1-to-1 therapeutic change

The key to this intervention Counselling interventions are facilitated by qualified professionals who help clients to identify desirable outcomes during the therapeutic process (these could be as diverse as sexual behaviour change, improved communication, or increasing self-confidence).

What is the activity?

Counselling is an in-depth, personalised intervention that aims to help individuals, couples and families achieve greater psychological well-being through reflection and discussion. Counsellors may be voluntary or paid, with a minimum qualification of a Diploma in Counselling (or equivalent). On-going supervision contributes to counsellors’ professional development, and provides monitoring and support for their ethical judgements and well-being.

Free counselling support for sexual health promotion, usually occurs over a relatively short period of time - typically 6 to 12 weeks - during which counsellors and clients build up a trusting relationship. Sessions typically last for 45 to 60 minutes each, within which clients are supported in their exploration of feelings, experiences, traumatic life events and goals in order to encourage emotional and behavioural stability. Where families and couples take part in counselling together, aims often include strengthening relationships and communication strategies.

Strengths and limitations

Therapeutic interventions have a significant advantage over shorter and less intense interventions because their duration enables identification of personally-relevant issues, reflection on these, and support in finding and enacting solutions. This means that the potential for behaviour change resulting from therapeutic interventions far exceeds other types of interventions (see the Planning section).

Most free counselling is available on a short-term basis (often between 6 and 12 weeks) and may not be suitable for more in-depth need. Or it might offer only a limited variety of therapy - such as cognitive behavioural therapy - that may not be most suitable for specific individual need. Experienced therapists will know their limitations and be able to referral to more specialist services when necessary, including psycho-sexual support services.

Participation in a programme of counselling requires that service users commit to an ongoing intervention. This requires a significant degree of motivation, trust in the service provider, and the resources and social capacity to take part. Attending counselling also requires that participants recognise the potential benefits, including identifying and prioritising their HIV prevention needs. It is possible that those in greatest need of therapeutic interventions may be least able to access them because they may feel alienated from them, or are unsure of their outcomes, making engagement unlikely.

Where does it happen?

In the main, counselling occurs on the premises of a provider agency. This arrangement helps to ensure the security of both clients and counsellors. Counselling requires a private room with few distractions, with phones (including clients’ mobile phone) switched off or silenced for the duration of the session. Some agencies install a panic button in counselling rooms so that other staff members can be alerted in case of physical danger. Counselling staff require the time, space and resources to keep adequate notes on client sessions, and notes must be handled in accordance with the Data Protection Act 1998.

Frequently delivered alongside ...

Issues to consider

In the context of very scarce resources, one-to-one therapeutic interventions whose aim is preventing HIV exposure or transmission will need to be targeted at those in greatest need of psycho-social support.

Keeping coherent, accurate notes of counselling sessions can be a key tool for the counsellor, but raises acute data protection and confidentiality issues. As a result, records kept in relation to counselling sessions should be carefully handled within each agency’s confidentiality policy, and in accordance with obligations under the Data Protection Act 1998. These record-keeping practices should be subject to regular review. Confidentiality and its limits must also be clearly communicated with service users.

The use of full-time qualified staff in the provision of counselling can be prohibitively expensive for some service providers. Many agencies circumvent this problem by recruiting voluntary specialists (or trainee counsellors) to offer psycho-social support to service users. Of course, this can mean challenges in coordination and commitment.

Social stigma continues to be attached to counselling. Agencies that have successfully offered these services to those who would not usually take them up of their own accord have found innovative means of challenging that stigma, sometimes by enabling familiarity with counselling staff through diverse service provision contexts.

Aims and outcomes

The aims and outcomes from 1-to-1 counselling often tend to focus on increased motivation and skills to avoid participating in HIV transmission. The list below offers some examples of outcomes (dependant on the content of the therapeutic intervention) but is not exhaustive.

  1. Increased motivation to avoid HIV exposure and transmission (see associated choice and some of the basic information, opportunities and resources and skills needed).
  2. Increased control over involvement in HIV exposure and transmission in their lives (see associated choices such as declining or deferring a new sexual partner or choosing monogamous rather than open regular relationships with men) and aims such as knowing the increasing risks associated with having higher numbers of male partners.
  3. Increased confidence to openly discuss sex, sexuality, and sexual health with partners and in social networks, including the resources and skills to share information with partners and to decline sexual contact.
  4. Increased confidence to decline any unwanted sexual activity or defer having new sexual partners and associated aims, such as knowing the increased risks associated with having higher numbers of male partners.

Monitoring and evaluation

Therapeutic interventions aim to meet an extensive range of needs tailored to individual service users, but the outcomes may not be immediately apparent, or may have a very indirect relationship to HIV prevention.

In terms of evaluation, questionnaires aimed at those who use and do not use the service can help to assess perceptions about recruitment to the service, access challenges, and to identify key areas for change in delivery. Reviews of anonymised case notes can be used to assess short-term changes noted by practitioners. However, longer-term follow-up - through repeated interviewing - is perhaps the best way to evaluate longer-term benefits to individuals, couples and families.

Some counselling organisations use CORE to measure changes in client need by comparing pre- and post-intervention self-report psychological well-being scores. These are used alongside the practitioner's assessment, as a marker for counselling efficacy.

Page last updated: 17 June 2013

Case study

Counselling & Psychotherapy Service

Healthy Gay Life’s Counselling & Psychotherapy Service provides a wide range of talking therapies to gay, lesbian, bisexual and trans individuals, and their partner(s). The service is open to individuals regardless of HIV status or testing history. Running in a variety of settings including health centres and GP premises, the Service aims to enhance sexual and physical well-being through the alleviation of emotional distress. Utilising CORE (a widely utilised outcome measuring system) clients’ progress is assessed and their clinical improvement monitored. The Service is staffed by highly qualified volunteers from local universities and clinical supervision is provided by Healthy Gay Life’s Counselling & Psychotherapy Service Coordinator.

Case study

THT counselling

Terrence Higgin Trust counselling services offers up to 12 individual or couples sessions to gay and bisexual men across a range of sites in London. Given the diverse population sessions are offered in English, French, Spanish, Italian, Portuguese and German. Each new client is assessed to gauge if their needs can be met by the service or if they might benefit more from another service or a groupwork programme instead, Counsellors use CORE to measure changes in clients levels of need by comparing pre and post intervention self-report psychological well-being scores. These are used, along with the practitioner's assessment, as a marker for intervention efficacy. More recently, the service has trialed methods for providing counselling to more marginalised MSM, including an online counselling service.