Individual health education is an important part of your work and it takes place when you exchange opinions, feelings, ideas or information with another person. It can be more powerful than other methods of communication in bringing about behavioural change. Using individual opportunities will help you to create mutual understanding with the other person and help you to get to know each other more closely. Your sessions should promote frankness between you and the other person and help you develop the ability to give and receive feedback immediately. It also creates the opportunity to discuss problems which are sensitive and need special handling, for example discussions on sexuality. You can do counselling on home visits or undertake community practitioner — client interaction in many other settings.

Counselling (one-to-one communication) is a helping process where one person explicitly and purposefully gives his or her time to assist people to explore their own situation, and act on a solution. The process includes several steps through which the counsellor first understands the problem and then helps people to understand their problem for themselves. After this the counsellor needs to work together with the person to find solutions that are appropriate to their situation (Figure 11.2). Counselling involves helping people to make decisions and gives them the confidence to put their decisions into practice.

Counselling is not advice — it is a helping process in which people are helped to make choices. Advice on the other hand is usually based on opinions or suggestions about what could be done about a situation or problem. It is an opinion given by someone who is considered to be an expert. With advice, the decision is made by the health worker — and then the clients are expected to follow that decision. In counselling, the decisions are made by the clients themselves.

Before you read any further, ask yourself why you think advice might not be appropriate in health counselling?

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There are two main reasons. First, if the advice is right the person may become dependent on the expert for solving all their problems in the future. Health education work in general and counselling in particular aim to help people to become self-reliant. Second, if the advice turns out to be wrong the person will become angry and no longer trust the health worker.

You may be able to use counselling to help individuals think about their problems and help them gain greater understanding of the issues. There are several clear steps in the counselling process:

During your counselling work as a Health Extension Practitioner you will need to develop some rules and follow certain principles of counselling. Of course, counselling can't do everything for everyone, and you need to recognise your own limits and the limits of the counselling process.

You must always make sure that it is the person who needs help who makes the final decisions about their own lives (Figure 11.3).

You should always ensure confidentiality and tell the truth, even if that is difficult. Confidentiality and truth-telling are two of the ethical principles covered in detail in the Module on Health Management, Ethics and Research.

Box 11.1 gives some of the most important rules to keep in mind for counselling.

Box 11.1 Rules for counselling

Good relationships: A counsellor must build a good relationship from the beginning with the person they are trying to help.
Feelings: A counsellor should develop empathy (understanding and acceptance) for people's feelings, not sympathy (sorrow or pity). The counsellor's task is to listen carefully. Empathy is the ability to imagine yourself in someone else's situation so you can get a better sense of what they are feeling and experiencing. It involves understanding the client's verbal and emotional behaviour. It requires comprehending another person's feelings, emotions and perspective, rather than imposing your own.
Identifying needs: A counsellor seeks to understand a problem as the client sees it from their point of view. The clients must identify their own problems for themselves. The use of open questions will help here, not just those questions requiring a yes or no answer.
Participation: As a counsellor you should work with the clients towards finding their own solution. A counsellor should never try to persuade people to accept their advice.
Privacy and confidentiality: Information that you might gather during your work, especially during counselling, must be kept secret from all other people, even from the client's relatives. The places where you do counselling should be arranged in such a way that noone can listen to your private discussions.
Provide information: Although counsellors do not give advice, as a health worker you should share information and ideas on resources which the clients may need in order to make an informed decision.

Based on what you have read so far, write down briefly what you think counselling aims to achieve.

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Counsellors encourage people to recognise and develop their own coping capacity, so that they can deal more effectively with problems. In counselling, you not only help people think clearly about their immediate problems, you also help them to recognise and draw upon their own resources, which they can use for resolving the future problems they encounter.

Counselling is about creating new perspectives and change. The change may be inside the person (helping them to feel differently about a situation); or a change in their behaviour (for example practising safer sex), or a change in something in their environment (for example setting up a support group).