HELPERS
FOR A
HEALING
COMMUNITY
A PASTORAL COUNSELING MANUAL FOR HIV/AIDS
Map International
The Balm In Gilead
Helpers
for a
Healing
Community
A Pastoral Counseling Manual for HIV/AIDS Map International
The Balm In Gilead
2
PUBLISHED BY MAP INTERNATIONAL P. O. BOX 21663 NAIROBI, KENYA First Edition 1994 Second Edition 1996 Third Edition 2004 and THE BALM IN GILEAD, INC 701 EAST FRANKLIN STREET; SUITE 1000 RICHMOND, VA 23219 Any part of this manual, including illustrations, may be copied, reproduced or adapted to meet local needs, without permission from MAP international or the Balm In Gilead™, PROVIDED THE PARTS PRODUCED ARE DISTRIBUTED FREE OR AT COST AND NOT FOR PROFIT. However, MAP and The Balm In Gilead does request notification of this usage in order to assist in the evaluation of the whole manual or for commercial ends, permission must be obtained from MAP International and the Balm In Gilead. 3
acknowledgements MAP International would like to specially thank the Machakos and Coast dioceses, Anglican Church in Kenya, and the Association of Evangelicals of Africa for providing the opportunity for group inter‐ action with pastors and church leaders. Without this assistance, the initial project of assembling a manual for church leaders would have been impossible. The third edition of this manual is the contribution of The Balm In Gilead™. The entire staff of the Balm In Gilead wishes to thank Map International for its partnership in fighting HIV/AIDS in Africa. The invaluable contributions of Dr. Alton Pollard, III and Dr. Selena Smith, both of Emory University, Chandler School of Theology is greatly appreciated. The insightful thoughts and edits of Dr. Terrie E. Griffin of HEAL International is also appreciated. Map International and The Balm In Gilead salutes every individual that rendered invaluable assistance at various points in this project. Finally, we thank the Bill and Melinda Gates Foundation for making the 3rd Edition possible. The Bible text designated RSV is from: The Holy Bible: Revised Standard Version. Copyright 1946, 1952, 1959, 1973 by the Division of Christian Education of the National Council of the Churches of Christ in the United States of America. Used by permission. 4
Table of Contents Page PART I: Guiding Principles Introduction 11
11 17 17 18 18 19 19 19 20 PART II: On Becoming A Good Counselor Qualities of a Good Counselor 22 23 23 24 24 24 25 25 26 4
5 5 Acknowledgements Understanding HIV/AIDS Understanding Pastoral Counseling Purpose of This Guide Four pillars Hard Bought Wisdom Why HIV/AIDS Pastoral Counseling Theological Insight The Language of HIV and AIDS Distinguishing HIV and AIDS The Extent of the Problem Our Own Sickness Taking Counsel with Others Inside Story: Tshepeso Health Brief Theological Insight: The Acceptance of Self God’s Instrument: Worksheet #1‐‐ Study the Word 11 13 14 15 16 17 Confidence in Who You Are Supportive Care ‘Self’ as God’s Instrument In Relationship with Others Empathy not Sympathy Person not Problems Challenges of HIV/AIDS Pastoral Counseling Inside Story: Adjatay 29 Health Brief 29 Theological Insight: Acceptance of Self 29
5
Who Can Become Helpers? 30 Inside Story: Sule & Ashaki 32 Health Brief 32 Theological Insight: The Practice of Presence 32 God’s Instrument: Worksheet #2‐‐ Self‐Assessment 33 PART III: Being a Steady Presence How to Begin A Session Establishing Trust Keeping Records Inside Story: Saran Health Brief Theological Insight: God’s Instrument: Worksheet #3: Lean & Depend Worksheet #4: Keeping Records Sample card and session notes Steps in Counseling God’s Instrument: Worksheet #5: Finding Answers Ventilation Exploration of problems Clarification Suggestion Reassurance Education Action Plan God’s Instrument: Worksheet #6: Action Plan Responding to HIV/AIDS Loss and Grief Inside Story: Shartati Health Brief Theological Insight: There is a Presence God’s Instrument: Worksheet #7: Stages of Grief 34
35 36 37 37 37 38 39 40 41 42 43 43 44 45 45 46 47 48 49 49 50 50 50 51 6
Alienation God’s Instrument: Worksheet #8—Study the Word Confidentiality Risks Sexuality God’s Instrument: Worksheet #9—Sex & the Church 52 53 54 55 56 58 Facing Spiritual Needs 59 Repentance and Forgiveness Reconciliation The Bible & Reconciliation God’s Instrument: Worksheet #10: Be Ye Reconciled Hope Purpose and Meaning Renewal God’s Instrument: Worksheet# 11: Test Your Values 59 60 60 61 62 63 64 65 Preparing for Death 66 Death and Dying Inside Story: Akello & Sanyu Health Brief Theological Insight: There is a Presence God’s Instrument: Worksheet #12: Death’s Sting Children God’s Instrument: Worksheet #13: Suffer the Little Children 66 67 67 67 68 69 70 How to End A Session 71 (Re) Reading the Bible God’s Instrument: Worksheet #14: Study the Word Bible References Praying 71 73 74 76 7
Special Needs 77 Pre‐Marital Counseling Marital Counseling Protecting a Spouse God’s Instrument: Worksheet #15: Couples’ Counseling Dealing with Traditions 77 77 78 82 PART IV: To Whom Shall We Go? Follow‐Up Mobilizing the church Managing Relationships Making Policies God’s Instrument: Worksheet #16: Policies Help for the Helper Home care guidelines 84
85 85 86 87 89 90 90 8
Understanding: HIV/AIDS HIV stands for Human Immunodeficiency Virus, the virus that causes AIDS. A virus is a tiny germ, which cannot be seen. HIV testing is done in a medical laboratory and shows if a person has been infected with HIV. People positive for the virus are said to be HIV+. HIV+ persons have been tested and know the virus is living in their body. AIDS is short for Acquired Immune Deficiency Syndrome. AIDS is a combination of certain diseases such as persistent chest infections, diarrhea, fungal infections and/or certain cancers. After a person has had the HIV, the virus that causes AIDS for some time, they will develop AIDS because their body can longer fight off these diseases. Sexual fluids refer to either semen from a man or vaginal wetness from a woman. If a person is infected with HIV, sexual fluids have high amounts of the virus. Condoms are rubber sheaths put on a man’s firm penis. They are used for family planning and protection against sexually transmitted diseases. Condoms are not completely safe, but they are safer than using nothing if a couple insists on having sex outside marriage, or within a marriage when a partner is unfaithful or one is HIV+. Non‐penetrating sex is the sexual arousal of either a man or a woman without the man inserting his penis into the woman. Within a marriage, a couple can achieve sexual fulfillment through making time to stimulate each other using their hands until the man releases semen or the uncircumcised woman becomes sexually excited. If one of the partners is HIV+, non‐penetrating sex is much safer in protecting the uninfected partner. If there are open cuts or sores on any body part that comes in contact with sexual fluid, the HIV virus can be passed. Breast milk contains HIV if the mother is infected with HIV. The virus does not pass easily to the infant through breastfeeding. It is recommended that mothers positive for HIV beast feed their infants, because the risk of a child dying from diarrhea or malnutrition without breast milk is greater than the risk of becoming infected with HIV. 9
Universal precautions refer to protecting caregivers through wearing gloves or plastic bags when touching body fluids while examining or caring for any sick person. Sterilizing is a process of making items free from HIV. The HIV virus cannot survive boiling, long exposure to sunshine or dryness, or soaking or cleaning with a bleach solution. It is a good idea to clean up blood using a bleach solution or one part bleach to ten parts water. Instruments with blood or sexual fluids on them should be boiled with a tight lid on the pan for at least 15 minutes. PASTORAL COUNSELING Pastoral counseling is the exploration, clarification and guidance of human life through a theological perspective. Persons seeking pastoral counseling want to look at themselves and their problems in light of their faith and religious tradition. Christian pastoral counseling attempts to understand these problems in light of the God who is Creator, Redeemer, Life‐Giver and Liberator. Pastoral counselors are a part of a ministry of a church. They are members of a believing community called to provide supportive care that will benefit people with emotional and spiritual problems. Permission form is a written statement that is signed by a person being counseled to protect a counselor/helper from legal actions. A sample permission form can be found in the Help for Helpers section of this manual. Theology is language about God. 10
PART I: GUIDING PRINCIPLES 11
Introduction PURPOSE OF THIS GUIDE The extent of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) in the world has reached epidemic proportions. Africa claims a disturbing 80 percent of the world’s AIDS cases. In Africa, a staggering 5,000 adults and 1,000 children die daily from HIV and AIDS. The faith community has always been the resource that Africa’s people turn to in a time of crisis. The African Church is a critical component in the fight against AIDS in Africa. Christians must mobilize to change social norms and deal with the deep and important issues surrounding the spread of HIV/AIDS throughout the continent. The challenge for the church is one of decisive action through AIDS ministry and HIV education prevention. We are called to work together, to be the source of compassion, acceptance, understanding, responsible and transformative love and hope for those who are infected with and affected by HIV. In providing HIV/AIDS pastoral counseling, we will be serving and reaching out to others just as Jesus did. Jesus gives us this challenge in John 13:34: I give you a new commandment, that you love one another. Just as I have loved you, you also should love one another. Nonprofessional counselors, including pastors and church leaders, will likely encounter persons stricken by both HIV and AIDS. They may be consulted by individuals suffering directly from it, or more likely, by those in their family or circle of friends affected indirectly by it. As Africans we need to understand this killer, which like a bad storm, continues to slash a wide path of physical, spiritual and emotional damage across our villages, townships and continent. As the body of Christ, we need a way to be prepared to offer sensitive and compassionate help as Christ commands, “to the least of these.” (Matthew 25:40) Helpers for a Healing Community embraces and celebrates our identity as Africans and as Christians. The kinship and fellowship of both identities is at the center of this guidebook. 12
Users of this manual will be challenged by these questions: 1. How do we prepare members of our congregation to live in the context of HIV/AIDS? 2. What approach is most effective in helping members gain a greater understanding of HIV/AIDS and its impact? 3. How can pastors, leaders and church members become partners in the struggle against HIV/AIDS? 4. How can HIV/AIDS pastoral counselors provide quality care to the infected and affected of our congregations? 5. How can we learn to re‐read the biblical story, not as a source of divine punishment, but as a source of sacred healing, in light of HIV/AIDS? 6. What is the process for helping churches develop theological insight into the HIV/AIDS epidemic? 7. Can our own illnesses of stigmatization and discrimination around HIV/AIDS define us as “affected” and can the process of our own healing begin with pastoral counseling? This guidebook empowers counselors to:  understand the difference between HIV and AIDS  determine differences in challenges involved in responding to persons positive for the virus and those with the full‐blown disease  discern behaviors that put individuals at high risk for developing and transmitting HIV  serve as a reliable community resource for what is true and what is false about HIV and AIDS  extend the work of the church into the community  become a part of the effort to stop the spread of HIV  uncover issues (which may be partially hidden) that impact the physical, social, emotional and spiritual lives of persons infected with or affected by HIV/AIDS Helpers for a Healing Community explains how to provide pastoral HIV/AIDS counseling in your church or other Christian environment. It tells how to create a counseling program to fit your church and congregational structure. …giving hope, reconciliation, and purpose for life that only God can bring. 13
Four pillars Meaningful HIV/AIDS pastoral counseling is the goal of this manual. Developing approaches that facilitate this effort, which lead to Helpers of a healing community is dependent on four (4) important elements. We call these parts “pillars” because they are like the pillars of the church. Just as a church building needs support from all four sides, successful HIV/AIDS counseling needs all four pillars to be active and strong. This guidebook to HIV/AIDS pastoral counseling, developed for pastors and lay church counselors (hereafter referred to as helpers), works by combining four components:  Theological Insight  Inside Story  Health Brief  God’s Instrument 1. Theological Insight: An overview of theological insights that provide a foundation for Christian counseling. These non‐denominational passages equip users of this guide with a way of viewing HIV/AIDS and those seeking spiritual guidance from both a biblical and a humanitarian view. They help to connect the person not the problems, which result from HIV/AIDS, to God through the revelation of Jesus Christ. They challenge Helpers to assist others to re‐read the biblical message in light of HIV/AIDS. 2. Inside Story: A glimpse into living with HIV/AIDS. These real life situations of the realities of living with HIV/AIDS from the perspective of the infected and the affected represent cases which will likely be presented to Helpers during counseling sessions. Inside Stories are an essential element of this manual as each allows the pastor, lay leader and congregational member to gain insight into the kinds of issues they may face as counselors. 3. Health Brief: A look at the health myths and realities of HIV/AIDS. Health briefs provide basic information on HIV and its transmission, AIDS, and the most common misconceptions associated with this complex disease. Helpers are invited to focus on cultural and popular misunderstandings and to become an important resource for their congregations, villages and townships for accurate information about HIV/AIDS. 4. God’s Instrument: An approach to pastoral counseling based on principles of motivational interviewing. Jesus associated, cared for and touched those who were not socially acceptable during his time. Like HIV/AIDS sufferers, the tax collectors, women, children and sex workers Jesus associated with were otherwise isolated and alone. As God’s instruments, Helpers offer one‐on‐one attention and support to those who need it. This personal touch is the forth pillar. 14
Hard Bought Wisdom HIV/AIDS is a major attack on life for all Africans. Those suffering from HIV/AIDS experience a spiritual crisis when they ask, “Why has God brought this punishment on me?” Unfortunately, the church’s first response has been defensive—a negative attack—that served to stigmatize those affected and infected by the disease. As is usually the case, in the face of the fear, hopelessness, poverty and overall devastation of HIV/AIDS, the faith community turned to the Bible in search of answers. We relied on Scriptures that told us that disease is a punishment sent by God on those that have sinned: Deuteronomy 7:12 And because you hearken to these ordinances, and keep and do them, the LORD your God will keep with you the covenant and the steadfast love which he swore to your fathers to keep; 13 he will love you, bless you, and multiply you; he will also bless the fruit of your body and the fruit of your ground, your grain and your wine and your oil, the increase of your cattle and the young of your flock, in the land which he swore to your fathers to give you. 14 You shall be blessed above all peoples; there shall not be male or female barren among you, or among your cattle. 15 And the LORD will take away from you all sickness; and none of the evil diseases of Egypt, which you knew, will he inflict upon you, but he will lay them upon all who hate you. Deuteronomy 28:27 The LORD will smite you with the boils of Egypt, and with the ulcers and the scurvy and the itch, of which you cannot be healed. 28 The LORD will smite you with madness and blindness and confusion of mind; 29 and you shall grope at noonday, as the blind grope in darkness, and you shall not prosper in your ways; and you shall be only oppressed and robbed continually, and there shall be no one to help you. The result of this approach seemed to overlook the church’s moral obligations to care for those infected and concentrate more on the lack of sexual morality of the infected. These responses of the church excludes those who suffer from the disease, adding to their pain and suffering. 15
In the early days of the AIDS epidemic, the church also turned to the laws in the Bible concerning lepers : Leviticus 13: 43‐46 Then the priest shall examine him, and if the diseased swelling is reddish‐white on his bald head or on his bald forehead, like the appearance of leprosy in the skin of the body, 44 he is a leprous man, he is unclean; the priest must pronounce him unclean; his disease is on his head. 45 ʺThe leper who has the disease shall wear torn clothes and let the hair of his head hang loose, and he shall cover his upper lip and cry, ʹUnclean, unclean.ʹ 46 He shall remain unclean as long as he has the disease; he is unclean; he shall dwell alone in a habitation outside the camp. Lepers were placed outside the community, unable to return until they were no longer infected. Although HIV/AIDS is relatively new, we have learned some lessons from our approaches to it. As the havoc of HIV/AIDS continues to devastate our land, rather than condemnation, our energy is being refocused on what we can do to prevent HIV/AIDS, how to care for those infected and affected and how to embrace the least of these in order to minimize, or even eliminate, the injustices of stigma and discrimination associated with the disease. This requires reading the Bible not for proof of judgment and condemnation, but searching the Bible for healing and liberation. In light of HIV/AIDS, we are challenged to show that God is a God of life; that God is the God who conquered death through Jesus Christ. By preparing ourselves to give counsel to those impacted by HIV/AIDS, we begin to deal with the overwhelming devastation this disease has had on our land. What then do we say to non‐believers who would deny the existence of God in light of HIV/AIDS? How do we respond when our prayers for healing seem to go answered? Our theological quest begins by being among those affected and infected by HIV/AIDS. It is impossible to consider the widespread nature of this disease without being conscious that it affects all of us. To be among the affected means to join in community with others, to join in doing a theology which includes the infected and the affected and to responding to the challenges to life and faith raised by HIV/AIDS. WHY HIV/AIDS PASTORAL COUNSELING The Bible supports AIDS counseling in our pastoral duties. How can we say this? Because Jesus did not fail to touch even the leper: Mark 1:40 And a leper came to him beseeching him, and kneeling said to him, ʺIf you will, you can make me clean.ʺ 41 Moved with pity, he stretched out his hand and touched him, and said to him, ʺI will; be clean.ʺ 42 And immediately the leprosy left him, and he 16
was made clean. 43 And he sternly charged him, and sent him away at once, 44 and said to him, ʺSee that you say nothing to any one; but go, show yourself to the priest, and offer for your cleansing what Moses commanded, for a proof to the people.ʺ 45 But he went out and began to talk freely about it, and to spread the news, so that Jesus could no longer openly enter a town, but was out in the country; and people came to him from every quarter. There are people in our congregations suffering from HIV and AIDS. They are in need of reconciliation or advice and help for their marriages. Some may have gotten the infection from sexual activities when they fell into temptation. Those individuals need to be brought to repentance and receive forgiveness. Some may be suffering temptation and in need of the counselor’s voice to stay pure or faithful. It is better to visit and counsel in order to prevent infection than to attend the funeral of the person you failed to help and warn (Hosea 4:6; Ezekiel 3:18). The hope and the healing from HIV/AIDS is that even in sickness, Jesus helps us to be victorious. The poverty of self‐pity and helplessness can be changed to the richness of showing the strength of Christ. We must give counsel to the affected. Only as we counsel and teach can people be challenged to be responsible for their actions and the prevention of the spread of AIDS. This is a God‐
appointed moment in history. In darkness the light of Christ shines brightest. In the world’s despair our Christian hope shows more closely! THEOLOGICAL INSIGHT As humankind we are more than the sum of our attributes, more than our individual parts, a fact that would seem to be obvious to most, but one that we have not hesitated to ignore when convenience and comfort are at stake. In the tradition of African peoples to be communal is to be human. Communal life is a single entity, the lung through which we breathe, filled with religious and moral obligations, and without which every person ceases to be. Children, women and men find meaning in life through the culture of their origins, in the family and through the collective which is bound together and lives together by ancestral guidance, rites of passage, and ritual at key moments of life. The Sotho saying, “a person is only a person through people”; the Zulu saying, “a person is a person because of people”; the Venda saying, “a person is born for the other”; Sojourner Truth’s saying, “I feel the power of a nation within me”; Martin Luther King Jr.’s saying, “all people are interdependent”; and the African ancestral saying, “the blood that unites us is thicker than the waters that divide us” each reflect notions of ubuntu, community, kinship, relatedness—mutual and reciprocal presence—as key to understanding the African continent and Diaspora view of being. It is also at the center of Christian living. 17
The Language of HIV and AIDS DISTINGUISHING HIV AND AIDS HIV is a human retrovirus first discovered in 1984 (although the illness had been diagnosed in the early 1980’s) that can produce profound immune deficiency. HIV is transmitted through bodily fluids: blood, semen, vaginal secretions and breast milk. Tears, saliva and urine are less likely to be modes of transmission. When HIV first affects a person, it selectively invades certain cells of the body. After the virus enters the body, it multiplies very quickly. Within three‐to‐six weeks after being infected, most individuals get flu‐like symptoms. Most people think they have the flu, not HIV, while some people have no symptoms at all. While HIV is spreading across the body, there are usually no physical symptoms. Sometimes, after many years, clinical diseases begin to appear because the virus has begun to take over the person’s immune system. That person, no longer able to fight off the virus, is diagnosed with AIDS, because of the failure of the immune response. It attacks and destroys the body. It also intensifies human poverty, as it adds to the suffering, fear and hopelessness of those affected by it. THE EXTENT OF THE PROBLEM More than 36 million people worldwide will be infected with HIV, the virus that causes AIDS, by the end of this year, including an estimated 5.3 million new cases. Although only about one‐tenth of the world population lives here, sub‐Saharan Africa remains the hardest‐hit region, accounting for 72 percent of the people infected with HIV during 2000. AIDS is a global problem among Black people. The World Health Organization reveals that the disease is the number one leading cause of death in Africa. The United Nations estimated that two million Africans died of AIDS in 1998, accounting for 80 percent of the worldwide total of AIDS deaths. Nine out of ten children with HIV are in sub‐Saharan Africa. By the end of the year 2000, a cumulative total of 13 million children – the majority in Africa – lost one or both parents to AIDS. Because it crosses the social, economic and political spheres of human lives, HIV/AIDS is a threat to humanity and to life as a whole. 18
OUR OWN SICKNESS In the process of becoming an HIV/AIDS pastoral counselor, Helpers for a Healing Community will emphasize helping users understand personal biases, or the illness of the helper, which may impede effective pastoral counseling. You will be invited to participate in a self‐healing process as you learn that you too, have been “affected” by HIV/AIDS in your community. Through the “Inside Stories” of Sule & Ashaki, Shartati, Adjatay, Tshepiso and others included in this guidebook, helpers can discuss openly and honestly what is really happening in each real‐life situation, and begin to deal with his/her own feelings about HIV/AIDS. Becoming an HIV/AIDS pastoral counselor means reflecting on one’s own beliefs and exploring the effects of those beliefs on the individuals to be counseled. Helpers will also be provided tools aimed at helping them to learn to suspend personal judgments in order to put the needs of others into focus. This approach requires great sensitivity and hard work on the part of the helper; however, it strengthens the capacity to be helpful in being effective HIV/AIDS pastoral counselors. Learning how and when to ask questions is an important element in this process. TAKING COUNSEL WITH OTHERS For the church, HIV/AIDS is more than a moral condition. While the question of sin is real, the only answer relevant to the HIV/AIDS pastoral counselor is the one of healing, wholeness and health. HIV/AIDS pastoral counseling has the power to provide transformation for those impacted by HIV/AIDS. Issues of fear, shame, guilt, hopelessness, death, children, husbands and wives—to name a few, are important to those you will counsel. This guidebook will help you minister to those needs. a good counseling relationship ought to look much like the relationships between people in the congregation 19
Inside Story: Tshepiso
Tshepiso is 25 years of age, and has already graduated from a private university with a bachelor’s degree. Her family is well‐known because her father has been the chief for many years. Recently she came to a private clinic for a minor health problem. “I can give you a treatment for this vaginal discharge,” the doctor had said when he saw her, “but we need to talk more about how you might have gotten it. Do you know how you might have gotten it?” Tshepiso immediately became anxious and asked if it was unusual. The doctor had assured her it was not unusual, but that it looked like a sexually‐ transmitted disease. When she heard that she immediately began to cry, and mentioned a relationship she had. “Tshepiso, I can see that you are afraid,” the doctor said, “and you might have a reason to be afraid, but worrying will not help you. I want to have some laboratory tests done so that you know what really is wrong.” The doctor explained about the tests, including the AIDS test, and made sure she understood why it was important to know. When the test results were back, Tshepiso again came to the clinic. The test was positive, and he counseled with her for a short time, He encouraged her to talk with a pastoral counselor who could give her more help. “No!” she yelled back at the doctor. “I can’t be HIV+, and I won’t go to any pastoral counselor!” She left angrily, but her face showed a dark cloud of worry. In her mind crowded the thoughts of death, sickness, rejection, and stigma. She even thought about suicide. She felt guilt like an ox yoke around her neck. For months she did not tall anyone that she was HIV+. Every day Tshepiso went to work and acted as if nothing was wrong. She pretended to be happy and even joked about people that were HIV+. She knew that if she told anyone at work about her status, then she would lose her job in the Christian organization where she worked. After six months it became too hard to keep living a lie, and she told a good friend about her HIV condition. She felt a little better after she told someone, but several months later she learned that her friend betrayed her confidence and informed others of her problem. She finally made an appointment to talk with a pastor, but not of the church she unusually goes to. Health Brief Myth: HIV or AIDS can be cured. Theological Insight: There is a Presence Reality: To date, there is no cure for HIV or AIDS and there are no vaccines to prevent HIV infection The Christian tradition, broadly defined, professes to be a community of presence, as it is a group of people called out by a God who we believe is always present to us both in our faithlessness and faithfulness. Because of God’s faithfulness believers are supposed to be a people who have learned how to be faithful to one another by our willingness to be present, with all our vulnerabilities and frailties, one to another. For what God requires of us is none other than our unfailing presence in the midst of the world’s sin and pain. And nothing less than to take our own struggle with pain and to make of it a sacrament of life. Thus, our willingness to ask for help in our suffering, as well as our willingness to be present with those who suffer and are violated, who are oppressed and demeaned, is no special or extraordinary activity, but rather a form of the Christian commitment to be present to one another in and out of pain, through sickness and in health, from this life to the next. This sacred opportunity and obligation is ours wherever “two or three are gathered.” (Matthew 18:20) 20
STUDY THE WORD God’s Instrument: Worksheet #1 Select and read at least three synoptic accounts of Jesus’ healing miracles from the following list: Healing Miracles
Matt
Mark
Luke
1. Cleansing of a Leper 2. Healing a Centurionʹs Servant 3. Healing Peterʹs Mother‐in‐law 4. Healing the Sick at Evening 5. Healing a Paralytic 6. Healing the Hemorrhaging Woman 7. Healing Two Blind Men 8. Healing a Manʹs Withered Hand 9. Healing the Gentile Womanʹs Daughter 10. Healing the Epileptic Boy 11. Healing a Blind Men 12. Healing a Deaf Mute 13. Healing a Blind Man at Bethsaida 14. Healing the Infirm, Bent Woman 15. Healing the Man with Dropsy 16. Cleansing the Ten Lepers 17. Restoring a Servantʹs Ear 8:2 8:5 8:14 8:16 9:2 9:20 9:27 12:9 15:21 17:14 20:30 ____ ____ ____ ____ ____ ____ 1:40 ____ 1:30 1:32 2:3 5:25 ____ 3:1 7:24 9:17 10:46 7:31 8:22 ____ ____ ____ ____ 5:12 7:1 4:38 4:40 5:18 8:43 ____ 6:6 ____ 9:38 18:35 ____ ____ 13:11 14:1 17:11 22:51 1. How did Jesus respond to those who approached him for healing? ________________________________________________________________________
________________________________________________________________________
________________________________________________________________________ 2. What lessons can we learn from Jesus as helpers for a healing community? ________________________________________________________________________
________________________________________________________________________
________________________________________________________________________ 21
PART II:
ON BECOMING A GOOD COUNSELOR 22
Pastoral Counselor as Prophet From a biblical perspective, pastoral identity is found in several Old Testament offices. Perhaps the most neglected role in terms of pastoral counseling is that of the prophet. The prophet was an individual called from among his or her peers. To be a prophet required no special genius, elite status, or innate talent. Moses stammered before God, Jeremiah complained that he had no experience, and Deborah was empowered by God to empower others in the face of insurmountable odds. At the heart of their identity, the Hebrew prophets were a mouthpiece for God, persons called to speak in the name of God. The prophet was enabled to see spiritual realities that others could not or would not see, and authorized to speak authoritatively for God: Exodus 7:1‐2— 1 And the LORD said to Moses, ʺSee, I make you as God to Pharaoh; and Aaron your brother shall be your prophet. 2 You shall speak all that I command you; and Aaron your brother shall tell Pharaoh to let the people of Israel go out of his land. Daniel 9:6—6 we have not listened to thy servants the prophets, who spoke in thy name to our kings, our princes, and our fathers, and to all the people of the land. The prophet was often overwhelmed by the profound sense of Godʹs message. There was no freedom to shrink from declaring the divine message. The prophet was under such compulsion that a different person emerged as a result of this call: 1 Sam. 10:6‐9—6 Then the spirit of the LORD will come mightily upon you, and you shall prophesy with them and be turned into another man. 7 Now when these signs meet you, do whatever your hand finds to do, for God is with you. 8 And you shall go down before me to Gilgal; and behold, I am coming to you to offer burnt offerings and to sacrifice peace offerings. Seven days you shall wait, until I come to you and show you what you shall do.ʺ 9 When he turned his back to leave Samuel, God gave him another heart; and all these signs came to pass that day. The prophet was in discomfort until the message was released. The act of keeping the revelation inside Jeremiah was likened to a ʺburning fire shut up in [his] bonesʺ (Jer. 20:9). 23
Brought on by his refusal to proclaim it to a derisive audience, he mourned, ʺI am weary of holding it in, and I cannot endure it.ʺ From the prophetic office the model of the socially active minister emerges, as does it also for lay leaders of the church. Embracing the prophetic model of Jesus and his disciples, continued by Paul and others in the New Testament, will help further guide the HIV/AIDS pastoral counselor in the execution of his/her ministerial duties. The role of the prophet graphically expresses the purpose of the Church as Godʹs chosen vehicle for penetrating the social order with God’s concrete word of grace. Prophets have a clear and strong conviction that they are speaking for God‐that they can do none other than articulate the will of God for a particular people, time, and place. But the prophet does more than speak. The man or woman who is called to serve as the ‘mouthpiece of God’ also acts – and acts decisively – among their own people and beyond the confines of their fellowship. Through divinely inspired action, a personal example of redemptive participation in the larger community dramatizes the impact of Godʹs Word that brings hope and healing to a sick and dying people. Far more than condemnation and judgment, this Biblical background of the prophetʹs task has to be adapted to the realities of our modern‐day African culture. Today the prophet is called to awaken the mind, care for the soul, and instruct the human heart in the context of the harsh realities of people living with HIV and dying from AIDS. Among the pastoral identities in the Bible, none is more important for the HIV/AIDS pastoral counselor than that of prophet. In our approach to HIV/AIDS pastoral counseling, we are called to be prophets, men and women who go among the people and into the community, proclaiming the good news of Jesus Christ. This prophetic role has two sides: servant and counselor. As servant, we minister to the needs of those infected with or affected by HIV/AIDS. This often means ensuring that the medical and social needs of the patient and his/her family are identified and met. As counselor, we listen to, engage and advise those we meet with Godly wisdom and neighborly love. This especially means providing compassion and warmth for those individuals who may not have experienced much otherwise without a prophetic encounter. Many individuals will seek your help as an HIV/AIDS pastoral counselor. Many others, whose need is equally great, will not. An important part of becoming an effective pastoral counselor is taking the initiative, as one sent out by God, to serve and counsel your neighbor. As a divinely appointed disciple of Jesus Christ, you speak and act on behalf of God. The pastoral counselor‐prophet is a role not limited to pastors alone; it includes all individuals filling the role of providing care for God’s creation. As such, you are called “to do justice, love mercy, and walk humbly with God” – to go out, to seek those in need, and not just wait for those in need to come to you. (Micah 6:8) 24
Inside Story: Pastor Semelo Pastor Semelo left the church to make the long walk home. As he traveled along the dirt road, he wondered why the church’s HIV/AIDS pastoral counseling program had not gotten off the ground. Instead of healing hands, they were left with empty hands, because only a few people had sought their help. Crossing to the other side of the road, with his head bowed, he prayed, “Lord, what are we doing wrong? We know that our people are in need, and we have prepared ourselves to meet their needs, yet they do not come. O’ God, please show us what we are doing wrong.” Pastor Semelo lifted his head just in time to see little twelve‐year‐
old Adanna dart in front of him. He called out to her, “Adanna, why are you avoiding your lessons? A smart one such as you must keep up with her studies.” Adanna was so quick, like a gazelle she ran into her house without looking back at the pastor. Following her, Pastor Semelo entered the opened door of the house, to find the girl’s father, Safiya, lying on a cot next to the window. Adanna quickly hid the soiled bandages and dirty clothes that lay on the floor next to the cot. Safiya, rotating on his side with great difficulty, turned slowly towards Pastor Semelo and said in a very low voice, “Where have you been, prophet, I have been waiting on you. I need to hear a word from the Lord.” Not only was the pastor able to connect Safiya to the medical and social services he needed, he was also able to ensure his daily care so that Adanna, his caring daughter, was back in school where she belonged. Pastor Semelo’s prayer was answered that day as he realized that he and the other counselors could best serve the people by going out, among them, like the prophets. Health Brief
Myth: When youʹre on HIV therapy you canʹt transmit the virus to anyone else. Reality: Antiretroviral drugs donʹt keep you from passing the virus to others. Therapy can keep the viral load down to undetectable levels, but HIV is still present in the body and can still be transmitted to others. Theological Insight: There is a Presence The Christian tradition, broadly defined, professes to be a community of presence, as it is a group of people called out by a God who we believe is always present to us both in our faithlessness and faithfulness. Because of God’s faithfulness believers are supposed to be a people who have learned how to be faithful to one another by our willingness to be present, with all our vulnerabilities and frailties, one to another. For what God requires of us is none other than our unfailing presence in the midst of the world’s sin and pain. And nothing less than to take our own struggle with pain and to make of it a sacrament of life. Thus, our willingness to ask for help in our suffering, as well as our willingness to be present with those who suffer and are violated, who are oppressed and demeaned, is not special or extraordinary activity, but rather a form of the Christian commitment to be present to one another in and our of pain, through sickness and in health, from this life to the next. This sacred opportunity and obligation is ours wherever “two or three are 25
gathered.” (Matthew 18:20) STUDY THE WORD God’s Instrument: Worksheet #2
Study each of the following prophets in the Old Testament. Determine the key elements of the role as prophet for each: 1. Moses (Exodus 2‐40) ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ 2. Jeremiah (Jeremiah 1‐52) ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ 3. Deborah (Judges 4‐5) ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ 4. Jesus Christ as Prophet Jesus made real the office of prophet. What Scriptures describe this role? Focus on Christ and his disciples. Describe their function as prophet, emphasizing the HIV/AIDS pastoral counselor charge to go out to the people to proclaim the good news. ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ 26
Qualities of a Good Counselor People infected or affected by HIV/AIDS want to talk and they need good listeners. Whether sick with AIDS themselves, or one of the cluster of family or friends surrounding someone who is, Helpers can use their personality and spirituality to help others. Counseling is a process of helping a person look into his or her own problems and situations in a realistic way in order to find solutions. HIV/AIDS counseling means giving hope, reconciliation, and purpose to those in need. The HIV/AIDS pastoral counselor uses supportive exploration of core beliefs and meaning of life as basic tools. The approach in this manual teaches a method which combines elements of feeling, active listening and sharing. The overall objective is to provide practical methods for pastors, and empowering tools to help them teach others to provide meaningful HIV/AIDS pastoral counseling. A good helper is one who is:  confident in his/her identity as Christian and African  committed to providing supportive, compassionate care to others  committed to using ‘self’ as instrument in helping others  willing to learn what it takes to be in relationship with others  empathetic not sympathetic in his/her approach to counseling  able to see the person while being conscious of the real life realities of living with HIV/AIDS  understanding of the challenges of HIV/AIDS pastoral counseling CONFIDENCE IN WHO YOU ARE Basic to becoming a good HIV/AIDS pastoral counselor is having confidence in your identity: both as Christian and as African. Those seeking to counsel others must not apologize or obscure either of these traits because both are important in providing compassionate care to those infected with or affected by HIV/AIDS. This means depending on Christian experience and godly wisdom—as important sources of information. It also means drawing from specific traditions of your church and community—in order to help those who seek you out. Aspects of African traditional 27
culture that promote healing and wholeness, and that challenge those practices which may lead to discrimination and stigmatization are important. Reflection upon African traditional wisdom can be a great resource in this struggle. Reaffirming the fullness of our traditions can contribute to moral and humane ethical decision‐making in respect to the life‐threatening reality of AIDS in Africa. Failure to tap these unlimited reservoirs often results in limited confidence in the very things that make you the specific person being approached by those in need. As pastors, lay leaders and congregational members, our reputations of being ‘understanding’ and ‘easy to talk to’ are mainly grounded in those indispensable traits which make us children of God and African. Helpers who stay within the boundaries of who they are will do the most for those they assist. SUPPORTIVE CARE In order to provide pastoral counseling to those in need, Helpers must always focus on the current life situation of the person seeking help. We are less concerned with the deep psychological needs as we are those needs that the individual infected with or affected by HIV/AIDS is aware of. The overall strategy of support is accomplished when the conversation with the person is based on the situation at hand. Supportive care is like responding to the medical emergency of someone that has been cut. The immediate goal is to stop the bleeding, not to fix the underlying cause of the bleeding. Like fixing a cut, supportive care should be brief, active and to the point. SELF AS GOD’S INSTRUMENT Our commitment as The Body of Christ places us on the front line of the HIV/AIDS crisis. Relying first on the strength of God is the key to successful pastoral counseling. Relying secondly on your own strength as God’s instrument enables the Helper to work effectively with others. The gift of God to the world is Christ. The gift of Christ to the world is His people—Christians. It is important to realize that for most problems Helpers will encounter related to HIV/AIDS, a little help is a lot. To help persons move even a few inches closer to solving their problems is assisting them to turn in a new and healthier direction in life. Understanding is at the heart of using the self as God’s instrument as Helpers. IN RELATIONSHIP WITH OTHERS Helpers must learn what it means to be in relationship with others. For most of us, this is easier when it comes to family, friends and church members, but harder when it is the stranger or ‘other’ person whom we do not know. To make room for the ‘other’, a Helper must empty him/herself of personal concerns to make room for the needs of 28
others. Here, the Helper becomes affected by HIV/AIDS, as he/she attempts to share the same life‐space as the person being counseled. Getting this close allows the Helper to determine that something is going on, and equips him/her to ask what. In relationship with others, we can determine if we can help them to heal and if through this process, we will ourselves be healed. With God at the center, we are able to be in relationship with those we counsel. EMPATHY NOT SYMPATHY Empathy is the ability to understand what another person is feeling without feeling the emotion ourselves. Sympathy, on the other hand, is to feel with another person by experiencing the same emotions—joy, sadness, alienation—as another person. The goal of this guidebook is to assist Helpers in developing an empathetic approach to counseling. A lifeguard, when trying to prevent a swimmer from drowning, must be able to prevent the person from pulling them under in the process. He/she must use their strength to help the other survive, rather than being exhausted by becoming entangled in the drowning person’s panic. The HIV/AIDS pastoral counselor, like the lifeguard, must preserve his/her strength though empathy in order to keep others afloat. Sympathy means being overcome by the emotions of the person being counseled and to do so, means giving up your strength. In this case, both you and the person that you are trying to help risk drowning. Your greatest strength as a Christian is not to become neutral, unemotional or unattached to the condition of another, but to understand the person’s need, in the light of Jesus Christ. PERSON NOT PROBLEMS The realities of HIV and AIDS are many. Both come with emotional, spiritual, economic and physical baggage, most of which may be too difficult to unpack in one or two counseling sessions. An important point to remember in pastoral counseling is to focus on the person and not the problem(s) as the initial step. Helpers must be mindful that as a part of God’s creation, our response must always be to the person rather than to the virus. Throughout the counseling relationship, persons remain the focus—their feelings, thoughts, and perceptions—in our approach to helping them. By concentrating on the realities of HIV and AIDS too much, helpers can distort the situation and miss the person who is in trouble and in need of care. We cannot view the realities of HIV/AIDS as separate from the reactions of the individual infected with or affected by these conditions. Good HIV/AIDS pastoral counselors do not treat people as cases we’re being asked to examine, diagnosis, and cure. This is beyond our scope. Helpers are, however, being invited into the inside stories of members of the Assembly of God’s people. A common mistake in counseling is to ask too many questions of individuals seeking our help and rush to find solutions or answers as quickly as 29
possible. This is not the task of helpers for a healing community. HIV/AIDS pastoral counseling does not seek to solve all the problems of others. Instead, our goal is to understand the realities of living with HIV/AIDS in the context of the person who experiences it. Communicating the strength of the gospel of Jesus Christ and giving the support needed is the first step to empowering those we counsel in finding solutions for themselves. CHALLENGES OF HIV/AIDS PASTORAL COUNSELING As Helpers, we will be faced with several challenges as we begin to mobilize as moral agents of care and change in the face of AIDS. Listed below are a few of the ethical dilemmas presented to the HIV/AIDS pastoral counselor: 1. Ethical Challenges:  Affirming and accepting our God‐given responsibility to be a voice for the voiceless and hope for the hopeless. We have been empowered to empower others: Luke 4:18 ʺThe Spirit of the Lord is upon me, because he has anointed me to preach good news to the poor. He has sent me to proclaim release to the captives and recovering of sight to the blind, to set at liberty those who are oppressed, 19 to proclaim the acceptable year of the Lord.ʺ  Providing just and ethical care that is spiritual and concrete, for every person.  Overcoming stigmatization and discrimination within our own religious ranks, while being a voice of moral resolve in the broader community, society, nation, continent, and world. Discrimination is sinful. Stigmatizing any person is contrary to the will of God.  Affirming the infinite worth and value of all persons. Often, it is the stigma and stereotype, the possibility of rejection and discrimination that HIV positive people are confronted with that hurts even more than the condition itself: Isaiah 53:3 He was despised and rejected by men; a man of sorrows, and acquainted with grief; and as one from whom men hide their faces he was despised, and we esteemed him not. 4 Surely he has borne our griefs and carried our sorrows; yet we esteemed him stricken, smitten by God, and afflicted. 5 But he was wounded for our transgressions, he was bruised for our iniquities; upon him was the chastisement that made us whole, and with his stripes we are healed. 6 All we like sheep have gone astray; we have turned every one to his own way; and the 30
LORD has laid on him the iniquity of us all. 7 He was oppressed, and he was afflicted, yet he opened not his mouth; like a lamb that is led to the slaughter, and like a sheep that before its shearers is dumb, so he opened not his mouth. 8 By oppression and judgment he was taken away; and as for his generation, who considered that he was cut off out of the land of the living, stricken for the transgression of my people? 9 And they made his grave with the wicked and with a rich man in his death, although he had done no violence, and there was no deceit in his mouth. 
Undertaking prophetic advocacy for the treatment of all who are in need. AIDS is everyone’s struggle: Matthew 25:45 Then he will answer them, ʹTruly, I say to you, as you did it not to one of the least of these, you did it not to me.ʹ Micah 6:8 He has showed you, O man, what is good; and what does the LORD require of you but to do justice, and to love kindness, and to walk humbly with your God? 2. Pastoral Counseling Challenges:  Counseling members of our congregation and others who may or may not be engaged in behaviors that put them at risk for developing HIV. The behaviors that can promote HIV infection include unprotected sexual intercourse with an HIV‐
infected man or woman or sharing unsterilized needles (for example, during intravenous drug use). Both these behaviors present a special dilemma for the church because they are believed to be ungodly acts—sin. The transmission of AIDS is not limited to irresponsible behavior however. Blood transfusion recipients, children, spouses, health care professionals and family caregivers are counted among the infected. Because of the need for repentance and/or reconciliation, Helpers should approach these challenges by addressing spiritual issues, and remember that healing, not condemnation, is the goal of pastoral counseling. The ultimate goal is to assist the person in changing behaviors and circumstances which prevent further spread of the disease. Resource persons who work with HIV patients may be a source of referral for the Helper. Beyond pastoral counseling, there is a need to monitor the clinical status of the HIV+ person.  Being faced with a marital partner who has been infected by HIV outside of his/her marriage. This moral dilemma, similar to the one describe above, is real and calls for repentance, reconciliation, and changes in behavior. We may also be faced with knowing that some individuals coming to us for counseling engage in promiscuous 31
behavior without warning their partners of their HIV status. Helpers should approach this challenge cautiously, remembering the commitment to protecting the confidentiality of the person being counseled and the life of their partners. 32
Inside Story: Adjatay Adjatay’s foot pushed his chair away from me as his athletic body slumped down. His eyes could fire up entire groups of people, but this time they were dark holes. “It seems you’re busy now, Pastor,” he said, before I had even had the chance to stand and extend him a hand. “I should come another time…” and his voice became a whisper as he continued an empty stare out of the window. “No, not at all. Now is the best time.” As I rose to shake his hand I bumped my chair in his direction. We continued with out greetings, and of course everything was fine‐his wife, children, farm and parents. But his heart seemed to be on safari somewhere; he scarcely looked at me. “Adjatay,” I continued as I tried to meet his eyes. “A trapped bird doesn’t sing, and you don’t seem to be singing today. What’s wrong?” Carefully he took me on a tour of his lat few weeks. I saw a few of the shadows that moved in his life and tried to figure out what caused those shadows. He had been sick a lot recently‐malaria, he said‐and had not been very free to be at church because of traveling. His farm was not doing as well as usual because of the drought, but it was no worse than everyone else’s right then. He was worried about his children’s schooling and said nothing about his wife, hope. What was really depressing him most, he said, was his friend’s recent funeral. Adjatay suspected he had died of AIDS. He left behind three kids and a sick wife. “But at least he had two sons to keep his name,” he said with a kind of desperate voice. “We used to travel together a lot when we were taking fruits to the market,” and his voice stalled like a bicycle in deep sand. Health Brief
Myth: I would know if I‐or a member of my congregation had HIV. Reality: A person with HIV may not show any symptoms for up to 10 years. Since HIV affects each person differently, many people with HIV can look and feel healthy for years. The only sure way to know is to get tested. Theological IInsight: The Acceptance of Self I believe in myself. I am special. I am my own best self. I possess myself with quiet confidence. I love myself fiercely. There is no one I would rather be than me. This lyrical declaration is grounded in a full and embodied understanding of life and living that is worthy of my existence. What I affirm for myself I affirm in others. To love myself is to honor something in me that is beyond any feeling that I may have of my worth or worthlessness. I am conscious of being loved, at a place deep within me that is beyond mere feeling, or thought. It is a stirring at the center, the sound of genuine, the movement of the spirit, the eruption of the heart, and the redemption of my soul. I have been confirmed and affirmed by the presence of other human beings, the created world, the endless universe, and the Presence of God. I have plummeted in the mystery of my own existence only to emerge in the midst of all life. I am because we are, and because of this fact, there is nothing in life that I ultimately cannot endure. 33
WHO CAN BECOME HELPERS? Many people give advice to a person in need. Often the least prepared or able person is the one who is listened to the most! Why? Because that person is trusted, available and will often give the advice that a person wants to hear. In deciding who can become a helper, it is important to choose people who are able to create a trusting relationship, are available, and who are able to help the client make wise choices. Sometimes a pastor or counselor thinks that they are the only ones to do that. The kinds of people that you might have in your congregation who could help in counseling with HIV affected families are:  the elders  women’s leaders , or certain women  medical personnel in the church  mature, spiritual young people  Sunday School Teachers  Church members  Other persons affected by HIV You can see that the list includes every kind of person in your church! But not every person would be good to establish a trusting, helpful relationship. Often we have perceived or thought of people affected or infected by HIV as problems. They might become some of your most useful helpers. Some churches have found that people who are living positively that are HIV are the ones who can help the most. They understand the problems. They have gone through the denial and anger and depression that are common. When they have found renewing and forgiving strength in Christ, they are able to give a special kind of advice to others who suffer. They are often effective evangelists. “Dear Child of God … you are God’s partner, and you matter. Only you can fulfill your part of God’s dream. In addition to all the good you are already doing … find those who also need your help.” Archbishop Desmond Tutu 34
Inside Story: Sule & Ashaki
Sule had learned his wife Ashaki is HIV+. He feels he cannot face this, so he thinks about sending her home to her family so that he can go on with his life. He is sure that he is not infected, but he has not had an HIV test. Both Sule and Ashaki had post‐
test counseling and are aware of the fear of rejection. Ashaki wants him to be tested also. He responds by saying that she is only accusing him falsely of being responsible for her infection, and refuses. If he is infected, then Sule knows that he, too, would die and aborting Ashaki’s child would leave him without a name. He decided to send Ashaki home to her family without an abortion and find another wife who might also have a child. Then he would have two chances to leave a son behind. Before he sends Ashaki away, he talks with his friends and wants his friends to agree that he is doing the right thing. Health Brief
Myth: You can get HIV from breathing the air around an HIV‐infected person or from hugging or holding hands with an HIV‐infected person. Reality: HIV is transmitted through contact with an HIV‐positive personʹs infected body fluids, such as semen, pre‐ejaculate fluid, vaginal fluids, blood, or breast milk. HIV can also be transmitted through needles contaminated with HIV‐infected blood, including needles used for injecting drugs, tattooing or body piercing. HIV cannot be transmitted through : 

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Toilet seats or doorknob handles. Touching, hugging, holding hands, or cheek kissing with an HIV‐infected person. Sharing eating utensils with an HIV‐infected person. Mosquito bites. Theological Insight: The Practice of Presence Over the great expanse of time and around the world, in traditions both oral and written, perhaps no more sacred words have been said: God is one, humanity is one, life is one. We are sore distressed, as well we should be over the many manifestations of divisiveness we encounter and encourage—divisions of gender, generations, religion, region, nationality, ideology, sexuality, ability, opportunity, ethnicity, race and class. In the midst of this, the divine imperative remains to learn the skills of presence or else the world of those who suffer and who are demeaned becomes a separate world, both for we who hurt and those who care about us. Only a community that is pledged not to fear the stranger out of hand can welcome the continued presence of the wounded in our midst ‐‐ so often we ourselves ‐‐ and heal our land. The church should and must be a house of hospitality. You are a sign, one among the many, that humankind will not abandon those who become dismissed, forgotten, locked away because we, all of us, are suffering from finitude and fear. In the farthest sweeps of history yet to be, the prophet’s dream is that the knowledge of God will cover the face of the earth as the waters cover the sea…and time is 35
God’s Instrument: Worksheet #3 The qualities listed above are not like tins or paint that you can go out and buy and brush onto a situation that you are working with. They are more like trees that must be planted and cared for They
reflect deep attitudes to a person
SELF ASSESSMENT Confidence in Who You Are Supportive Care Self as God’s Instrument In Relationship with Others Empathy not Sympathy Person not Problems 1. For each quality of a good counselor, write one way you might tell if you or someone you know has that quality. 2. For each characteristic, write one thing you can begin to make a part of your life and practice. Ways of Identifying
Making this a part of your life
 Write down the names of people in your congregation whom you could encourage and help to become counselors or counselor helpers.  Turn to the last section of this manual and read about how to start a training program.  Decide how you will encourage and help the people you have listed to become effective counselors and helpers. 36
PART III:
ON BEING A STEADY PRESENCE 34
How to begin a session In the counseling session, the opening and closing moments can be where some of the most important communication takes place. Learning to read the messages delivered and received in these moments often unveils the conflicted dynamics of the person receiving counseling. This guidebook therefore pays close attention to how to begin a session and how to end a session. Being at ease during the session is important to not only listening but to hearing what a person says. Establishing trust is the first step. Establishing Trust Trust is acting on the confidence that someone is able and willing to help. Without trust in the helper, the counseling session will not be effective. If a client does not have other trusting relationships, his/her problems probably will not change. As a helper, you have the opportunity to model trust. Trust is often not difficult to establish, but it is easily broken and difficult to repair. If a person has had many experiences of broken trust, then it will be difficult for that individual to establish trust again. Trust is based on experiences, fears and expectations. It grows or shrinks, step by step. It is easier for me to trust you when:  You believe what I say,  You listen to me,  You are objective,  You appreciate me,  You keep confidences,  You help me,  You respect me,  You believe in my ability to change Establishing a trusting relationship with a person is usually not difficult in a pastoral counseling setting. It is usually assumed that if a person comes with a problem, they already have some trust in you. But initial trust is quite fragile. It is important to quickly communicate some of the above messages. 35
One of the first things a helper can do to establish trust and set the counselee at ease is to let them know what they say will be kept in strictest confidence unless something that is revealed would harm them or someone else. Because an HIV+ person can bring deadly harm to others, it will be necessary eventually to ask the person two questions:  Who needs to know that you are HIV+?  When and how will they be told? The information does need to be told, and the person being counseled is the one to decide how and when the telling will happen. Often this is very difficult and it may take quite a long time to help the counselee understand his/her responsibility. If they refuse to tell the affected person(s), then the counselor must explore alternatives with them or end the counseling relationship. Establishing trust while still maintaining the counselor’s responsibility for the safety of others may require:  Giving the counselee time to think and decide;  Asking for a plan about who will be told;  Making it clear that the counseling role is one of helping, not opposing;  Setting the boundaries of the counseling relationship Just talking about trust does not guarantee its presence any more than talking about a garden will yield fruit. Trust is established, earned and kept by actions that support one’s positive expectations. It is broken by actions or attitudes that support one’s fears. The qualities that a counselor must show to a person struggling with HIV/AIDS so that they can have trust are:  Competence, because they feel hopeless and need someone that can really help;  Confidentiality, because they feel ashamed or trapped by people’s response;  Respect, because they often feel that they will be judged unworthy of any respect since they have “caught” the disease. KEEPING RECORDS To make a mistake is human. To forget is human also. If you do not keep records, then you will probably forget some important details. Good counseling requires follow‐up, and details of assignments or problems or resources must be followed up. The kind of records you keep depends upon the kind of counseling you do. If you are a friend counseling a friend, then you may not keep any records except a note somewhere in your diary about the things you are praying for. But if you are part of a counseling program in a church, you need to keep records. 36
Inside Story: Saran
Saran was a 23‐year‐old woman who was born in a city. Her parents died in a road accident when she was ten. There were two children in the family, and her relatives decided to separate the children. So Saran lived with her grandmother wile her brother lived with her grandmother. But she found it very difficult to live up‐country, where she struggled with the language that was said to be her mother tongue. At 15 she ran away to the city and eventually became a prostitute in order to survive. While she was involved in the sex trade, she met a foreigner who said he loved her and she moved to a coastal city in order to live with him. But after a few months he left the county. She found out that she was HIV+ when discovered she was pregnant. The baby that was born soon after did not seem to be infected. When Saran came to see me, she was very sick and said, ʺI have been living in the city, but my real home is up‐county. I just need some money so that I can return home and die.” Health Brief Myth: When youʹre on HIV therapy you canʹt transmit the virus to anyone else. Reality: Antiretroviral drugs donʹt keep you from passing the virus to others. Therapy can keep the viral load down to undetectable levels, but HIV is still present in the body and can still be transmitted to others. Theological Insight: T
a P
Presence There iis a
In our human arrogance it is often assumed that unless we ourselves can accomplish the corrections of the world in our own way and time, all is forever lost and existence will cease to be. While there should always be a certain degree of drive spurring human behavior, our principal task must always be to never lose sight of the fact that spiritual resources are required to sustain the love and care of those who hurt and are in pain over the long run. For it is no easy matter to be with the ill, distressed, diseased, incarcerated, violated, humiliated, discarded and discriminated against, especially for those whose suffering we alone cannot heal, whose condition we ourselves cannot ultimately fix, when the greatest gift is the courage simply to be present with those who suffer. Often, we have substituted technique for compassion, knowledge for wisdom, the formulaic for understanding, our wherewithal for ourselves. Only when we remember that our presence is our doing, that our beneficence is our action, when sitting of the ground seven days and doing nothing, nothing according to the world’s standards, but learning to be still like Job’s friends, only then can be be saved from our fevered and hopeless attempt to control others and our own existence. To believe that such an ethical and just presence is what we sometimes can and should do entails belief in a meaning and power beyond our sovereign and solitary worlds. We, all of us, need someone who will be with us. 37
God’s Instrument: Worksheet #3
LEAN & DEPEND List some specific ways that you can show these qualities within the first few minutes of your counseling session. 1. How can you help the counselee know that they are unique and worthy of your time and attention? _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ 2. Think of a person that you trust. Write some things that they have done or said to build your trust. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 3. Think of a person that you do not trust. What have they said or done that causes you not to trust them? __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 4. What can a pastor do to rebuild trust who has broken confidentiality or has been seen abusing a fellow leader? __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 5. How do you know when someone trusts you? __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 38
KEEPING RECORDS God’s Instrument: Worksheet #4
Here are some simple guidelines for counseling records:  Confidentiality is important. Keep your counseling files separate from other information files. Keep counseling files in a place that only you have access to.  A name/number code is often the best way to keep confidentiality. In one file keep a record of the identifying names that a counselee uses. Assign each person a number and record that number with the name. The actual counseling file should be kept in a different place than the name‐number key. Each counselee should have a file that is known by its number.  Nowhere in the counseling session notes should you write full names. Do not take extensive notes while in a counseling session. It destroys trust and confidentiality if the counselee thinks that you are recording every detail being said.  Do write more extensive notes after the session, being sure to record the problems, resources and action plan.  Include a permission form signed by the counselee. It should give you permission to share the information with people that the counselee agrees to. 1. What information do you think you need to know and remember? 2. Make some record forms for your own use. 3. Decide where you will keep your records. 39
Sample card for keeping records (3 x 5 inch file cards) Names Tel Number (if any) PO Box Location Counseling Number Dates counseled Sample counseling session notes Date Issues Number 023
Homework/action
 Found out he was HIV+
 Has not told wife
 Boss angry about lost
work time
Decide who needs to know
2 weeks to tell
Identify a mediator
40
Steps in counseling
The problems that AIDS creates in our society are the same old problems that humankind has struggled with throughout time. Because the problems are not new, the person being counseled needs to know that others share their needs and have experienced hope and help. In identifying problems, begin by dividing the problem into parts. Although a man or a woman is a whole person, a problem will have many different parts. It will help you to think of human beings as basically spiritual (the part that is made in God’s image) and material (the part that you can see, touch and experience). The five fingers of our hand are each connected to our palm. It is the muscles in the palm that support and control the fingers. In human beings, it is the spiritual that controls the material. Like the hand we will find a spiritual “palm” that affects every problem “finger.” Below is an outline of the basic needs of a family with AIDS:  Physical—medicine, proper food, work, finances, shelter, and exercise.  Mental—understanding about AIDS, how to plan finances, how to live godly lives, how to have good relationships with people, how to approach problems, etc.  Social—fellowship, a mediator to help with reconciliation, acceptance.  Emotional—love, encouragement, hope, forgiveness, purpose of life.  Decisions—decisions to follow God’s plan for sexuality, finances, personal and family relations and faithfulness or abstinence.  Spiritual—reconciliation with God, obedience, hope, repentance, forgiveness. 41
God’s Instrument: Worksheet #5
Based on the diagram below, what are the needs of Saran (p. 34)? Think about each of the six areas of life to help Saran in finding answers:
What are the emotional needs? (love, anger, confusion, denial) EMOTIONAL What choices need to be made? What should be decided and accomplished (using the will to make decisions) What are the family and community needs? SOCIAL VOLITIONAL SPIRITUAL MENTAL PHYSICAL What are the physical needs (food, medical care, living assistance)? What relationship does this person have with Jesus Christ? What fact or information does the person need to know? 42
VENTILATION The first technique in supportive counseling is ventilation. Helpers are encouraged to try to uncover the nature of the problems faced by the person being counseled by asking a simple question such as, “What’s bothering you?” This gives the person permission to tell the helper from his/her point of view, what concerns or issues he/she has. It also serves as the basis for further conversation. Ventilation requires active listening on the part of the Helper. Look for cues that suggest needs that may be present but are not being expressed. Listening is the most important skill of a good counselor. Even though we believe that we are listening, often the person speaking to us does not agree. When a client leaves a good counselor, they think “That person really listened. She understood me even when she did not agree with me.” Good listening involves a combination of active and passive listing. Passive listening is when I allow a person to talk without interruption, and share whatever she wants to share. Active listening is when I help a person to express herself more fully and when I give and receive feedback that lets both of us know that I have understood. Passive listening is usually the best place to start. We might begin the session with “open” questions like,” Tell me why you came”, or “How do you think I might help you?” When the client seems to be stuck or ends what to say and you do not yet understand them, ask “Would you tell me about…?” EXPLORATION OF PROBLEMS Gentle prompting will allow further expression of problems uncovered during the ventilation phase of counseling. Helpers should elicit details of these problems based on the cues provided by the person. Caution is advised in this step because it does not call for psychological analysis, but for careful, active listening. When you think you have understood, you need to make sure! You also need to let the client know you understand. This is active listening. You make sure you have understood by paraphrasing or restating what they have just said. Restating is when you say in your own words what you think the counselee meant. You might say “What I understand you to mean is…. Is that right?” Sometimes a person says something that shows an important emotion, a significant action, or states what you think is the core problem. In that case you may want to repeat what they have said. At regular points in a session it is helpful to summarize what has been said so far. Summarizing gives the opportunity to make sure the counselee knows you have listened and it give you the opportunity to move the session to another topic or phase. In order to clarify the problem, or gain deeper understanding, it may be necessary to be a mirror for the client. Reflecting involves helping the person to see him or herself from another point of view. 43
You might say ‘”You seem angry” or “Would you really be happy if” or “How do you think another person would feel or understand that?” The goals of listening are:  to understand what you are being asked to do or say  to clarify what the client thinks the problem is  to help the client have a deeper understanding of the problem  to identify possible solutions or resources for the problem Active and passive listening must take place on three different levels. On the easiest level are the facts. Facts describe what took place. Often problems arise because people have perceptions of the facts. A deeper level of listening requires understanding human feelings. Feelings describe a person’s response to the facts. The deepest level listens for meaning or motive. The meaning describes why a person did, felt, or thought what she did. What was in her heart? Good listening requires that you look for understanding at all three levels. CLARIFICATION 
Helpers will often be required to assist the person being counseled in clarifying issues or concerns. As the counseling session progresses, non‐judgmental responses to cues from the person will assist the Helper in catching the feeling beneath what is being described. Clarification is liberating because it helps the individual to recognize and acknowledge what he/she is trying to express. This technique is like finding a missing piece of a puzzle. Once it has been found, it fits into place, bringing the puzzle closer to completion. In HIV/AIDS pastoral counseling, clarification allows the person being counseled to come closer to describing what he/see sees as a problem. Questions are like keys: they will either lock or unlock the door of understanding. Some of the concerns that the Helper can help to clarify include the following: Are there any other affected people? Are there any other problems or stresses that the counselee might have? What can the counselee see that can be done about this problem? What can other people do to help? 
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Like keys, different questions are used for different kinds of situations: For more information, ask:  “bigger” questions  “more” questions, for example: “Did anything else happen?” “What else might be the problem?” 44
For understanding and clarification, ask:  “rephrase” questions: “Is this what you mean…?” For knowing attitudes ask: “reason” questions “motive” questions: “Who made you do that?” “What led you to…?” “How did you get that feeling?” For self‐reflection ask:  “what” questions  “and then…” questions: “ If he does have HIV, then what?” “If you sell your land for doctors fees, what will happen to your children?” Questions, which threaten people, are:  “accusation” questions  “assumption” questions: “How long have you been moving around?” “What did you do that made your spouse want to move around?” While we usually want to avoid threatening the person being counseled, questions must be challenging to help him face his own situation realistically. ” Who?, what?, Where?, How?, When?, And then…? questions are usually not hard to answer. SUGGESTION Straightforward prompting is important in HIV/AIDS pastoral counseling. This technique is not meant to manipulate the person’s perceptions, but to provide support in counseling. It is most often used in counseling as a question by the Helper to assist him/her in understanding what is being expressed. Offering a topic to be discussed, based on cues from ventilation or problems discussed, is another important approach to this technique. In order to avoid the manipulation of magicians or fake mediums, it is important that Helpers do not go beyond the boundaries of cues or issues presented by the person being counseled. Authentic suggestion is an important tool in counseling. Be careful how you give advice. Counseling is not telling people what to do, but helping them to find God’s solutions. The biggest help a pastoral counselor can give people is to help them find and understand God’s direction for their lives. REASSURANCE Simple, direct encouragement from a person of God brings confidence to those infected with or affected by HIV/AIDS. Reassurance is agreement with or endorsement of the 45
way the person being counseled is progressing. As the action plan is being formulated, it is important that Helpers provide positive feedback in order to instill confidence that the person is on the right track. Encouragement is often the most important motivator for changing behavior or sticking through a difficult situation. Encouragement comes in several ways:  When we have hope that a situation will improve or that we will be able to cope  When we achieve goals that we have set  When we see physical evidence of change The Helper must not think that he/she alone must bring encouragement to a person. Other people who may be “encouragers” are:  Family members  Friends at work  Friends at church  People who are helping with various needs (like the doctor, nurses)  People and families affected by AIDS In order for all these people to be encouragers, they will need to know how to help, and what the counselee is dealing with. The counselee should be encouraged to share part of their action plan with others that they can trust. Asking others to pray for them, and help them is good, and it binds them to their family and community. Helping a person infected with or affected by HIV/AIDS to persevere is one way that God gives hope: Romans 5:4 and endurance produces character, and character produces hope, 5 and hope does not disappoint us, because Godʹs love has been poured into our hearts through the Holy Spirit which has been given to us. EDUCATION Educating those we counsel is important to the healing process. Consciously informing the person about issues relevant to living with HIV/AIDS is one technique for constructively exploring their emotions. Effective teaching is when Helpers, without imposing meaning that the person is not ready to accept:  explain something that is poorly understood  dispel misconceptions or myths  provide the truth about the church and HIV/AIDS 46
ACTION PLAN After a problem is understood, an action plan should be made. An action plan is like a railway track: it will keep the person being counseled and the Helper moving toward the agreed place. Many different stations or stages must be passed in order to reach the final destination. Our plan must include the many stages, the rails, and the crossties that connect them all. A person’s actions and feelings are also like a railroad track. The cross ties are first laid and then the rails attached, not the other way around. In pastoral counseling, right actions must be done first and the feelings will come after. A person being counseled often will not stop a harmful behavior simply because he/she thinks it is too late or will not succeed. The Bible tells us to do certain actions no matter what we feel. When we do what God says, we will experience God’s peace, joy and the other fruit of God’s Spirit. Every act of obedience brings a blessing of its own. Based on the “hand” model of understanding problems, an action plan should begin with the problem as it is first talked about in one of the material finger areas. Then the spiritual roots of that problem can be identified. When the spiritual roots are identified, action steps that touch all of the areas can be made. It is best when the person being counseled is involved in making the action plan. Help them make a small chart. If they cannot write well, then help them think through the answers without writing. For each “finger” there ought to be:  something to do  something to learn  an action related to family, congregation or community  some emotion that needs to be changed  some decision to be made  a physical step (for example, making a change in one’s daily schedule) Clearly stating a problem and possible solution helps a person to identify how he/she is feeling and reacting to the problem. Clear statements help the Helper and the person being counseled to claim God’s help and strength. It might be that a solution has been tried but has not been successful. It is necessary to discover why it was not successful. Does it need more time? A different attitude? A different approach? Was it a poor solution? 47
God’s Instrument: Worksheet #6
 Practice making an action plan. Remember that one step leads to the next. Do not try to take an entire journey in one step.  Make an action plan for one of the Inside Stories with a small group. Take turns saying how you might respond to it if you were the person being counseled. Let the members of the small group role‐play the Helper’s part. ACTION PLAN My problems
What will I do
When will I do it
48
Responding to HIV/AIDS LOSS AND GRIEF When a person suspects that someone they love, or they themselves are HIV+, a process of grief begins. That person knows that death will soon overcome him/her or the one they love. People often have several responses to their grief. They may go from one response to another and sometimes repeat a certain response. The normal responses to grief are these: Denial: In this stage, a person may seem to not know or understand what has happened. A woman carries on as if nothing were new. Or a man might blame his wife for giving him AIDS even though he knows he has been moving around. Anger: In this stage, a person often speaks or shows anger against God or against self for what is happening. For the person who does not understand this stage, they may become very unreasonable in their bitterness. For instance, an angry young man with AIDS might decide that he will infect as many people as possible before he dies! Bargaining: In this stage a person will often try to bargain something they have or can do in order to ease their grief. A wife may bargain with her infected husband that if he will not move around anymore, then she will not insist on his using condoms. Often an infected person thinks that by becoming religious, God will grant him/her longer life. Depression: In this stage a person might not see any hope or purpose for life. He or she might wish they were dead. One might feel as if they can no longer do even the simplest things. An infected mother might stop caring for her family or an infected father might suddenly quit work. Acceptance: In this stage a person is able to talk about her problems with more people. She is able to see things she can do to help herself. But if she does not have a good plan for dealing with her problems, she may easily go back to an earlier stage of denial, anger or depression. 49
Inside Story: Shartati Shartati was a 30‐year‐old lady who came to the clinic with a baby who was about eight months old, but too small for the age. When Shartati was worried about the baby’s slow growth and asked for treatment, the doctor tested Shartati’s blood and found her to be HIV+. In the next few months Shartati developed a sexually transmitted disease and was treated. She also lost her job and soon found it so difficult to manage that she decided to give the baby back to the father of that she could take care of herself. She managed to find another husband and began to feel healthy. She gained weight. A year later she was in the hospital for treatment of typhoid and met `the counselor who told she was HIV+. She was angry with the counselor for giving her false information because the baby now seemed healthy, and she too, had gained weight. “I am sorry that you are angry with me Shartati,” the counselor told her “I understand that because you and the baby are not weak today I gave you the wrong diagnosis. Please remember that I only gave you the results of a test. Those results did not mean that you would get sick and die immediately. It only tells us that the virus is waiting in your blood and will not go away. A year later Shartati again met the counselor. This time Shartati was very thin and feeling sick and miserable. “Oh Shartati, I am happy to see you again, even though you are not feeling well. If I can help by talking with you. I want to. Shall we talk now? Or shall I come back tomorrow?” Health Brief
Myth: A person can have more than one sexually transmitted disease (STD) at a time. Reality: A person can be infected with more than one STD. A person with an untreated STD may also be 6 to 10 times more likely to pass on or acquire HIV during sex. Risk for infection increases 10 to 300‐fold in the presence of a genital ulcer, such as occurs in syphilis or genital herpes. Theological Insight: There is a Presence The Christian tradition, broadly defined, professes to be a community of presence, as it is a group of people called out by a God who we believe is always present to us both in our faithlessness and faithfulness. Because of God’s faithfulness believers are supposed to be a people who have learned how to be faithful to one another by our willingness to be present, with all our vulnerabilities and frailties, one to another. For what God requires of us is none other than our unfailing presence in the midst of the world’s sin and pain. And nothing less than to take our own struggle with pain and to make of it a sacrament of life. Thus, our willingness to ask for help in our suffering, as well as our willingness to be present with those who suffer and are violated, who are oppressed and demeaned, is not special or extraordinary activity, but rather a form of the Christian commitment to be present to one another in and our of pain, through sickness and in health, from this life to the next. This sacred opportunity and obligation is ours wherever “two or three are gathered.” (Matthew 18:20) 50
STAGES OF GRIEF God’s Instrument: Worksheet #7
Take a few minutes to think back to a loss or grief you have had. Identify those stages you yourself went through.  Knowing what stage a person is in is like telling time without a clock. At least you know the difference between morning and evening, and perhaps you can tell when it is ten o’ clock in the morning. You can plan to do different things depending upon which time of day it is.  In counseling you must know the “time” or response stage that the counselee is in. If they are denying, you will need to help them see the things they are denying, you will need to help them see things as they really are. If they are angry, you may only be able to tell them that you understand they are angry before they can live positively. Once they recognize their anger, a person may quickly begin bargaining or become depressed. In fact, they may go back and forth between different reactions. Your job is to help them see what these responses are so they can begin to live positively by doing what they need to as long as they are able. Think about the inside story of Shartati. 1. What clues can you find that show the stages she went through? __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 2. How can you help a person when he is angry or denying he is HIV? __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 51
ALIENATION In African cultures, where group values are important, alienating someone has two serious effects: 1. It pushes a person or family out of the community that might help them. 2. It is a sin against God’s law of love. Alienation is an attitude that makes a person insignificant or unworthy of friendship or association. Alienation is also what happens when a person decides that he/she will no longer associate with friends or a group. This often occurs with people living with HIV and AIDS because they fear the response of others. What are the reasons or thoughts that cause one person to be alienated from another? 1. If I publicly associate with this person, I will be thought to be agreeing with his actions. If I think that someone’s life‐style has caused him to get HIV, then I don’t want to associate with him. 2. This evil which has come to a family or individual will come to me too if I associate with them. 3. People feel anger and condemnation when a person is seen to have brought an evil to a society. As a helper it is your job to find a way reconcile people and to keep informal alienation from happening. In many cultures there is a way of “cleansing” or reconciling that involves both words and actions. Usually there is a public side as well as a private side to the process. Often the only way to connect an “outcast” with other is by identifying a “bridge” person. A bridge person is one who can help a larger group of people be willing to associate with someone. A good “bridge” person becomes a champion for that person. It does not mean that they approve of their conduct or choices. It means that they see them as individuals of real value whom God created in the divine image and wants to restore. Often an uninfected person with an HIV+ family member needs a bridge person to help them overcome a feeling of alienation. 52
STUDY THE WORD God’s Instrument: Worksheet #8
a.
b.
c.
d.
Write down how you can recognize when someone is being alienated. 1. How could your congregation help restore fellowship to someone who might be alienated? ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ 2. What can you do to keep people from fearing the words of another member? ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ Read Matthew 9:9‐12: 9 As Jesus passed on from there, he saw a man called Matthew sitting at the tax office; and he said to him, ʺFollow me.ʺ And he rose and followed him. 10 And as he sat at table in the house, behold, many tax collectors and sinners came and sat down with Jesus and his disciples. 11 And when the Pharisees saw this, they said to his disciples, ʺWhy does your teacher eat with tax collectors and sinners?ʺ 12 But when he heard it, he said, ʺThose who are well have no need of a physician, but those who are sick.” Did Jesus avoid “tax‐gathers and sinners” because they might spoil his reputation? What did the Pharisees think of him? What did others think of him? Did his actions make it easier or harder for people to hear and respond to his message? 53
CONFIDENTIALITY Confidentiality means keeping the situation of a person’s life private. In pastoral counseling, this is very important and often very difficult. Why is it difficult?  Usually the person being counseled is someone from within the congregation. The church secretary and church elders may know them.  Other church leaders may believe that a problem has to be shared with them.  Problems in their personal or family life may be quickly spread around the church. Keeping confidence is important because people may be afraid to return if they believe that their affairs will be widely known. Establishing trust in the counseling relationship will not happen if this is the case. A person’s job and means of income might be at risk if people were aware of his/her problems. The fact that bad news is often exaggerated beyond what is true also makes confidentiality a challenge. On the other hand, when a person is HIV+, it is important that certain people know. In addition to the person infected, his/her husband or wife should also be informed. If the person being counseled is a young person, his/her parents will need to be told of their HIV status. In order to inform the infected person’s sexual partners of their risk, they should be told. Likewise, any past sexual partners or future partners must be informed. The responsibility to tell these people is that of the infected person, not the Helper. It is the Helper’s role to help the person:  come to the point where he/she will take responsibility for his/her own situation by talking with those who need to know  have the confidence to know how to tell others, perhaps through role playing or practicing what and how he/she will tell them  overcome the fear and embarrassment that they might have Helpers can assist the person being counseled by asking the following questions: 1. Who do you think needs to know that you have the virus? 2. Why don’t you want to tell them? 3. How do you think you could approach them so that they will listen? 4. What do you think will happen if you don’t tell them? 54
RISKS Risk is the measure or amount of danger that we are in. Everything we do involves some danger, so we can never completely avoid it. Some things we do are much more risky than others. Crossing a small street might be dangerous. Crossing the street without first looking is much more dangerous. Crossing the street blindfolded would probably mean injury. With HIV and AIDS, there are things that one can do which are not very risky if one takes a little care. But some other things are almost certain death. Because you will counsel families that provide care for people that are positive of HIV and people with AIDS, it is important that both you as the Helper, and the people you counsel understand what is dangerous and what is not. High Risk Some Risk
No Risk  sexual intercourse with  using a condom during  sexual intercourse a person who has HIV, sexual intercourse with between a husband and or whose HIV status is a person who has HIV wife who remain unknown  helping deliver an faithful to each other  polygamy and spouse‐
infected mother during  abstaining from sexual inheritance where one childbirth without contact with an HIV+ party may be infected or gloves person whose HIV status is  health care workers  shaking hands and unknown caring for a patient with casual contact  traditional scarring, skin HIV or AIDS without  washing up piercing or circumcision using universal  feeding and caring for with unsterilized precautions an HIV+ patient (if there instruments  breastfeeding an infant is no contact with  using an unsterilized from an HIV+ mother. blood) needle (Breast milk may  lip kissing if there are  blood transfusions transmit HIV, but the no mouth sores which have not been risk of an infant dying  hugging tested for HIV without breast milk is greater than the HIV risks. Health experts recommend breastfeeding all infants in Africa)  home care givers directly exposed to fresh blood from an HIV+ person 55
There are things that a person can do to lower the level of danger for any of these activities. Some suggestions are:  During sexual intercourse a condom should be used properly every time there is penetration if either partner is infected or is suspected of being infected. Improperly used condoms are the reason that intercourse even with a condom is dangerous.  During foreplay, care should be taken not to touch sexual fluids or blood if any body part has open sores or cuts.  A person with AIDS can be safely cared for using gloves or a plastic bag to cover your hands.  A solution of 1‐part bleach in 10‐parts of water is strong enough to clean household items with blood contact.  Use a rubber glove or even a plastic bad to cover your hands if you are assisting someone with a bleeding wound from an accident. SEXUALITY Talking about sex in the church is very difficult because church leaders have not often been open to discussing it. When sexuality is discussed, coded language has almost always been used. Some believe that the church will be made unholy by such talk. But sex was God’s idea, and God talks a great deal about sex in the Bible! The entire book of The Song of Solomon is about God’s beautiful gift of love and sexuality. Chapter 8:3 even suggests a position for lovemaking. The book of Proverbs gives clear warnings about the misuse of one another sexually and clearly instructs youth about the same (Proverbs 5). We often think of sin as a violation of religious or moral law or as an offense against God. But we sin whenever we are less than we could be, when we miss the mark of our higher calling to be fully loved and loving human beings. Sexual enjoyment is good when it is accompanied by sexual responsibility. When churches become more involved in helping people to understand their sexuality, there will be fewer problems for intervention. Why don’t we talk about these things God talks about? Here are some of the reasons:  We have not thought about acceptable words to use for sexual activity or certain body parts.  We have not set aside times when we will talk about these things.  We do not make a plan for teaching our youth or parents about good sex. 56
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We are uncertain about the social, political, and economic factors that influence sexual behavior. Sexual irresponsibility is all around us, so we think if we talk about sex we will betray our sacred relationship with God and one another and encourage sin. Because AIDS is a disease that is mostly spread through sexual contact, we cannot avoid talking about it. The reclaiming of our communities cannot occur without such a commitment. 57
God’s Instrument: Worksheet #9
SEX & THE CHURCH Activities to enhance discussions of sexuality in the church:  Plan ‘marriage‐enrichment” seminars when married couples can deepen their understanding of each other and have a time to talk about things that they might not otherwise mention.  Put up posters that suggest the positive results of marriage faithfulness.  Find examples and talk about the healthy marriage relationships in your congregation. Remember that sexuality in marriage includes roles, relationships, and communication, as well as intimacy.  List the people you know who could help you think about and plan for these activities.  Make a list of the sexual issues that you need to study from the Bible. Begin to make a file about what the Bible says concerning such issues.  What are your cultural traditions that teach sexuality? Write them down and then write how they either complement or can be improved upon through the Bible.  Plan a seminar your congregation could have for boys or girls that would help them learn about their changing bodies, relationships with the opposite sex, and future roles in society.  Identify the people in your congregation who could be resources for teaching and good examples for helping in such a seminar for youth 58
Facing Spiritual Needs REPENTANCE AND FORGIVENESS Repentance and forgiveness are necessary for Christian counseling. There can be no lasting reconciliation without forgiveness. There is no deep hope without forgiveness. There is no forgiveness without repentance. Families and persons with AIDS usually have feelings of guilt, although in the denial and anger stages of their grief, they might not talk about guilt. A counselor should not try to make a person feel guilty. He or she should try to help the counselee acknowledge his/her true guilt, and understand what to do. Sometimes a person struggles with “false guilt,” which is feeling guilty for something one did not do or truly had no control over. Repentance is turning from sin to our Savior, Jesus Christ. When we receive his forgiveness, we are able to forgive others the things they have done against us. We sometimes think that forgiveness is forgetting. But it is not. Forgiveness is making a choice to let go of the bad feeling we have toward someone for what they did or said. Every time we remember that thing, we have to choose again to let go of our feelings. The Bible uses different words to translate “forgive.” They mean “to lift,” “to leave, forsake or lay aside,” “to release, dismiss, or pardon.” None of the words mean “to forget.” God removes the punishment of our sin and failure, though the memory and consequences may stay. …there is no hope without forgiveness…no forgiveness without repentance. 59
RECONCILIATION Reconciliation is when two or more people reestablish a relationship after they have experienced conflict. Human reconciliation is a reflection of a right relationship with God. True Christianity is seeking human reconciliation because of being reconciled with God in Jesus Christ. HIV/AIDS counseling must promote reconciliation. Reconciliation is making an opportunity for growth out of a negative conflict. Below are principles of conflict resolution that are helpful for AIDS sufferers. 1. Conflict comes to everyone; it can bear positive fruit. 2. Between believers, conflict can and should be resolved. 3. Even without a biblical commitment, many people do resolve their conflict. 4. It is possible to live at peace with ourselves even when the other party refuses to be reconciled. Families with AIDS often need reconciliation between:  husband and wife  the immediate family and extended family  an infected person and his/her sexual partners  parent and child  church members  friends THE BIBLE AND RECONCILIATION The Bible gives clear directions for reconciliation. 1. Both the offender and the one offended have the responsibility to mention and to deal with the offense (Matthew 5:24‐25; 18:15‐17). 2. If reconciliation fails on the first attempt, a second attempt should be made using a mediator if necessary (Matthew 18). 3. Reconciliation should be done quickly (Matthew 5:25; Ephesians 4:26, 27). 4. The words that we use should be building and loving words, not breaking and harsh words (Ephesians 4:25, 29). HIV/AIDS counseling must promote reconciliation 60
God’s Instrument: Worksheet #10
BE YE RECONCILED 1. Choose a conflict that you know needs reconciliation. ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ 2. Make a list of the people involved, the problems that feed the conflict, and the process that might be used to bring reconciliation. People Involved Problems Feeding Conflict
Process of Reconciliation
3. Reconciliation requires repentance and forgiveness. In the above conflict, write the sins that need to be forgiven. ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ 4. How is repentance between people like repentance between a person and God? ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ 61
HOPE Providing hope for the person with HIV or AIDS or his/her family is one of the main objectives of pastoral counseling. The aim is to instill hope so that their lives will be productive, useful and healthy. It is hope that God gives to those who come in repentance and faith to be reconciled with God. It is hope that keeps a person going when he/she would normally be defeated. Hope is spiritual, it is not something that can be touched. But like the wind, you can definitely know when it is there. Hope can come from something given, done or said. Hope needs to be given to a person being counseled soon after the counseling session begins and as soon as problems or needs have been identified and clarified. Imparting a sense of seriousness to the person about their condition and its impact on others is an important first step. Real hope is telling truth that heals the soul. Before beginning, Helpers should learn the difference between true hope and false hope. Often Helpers will be tempted to let the person being counseled believe things that are not true in order to give them hope. They may actually tell them things that are not true. This is false hope that leads a person to believe what might not be true. Some Christians want to give hope simply by saying, “If you believe God enough, then whatever you want will happen to you.” It would be wonderful if Helpers could simply pray and lay hands on those they counsel and depend on faith to heal. But Jesus did not heal everyone. God’s true hope and promises for families with AIDS are that God will be with them, comfort them, strengthen them, provide for them and heal them. But those promises are not that God will provide everything that they want, or heal every disease, or make them so strong that HIV will not hurt them. God can heal, but it gives false hope to the person being counseled to tell them that God will. The person infected with or affected by HIV/AIDS can find true hope in a living relationship with God. Here are some things that give hope:  the promises of strength and help in Jesus  purpose for the life or lives that remain  fellowship in the congregation  family and friends  healing of relationships  eternal life in Christ  healthy living (even with sickness) 62
PURPOSE & MEANING One of the greatest needs that a person with HIV or AIDS has is a sense of purpose and meaning in life. When a person is in the phase or stage of depression, it is often because they have no hope and no meaning for life. The Helper is able to offer both. Those that need to have help in discovering purpose for their lives are:  people with HIV/AIDS  spouses (infected and affected)  children  family members (parents and siblings) Many people have made their greatest contribution to society when they came to accept their HIV status and reached out to help others. People who have come to receive forgiveness and find their new purpose in Christ are likely to be the greatest resource for counseling families affected by AIDS. It is not good to push people to make an emotional decision to be religious simply because they recognize that their lives will be shorter than they might have been because of AIDS. It is because of that known shortness, on the other hand, that many people may come to a decision, in order to make the most of the time that they do have. Because of the way that AIDS progressively disables the sufferer, the Helper should remember that:  Purpose‐and meaning will come as the person focuses on changing themselves and giving to others  It is best to recommend focused, specific activities  Recommend activities that are flexible in energy and time requirements  Meaning and purpose is greatest when a person is doing something that will last  The discouragement of seeing a body waste away is helped the most by faith in God’s transforming love that is made perfect in human weakness HIV infected persons often think of themselves as useless, rejected by friends and being remembered only as someone unfaithful or immoral. For them, purpose comes when they understand:  who they are (in their physical and spiritual family)  to whom they belong (Christ)  what their accomplishments are  how they will be remembered 63
RENEWAL Telling people about HIV/AIDS is important. But now most people know something about it. The problem is that simply passing along information will not stop wrong or destructive behavior. It will not even necessarily stop ignorant behavior. Why? Because people do things based on values that they believe in. A belief is anything that a person thinks is really true, and that he/she will act upon no matter what evidence there might be. Beliefs are the deep reasons we “value” something as good or bad, true or false. Changing a belief is difficult. It usually takes more than one generation to change the deep beliefs that are the reasons for a value. But values can often change more quickly when there are a number of “pushers.” Values are like a big lorry. It can get stuck in mud, and when it does, it takes many “pushers” to get it unstuck. Helping people to change their values is like getting a lorry unstuck. It takes time, skill, a lot of work and dry weather that God alone can give. Changing the behaviors that bring HIV requires changing values. In many cases the deep beliefs have not changed for generations, and may not need to change if they are Biblical beliefs. For example, fidelity or faithfulness in marriage is a value that is fading in our societies today. It is based upon the good belief that many cultures have held which forbids sexual intercourse outside of marriage. So how do we change values? 1. Clarification—understand what you really believe, and why you believe it. 2. Check—ask if the Bible supports your belief. Compare your beliefs with absolute Truth found only in the Bible! 3. Comparison—do the values of friends, family, or peers around me agree with biblical values? 4. Adjustments—make a commitment that you will obey God’s Word, and God’s directions for life. Deep change in any person requires a work of God that makes a person able to:  Put off their old sinful patterns,  Put on new patterns of obedience,  Have a new outlook and understanding. 64
God’s Instrument: Worksheet #11
TEST YOUR BELIEFS Outlined below are some values that have proven false and have helped the spread of HIV:  A person will go crazy if he abstains for sex for very long.  People can’t really help it when they have intercourse outside marriage, it is Satan that makes them do it.  If a young man does not have intercourse with his girlfriend before marriage, he can’t be sure she will be able to produce children.  Encouraging a couple to have HIV testing before marriage challenges faithfulness.  It is offensive to God that pastors talk openly about sex.  Talking about private things in the presence of an in‐law brings a curse.  Using a condom causes sterility. 1. For each of the above values, decide who might believe it, and why. ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ 2. How can the AIDS epidemic be an opportunity and help to change values that are not biblical? ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ 3. What are some values held by people in your congregation that contribute to the spread of HIV? ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ 4. What other values keep people from reaching out to families with AIDS? ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ 65
Preparing for Death DEATH AND DYING Everyone will die some day. People with the AIDS virus will die sooner than they might otherwise die. Because AIDS often brings death quickly and because it may cause others to die, the counselor must prepare the person or family with AIDS for death. These are the things that are most necessary to prepare a person and family for:  Reconciliation with God  Inability to care for oneself or  Reconciliation with family members children that may remain behind  Reconciliation with other people  A spouse that may remain behind  Financial stress  Possessions and land  A lessening ability to work  Writing a will  Increased sickness All these things are emotional issues for most people and families, and they are especially difficult to handle at a time when a person or their families may be denying the reality of HIV or AIDS. The more advanced the disease seems to be, the more urgent the necessity for talking through these issues. The need for reconciliation with God, self, family and others is a most important issue in terms of eternity. Be sensitive to an appropriate time to discuss this. Talking about a right relationship with God at a time when a person is angry or depressed might either cause them to be angry with God, or to make an emotional decision that is not real or lasting. Usually the counselor will have to rely on other family members to do most of the preparation for death and dying. If the family refuses to deal with these things in advance, they are sure to have more problems later on. But the Christian counselor must convey the real hope of Christ that every person can have. It is important that a person with HIV or AIDS be involved in talking about planning for their death. Doing so will help them work through the pain. One mother dying of AIDS wrote notes and left pictures for her children that could not yet read. She knew that in the future they would continue to deal with the pain of her early death and to wonder why she died. Her letters communicated to them her concern and love for them long after she was gone. Help the client with HIV or AIDS to also see that it is important for them to talk to anyone with whom they have had sex. Those partners may also have the virus and are likely to spread it further. Accepting personal responsibility is an important part of dealing with death and is a necessary part of being truly reconciled to God. 66
Inside Story: Akello & Sanyu Akello is a 33‐year‐old doctor. He first suffered from a sexually transmitted disease in his third year of university. He graduated with honors and became well known because of his love for Jesus and his great care for people. The day before his wedding he found out that he was HIV+. He was in shock, and greatly embarrassed. His fiancée, Sanyu, decided to marry him even though he was HIV+, in order to show her true love. Akello worked some time until he became weak. Because of his access to good medical care and the loving care Sanyu gave him, his health improved somewhat. He began working at a hospital near his home and transformed it into a large and beautiful heath center. He continued to get sick from time‐to‐time; bud did his best not to show his sickness. Many Christians supported the family in prayer and encouragement, and Akello continued to work tirelessly. His strength became less and less and he finally became very sick. Akello’s older brother also became very sick with AIDS, and Akello witnessed to him and asked people to pray for his salvation. Three days after Akello was buried, his older brother died and within the same year, the first‐born brother also died of AIDS. In one year, all the sons of the family had died of AIDS. Sanyu is praising God for how God has helped her deal with all the struggles. She is HIV negative. Health Brief
Myth: There is no such thing as safer sex. Reality: Safer sex is sexual activity without penetration, or sex with a latex condom or a latex barrier (in the case of oral sex). Although safer sex can substantially reduce the sexual transmission of an STD like HIV, sexual abstinence is the surest way to prevent the sexual transmission of an STD, including HIV. Theological Insight: There is a Presence Humankind builds social, political and economic systems to last forever, and into our building do we put the blood, sweat, and tears of our convictions. But political systems do not leas forever; neither do forms of hierarchy and oppression. Certainly we have seen in just the last few years the demise of the South African apartheid state and the breaking out of peace in unexpected places around the world. Notwithstanding our current HIV/AIDS crisis, our world around us is changing. The challenge to the African faithful, if we would maintain our integrity, is to embrace the very winds of change sweeping the continent, freedom’s changes to which our people have so often born witness, and in which we must now participate without flinching or hesitation if our own humanity is to be sustained. Reflect on Akello and Sanyu’s inside story. Allow these questions to guide you thoughts:  If you had been the Helper counseling Akello, what would you have advised him to do when he told you that he was HIV+?  Now that you know the end of the story, what does it tell you about how God often works in people’s lives?  What kind of healing took place?  What Scripture would you use to help Akello know God’s will for his life?  What would you have prayed for? 67
God’s Instrument: Worksheet #12
DEATH’S STING 1. What community leaders can you talk to so that the community can better help families deal with death? ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ 2. List the Bible passages that you would use to help a person be reconciled to God. ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ 3. List the things, which your own culture feels, are important to prepare for before death, for example, property rights or who will pay school fees, etc. ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ 4. What policies or organizations in your area discriminate against people with AIDS? ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ 5. How could your church assist at death other than by giving money? ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ 68
CHILDREN Children in families with AIDS have special needs. Often they are ignored because of the parents’ more urgent needs. Sometimes they are ignored because adults think that children will be all right if they simply have food to eat. Children are often the final caregivers for their parents. It is vital that the counselor given them special attention. He/she should make a special point to ask about them, and to counsel with them and other people who are close to them. Children need:  a sense of security  attention  communication  future planning  understanding about HIV/AIDS  help to correctly express and deal with their emotions, such as anger and guilt The counselor should give children attention to make sure they:  are being cared for,  do not suffer in the denial, anger or depression their parents may feel,  are not exposed to the virus because of giving care to parents Communication with children means:  helping them express their feelings, fears, uncertainties,  giving them assurance for the future,  talking to them about the disease, its prevention and care Future planning for children includes:  deciding who will be their future caregivers or guardians  planning with the future caregivers for their future, including finances  protecting inheritance and land rights Children need to understand about AIDS  to know something about their parent(s) situation  to be prepared for the death of their parent or parents. If they are able to talk when a parent comes to know that they have HIV, then they need to understand about death  to know that the death of their parent(s) is not their fault  to know that the counselor wants to help them understand and help them through their difficulties  to keep family confidentiality, and know who they can talk to 69
SUFFER THE LITTLE CHILDREN God’s Instrument: Worksheet #13
1. List the people in your congregation that you can prepare to help you care for children’s needs. ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ 2. List all the issues that you know should be talked about before a child is orphaned (including cultural, spiritual, economic, social and educational issues). ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ 3. Make a plan for how parents or a family could deal with those issues before death. ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ 4. If there were to be many orphans in your area, what can the churches do? How can you get the churches to do it? ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ Children need to know
something about
their parent’s
situation
70
How to end a session (RE)READING THE BIBLE Anyone who has a Bible can read it. In HIV/AIDS pastoral counseling, the task becomes one of reading the Bible in the light of HIV/AIDS. Reading the Bible to help in the prevention, provision of quality care, elimination of the stigma of HIV/AIDS and discrimination, as well as minimizing its impact is our goal. We must read the Bible not only as an historical and ancient book, but also with a view of current concerns. The most common approach to reading the Bible is a literary one. With this method, the following strategies are important:  Know where a Bible passage that talks about your subject is found. Don’t just say. “Some where in the Bible it says…” Where does it say that?  Prayerfully, understand what the main idea was when the passage was written. (What did it mean to the author?)  Understand the principle or universal truth that is in the passage. (What is it there for?)  Understand how the principle applies to the people who first heard it and then decide how and in what way it applies to you. (How does it help me?) Helpers should also try to discern ways that the life experiences of the person being counseled can be used in re‐reading the Bible. The Bible, as the Word of God, is intended to liberate, save and sustain life. Look for biblical examples of each of these and read them to the person being counseled at the end of the session. Story telling is an important frame of reference for most people in the church. Coupled with the African tradition of telling history and teaching through the oral tradition, retelling Biblical stories in the context of HIVAIDS can be liberating and healing. Re‐reading the bible by focusing on specific themes, which arise in counseling sessions, is important. For example, reading the miracles and healings of Jesus in the synoptic gospels can give hope; recalling how Jesus destroyed stigma and discrimination by 71
associating with social outcasts can bring reconciliation; and retelling the creation story can empower the AIDS sufferer to feel he/she is a child of God. 72
God’s Instrument: Worksheet #14
STUDY THE WORD From an HIV/AIDS perspective, even familiar biblical stories take on new meaning! Read the story of the healing of the hemorrhaging woman: Matthew 9:20‐22 Mark 5:24‐34 Luke 8:43‐48 24 And he went with him. And a 43 And a woman who had had a From! 20 And behold, a woman great crowd followed him and flow of blood for twelve years who had suffered from a thronged about him. 25 And and could not be healed by any hemorrhage for twelve years came up behind him there was a woman who had had one, 44 came up behind him, a flow of blood for twelve years, and touched the fringe of his and touched the fringe of 26 and who had suffered much his garment; 21 for she garment; and immediately her said to herself, ʺIf I only under many physicians, and had flow of blood ceased. 45 And touch his garment, I shall spent all that she had, and was Jesus said, ʺWho was it that be made well.ʺ 22 Jesus no better but rather grew worse. touched me?ʺ When all denied turned, and seeing her he it, Peter said, ʺMaster, the 27 She had heard the reports said, ʺTake heart, about Jesus, and came up behind multitudes surround you and press upon you!ʺ 46 But Jesus him in the crowd and touched daughter; your faith has his garment. 28 For she said, ʺIf said, ʺSome one touched me; for made you well.ʺ And I touch even his garments, I shall I perceive that power has gone instantly the woman was made well. forth from me.ʺ 47 And when be made well.ʺ 29 And the woman saw that she was not immediately the hemorrhage What is helpful in hidden, she came trembling, and ceased; and she felt in her body this text when it is falling down before him declared that she was healed of her read in light of disease. 30 And Jesus, perceiving in the presence of all the people why she had touched him, and in himself that power had gone HIV/AIDS? how she had been immediately forth from him, immediately turned about in the crowd, and healed. 48 And he said to her, said, ʺWho touched my ʺDaughter, your faith has made garments?ʺ 31 And his disciples you well; go in peace.ʺ said to him, ʺYou see the crowd pressing around you, and yet you say, ʹWho touched me?ʹʺ 32 And he looked around to see What ideas for who had done it. 33 But the transformation can woman, knowing what had been we gain by such a done to her, came in fear and trembling and fell down before reading? him, and told him the whole truth. 34 And he said to her, ʺDaughter, your faith has made you well; go in peace, and be healed of your disease.ʺ 73
BIBLE REFERENCES COMPASSION FAITHFULNESS
FORGIVENESS Matthew 9:36 Matthew 14:14 Mark 6:34 Mark 8:2 Luke 7:13 Luke 10:33 Luke 15:20 Romans 9:15 Colossians 3:12 Hebrews 10:34 Genesis 2:18 Proverbs 14:1 Song of Solomon 4:1 Mark 10:10 Mark 12:31 1 Corinthians 1:9 Galatians 5:22 Ephesians 5:21 1 Timothy 1:12 Hebrews 13:4 1 John 1:8 1 John 1:9 Genesis 50:17 Exodus 32:32 1 Kings 8:30 2 Chronicles 6:21 2 Chronicles 7:14 Psalm 86:5 Psalm 119:116 Psalm 121:1 Psalm 130:7 Psalm 146:5 Psalm 147:11 Proverbs 10:28 Proverbs 11:7 Proverbs 14:32 Jeremiah 17:7 Jeremiah 17:13 Jeremiah 29:11 Lamentations 3:21‐29 Joel 3:16 Isaiah 1:18 Jeremiah 31:34 Matthew 6:10 Matthew 9:6 Matthew 11:28 Matthew 18:21 Mark 11:25 Luke 5:32 Luke 6:37 John 5:24 John 8:32 Acts 2:26 Romans 4:18 Romans 5:2 Romans 8:24‐31 FAITH Matthew 6:30 Matthew 8:10 Matthew 9:2 Matthew 14:31 Mark 2:5 Mark 10:52 Mark 11:22 Luke 5:20 Luke 7:9 Luke 7:50 Luke 12:28 Acts 3:16 Acts 6:5 Romans 1:8 Romans 3:28 Romans 4:11 1Corinthians 2:5 1Corinthians 12:9 1Corinthians 13:2 Galatians 3:7 Galatians 3:8 FEAR Matthew 10:28 Mark 5:36 Luke 1:50 Luke 12:7 John 19:38 Acts 13:26 Romans 3:18 Romans 8:15 Philippians 1:14 Philippians 2:12 1Timothy 5:20 Hebrews 5:7 1Peter 1:17 1Peter 3:14 1John 4:18 Revelation 2:10 Revelation 14:7 Revelation 15:4 1 Corinthians 10:12 Galatians 5:5 Ephesians 1:18 Philippians 4:4 Colossians 1:5 Colossians 1:23 1 Thessalonians 4:13
Hebrews 3:6 Hebrews 6:11‐19 Hebrews 10:19 1 John 1:9 1 Peter 1:3 1 Peter 3:15 1 John 3:3 GRIEF 2 Chronicles 6:29 Job 2:13 Psalm 23:1 Psalm 31:9 Isaiah 53:3 Lamentations 3:31 Matthew 5:4 Matthew 11:28 Luke 4:18 John 14:1 John 16:33 Romans 5:1 Romans 8:18 1 Corinthians 10:13 2 Corinthians 12:7 Philippians 4:4 1 Peter 2:19 1 John 5:4 Revelation 2:9 74
HOPE Exodus 15:26 Psalm 16:9 Psalm 31:24 Psalm 33:18‐22 Psalm 38:15 Psalm 42:5‐11 Psalm 43:5 Psalm 51:10 Psalm 55:22 Psalm 68:19 Psalm 71:5 Psalm 71: 14 Psalm 78:7 Psalm 119:49 Psalm 119:81 Psalm 119:114 Romans 1:16 Romans 10:8 2 Corinthians 6:2 2 Corinthians 7:10 Ephesians 6:17 2 Timothy 3:15 Titus 2:11 Hebrews 2:3 1 Peter 1:3 Revelation 12:10 SALVATION Exodus 15:2 1 Samuel 2:1 2 Samuel 22:3 1 Chronicles 16:23 Psalm 3:8 Psalm 13:5 Psalm 18:2 Psalm 18:46 Psalm 27:1 Psalm 51:12 Psalm 88:1 Isaiah 12:1 Isaiah 52:7 Isaiah 59:11 Habakkuk 3:17 Luke 1:76 John 3:16 John 5:24 John 10:11 Acts 4:12 75
PRAYING
Praying with a client and for them is one of the most powerful helps that a counselor can give. But sometimes people think that praying is magical. Traditional healers use language that people cannot understand, so what is the difference between Christian prayer and traditional healing? Prayer is talking with God. It is the time when we can fully reveal who we are, and what we think and do. It is often in prayer that God gives us ideas and applications from the principles in the Bible. It is understandable communication with an understanding God that distinguishes Christian prayer.. Prayer should not be a time when the Helper says things to God about the person being counseled that he/she would not say directly to that person. It should be a time when specific needs and praises are brought to God. Prayers could include:  confessions of sinful attitudes and actions,  confession of need for God’s help,  praise for who God is,  praise for what God promised,  praise for what God has done in the person’s life,  request for wisdom,  request for help in doing the action plan,  request for help to be open and honest,  request for deliverance from fear, oppression or obsession. It is good for the pastoral counselor to begin the session with prayer, seeking God’s blessing and help for the time. It is good to stop in the middle of a session when difficult issues are being talked about and ask for God’s help. It is good to end with prayer when the entire session can be given back to God. If the counseling session is informal or done outside a church setting, the person being counseled might be offended by automatically praying. It is always best to first seek permission and agreement from the person with whom you pray. Praying together is like eating together. It not only feeds the person, but it also feeds the Helper. It heals wounds. It can create trust and openness. But prayer should never be seen as a kind of “trick” that keeps the unbelieving person quiet while the Helper talks. It should not be seen as a way of getting God to do what God would not have otherwise done. It is important that the person praying is able to clearly express the praise or the need or the confession. Verbalizing the need, problem or confession is an important step in the healing process. The wise Helper will help the person take the healing step. God listens to the sincere heart, not to the mouth that says things in a fancy way. 76
Special Needs PRE‐MARITAL COUNSELING Many cultural traditions call for advice and counseling to be given by parents, uncles, aunts or a “best couple.” These are often good sources of counsel, and should never be ignored, even when those giving the counseling may not be the best counselors. These people will be a part of a chain of helpful relationships that can keep a new marriage strong. The role of pastoral counseling before marriage is not to replace other godly advice, but to make sure that essential things have been thought about. Most of the advice that a couple receives from family or friends may be limited to the areas of how to handle a family. Helpers for a healing community have a role in premarital counseling. The inside story of Akello and Sanyu is a good example of what should take place before marriage when one of the partners is known to be HIV+. Pastoral counseling can assist the infected person in openly admitting his/her HIV status before marriage, and thereby avoiding further transmission of the virus. Akello’s admission to Sanyu did not stop their wedding. On the contrary, his willingness to face embarrassment and possible rejection did not prevent Sanyu from marrying him and become a supportive caregiver on his behalf. MARITAL COUNSELING Counseling married couples about HIV and AIDS can be complicated and full of surprises. There are often no easy answers of solutions to the problems faced when one partner is HIV+. Successful marriage is good for humanity and from the perspective of the church, important to Christian living. AIDS in Africa has become a major threat to problems and failures in marriages. Helpers can assist marriages in several areas, including:  facilitating communication between husband and wife  encouraging open dialogue with extended family members  helping to couples make action plans for finances, time schedules and for their relationships  when possible, promoting reconciliation  teaching expressions of affection and sex which do not promote HIV transmission 77
Most marriage counseling begins with one partner; however, it should quickly progress to include the other. Special attention must be given to the person who is at greatest risk in being infected with the virus, or if already infected, to the one at risk of infecting others. The goal is to keep the uninfected person from becoming infected. Reconciliation between the couple and restoration of the two to God should be the initial focus of the Helper in approaching counseling between couples. As these health and relationship needs are met, the family will be able to be at peace so that they can deal with other HIV/AIDS‐related needs. As with other forms of counseling, the first session should be centered on trust. First, Helpers should try to establish trust with the person(s) being counseled. Second, it is important to find out who might be a trusted person for the individual you are trying to help. Being aware that you might not be the best person to provide marital counseling (for example, because of your age, because you are unmarried, or because of cultural differences) is important in helping. Other godly counseling from trusted Helpers may be needed. The pastoral counselor needs to be sensitive to the fact that marriage problems can be like charcoal: one issue burns into another until finally the relationship is finished. HIV/AIDS brings many problems, but usually it makes other problems that are already present much worse. Some of the deep needs that the Helper should be prepared to address are:  restoring trust  controlling anger  learning to forgive  chipping away pride without destroying proper self‐esteem  helping with personal discipline  facing a sense of failure and defeat PROTECTING A SPOUSE When a person becomes HIV+ or when it is known that one marriage partner is not faithful, the counselor must help the couple talk about how to keep the infection from spreading to the uninfected partner. Different situations require different approaches to protect a marriage partner. The counselor must decide if:  The infected partner is infected because of unfaithfulness, or through infected blood.  Either person is unfaithful. 78
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There is a bad relationship between husband and wife that might block protecting an uninfected spouse. If there appears to be unfaithfulness on the part of a spouse, or if one person is already infected, then the uninfected spouse must be protected. There are several ways to help protect from infection, but there is no way to be certain of protection. Any method is very difficult to apply if there is a bad relationship between the husband and wife. If there is good communication and loving consideration, two things can help protect the uninfected spouse from getting the virus from their infected spouse. These are in addition to being and remaining faithful.  Learn to show and express love without penetrative sexual intercourse.  The man must use a condom every single time they do have sexual intercourse. If there is a bad relationship, probably one will refuse prevention. The counselor will need to begin by helping to restore the relationship. When there is a good reason to suspect that a partner is infected and is not willing to help protect their mate, then the uninfected spouse might have to refuse sex. If there are children, it is also important to protect them from becoming orphans by the loss of both parents. It is best when a counselor can talk with both partners about how to protect the uninfected spouse. When you talk about the methods, remember these points:  Any exchange of sexual fluids is risky.  Condoms can be helpful to prevent the exchange of infected sexual fluids if they are used properly and used every single time.  Expressing love before penetration is talked about in the Bible Proverbs 5:19 a lovely hind, a graceful doe. Let her affection fill you at all times with delight, be infatuated always with her love. Song of Solomon 4:1 Behold, you are beautiful, my love, behold, you are beautiful! Your eyes are doves behind your veil. Your hair is like a flock of goats, moving down the slopes of Gilead. 2 Your teeth are like a flock of shorn ewes that have come up from the washing, all of which bear twins, and not one among them is bereaved. 3 Your lips are like a scarlet thread, and your mouth is lovely. Your cheeks are like halves of a pomegranate behind your veil. 4 Your neck is like the tower of David, built for an arsenal, whereon hang a thousand bucklers, all of them shields of warriors. 5 Your two breasts are like two fawns, twins of a gazelle that feed among the lilies. 6 Until the day breathes and the shadows flee, I will hide me to the mountain of myrrh and the hill of frankincense. 79
These ways of loving should be encouraged and practiced by the couple. 80
COUPLES’ COUNSELING God’s Instrument: Worksheet #15
Do the following activities before you need to counsel a couple for protection.
 Make a file folder “facts and feelings of condoms.” In it put information, samples, and guidelines for correct use, and organizations or people as references.  Make a list of the advice that you might give to people who are at high risk for AIDS because of their  Jobs or life‐styles (traveling, salespersons, lorry drivers, etc).  Make a list of advice that you might give a person whose spouse is HIV+.  Visit a hospital or family planning center and get to know the people there who can help you counsel on sexual issues.  Make a plan for what you will do if a couple has a relationship that will prevent protecting an uninfected spouse.  Whether or not you recommend condom use for anyone, make a plan for how you will help people change risky behavior. 81
DEALING WITH TRADITIONS Because AIDS affects families and not just individuals, there are many traditions that may make bad problems worse. Other traditions have been very helpful but they have been ignored. The Christian pastoral counselor must come to know or learn the counselee, and the church traditions of both counselor and counselee. Church traditions are usually more elaborate and formal than what is found in the Bible. This is so because every culture applies the Bible to their cultural ways. For example, the Bible honors marriage, and makes it very important in understanding the relationship between Christ and the church. But the Bible says almost nothing about the procedures for a wedding. (Do we really need a cake? A white dress? Why is it important to be married in a church building? What state laws make requirements at a wedding?) In parts of Africa the tradition of wife inheritance is seen as a great problem. But it does not affect all cultures. Traditional circumcision rites are another practice to which many Africans no longer subscribe. Some cultures have encouraged chastity before marriage. But those traditions are not enforced much today. Why not? What are the changes in our life‐styles that have weakened such good traditions? Because there are traditional practices that affect the spread and care of AIDS, it is not possible to talk about each of them in this short book. It is important that the counselor think through his/her own cultural traditions and know how they impact the people you will counsel. Here are some guidelines to help you. 1. Know your traditions. Is the tradition a recent or an ancient one? Is it practiced by most people, or only practiced by a few? What traditional values can and should be encouraged? 2. Know what the Bible says about each tradition. Don’t condemn or condone what the Bible does not! 3. Talk with your spiritual and village elders about ways to change harmful and dangerous cultural practices. 4. Involve other church leaders from your denomination and other denominations in discussions about the church’s response to traditional cultural practices. 82
 Visit other denominations and churches in your area and ask what they are doing to identify cultural practices that are either harmful or helpful.  What are the cultural practices in your area that contribute to the spread of HIV?  What can you do about them?  What are the cultural practices in your area that help in AIDS care or prevention?  What are some of your church traditions which make AIDS care and prevention difficult? 83
PART IV:
To Whom Shall We Go?
84
Follow‐Up MOBILIZING THE CHURCH Even before AIDS, there were more hurting people and relationships than churches were helping. Now the need is much greater and our people are often afraid to minister. In Nehemiah’s time the city of Jerusalem was in worse condition than the people were able to cope with. Nehemiah might have given up. He might have been tempted to go to his Gentile friend, the king, and apply for a large amount of foreign aid. Instead, all he asked for was permission to go on leave, permission to cut some trees down, and clearance from the military to travel without difficulty. When he arrived in Jerusalem the situation was worse than he had thought, but he did not sit with the elders and encourage each person to apply for a good paying job. Instead, he encouraged each person to do what he or she could do. The result was that a goldsmith and a man that made perfume both worked on constructing the wall and hauling away the trash. The answer to our struggle against famine or poverty or illiteracy, will never be to find large donor agencies. The answer will come when we take responsibility for our own struggles and decisions. In the present struggle every person is needed. Most programs for the prevention of AIDS have failed to actually change behavior. Even though the rate of growth of HIV infection is slowing down, it is still growing! Daily, more and more people are getting infected and then getting the disease. That means our defenses are still weaker than the enemy. Every person is needed for the defense and care of God’s city of joy. Here are some of the things that the church could do to fight AIDS and to strengthen its own fellowship:  have a regular visitation program  learn to listen to problems  learn to encourage each other  learn to counsel each other  give hope  pray  evangelize and lead people to Christ  create home care programs 85
 work with health care agencies  share food  have home Bible Studies  have a men’s association to encourage faithful living  serve as intermediaries in the time of crisis or conflict  become familiar with government policies  provide burial  provide foster care or orphanages for orphans  show love Most of these do not cost money. But if the church were willing to form ministry groups to meet these needs, then the fellowship and power of the church would grow, fewer people would get HIV, and those that do would have hope.  Plan a visitation program that would involve at least half of your people. Plan how you can motivate and prepare them for the ministry.  Identify leaders who would be willing to think and pray with you to begin such a program.  Set a date when you would like to begin. MANAGING RELATIONSHIPS The skill of managing relationships comes from doing many different things well. The pastor cannot do all the helping, all the teaching, and all the counseling in a church. Even if the pastor could do it, he or she should not. If is often easier to do something than it is to help another person do the same thing. That is the reason a counselor often tells a person what to do rather than help them find what God says. Pastoral counseling will only be effective when the pastor, or counselor, helps the whole congregation work together as body. A good counseling relationship ought to look much like the helping and healing relationships between people in the congregation. If you want to manage relationships well, these are some of the things you will do: 1. Respect other people for who they are and what God made them to be. 2. Appreciate the abilities and potential of other people. 3. Publicly mention the good things that people do and are. 4. Speak privately to people about their weaknesses. 86
5. Need other people. (Needing other people is like using our arms. If you think that one arm is weak, and you never use that arm, then after only a year it would be useless!). 6. Honor others more than yourself. 7. Serve others more than yourself. 8. Know the strengths and weaknesses of others. In order to manage relationships well, you will need to: 1. Organize your time. 2. Be open and honest, 3. Avoid negative talk, 4. Make use of people’s gifts, 5. Have a vision for what you are doing and then help others to dream with you, 6. Connect people with people, not with yourself. Think about a bicycle wheel; it has a hub at the center of the spokes, and it also has a rim. The hub drives and moves the spokes, but the rim helps distribute the weight of the rider evenly among all the spokes. The church has many people and gifts who are “moved” by a good leader and “connected” by a good program, and not when a few carry all the load themselves.  Evaluate yourself on the above points of self‐management. Decide if you usually, sometimes, or rarely do them.  Think about your relationship with people in different age sets. How do you rate?  Think about your relationship with people of different economic backgrounds. How do you rate?  Think about your relationship with other ethnic groups. How do you rate?  Write down some goals for yourself in your self‐management and in your relationships. Share them with someone you trust.  Ask several of your fellow leaders or counselors to forms a group to help each other grow in the ability to manage relationships. 87
MAKING POLICIES
Policies are clearly known opinions and advance decisions of a person organization. A male Helper will have a clear policy about when and how he counsels a woman. The same will hold true for a female Helper when counseling a man. People know their policy, and the counselor uses it for his or her protection. It is a rule that they are committed to follow. Policies are like trousers: they should be loose enough to let you work, tight enough that they don’t fall off, and new enough that they don’t look all patched up or let you show through! Here is a list of others issues that should have policies (written policies are best).  confidentiality  counseling the opposite sex  pre marital counseling requirements  pre‐marital testing for HIV  what to do when an employee has HIV/AIDS  condom use Why have policies? Some reasons are to:  make sure you have thought through an issue before it comes up at a difficult time  maintain equality and consistency  protect your ministry and reputation  make decision–making easier during actual client counseling How will policies be implemented?  If flexible, be sure to include the exceptions or condition of flexibility in the policy.  If not flexible, include the reasons in the policy.  If it is implemented after a grace period, make sure it is clear when the grace period, make sure it is clear when the grace period starts and stops.  If a policy is to be immediate, say so. How do you make policies?  Together, with the highest level of authority in the church (usually the elders and pastors), decide what needs a policy and why.  Gather samples of other church’s policies on similar matters.  Involve families with AIDS in your policy discussions.  Obtain consensus on the main issues that need to be included in the policy.  Make the policy as simple as possible with only the essential issues and conditions.  When you have reached consensus, write the policy down. 88
Publicize your policy. Don’t make a policy too easy to change, nor impossible to change. God’s Instrument: Worksheet #16
POLICIES 
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 Look through the contents of this manual. What are the issues for which you know you need policies? Mark them.  Who needs to be involved in making the policies for your church? Make a list of their names. POLICIES  How will you help those people understand what a policy is and why you needed one? Write your action plan for each person next to their name.  Who will you contact for sample policies on these issues? Make a list of people you will contact for each issue. 89
Help for the Helper HOME CARE GUIDELINES Persons and their families affected by HIV need support in caring for sick members. We now know that good care and loving acceptance by the person’s natural and spiritual family can greatly improve the physical condition of persons with AIDS. Most problems associated with AIDS can be managed at home with support for family members. The care–giver should have two basic goals in focus when caring for persons with AIDS: his comfort and the control of infection. Comfort Person with AIDS need to feel accepted and loved. Care always takes time. Time to visit, to talk, to just sit together, to hold a hand, to read the Bible, to be present. Touch is very important in helping the person with AIDS feel they are not rejected. Every church member, young or old, can have a role in helping people infected with HIV. Physical comfort and care involve:  daily exercise, like taking a walk every day if possible or good positioning and charging of position in a bed or chair,  a clean body and environment  healthy food. Persons with AIDS may have mouth sores or trouble eating some foods. It is still very important that a good diet is maintained. Good food choices should include milk, eggs, maize, millet or wimbi porridge, cooked vegetables with maize or rice, fish, lentils and beans. Soft fruits such as papaya, bananas, or mangos aid in digestion. It is important to encourage drinking lots of pure water since dehydration from diarrhea is a very real danger. People with AIDS may not be able to eat a lot at one time. It may be necessary to provide small but frequent meals (every 2‐3 hours). Control of Infection Persons with AIDS pick up common infections very easily and may not get over these ordinary illnesses like a healthy person would, since their immune system is very weak. So it is important to prevent infection as much as possible. Common germs may cause skin infections, and stomach problems. Careful cleaning of the environment and skin, 90
clean water, and well cooked food not contaminated by flies or rodents will help to control infection. Good ventilation in the room or home is important. When diarrhea is a problem, make sure that the patient receives enough fluids to drink. If needed, use ORS (oral rehydration solutions). To care for the patient, place a piece of think plastic on the bed, cover with newspapers, and then cover with a bed sheet or towel. It is important to have a clean cloth next to the patient’s skin. Whenever the skin is soiled, it should be cleaned with soap and water and thoroughly dried with a towel. After washing is a good time to change the person’s position in bed to help prevent bedsores and pneumonia. While caring for a patient, remind them to take good deep breaths often throughout the day. The bed sheets and clothes should be carefully washed. It is helpful to keep a supply of clean rags or nappies available for clean–up. If there is blood anywhere, the care provider should protect themselves while working by covering their hands with plastic bags or wearing plastic gloves. Any blood on clothing or sheets should be soaked in a 10% bleach solution (one part bleach to ten parts of water) and then hung outside in the sun to dry. The family of a person with AIDS may need help with cleaning, shopping, garden digging, water carrying or patient care. The church can create a healing community environment around such a family! 91