As soon as one receives an HIV reactive result, one starts the process of grieving and acceptance. This is very important because in therapy, a psychologist or psychiatrist needs to know in which stage a client is in and how long the client is that specific stage for intervention purposes.
This is the reason why counselors and doctors need to understand what a client is undergoing for easy intervention. A client who its arrested in any of the first four stages need to be guided to overcome challenges and progress to the final stage which is acceptance. The longer a client is arrested in any of the four stages, the more difficult the behavior change especially for antiretroviral (ARV) adherence.
Below is a table showing the stages of grieving and acceptance. Note that is applicable to death and disease process.
Knowing and understanding the stages are very important to health care workers, counselors and support groups. It is important to assess a client through frequent communication. One also needs to assess the verbal and non-verbal communication being exhibited by the client. A thorough evaluation of each stage needs to be done and small bits and pieces of the symptomatology of each stage need to noted and documented.
The table above shows the verbal or behavioral examples of each stage. However, we also need to know some non-verbal actions to identify in which stage the client is in.
DENIAL
Here are some examples of behaviors that may be indicative that the client is in denial.
1. Not talking about it, as if the HIv test never happened.
2. Hiding and forgetting about the confirmatory HIv result.
3. Continues to go on the daily living activities, work and vocation as if nothing happened.
4. Not showing up to a referred treatment facility.
ANGER
Here are some examples of behaviors that may be indicative that the client is in anger stage.
1. Have destructive behavior, i.e. suicidal gesturing and attempts,
2. Negative transference to family, friends and coworkers,
3. Becomes violent to others.
4. Self destructive behavior such as resorts to alcoholism, drug addiction, smoking, etc.
5. Some would resort to spreading the HIV to others, but having unprotected sex, etc.
BARGAINING
Some examples are:
1. Client will try to become more religious but going to church
2. Become a philanthropist
3. Become more caring to others
4. Cleansing of vices: not smoking anymore, not drinking anymore or will do drugs anymore
5. Will become loyal to family or partner or won't have sex with multiple partners anymore
DEPRESSION
Some examples of behaviors that may be indicative of the stage of depression
1. Lack of sleep
2. Loss off weight
3. Becomes anti-social
4. There are bouts of crying spells
5. Non productivity
6. Job hopping
7. Not paying bills
8. Tardiness
9. Becomes a procrastinator
10. Frequent misses or even skips doses of his or her ARV
ACCEPTANCE
Some examples of behaviors that the client has reached the acceptance stage
1. Talks about his or her condition to others
2. Talks about it confidently
3. Becomes socially productive
4. Establishes intimate relationships
5. Good sleeping habits
6. Good eating habits
7. Knows how to protect oneself
8. Knows how to protect others
9. Strict with treatment protocols
10. Adherent to the ARVs
These are just examples of verbal and nonverbal communications and behaviors that one needs to identify. Also, some just from stage to stage, and some even regress to a previous stage. Thus it is really important for constant communication and observations.
HOW CAN WE HELP?
Here are some examples of interventions:
1. Regular assessment through interviews during counseling
2. Regular one-on-one counseling
3. Participation in support groups talks
4. Referral to psychologist or psychiatrist in extreme behaviors for medical intervention
Acceptance is a process. However, we can all help a client go through the process and resolve the issues fast.
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