experience, the counselor should listen and help the client locate answers to any questions

concerning the process of dying. Counselors should ask their clients how much they want to

know and make sure that clients know what to expect physically. Understanding the process and

planning the details within their power can give clients a sense of control.

In addition, clients may ask counselors to share their own beliefs about death and dying. Minimal

sharing can be reassuring, but counselors should focus on the clients' perspectives, beliefs, and

needs. As counselors listen, valuable information and insight into possible resources and support

needed by clients will come to light.

Pain management

Pain management is often a difficult struggle with those who are in the end stages of AIDS. The

issue of pain is complex because many medical conditions related to a client's HIV/AIDS can

cause her pain. Clinicians may be concerned that pain medications may reinforce an addiction.

Also, clients who have achieved abstinence from drugs may not wish to use medications for pain

relief. Another concern of clients is the appropriateness of pain management when it might

hasten death. If a client raises this issue, the counselor should be prepared to discuss it, however,

the counselor does not initiate discussion on this topic. If the topic arises, clients should be

encouraged to discuss pain management issues with their physicians and, if appropriate, their

significant others. Pain management is discussed (i.e., from a medical perspective) in Chapter 2.

Unfinished business

One important area that counselors should explore with their clients is "unfinished business." For

example, a counselor might suggest that a client make a will. But there may remain other issues

to be addressed. Should a client consider making an advance directive or a living will? Will the

client want to appoint a health care proxy? Should he consider granting power of attorney to a

significant other? Should he appoint a guardian for his children? Are there family issues that he

wants to address?

Some counselors express a desire to be there at the time of a client's death, or a client may

request that someone be there until death. Counselors and health care providers may also spend

more time counseling the client's significant others or support people during this time than they

spend counseling the client. Here again, a little information can go a long way to reduce fear and

anxiety in clients and their significant others.

Bereavement

Bereavement is a particular problem for programs with large numbers of HIV-infected clients.

Bereavement can affect clients (who may grieve at the deaths of other clients, friends, or loved

ones from HIV/AIDS); clients' significant others; and counselors who work with dying clients.

The following strategies may be helpful in supporting those clients who are dealing with

bereavement.

Acknowledge the reality of the bereavement in supportive individual counseling.

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Encourage the expression of grief both verbally and nonverbally (e.g., art therapy,

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