Mission & Evangelism
HIV/AIDS resources

Pastoral 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.

Exercise 1: Feelings concerning church and AIDS
On a large sheet of paper print the word “church”. Ask participants to share what comes to mind when they think of the word “church” and write their responses on the paper. Questions for clarification may be asked but this is not a time for discussion: simply record the responses.

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.
If the object of the exercise is to help participants think about the action/inaction of the church and the call to healing, the following might be used. In either case, keep the two sheets of paper where participants can easily consult them.

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*
Have each participant write the following on a piece of paper:
• four people who are very important to you (by name);
• four roles you perform which are important to you (pastor, teacher, husband, wife, son, mother, etc.);
• four things that are important to you (car, house, pet, etc.);
• four abilities you have that are important to you (singing, writing, gardening, etc.).

Read the following scenario to the participants, pausing for them to follow directions given.

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.

Ask the following questions to direct the discussion of the exercise:
• If you care to share, please tell the group what is left on your list. What does this mean to you?
• What was the hardest part of the exercise for you?
• What did each loss mean to you?
• Did you want to have control over what you were losing? Would it have been easier for you if the facilitator had told you which ones to strike out?
The losses you have suffered today are imagined yet heartfelt. Those infected by HIV/AIDS suffer constant losses and have little control over what they lose and when they lose it. Discuss ways the church or pastors may be contributing to the sense of loss.

Ask each participant to rewrite his or her list on the paper. This returns their losses to them.

Exercise 3: Feelings about death
Quietly share with participants that we are still at the beginning of a new century. Remind them of the big celebrations just a few years ago and the often-discussed Y2K. Continue by sharing that the century is still new and holds many exciting possibilities. The 20th century began before humans could fly and ended with walking on the moon and probing the galaxy. Who knows where the 21st century will lead? But one thing is predictable: before the century is over, everyone in the room will be dead!

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 and refreshed.
• What resources are available in the community or through the denomination?
• How can pastors support one another?
• What does a congregation need to know to help it understand the pastor’s needs? How might this be done?

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
The following exercise is most effective when the room is quiet and all attention is on the presenter. The presenter should become very dramatic, using a loud voice, waving his/her hands, and perhaps even stomping around while delivering the following or similar monologue. In short, the presenter must act out the feelings of an angry and shouting client.
“Damn right I’m still having sex! I don’t give a damn that I have AIDS. I’m going to die anyway and so is everybody else. Might as well enjoy life while you can. I don’t care what the hell you or anybody else thinks...” And very often the language is much more explicit.

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.
• What are your feelings about this outburst?
• What feelings do you think the client may be experiencing? Why do you think the client may have those feelings?
• In what ways might the client’s culture, community or family have contributed to such feelings?
• What feelings do you think the client may have towards the church?
• How might the church have contributed to these feelings?
• What feelings might the client have towards God? Why might he/she have come to have these feelings?
• Why might a client have acted-out in this manner in front of a pastor?
• Does the client trust the pastor or is he/she seeking trust? Explain your reasons.
• If the client trusts the pastor, how might the pastor continue to keep that trust?
• If the client does not trust the pastor, how might the pastor gain it?
• Have your feelings or understandings about the outburst changed since your first reaction? If so, in what ways?
• What theological understanding might the client have about grace and hope?
• How could you help the client develop a sense of grace and hope?
Through this exercise the participants should become aware that they have feelings even while they are counselling. This exercise is designed to help them become aware of those feelings and what may contribute to them. Further, it assists participants in understanding what feelings the client may have and what gives rise to them.

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
The following are easy methods to assist in teaching the use of open-ended questions and paraphrasing.

Open-ended questions are used to assist the client in being more expressive and at the same time provide the pastor/counsellor with clearer information. Closed questions seek only a yes or no answer. Open-ended questions bring more insight.

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
Have the participants gather in a circle. Starting with one participant, have him/her ask an open-ended question of the person on the right. The second participant must respond. If he/she responds with yes or no, the first person must try again. If the second person responds in an open manner, he/she continues the exercise by asking an open-ended question of the next person.

Paraphrasing is a tool that assists the pastor/counsellor in three ways. First, it helps the pastor/counsellor know if he/she has heard or understood the client clearly. Secondly, the pastor/counsellor can use the paraphrase to put a name on what has been said. Thirdly, it lets the client know the pastor/counsellor is interested in what is being said.

Client: When the people at church found out I had AIDS, they quit talking to me so I quit going to church.
Pastor: You quit going to church because the people no longer speak to you.
The pastor above has used a simple paraphrase. In the example below, the pastor uses a paraphrase that puts a name on what the client has said.
Client: When the people at church found out I had AIDS, they quit talking to me so I quit going to church.
Pastor: You quit going to church because the people are hypocritical.
After either paraphrase the client is free to expand, change or clarify his/her statement. The client is also free to correct the pastor.

Exercise 2: Paraphrasing
Participants should remain in a circle. Ask one person to share with the person on the left what he/she thinks of the workshop so far. The second person must respond in a paraphrase that the first person believes to be an accurate understanding of his/her statement. If the paraphrase is not accurate, the second person must try again. When an accurate paraphrase has been made the second person continues the exercise.

Exercise 6: Role play in a fishbowl
Role-plays are an excellent method of sharpening counselling skills in a controlled environment. Having those not acting in the role-play sit in a circle around those who are participating creates 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:
• What were the client’s feelings?
• Did the client trust the pastor?
• What did the client want from the pastor?
• What were the pastor’s feelings?
• Was the pastor using active listening?
• Was the pastor ethically able to assist the client in what he/she wanted?
• What did the observers learn from listening to the tones of each?
• What did the observers learn from the physical actions of each?
• What were some of the theological understandings of the client?
• What were some of the theological understandings of the pastor?
• Was the client accepted unconditionally?

1. Did the workshop meet the objectives? Please explain your answer.
2. What was the most valuable part of the workshop?
3. What changes would you make?
4. What teaching methods might you implement as a result of this workshop?
5. Please make any other comments that will help develop this into a better workshop.