide an in-depth understanding of participants' perceptions of the use of the ARRM, based on their experiences of using the model and their views on its applicability for sexual risk reduction counseling in the current South. African context. The participants consisted of a sample of vCT counselors trained in the client-centered, TASO model and the ARRM model. The participants provide a vCT service to clients in the midlands of the province of KwaZulu Natal.
Lungi states that she never intended to become a counselor, but through becoming a VCT counselor, she developed an interest in counseling skills. Tabita is a 26-year-old African woman who has been a VCT consultant for more than three and a half years. Sma is trained in both the TASO model and the AIDS Risk Reduction model.
In summary, reasons for wanting to become a counselor were seen as a useful way to engage the participants in conversation in the initial stages of the interview.
Semi - Structured Interview
The designed questions are based on a literature review on the topic of sexual risk reduction. The coding unit depended on referring to the research questions asked and the objectives of the study. Triangulation, peer review and audit trailing were three of the methods used in the study and will be described in the following sections.
Detailed records were kept of how the study was conducted and how the data was analyzed to ensure the reliability of the study. In qualitative research, validity is defined by the extent to which the researcher makes observations that are credible to themselves, the subjects being studied, and the audience of the research. Participants received an introduction to the purpose of the study and a full, non-technical and clear explanation of the tasks expected of them.
Ultimately, it makes them question what they want to change about their lifestyle.
Socio-Contextual Constraints to using the ARRM (Cognitive Behavioural Approach)
You are dealing with a society and culture where there are unequal power relations and a society and culture that encourages this way of thinking. They want you to tell them what to do because you are supposed to know all the facts, all the medical terms, all the biology. I mean you are supposed to know about ARVs [Anti-retrovirals}, MeTs [mother to child transmission} and on the other hand you are the counsellor.
Interviewer: So you're saying it's difficult to combine the two, the medical part and the counseling part. Participant: Yes Kamilla, because on the one hand you are involved in biology and the medical sector and on the other hand with counseling. Counselors also indicated that because counseling is seen as something new in rural South Africa, using counseling techniques such as confrontation and challenging the client's thoughts was difficult.
I think as a counselor you have to respond to clients' risky sexual behavior, but you also don't want to come across as disrespectful as if you're passing.
Need for Support and Training
Counselors also indicated that they need knowledge of new theories in the field of counseling and that training should not be just a one-time procedure, but rather an ongoing process so that counselors can be kept abreast of the latest developments in the field of counseling. We are the first contact that clients have when they come in for the test. That's why I think it's important that we as counselors have the most up-to-date information, not only about the necessary medical information, but also about the different counseling approaches being used. She indicated that she wanted to play a number of roles (mother, friend, counselor, disciplinarian) that created feelings of depression and anxiety.
Counselors also indicated that they need space and time to “vent emotions” they experienced as a result of counseling. I found myself wanting to be her mother, to tell her not to do stupid things on the one hand, on the other hand also to look after her. I think, Kamilla, that it is important that we can have some space to go to, "where we can deal with these things.
34; I mean it's not just the client who walks away with these hurt ftlings.
Usefullness of the Cognitive Behavioural Approach
- The Cognitive Component
- Problem Solving Component
- Collaboration
- Follow-Up and Monitoring Behaviour
- Facilitating Emotional Expression
This part of the counseling process facilitated the process of behavior change within a context that was not separate from the client's life. Helping clients identify specific steps they could take to implement the solutions into their daily lives was seen as a desired outcome of the counseling process. It was assumed that the collaborative nature of the cognitive-behavioral approach, where the counselor and the client work together, has a positive influence on facilitating sexual behavior change.
Collaboration is argued by Grazebrook & Garland (2005) to be one of the key factors influencing the effective delivery of CBT. Grazebrook & Garland (2005) claim that the ability to collaborate is important in the sense that therapy is not experienced as something that has been "done" to the client. Counselors indicated that following up on clients' initiatives to change their sexual behavior change was important, especially to facilitate the reinforcement of safe sex behavior.
Counselors also revealed that they felt it was important to get clients to express their feelings in sexual risk reduction counseling.
Barriers to using the Cognitive Behavioural Approach in the current South African context
Counseling for the reduction of sexual risk and adherence to safe sex practices is thus made difficult by these power relations. This expectation of the counselor to play this expert role made counseling for sexual risk reduction difficult, especially when considering that the cognitive-behavioral approach requires the counselor and client to share a relationship based on. Further, counselors reported that a “once off VCT session” placed limitations on counseling for sexual risk reduction and treatment of mental health problems.
Counselors indicated that based on their experiences with VCT counseling and sexual risk reduction counseling, they needed to be more creative and flexible in their counseling. They indicated that in the absence of any psychological intervention for these problems, counseling for sexual risk reduction was difficult. A key finding of this study was that although counselors considered the cognitive behavioral approach to be superior to the TASO model of counseling for sexual risk reduction, they perceived several barriers to its use in the South African context.
In terms of counseling skills, they indicated that skills such as empathy and positive consideration as well as confrontation and assertiveness were important in sexual risk reduction counseling, with the latter two also important to develop personally in their training as counselors. Although the interviewees in this study indicated that using the cognitive-behavioral approach in sexual risk reduction counseling has great potential for creating sexual behavior change, a predominant theme that emerged was that counselors experienced socio-contextual barriers to the success of this approach. Kelly (1995) argues for cultural adaptation in the use of cognitive behavioral approaches and counseling to reduce sexual risk.
APPENDICES
CONSENT FORM
Mini-Dissertation: Counselors' Perceptions of Using Cognitive Behavioral Counseling Approaches in Sexual Risk Reduction (HIV) Intervention. Dear Participant, We are asking you to participate in this research so that we can investigate the contextual appropriateness of using cognitive behavioral counseling approaches to reduce sexual risk for HIV. If you agree to participate in this study, you will be interviewed about your experience as a counselor and your views on the appropriateness of cognitive behavioral counseling approaches to reduce sexual risk for HIV.
By agreeing to participate, you will promote knowledge about the individual and contextual issues that make cognitive behavioral therapy successful or unsuccessful in facilitating protective sexual behavior in the South African context. I understand that my participation is completely voluntary and confidential, that I may withdraw at any time and that the nature of the study has been explained to me.
