Care and Counselling
The following presentation was made at the training-of-trainers event held in Gaborone, Botswana, in September 2001. It was assumed that all participants were pastors or teachers in theological training. Therefore, the presentation was developed as practical and hands-on, void of theory and not as a formal paper. This written version is in a format which may be developed into a participatory workshop for teaching methods.
The objective of the presentation was to provide practical methods to teach others. The first three exercises focus on feelings that students and their clients may have concerning HIV/AIDS, loss and death. The fourth exercise provides the students with an opportunity both to share their feelings and begin to develop listening skills. No. 5 is in two parts to sharpen the students’ skills in active listening. The final exercise is a role-play done in a fishbowl format. This is a teaching method combining elements of feeling, active listening and sharing.
1: Feelings concerning church and AIDS
On another large sheet of paper print “AIDS”. Repeat the process as above. Do not let the participants see the second paper until you are ready to present it.
After receiving responses to the second paper, place both papers next to each other where participants can easily see them. Give them a few minutes to compare both lists. Students usually respond with words such as “warm”, “friendly”, “welcoming”, “forgiving”, “loving” when stating their thoughts and feelings about church. When stating their first impressions of AIDS, participants often give words such as “fear”, “death”, “stigma”, “punishment”, “condemnation”.
After participants have had an opportunity to compare the two lists, ask, “How do you know these things about the church? How did you come to know this is what church means?” Repeat the same questions for AIDS.
Discuss the participants’ feelings about both church and AIDS. In the process be sure to note that our feelings often come from personal experience, expectations, or what we have been taught.
Note again the differences in the lists. If, in general, we think of the church as a place of love and forgiveness and we think of AIDS with fear and as punishment, what does this say about the church and AIDS? Do our feelings betray us?
The exercise may end here if continuing with the loss exercise.
Read Leviticus 13:43-46: The law concerning lepers, as stated in Leviticus, is quite clear. Those suffering from leprosy were placed outside the community and declared unclean. They could be reconciled to the community only when they were no longer infected. Although most churches do not have any written codes concerning those infected and affected by HIV/AIDS, the actions or inactions of the church often exclude those who suffer because of this disease. What are some of the ways the church sets individuals and families outside the church community because they are infected or affected by HIV/AIDS?
Read Mark 1:40-45: The laws of Leviticus were practised in the time of Jesus. He, however, dared to touch the leper and sent him to the priest to be declared clean. Jesus was willing to go past fear and to restore a person to the community through a healing touch. In so doing, he brought about wholeness. Jesus has set an example of ministry.
On a large sheet of paper print, “BREAKING OUR FEAR”. Have participants list ways that the church may begin to educate members about their fear of AIDS and begin to break that fear.
Using another large sheet of paper print, “THE WAY FORWARD”. Have participants list ways that the church may begin to minister to those infected and affected by HIV/AIDS. Be sure to encourage participants to think about worship, education and outreach to the community.
Exercise 2: Loss*
You have noticed lately that you feel tired all the time and that it seems to take all your energy to get through a day. Draw a line through one item on your list.
You have begun to have headaches and are not eating well. Your family and friends are concerned. It seems that every day someone says to you, “You need to see a doctor about this.” Draw a line through one item on your list.
You are having more physical problems and you decide to see a doctor. The doctor seems concerned and puts you through a lot of tests. He says, “Call me next week for the results and try not to worry.” Draw a line through two items on your list.
You call your doctor in a week and the medical secretary says, “The doctor wants to talk to you in person. Can you come in this afternoon?” You ask what is going on but the secretary doesn’t know, so you agree to see the doctor this afternoon. Draw a line through one item on your list.
Your doctor tells you that you have AIDS. The doctor barely gives you time to think before starting to talk about treatments and more tests. Draw a line through two items on your list.
You go home and start trying to deal with having AIDS. You have to decide what to do, when to tell, how to cope, and you are very frustrated. You feel angry and depressed and guilty all at once. You keep telling yourself, “This can’t be true, it’s not real.” Draw a line through one item on your list.
You feel sick most of the time now. You have diarrhoea and you cough a lot. You are losing weight. You are no longer able to work and feel that you can barely get out of bed. Draw a line through one item on your list.
Your doctor insists on putting you in hospital even though you’d rather stay home. You end up in an intensive care unit and you are very weak. You do not think you can possibly survive another night. Draw a line through two items on your list.
After a few minutes of silence, ask the participants to come back to the presence of the group, taking the time they need to feel comfortable.
Exercise 3: Feelings about death
Note the uneasiness and the nervous laughter that will come with the final pronouncement. Ask probing questions such as, “Why are you laughing? Why do you seem so nervous?”
Continue by reminding the participants that they are called upon to conduct funerals and to speak words of comfort and life. What do they say at funerals or to families experiencing death? Do they believe their own words?
Ask, “What feelings do you have when you think of your own death?” Where all participants can see write, “MY DEATH”. List their feelings as they say them. It may be noted that many of these feelings were those listed in the first two exercises. Here, however, the participants are sharing deeply about something that concerns them personally.
Most participants will feel somewhat uncomfortable or find they are in some form of denial about their dying. This is acceptable as there are no right or wrong feelings. It is important, however, that pastors know what they feel: awareness of their own feelings will help them be better equipped to provide care.
Participants need to be encouraged to review their theological understanding of death. A one-day workshop such as this does not allow time for an in-depth reflection. Other settings may allow for Bible study or for writing and sharing a paper.
Remind participants that the advent of HIV/AIDS has dramatically increased the number of deaths in southern Africa. Pastors are being called upon to care for those who are dying and to preach at an increasing number of funerals each week. Having to experience death on a day-to-day basis can become emotionally and spiritually draining.
Conclude this exercise by discussing ways in which the pastor may be restored
Emphasize that pastors should never be alone. Pastors need to find ways to share their feelings and receive support. Congregations may need to be educated about how to give support to their pastors and to allow them the time needed for their own nurture.
Exercise 4: The dramatic client
Persons suffering the pressures and indignities of HIV/AIDS may become explosive. Pastors counselling with HIV-positive persons often are on the receiving end of such explosions. Some may be greatly shocked or offended. The purpose of this exercise is to assist the participants in understanding why a client may react in such a way and to look at the feelings and sociological and theological issues the client may be expressing.
As a group, discuss the following questions.
Trust is the key in any counselling relationship. The pastor/counsellor must be aware that such outbursts are rarely personal but a way in which a client may be seeking trust by testing the counsellor or showing trust in the counsellor.
The last two questions focus on theological perceptions, conscious or unconscious, the client may have. These are often not expressed directly but can be heard if the pastor/counsellor is listening actively. Many people suffering from HIV/AIDS do not have an understanding of grace. It is important for pastors and church leaders to reflect on the way the concept of grace may be present, or lacking, in the church.
Exercise 5: Active listening
Example of a closed question: “Did you sleep well last night?”
The response to this question is “yes” or “no”. The counsellor has gained little information and has nothing on which to build a follow-up for further discussion.
Example of an open-ended question: “Will you tell me how well you were able to sleep last night?” Or, “Please share with me how well you slept last night.” The client is given the opportunity to share about his/her sleep in more depth. The client may give a quick, sharp answer such as, “well” or “not well”. This, however, allows the pastor/counsellor to hear more feeling than a quick yes or no response from a closed question.
Exercise 1: Asking open-ended questions
Exercise 2: Paraphrasing
Exercise 6: Role play in a fishbowl
Two chairs (or the number needed for the particular role-play) are placed in the middle of the circle, for the participants in the role-play. Those seated on the outside will observe the proceedings.
Ask for volunteers to be the pastor and the client. They are given pieces of paper marked pastor and client respectively. Allow time for the two participants to read the information given and to get into their roles. When the workshop leader is clear the participants understand their roles, the role-play begins. In this role-play, the pastor is seated as the client knocks at the door of the office.
Pastor: You are the pastor in a rural community or village. A young man of about 20, whom you do not know, knocks at your door seeking assistance.
Client: You are a young man of about 20. Several days ago you got drunk at a local bar and were raped. You feel very ashamed and scared. You went to your family but your father was angry and threw you out. You went to the police but they laughed at you. Now, out of despair, you seek help from a pastor you do not know.
When the role-play has ended, the participants remain seated. Ask the pastor how he/she feels about the experience. Then the client is asked the same and whether he/she thought the pastor assisted him/her well.
After the participants have had a chance to discuss their feelings and respond to each other, the observers may be invited to share their insights or ask questions of the participants.
The discussion may take many avenues but the following should be covered: