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In the last section, we discussed discrimination. Because discrimination against clients who are HIV positive is sometimes prevalent in society, we examined four related topics. These included the Louis Holiday case, five criteria for discrimination, reasonable accommodation, and assumed and direct threats.
In this section, we will discuss taking control of life. If your client has begun to learn to live with HIV, then he or she may have realized that in spite of an inescapable infection and the inevitable accompanying emotions, they’re in charge. Three ways you can help your client begin taking control of his or her life include dividing and conquering, positive denial, and maintaining equilibrium. As you listen to this section, you might consider your HIV positive client. How can applying these techniques help your HIV positive client reaffirm that his or her life is not yet over, after all?
♦ #1 Dividing and Conquering
First, let’s discuss dividing and conquering. Dan, age 27, had stated to me, "My life is over. Having HIV is just too much for me to handle." Dan had made this comment at the beginning of his first therapy sessions with me. Throughout therapy, Dan began to cut his overwhelming and insoluble problems into manageable, solvable parts by dividing and conquering. There are three steps clients can take to divide and conquer. -- First, Dan had divided his problems into those that had solutions and those that did not. -- Next, he focused on the problems that had solutions and accepted those that did not.
For example, Dan had been worrying about how his family would deal with his death. I stated to Dan, "There is no way to solve the problem that your death will cause problems for your family. But perhaps you can solve some of the problems actually caused by your death. Can you think of anything you can do now to make your passing easier?"
In addition to dividing problems into those which have solutions and those that do not have solutions, and focusing on the problems with solutions and accepting those that do not, the third step to dividing and conquering is for the client to begin to implement solutions. Dan acknowledged this and stated, "You know, I’m a real junk collector. I should probably get rid of all the stuff that I have so my family doesn’t have to deal with it when I’m gone."
Another HIV client, Stephanie, viewed the divide and conquer technique as a way to escape the ‘big picture.’ Stephanie, age 33, stated, "I just solve little problems, one at a time. You’d be surprised, but they add up. So I’ve just focused on making each day better, and, before you know it, I had a few good years." Could your client benefit from dividing and conquering in ways similar to Stephanie and Dan?
♦ #2 Positive Denial
Second, let’s examine positive denial. Do you remember Aaron from section 4? Aaron’s HIV had progressed rapidly due to genital herpes. When I mentioned positive denial to Aaron, he stated, "That sounds like an oxymoron, like you want me to avoid facing the facts." I stated to Aaron, "Whether denial is positive or negative depends on what you are denying. Denial is negative if you deny your infection and live inappropriately by putting yourself or others at greater risk. However, denial that admits both the realities of today and the unpredictability of tomorrow can be positive."
For example, if your client is preoccupied with uncertainty about the future or death, but needs a new car, he or she can use positive denial to deny doubt regarding the future and perhaps purchase a new car on a finance plan. Aaron later stated, "You really do have to deny some of this stuff. It still makes me sad to think about death, but death hasn’t happened yet, so I need to live while I can."
Do you have an Aaron who could benefit from positive denial? Would you like to hear your client admit they are sick but decide not to act sick and resign to HIV by becoming a shut in?
♦ #3 Maintaining Equilibrium
In addition to dividing and conquering and positive denial, a third way you might help your client begin taking control of his or her life is by helping them maintaining equilibrium. As you know, living with an HIV infection requires clients to balance hope and uncertainty. Robert stated, "The balance is tricky. I think the best way to manage it is to reduce stress." How does your client prefer to maintain equilibrium?
Dan, who divided and conquered the problem of how his death would affect his family, stated, "The best way to maintain equilibrium is to adhere to the medication." Dan had used a simple five step technique to assess his ability to adhere to medication treatment before beginning. Dan stated, "First, I got a thirty day supply of once-a-day vitamins. Then, I marked my start date and, thirty days later, my end date on a calendar. I decided it might help, so I also wrote the beginning and end dates on the vitamin bottle."
Dan then began taking the vitamins once a day. After thirty days, Dan reached his end date and checked the bottle to see how many vitamins were left over. Dan evaluated himself on his adherence using a percentage scale, which you can find included in your reproducible client worksheets. Dan later stated, "By knowing where I stood on adherence ahead of time, I think I was better prepared when I got going on the real medication."
Could your client benefit from adherence as a way to maintain equilibrium? Could Dan’s adherence evaluation benefit your client?
Are you treating a Stephanie or Dan? Could your HIV positive client benefit from these techniques for taking control?
In this section, we have discussed taking control of life. Three ways you can help your client begin taking control of his or her life include dividing and conquering, positive denial, and maintaining equilibrium.
Reducing HIV-Related Stigma: Lessons Learned from Horizons
Research and Programs
- Pulerwitz, J., Michaelis, A., Weiss, E., Brown, L., and Mahendra, V. (2010). Reducing HIV-Related Stigma: Lessons Learned from Horizons Research and Programs. Public Health Reports, 125. p. 272-281.
What are three ways you can help your client begin taking control of his or her life? To select and enter your answer go to Test.