Clients may raise several issues in therapy that then become clinical issues. Following are

common issues that clients raise during the inpatient treatment process along with suggested

responses from the counselor during individual therapy:

Feeling the problem (of HIV infection or living with AIDS) has not "hit them" yet. The

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counselor can provide the client with education about risky behaviors, living with AIDS,

and so on. Presenting the client with future scenarios and life trajectories if behaviors

remain unchanged may be helpful. Sharing success stories about positive changes in

peers may also be a helpful strategy.

Expressing the need to make their own decisions and choices regarding care, treatment,

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and their lives. Counselors should underscore the fact that clients must decide what is in

their best interests, taking care to define "their best interests" within the client's definition

of self as either an individual, a provider, a parent or caregiver, a member of a family or

community, or a combination thereof. Counselors should balance this by letting clients

know that no one has all the answers to their problems, and reassure clients that their

feelings are valid, not unusual, and realistic. Changing one's life is hard work.

Knowing how to change behavior, yet not making these changes. The counselor should

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support client efforts to reduce risk behaviors but educate the client as to why risk

remains. Exploring what the client is willing to consider changing provides an outline of

possible actions. Working together with the client on strategies to resolve barriers to

change in small steps may be a useful tactic as well.

Giving up hope for change or feeling overwhelmed by problems. Workers should

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reassure clients that their feelings are typical and that change is hard. Telling clients

about positive role models who have successfully changed after facing many difficulties

along the way is another useful approach.

Service providers should know that this initial phase of client change is the longest and most

difficult for many clients. It is not uncommon for clients to spend a lot of time in inpatient

treatment weighing the pros and cons of their behavior. Clients may have invested much energy

in intentionally not thinking about the problem. Thinking about the problem may release painful

issues (real or perceived) for clients that they have not allowed themselves to reflect on. Service

providers should be acutely aware of the power of denial for many substance-abusing clients

living with HIV/AIDS.

It is often difficult for the client to anticipate potential problems, interactions, and pitfalls,

particularly those that will be faced in the external community. The counselor must help the

client examine the barriers that may arise and develop strong responsive coping skills and

activities. A weak plan of action can lead to quick lapses and relapses. This level of client

activity (preparing for action) is characterized by switches in both personal external cues for

behaviors and the ways in which clients perceive and cope with internal situations. This is a time

for counselors to develop specific plans and identify individuals in a person's social environment

who may provide support or information to the client upon discharge.

The idea of self-liberation can be used to influence a client to choose to act in a specific manner

or believe in his ability to change. Clients can benefit from thinking about what may change once