GROUP COUNSELLING:

DEFINITION:
Group counselling is a dynamic interpersonal process focusing on conscious thought and
behaviour and involving the therapy functions of permissiveness, orientation to reality,
catharsis, and mutual trust, caring, understanding, acceptance, and support. The therapy
functions are created and nurtured in a small group through the sharing of personal concerns
with one's peers and the counsellor(s). The group counselees are basically normal individuals
with various concerns which are not debilitating to the extent requiring extensive personality
change. The group counselees may utilize the group interaction to increase understanding and
acceptance of values and goals and to learn and/or unlearn certain attitudes and behaviours.
These interactions give members an opportunity to increase understanding of self and others,
try out new ways of being with others, and learn more effective ways to interact. The content
of the group sessions is absolutely confidential; members must commit to confidentiality: that
is, they may talk about their own experience with whom they choose but may not identify
other members or what they say outside of group. Unprecedented economic and social
changes have, over the years, changed the ways in which we manage our lives. Consequently,
not all the lessons of the past can effectively deal with the challenges of modern times.
Effective counselling, especially in institutions of learning has now become important. Boys and
girls, and young men and women, need to be guided in the relationships between health and
the environment, earning skills, knowledge, and attitudes that lead to success and failure in life.

STAGES OF GROUP COUNSELLING:

Stage 1 -- Orientation (Forming):
Group members are learning what to do, how the group will operate, what’s expected, and
what’s acceptable. Students watch the facilitator and each other for cues and clues and seek
guidelines and stated expectations. They want to feel safe and comfortable, and many will do
only limited sharing until that comfort zone is established. This stage presents a time where the
group is just starting to come together and is described with anxiety and uncertainty. Members
are discreet with their behaviour, which is driven by their desire to be accepted by all members
of the group. Conflict, controversy, misunderstanding and personal opinions are avoided even
though members are starting to form impressions of each other and gain an understanding of
what the group will do together.
Stage 2 -- Power Struggle (Storming):
The second stage of group development is the storming stage. The storming stage is where
dispute and competition are at its greatest because now group members have an
understanding of the work and a general feel of belongingness towards the group as well as the
group members.
This is the stage where the dominating group members emerge, while the less confrontational
members stay in their comfort zone. The second stage of group development is the storming
stage. The storming stage is where dispute and competition are at its greatest because now
group members have an understanding of the work and a general feel of belongingness
towards the group as well as the group members. This is the stage where the dominating group
members emerge, while the less confrontational members stay in their comfort zone.
As a facilitator, one of your main challenges is to maintain boundaries, be an active but
compassionate leader, let everyone be heard and express thoughts and feelings, while
teaching,
Stage 3 – Cooperation and Integration (Norming):
This is where being in group becomes fun and enjoyable most of the time. Group interaction
becomes easier, more cooperative, and productive, with balanced give and take, open
communication, bonding, and mutual respect. If there is a conflict or disruption, it’s relatively
easily resolved, and the group gets back on track. Group leadership is still important, but the
facilitator can step back a little and let group members initiate more and move forward
together.
As a facilitator, you can stay aware and help the group get back on track as needed, encourage
participation and creativity, and enjoy the flow of the activities
Stage 4 – Synergy (Performing):
Stage four happens when the group shifts or evolves into another level, often without realizing
what’s happening. In this stage, there’s a sense of group unity, group members looking out for
each other even outside of the group setting, deepening friendships or bonds, and a dynamic
energy no matter what the task. This is the epitome of “The whole is greater than the sum of its
parts.” This is the time where the group becomes united. At this stage, the morale is high as
group members actively acknowledge the talents, skills and experience that each member
brings to the group. A sense of belongingness is established, and the group remains focused on
the group's purpose and goal.
Stage 5 – Closure (Adjourning):
This stage of a group can be confusing and is usually reached when the task is successfully
completed. At this stage, the project is coming to an end and the team members are moving off
in different directions. This stage looks at the team from the perspective of the well-being of
the team instead of the perspective of handling a team through the original four stages of team
growth. This is a normal part of group process. Many students (and adults, for that matter) have
no idea how to deal with endings, goodbyes, or losses, and they don’t know how to find
closure. Being angry with each other, or in conflict, is easier for many students than feeling or
addressing the sadness of saying goodbye. It’s easier for most to be angry than to be
vulnerable. Students who have abandonment issues may become especially argumentative or
unruly. As a facilitator, one of the best things you can do is explain to the students what’s
happening, validate their feelings, set clear boundaries, and treat the whole situation as
another opportunity to learn and practice a vital skill – how to say goodbye.
ADVANTAGES OF GROUP COUNSELLING:
1. People interact freely with their team members:
Many people satisfy themselves by encouraging themselves while listening to others in
the group. This helps them to grow freely and to establish new ideas that are more
confined.
2. Understanding the concern:
While this discussion is carried out then people will be more interactive as to
understand what bothers them a lot. It is very important to understand the unexpressed
difficulties. People express their self-disclosures that help them come up with concerns
that are modified within the group.
3. Participation of people in the group:
People in the group are very likely to participate that they become more involved in
expressing things easily. It delivers when people share to tell something and are more
competent in feeling the responsibility of others. Here the people listening, and thinking
will vary according to the different sayings that can be applied to other people.
4. Pre-group planning:
As the counselling begins, people can opt for pre grouping strategies that will involve
everybody in the same path. It is more widely used in the homogenous methods that are widely
compared with that of other basic techniques. It can be the first step of the process.
5. It can create a sense of belonging:
Group therapy becomes a place where a person feels like they can finally be understood.
Within the confines of a group setting, there are similar mental issues that are being
addressed. There are similar social issues being discussed.
6. It is a chance to benefit from practical wisdom:
Therapists can provide the foundation required to take forward steps on almost any issue.
The process of taking the actual steps, however, is wisdom that can only be provided by
someone who has already “been there” and “done that.” Group therapy allows people to
benefit from the wisdom of others who have had similar struggles but found a way to
overcome them to reach their goals.
7. Group therapy provides a chance for people to look in the mirror:
Therapy sessions come about because of negative thoughts, actions, or behaviours. When a
person is trapped in this cycle of negativity, it can be difficult to see that what they are
deciding to do is wrong from their perspective.
DISADVANTAGES OF GROUP COUNSELLING:
1. This form of therapy enhances rejection.
Bonding between a therapist and patient is often required for a therapeutic session to be
successful. In a group setting, it is difficult for individualized bonding to occur. Some patients
may feel like they are not receiving an adequate level of attention, which would create
feelings of rejection. If a person in therapy feels rejected by their therapist, the likelihood of
having a successful session decreases dramatically.
2. Not every person is a good candidate for group therapy.
An individual must be able to function on their own, completing daily living activities
successfully, for group therapy to be a potential success. Individuals who find themselves in
a crisis or are struggling with suicidal thoughts or tendencies are not good candidates for
group therapy.
3. It can make people uncomfortable:
Many group therapy sessions involve personal discussions that can become very intense.
Some therapists may use role-playing scenarios or encourage group members to share very
graphic details of the issue at-hand. For those who have a severe social phobia, it might be
difficult to speak in front of the group. Additionally, for members who have experienced
traumatic events, it could be triggering or overwhelming to have to take part in discussions
about abuse or trauma.

4. There can be personality conflicts:

 In a 1-on-1 therapy session, a personality conflict between a therapist and patient can be
easily controlled. In a group therapy session, every additional member of the group
increases the risk of a conflict occurring.
5. There may be privacy violations that occur:
Therapists are bound by HIPAA requirements not to share personal patient data with
others. The people in a group therapy session are not bound by the same professional
requirements for confidentiality. Even if everyone in the group agrees not to share anything
that is said, there will always be a level of risk that something shared in confidence will be
shared to others without the knowledge of the person involved.
6. Scheduling Conflicts:
Group sessions usually take place at specific days and times that might not be convenient
to you and could make rescheduling an issue. It’s not like making a one-on-one
appointment with an individual therapist.

STAGES OF HIV TESTING AND COUNSELLING:

RISK ASSESSMENT COUNSELLING:
A focused and tailored risk assessment is the foundation of HIV pre-test counselling. Risk
assessment is a process whereby the counsellor helps the client to assess and take "ownership"
of his/her risk for HIV infection. Client acceptance of risk is a critical component of this
assessment. Risk assessment should be conducted in an empathic manner with special
attention given to the ongoing behaviours and circumstances (e.g., sexual history, sexually
transmitted disease {STD} history, drug use) that may continue to place the client at risk for HIV
infection/transmission. For example, clients who are being counselled in STD clinics, where they
have come for the treatment of a symptomatic STD (other than HIV), should be advised that
their current infection demonstrates that they are at increased risk for HIV.
PRE - TEST COUNSELLING:
Pre-test counselling is given to an individual before an HIV test, to make sure that the
individual has enough information to make an informed decision about having an HIV test.
During the session the individual must be given an opportunity to decide on whether he or she
wishes to undergo the HIV test. Pre-test counselling should include discussions on:
• Assessment and awareness of personal risk, and the transmission of HIV infection.
• What an HIV test is and the purpose of the test.
• An opportunity for decision making about taking the HIV test
• The meaning of both a positive and negative result, including the practical implications such
as medical treatment and care, sexual relations, psycho-social implications, etc.
• Safer sex and strategies to reduce risk.
• Coping with a positive test result, including whom to tell and identifying needs and support
services.

POST-TEST COUNSELLING:
All clients, regardless of the outcome of the HIV test, should be offered and receive post-test
counselling on an ongoing basis as appropriate. All results must be given clearly. HIV-negative clients
should be offered a comprehensive post-test counselling prevention package that includes information
and advantages of MMC, TB screening, risk reduction and correct and regular use of condoms.
They should be encouraged to repeat the test three months after exposure to exclude the possibility of
the window period. The window period should be explained. HIV-positive clients must be given their test
results and counselled post-test about their HIV status only after the second confirmatory test is also
positive.
Clients who test positive should be informed and counselled about possible emotional responses (e.g.,
denial and anger) and they should be guided as to when and how they can manifest and what impact
these emotions can have on adherence to healthy lifestyle choices. These clients also need
comprehensive information on how to reduce the risk of HIV transmission, ongoing positive living,
healthy lifestyles and nutrition. Ongoing referral for psychosocial support (e.g., support groups) and
preventative packages including correct regular use of condoms and medical services should be
provided when needed.
After post-test counselling all HIV-positive clients must be referred for laboratory staging by CD4 count
and clinical staging by a clinician trained in HIV and AIDS clinical management. They must also be
screened for symptomatic TB signs and referred for diagnosis if suspected and either prepared for ART
or referred to attend the wellness services provided (pre-ART management) if they do not qualify for
ART immediately.

Counsellor should:
• Ensure client is ready to receive results
• Provide results in a calm manner
• Use simple language during communication
• Check for client’s understanding of results
• Allow time for client to understand meaning and implication of result
• Enquire if client has questions related to results
• Support client after negative or positive results
FOLLOW UP COUNSELLING:

 Ensure patient gets results of confirmatory test. When a patient has a reactive result on
the rapid HIV screening, a second, confirmatory test must be conducted by a certified
laboratory. If the second test is also positive, it is considered a final positive test result
which needs to be provided to the patient. In New York State, a variety of settings offer
HIV rapid screening and patients may not receive confirmed HIV test results from the
provider who conducted the rapid screening. In such cases, a patient may be referred by
the tester doing the screening to a care provider who will receive the HIV confirmatory
test result from a certified laboratory.

 Provide post-test counseling on the following topics or arrange for in-person post-test
counseling for all patients who test HIV positive.

1. coping with the consequences of learning the result;

2. the potential for discrimination;

3. preventing the transmission of HIV to others;

4. HIV reporting is required by law;

5. how to access prevention and supportive services.

 The medical professional who receives a patient's confirmed positive HIV test result
must provide an appointment or schedule an appointment for follow-up HIV medical
care. If the provider does not provide HIV medical care, the patient's medical record
should reflect the name of the medical provider/facility where the appointment was
made.

 Discuss options for notifying partners, contacts, and spouses, including screening for risk
of domestic violence; or refer to a Partner Services/Notification Program.
ETHICAL ISSUES IN HIV TESTING AND COUNSELLING:
Definition:
A problem or situation that requires a person or organization to choose between alternatives
that must be evaluated as right (ethical) or wrong (unethical). Ethics and morals relate to
“right” and “wrong” conduct. While they are sometimes used interchangeably, they are
different: ethics refer to rules provided by an external source, e.g., codes of conduct in
workplaces or principles in religions. Morals refer to an individual's own principles regarding
right and wrong.
AUTONOMY OF INDIVIDUALS:
Involves respecting their independence in decision‐making and protecting those who lack
decision‐making capacity and can be vulnerable. This also includes a commitment to treat
individuals with respect including confidentiality. This principle simply means that an informed,
competent adult patient has a right refuse or accept treatments, drugs and surgeries according
to their desires. People have the right to control what happens to their bodies because they are
free and rational. And these decisions must be respected by everyone, even if those decisions
are not in the best interest of the patient.
BENEFICENCE:
Enforces a responsibility to act in the best interest of individuals or research participants. This
usually requires that the risks of research are minimized so that the potential benefits of
research outweigh the risks.
All healthcare providers must make every effort to improve their patient's health, to do the
most good for the patient in every situation. But what is good for one patient may not be good
for another, so each situation should be considered individually. And other values that might
conflict with beneficence may need to be considered.
NON‐MALEFICENCE:
A principle of bioethics that asserts an obligation not to inflict harm intentionally – ‘First, do no
harm’. Where harm cannot be avoided, there is an obligation to minimize the harm and not to
increase the risk of harm to others.
JUSTICE:
It requires that individuals must be treated fairly, including fair selection and distribution of
participants within the research recruitment. The principle of justice obliges us to equitably
distribute benefits, risks, costs, and resources.
CONFIDENTIALITY:
A person with HIV/AIDS has a right to privacy, especially with regard to the doctor-patient
relationship. Deliberate breach of this right by disclosing confidential information to another,
constitutes an unlawful act.
INFORMED CONSENT FOR HIV TESTING:
While consent no longer has to be obtained orally or in writing, it is standard practice that
health care facilities provide services in accordance with patient consent. At a minimum,
patients must be orally informed that HIV testing is going to be conducted and have the right to
decline an HIV test.
Early in the AIDS epidemic, HIV testing was recognized as different from other blood tests
because it presented serious psychosocial risks, such as rejection by family; discrimination in
employment; and/or restricted or no access to health care, insurance, and housing. Special
procedures were adopted for obtaining consent for an HIV test, such as pretest counselling and
specific informed consent.

REFERENCES:
https://www.coursehero.com/file/21056034/5-Stages-of-Group-Counseling/
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%20tailored%20risk,critical%20component%20of%20this%20assessment.
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