Applied Psychology OPUS

Counseling During a Disease Epidemic

Jillian Shainman

Counseling and public health are two fields that have grown significantly over the past several decades. They have gained importance and recognition by encouraging people across the world to maintain safer and healthier lifestyles for themselves and for those who are less advantaged. In recent years, counseling and public health have been merged together in research and medical practice, emphasizing that a healthy body and a healthy mind depend on one another.

Counseling relies on creating a safe space in which the counselor provides the client with the comfort to explore their thoughts and actions, confront challenges, and face situations involving change in order to strengthen the mind (Cavanaugh & Levitov, 2002). Public health on the other hand relies on increasing accessibility to medicine and medical professionals and on teaching about living a healthy lifestyle in order to strengthen the body(CDC, 2013). When a person is confronted with a diagnosis that puts their health and life at risk, the best solution is often found when public health and counseling resources are combined. The HIV/AIDS epidemic in America in the 1980’s and in Africa in the present day exemplifies how patients can most benefit when they care for their minds as well as their bodies.  

HIV/AIDS has affected millions worldwide (UNAIDS, 2010; Valdiserri, 2011). In the United States, the first cases of AIDS that would be the start of a disease epidemic were recorded in June 1981 (CDC, 2011). Since those first cases, nearly 600,000 people have died in the United States as a result of HIV (CDC, 2011), and globally, an estimated 30 million people have died of HIV-related causes (UNAIDS, 2010) (Valdiserri, 2011). As of 2010, there were 39.5 million people living with HIV worldwide (Kumta, et al, 2010).

Being infected with a life-threatening disease such as HIV/AIDS causes extreme levels of stress, pain, and fear. Although scientists discovered drugs such as azidothymidine (AZT) that can keep the physical symptoms of HIV/AIDS at bay and increase the likelihood of survival, the psychological trauma may persist (Rogers, 2013). During the AIDS epidemic in the U.S., researchers made important discoveries about the ways that the mind can be used to strengthen the body.    

Psychologists have found success with counseling techniques such as hypnosis, narrative therapy, and open group discussions about the roles of gender and sexuality stereotypes in the spread of the disease in order to keep patients with HIV/AIDS both mentally and physically healthy (Garte-Wolf, 2011; Adler, Harmeling, Walder-Biesanz, 2013; Casale & Hanass-Hancock, 2011). However, the challenges of cost-effectiveness, stigma, and small numbers of health care workers in China, India, and Africa create barriers that prevent these vital services from reaching their general populations.  

During the late 1970’s-early 1980’s, a study on rates with suppressed immune systems demonstrated that immune systems can be altered with classical conditioning (Weisberg, 2008). The connection between classical conditioning and the immune system further demonstrates the connection between the brain and the body, showing that a strength in one area can lead to strength in the other (Weisberg, 2008).
In addition to classical conditioning, hypnosis can also use the mind ward off stress and thus, strengthen the immune system. Hypnosis has been linked to significantly increased levels of CD4 cells, a specialized type of T-cell that recognizes and helps destroy virus infected cells (Ruzyla Smith, Barabasz, Barabasz, & Warner, 1995) as read in (Weisberg, 2008, p. 17). Hypnosis took the emphasis off of expensive drug treatments and instead put control back in the patient’s hands, showing them that their minds were strong enough to physically alter their ability to defend themselves against HIV/AIDS.

In addition to helping to bolster the immune system, which provides long-term benefits, hypnosis can provide some immediate relief to patients by helping them manage the pain that accompanies HIV/AIDS. Hypnosis has been shown to improve patients’ self-ratings on measures such as severity of pain, percentage their time that was spent in pain, and the amount of pain medications they had to take (Langenfeld, Cipani, & Borckhardt, 2008).

Even with the developments in medicine and psychology that can effectively treat HIV/AIDS, finding positivity after diagnosis is daunting. Therefore, because dwelling on the negative aspects of life exacerbate stress levels and further weaken the immune system, having patients “reauthor” their lives to emphasize positive aspects can help provide some relief and comfort (Garte-Wolf, 2011, p. 332). This “narrative therapy,” created by Michael White, gives clients a break from the constant negative thoughts that surround a HIV/AIDS diagnosis by having them focus on more positive times in their lives (Garte-Wolf, 2011, p. 332). Narrative therapy gives power to the patient as opposed to the doctor or the disease. Instead of feeling overwhelmed by the doctor’s numbers, such as life expectancy and T-cell levels, or the disease’s ebb and flow of physical pain, the patient has the power to construct a narrative to address their physical state and how it is affecting them mentally (Garte-Wolf, 2011).

Purely positive narrative therapy, however, is not always the most healthy way to cope with a disease, such as HIV/AIDS, and ignoring the negative aspects that affect patients may be detrimental to their well-being (Adler, Harmeling, & Walder-Biesanz, 2013). In a study of 54 participants over 18 years of age, researchers found that speaking openly and coherently about negative experiences can help patients make meaning of their hardships and can strengthen them mentally (Adler, Harmeling, & Walder-Biesanz, 2013). Further, they found that avoiding negative experiences and topics, by speaking about them abstractly or not speaking about them at all, can reduce a person’s mental stamina when dealing with hardships, such as a disease (Adler, Harmeling, & Walder-Biesanz, 2013, p. 843). A combination of White’s positively-focused therapy and Adler, Harmeling, and Walder-Biesanz’s realistic confrontation of struggles and pain may be the best way for patients to author their disease path and strengthen their mental state (Garte-Wolf, 2011; Adler, Harmeling, & Walder-Biesanz, 2013). Narrative therapy should provide a safe space for patients to embrace the positives in their lives while gaining the strength to face the negatives.

Many therapists find it most useful to implement narrative therapy in a group setting in order to foster a sense of safety and support (Garte-Wolf, 2011). Since patients often use group therapy to discuss personal topics, it takes a strong sense of trust between the therapist and the members of the group in order to have productive sessions. Once they achieve that trust, groups help foster a sense of belonging to counter loneliness (Garte-Wolf, 2011). Most people do not know what it is like to live with HIV/AIDS and to confront mortality everyday. While sympathy from others can be helpful, having a safe, open environment in which HIV/AIDS patients can speak with each other about both their darkest, scariest times as well as their sources of strength can often be the most effective support system. With narrative therapy, group members can help others who are trapped by similar oppressive situations to benefit from the narrator’s more positive outlook (Garte-Wolf, 2011).

Since the 1980s HIV/AIDS epidemic in the U.S., domestic public health efforts have focused on easing the pain of people who have already been diagnosed with the disease, by using the therapies and counseling techniques described above (Weisberg, 2008; Langenfeld, Cipani, & Borckhardt, 2008; Garte-Wolf, 2011; Adler, Harmeling, & Walder-Biesanz, 2013). In addition to treating patients, many other countries with high HIV/AIDS prevalence, such as Africa and Asia, focus their efforts on developing and funding effective preventative measures as well. The southern region of Africa has some of the highest rates of risky sexual behavior—such as multiple partners and unprotected sex-- and HIV prevalence in the country (Casale & Hanass-Hancock, 2011). To prevent these from rising, researchers have found that it is important to target gender inequalities and concepts of dominant masculinity which portray males as risk-takers with uncontrollable sex drives (Casale & Hanass-Hancock, 2011). These dominant gender stereotypes may be contributing to males’ risky sexual behavior such as unprotected sex and having multiple partners.

Similar to the safe, open setting described in group narrative therapy, researchers in southern Africa aim to create a setting in which young people can explore “counter-hegemonic” masculinities and talk openly about their sexuality in general (Casale & Hanass-Hancock, 2011, p. 356). Empowering both men and women through these group therapy and other similar methods is vital in order to help African youth achieve greater comfort with their own bodies and increase contraception and safer-sex practices. Projects such as The Star School and Vukuzakhe help to empower men and women to achieve their goals and to promote literacy and responsible behavior in all aspects of life (Casale & Hanass-Hancock, 2011, p. 356, 59).. Although these measures do not specifically target people who have already been infected with HIV/AIDS, they help to promote awareness early and prevent the epidemic from spreading further. Further, similar to the treatment methods common in the U.S., the two projects unite youth in an environment where they can feel safe to explore their sexuality, openly discuss their fears and preferences, and receive advice from counselors, teachers, and advisers on how to best approach uncertain sexual situations.

The psychological prevention and treatment of HIV/AIDS is just as important as the medical treatment. While modern medicine has made great strides in the physical treatment of HIV/AIDS, it often leaves the patient’s mental health at risk. Hypnosis, narrative group therapy, and projects such as Star School and Vukuzakhe provide a more complete prevention and treatment: they can help patients improve their overall wellness and outlooks on life in order to prevent contraction of the disease, as well as lessening the impact of the painful physical and mental symptoms. However, many countries with high incidences of HIV/AIDS cases face barriers such as social stigma, cost effectiveness, and quality health care that prevent counseling services from reaching potential patients.

China has seen its incidence of new HIV/AIDS cases increase from 60,000 to 70,000 just over the past year. Even with this increase of 10,000 new cases, the government is struggling to justify the cost-effectiveness of voluntary counseling and testing (VCT) for the general population, for fear of stigma and discrimination, as described by the Asia Pacific Journal of Health. A (Wang et al, 2011, p. 629). Although the general population does not access VCT services as frequently, it has proved to be both cost and life saving among the men who have sex with men (MSM) population, which suggests that VCT should be targeted at the most at-risk population in order to ensure a more effective use of funds, and therefore a higher quality of treatment (Wang et al, 2011, p. 625). A study in India has shown similar results. The National AIDS Control Organization (NACO) has found that the current AIDS epidemic in India is heterogeneous and disproportionately affects specific high-risk communities, including MSM (Kumta et al, 2010, p. 230). In order to combat the high prevalence of the disease in India, an outreach program in the metropolitan Mumbai region provides information on HIV transmission, safe sex practices, and distributes free condoms to MSM and transgendered people, in order to specifically reach out to the most at-risk population (Kumta et al, 2010, p. 228).

None of these effective counseling techniques are possible without a strong health care staff. However, health care workers are often few and far between in the countries that need them most. In Malawi, vacancy rates remain around 50% for professional health workers throughout the sector (Namakhoma et al, 2010, p. 68). The health care workers that do work in high-prevalence countries are at especially high risk of contracting the disease, especially in developing countries with a high endemic rate. The Human Sciences Research Council (HSRC) found an HIV/AIDS prevalence rate of 15.7% amongst health workers in South Africa (Namakhoma et al, 2010, p. 68). This is partially due to the high level of exposure to HIV/AIDS that accompanies work in the health care field, and partially due to relatively low rates of HIV/AIDS testing especially among older, divorced, and widowed health care workers (Namakhoma et al, 2010, p. 71).

A diagnosis of HIV or AIDS can be extremely physically, psychologically, and socially painful—the physical weakness, the increased likelihood of mortality, and the social stigmas of being dirty or promiscuous weigh heavily on patients. However, counseling treatments provide patients with a positive outlook. Hypnosis allows them to gather internal strength to improve their physical condition, and narrative group therapy allows them to gather strength from others when they cannot muster it on their own. Further, opening the discussion to cultural stereotypes of gender and sexuality at an early age can help children have safer sex practices and lifestyles, which can help prevent them from contracting the disease in the first place. Finding skilled counselors and other health care workers, especially for developing nations, can be difficult and expensive. However, the services they provide are well worth the cost.

References

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Casale, M., Hanass-Hancock, J. (12 August 2011). Of drama, dreams, and desire: creative approaches to applied sex education in southern Africa. Sex Education: Sexuality, Society, and Learning, 11, 353-368.

Cavanaugh, M. E., Levitov, J. E. (2002). The Counseling Experience: A Theoretical and Practical Approach. Long Grove, IL: Waveland Press.

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Kumta, S., Lurie, M., Weitzen, S., Jerajani, H., Gogate, A., Row-kavi, A., Amand, V., Makadon, H., Mayer, K. H. (1 February 2010). Bisexuality, sexual risk taking, and HIV prevalence among men who have sex with men accessing voluntary counseling and testing services in Mumbai, India. Journal of Acquired Immune    Deficiency Syndrome, 53, 227-253.

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Valdiserri, R. O. (2011). Thirty years of AIDS in America: A story of infinite hope. AIDS Education and Prevention, 23, 479-494.

Wang, S., Moss, J. R., Hiller, J. E. (3 July 2011). The cost-effectiveness of HIV voluntary counseling and testing in China. Asia-Pacific Journal of Public Health, 23, 620-633.

Weisberg, M. B. (July 2008). 50 years of hypnosis in medicine and clinical health psychology: A synthesis of cultural crosscurrents. American Journal of Clinial Hypnosis, 51, 13-27.