Concepts, goals, and techniques of counseling: review and implications for HIV counseling and testing

Research to examine, understand, and improve the usefulness and effectiveness of HIV counseling and testing (HIV CT) has been challenging, to some extent because of a less than fully articulated conceptual framework. The goal of this article is to place HIV CT in a conceptual and theoretical context, not only of counseling and psychotherapy but also of a larger framework of models of behavior change. Counseling approaches are also compared with respect to how well they address five tasks of HIV counseling: relationship building, risk assessment, dissemination of information, behavior change, and emotional and coping support. No single counseling approach was found to meet all of these tasks. Behavioral and cognitive-behavioral approaches were considered most relevant to the tasks of HIV counseling, whereas client-centered and crisis counseling approaches were appropriate for the relationship building and emotional/coping support components of HIV counseling. In addition, this article provides a more differentiated view of HIV CT and suggests how further research into the effectiveness of HIV counseling can be informed by primary underlying counseling theories.