A long-time counselor from the BFC describes his style.
N: There seems to be, judging from the style of the people that were trained back then, a real difference in the goal of the counseling session.
C: Well, I think... certainly the way we were trained back then is to treat the client pretty passively, to conduct, to lecture, and to present the material and then check in if they understood it and continue and then sort of interview them and tell them what their risk is and what they need to do to do better, and you know, I don't know a lot about this client based stuff, but, the whole idea of having it more open ended and looking at..... so in some sense, I've observed some people who've been trained later and I have a sense of what it's about, but, uhm, and my sense is that the later trainings are sort of like, well you can skip over some of those things about what the test is and deal more with what's going on in the life of the client and how you can help them continue along the spectrum of improving/reducing their risk and modifying the behaviors along that continuum, and I don't think there was that concept back then, it was more OKhow do we get informed consent and how do we tell people what's right and wrong and make sure that's all cleared up, I don't know.
N: Well see my training was called Sharing the News, so I think I was the last thing before the client centered, which was in '94. But sharing the news kind of summarizes it, basically we're gonna give you all this information and what you do with it is none of our business, but, we've done our job here, we've given you all the facts kind of thing, and now it's kind of watered down harm reduction theory where there's a context to everything and you have to explore what's important to the client right now.
C: Yeah, what are you doing. Well, yeah, I guess all those make sense, I think all of them can, my feeling is that I still counsel because I have this habit, my main structure is probably inform and consent and making sure they understand it and then my secondary issues are helping the client deal with this critical information in their life right now, and contextualizing it and supporting them, and also the other thing is that, historically a lot of clients have been like, I've waited a long time, I've heard this before, I don't want to be put through another loop of, I don't want to hear another person tell me something that I've heard ten times that I already understand and maybe understand better than they do, uhm, I'm getting that less and less, but I used to get it all the time, '93 to '95 where there's a lot of impetus to sort of switch it, I've been tested five times and I'm sick of being judged, a lot of disturbed clients, clients that are disturbed by the process and so for me, I always disclaim. I have this agenda that I'm supposed to talk to you about and it's things you might already know and, uhm, if you already know them that's great, all I need to do is check in and make sure that you tell me you know them and then we'll skip over them, I want to skip over what you know, talk about what you might want to hear, and just make sure you know these things. And what I try to do is just outline what's supposed to happen and how it works here to start and sort of get a sense of, is that something you're comfortable doing? and then with that, go through my agenda. I'm pretty canned when I counsel, it's kind of sad I think that I get these phrases in my head and I just spit them out, so I have to be careful or when I'm tired and I'm not paying attention that I also have to slow down and try to focus on the client and not focus on how quickly I could spew every little thing.
But, but I , but for me I'm comfortable with a structure, pretty unfortunately linear and anal and I can do a structure and sort of filter people through it and stop and deal with their needs. I feel like my clients are comfortable because they know what I'm there for, what I think I need to talk about, or we need to talk about, sort through, and they can sort of see where we're starting and where we're finishing, and also sometimes uhm that, if they say I just want to get through this really quickly and so, i can say ok , these are the things let's check down the list, do you know about the six month gray area, and what does that mean and do you want any more of that information on that and then we talk specifically about dates, today is the ....., six months ago it would be the ......, so iif this result is negative, had you....////// I focus on them but I try to contextualize it in a linear structure. And that's, and sometimes I feel like up, I'm not opening enough questions like oh, how do you feel today (laughter) and so what does HIV mean to you? that I think about time, and still I think I take longer than other counselors, but I feel like I go through those topics and because I have that structure, I can stop it in the meantime, put it aside with a bookmark where I was, and I say to my clients, you can interrupt me, I can rewind, I can fastforward, I can do this backward if you want, so stop me at any time, and I use the form as a tool, saying you know the State is asking all kind of questions about how you could be at risk, and then I say there are three fluids, blood, semen, vaginal secretions, I say so from what you told me it sounds like blood isn't an issue in your life, you're not using needles, haven't had a transfusion, haven't been cut by something that somebody else was cut by, (.), can you think of any other way you could have come into contact with someone else's blood? and I think for me that's reiterating the question and also if they didn't disclose, it's repeating the question but repeaating it in another context the state might have screwed up.
N: This is after all the questions on the form which you go through in a linear way?
C: I insert that in the middle of my... I talk to them about what the test is, what the possible results are and what the results mean and my messages are for negative, the important thing I try to point out to people is the gray area and I get as specific as they want, like I'll do the in 21 days, 85% of people and three months is more than 99 and that at six months it's way on the other end of possibility, when we say six months we're really talking at the other end of possibility and then I try to find out where their risk is, a little bit, but I come back to it again after we've done the form on disclosure and I've talked to them more specifically about risk, but, the gray area/window period is my big message around negative. [For] positives, my big message is, there's a difference between HIV infection and illness, and that's important to realize and I throw out the fact that I have a friend who's had HIV for 17 years and he's doing fine, I mean he's had some minor illnesses but I sort of brush over those cause he's still big and fat and it's great to see him...And I talk about how it's real important to hook up to a doctor or clinic that understands HIV cause they can tell better how your body's doing and what shape it's in and they can recommend things to lengthen the amount of time you're healthy and lessen the severity of diseases you might get. I do it slower. But those are my main points and then I ask if they would understand if we told you negative or positive?
Then I go into the form, let's just get this form out of the way since it's here and you can decline to answer any of these questions and I don't care, I'll just go on, just let me know you don't want to answer and I'm not going to guess anything about you so please don't be offended if I ask something that's obvious, I'm just trying not to let my opinions get into this form. And then I, politically I have an agenda when I do that form. I really like to say: the first question is what race you identify as and there are six choices here and I'll circle any one or several you want me to. And I say that and a lot of people don't know what the hell I'm saying and think I'm wierd and are like, I'm white can't you tell, uhm because I strongly believe that people who appear white aren't necessarily white, uhm, and that's important for me to always keep conscious of and for white people to think about, to be conscious, that there are lots of people who are multiple heritages or dual heritages and I'll circle several of those even though we're not supposed to cause I think there's something wrong with the form that a person whose parents are white and black can't circle both.
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