A counselor discusses with Nicolas the similarities between her work in suicide crisis phone counseling and HIV test counseling clients who express a desire to be positive.
N: How is the phone crisis counseling different from the face to face counseling?
C: Uhm, it's very similar in that we try to, we're very non-directive on the phones, we try to empower people to make the best decisions for themselves and that's what I really see good counseling and education at the clinic being about. Not telling people what to do but talking to them about some of the latest information that's out and then kind of checking in with them about, you know, what they're doing, and if they perceive that what they're doing is a bit of a problem, uhm, trouble shooting with them in terms of things that they might change that uhm, might make it easier. Uhm, and so it's all very directed toward the safer sex or sexuality whereas the phones are any type of crisis, you know, but it's very similar I think. Uh. You know what we do on the phones often is sort of emotional CPR, uhm, we look at somebody in crisis and we try to assess whether or not they're going to stop breathing soon and if they are, it's in a situation like that that we would get very very directive and almost any other situation we try to help people to help themselves. So uhm, I don't know if you can draw that same kind of triaging analogy over to HIV counseling, but uhm, suicidality does come up in an indirect way in HIV counseling. Some people are involved in very high risk, very self destructive behaviors which are in a sense uhm, their own way of saying I don't care if I live or die, so that needs to be really checked in with.
N: Have you had clients who wanted positive results?
C: Yeah
N: How do you deal with that?
C: I think the only way to deal with that is to really make them aware of what it is they're saying and what they're feeling in the scope of a very, relatively brief session and really really encourage them to seek support for. I had one client who was Irish and was gay and had uhm, a lot of sex and a lot of unsafe sex and he was internalizing his parents' and religions' problems with homosexuality, so he just thought that he was worthless and he wanted to die but he couldn't kill himself. So he wanted to be positive and he wanted to die. And what I did with him was something that I do with other people on the phone very frequently is you know, I say to them, well if somebody calls a crisis line, basically you have two choices, you want to live or you want to die, and uh, there are a lot of people who fall somewhere on that continuum, and if they call the crisis line, 99.9% of them might want to die but there's some little teeeny bit of them that's feeling some degree of ambivalence and so, really check, what is it about you that makes you want to live, what about your life is life-affirming? what about your life is ok? or good? and same kind of thing applies in terms of counseling somebody like that, you know, what about your life is OK? and what would make your life ok in such a way that you would be able to take better care of yourself in terms of safer sex, so it's an interesting kind of thing, you know you can ask somebody, there are many many ways to kill oneself uhm, if somebody truly wants to die they could pick one of those ways, uhm, if they feel any ambivalence it's really good to check in, are you killing yourself because you think you're a problem and you want to eliminate the problem for your parents and for everybody else, or are you killing yourself because you truly want to die? And are you aware that this kind of behavior could not necessarily result in death, but definately could result in becoming HIV positive, which is something you've expressed to me you're very scared of.
N: Uhm, how do you do this kind of work, I mean in terms of just not burning out because there must be a certain sense like you can't reach everybody or you can't save everybody.
C: Well in terms of HIV counseling or are you talking about HIV counseling on the crisis?
N: Well, as related as you want to make them?
C: Uh huh. I am asked that question a lot and I feel like, I hope I'm not on a rescue trip and I don't think I'm on a rescue trip, and I think that I'm being honest in saying that I realized a lack of education on my part and I realized that uh, it was just really important to have good information and not be dealing with irrational fears and just a lot of sort of uhm, emotionally laden kinds of things that we just really need to deal in terms of people and have a really humanistic approach to things and so, uh, I just want to spread the education and for the most part, I really get, I'm not dealing with a lot of people that are HIV positive, I'm talking to people about how to keep themselves negative uhm, and so it's actually an empowering kind of effect on me and I think on others and a more positive kind of thing. People are realizing that they're things that they can do to keep themselves negative and I'm helping them to realize that, so I don't feel overwhelmed by it, really, at all, and I think I'm also pretty aware of my own limits in terms of, you know, I don't ever think to myself when I'm talking to a suicidal person, Oh my goodness I hope I got to that person, cause I realize suicide happens and people become infected with HIV and people die of AIDS and you know, I would be thinking I'm some kind of super human if I thought I could change that. What I can do is maybe get through to a very limited number of people and help them to look at things in a different way, so I think I have really realistic understanding of what my role is.
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