Psychotherapy and HIV: Assessment and Intervention. PHASE, Canadian Psychological Association and Health Canada Module developed by Paul C. Veilleux, Ph.D. UHRESS - Centre Hospitalier de l’Université de Montréal Montreal, Quebec. HIV and CD4 Cell Counts Typical of an Untreated HIV Infection.
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PHASE, Canadian Psychological Association and Health CanadaModule developed by Paul C. Veilleux, Ph.D.
UHRESS - Centre Hospitalier de l’Université de Montréal
The assessment must include:
The assessment must include:
Headaches, feeling ill, asthenia, insomnia, dreams, agitation, mania, auditory hallucinations, confusion
Headaches, asthenia, feeling ill, confusion, depression, convulsions, excitability, anxiety, mania, early wakening, insomniaIs it an adverse drug reaction?
Headaches, confusion, trouble concentrating, somnolence, asthenia, depression, convulsions, peripheral neuropathy
Nervousness, anxiety, confusion, convulsions, insomnia, peripheral neuropathy, pain
Insomnia, deliriumIs it an adverse drug reaction?
Visual hallucinations, depersonalization, tearfulness,confusion, thought insertion,insomnia
Delirium, peripheral neuropathy
Paresthesia, convulsions, headaches, irritability, hallucinations, confusionIs it an adverse drug reaction?
Confusion, paranoia, hallucinations, mania, coma
Depression, loss of appetite, insomnia, apathy
Psychosis, somnolence, depression, confusion, shaking, vertigo, paresia, convulsionsIs it an adverse drug reaction?
Depression, weakness, headaches, myalgia, confusion
Confusion, anxiety, emotional lability, hallucinations
...Is it an adverse drug reaction?
Adherence vs compliance
Transmission of HIV
Sense of one’s lifePossible Issues and Themes
Shame and guilt
Dependency, Loss of control
Fear of dying
Loss of a future
Envy of the healthy
Relationship with medical professionals
Winiarski, 1991Psychotherapy Themes
Coming to terms
Planning for the future
Interpersonal (partner, family, friends…)
Institutional (employment, community and medical services…)
Exploration/ resolution of family issues
Working through grief and loss
uncertaintyGoals of Psychotherapy
Knowledge of biomedical aspects
frequency.What’s unique about HIV psychotherapy ?
“… movement along a continuum of psychotherapeutic care is suggested – ranging from encouragement of exploration to interpersonal dialogues to, if necessary and mutually agreed upon, case management. The professional should feel free, within one’s competence, to respond therapeutically to the ever-changing situations caused by HIV-related chronicity.”
(Winiarski, 1991, p. 48.)
Stress and coping
Case management.Types of Intervention
At the present time, there are probably too few studies to be able to answer the question about which is the “best” psychotherapy approach with a patient who is living with HIV. Individual, couple, family and group therapies have all produced good results. (Brouillette & Citron, 1997, pp. 64)
With the exeption of the ongoing risk of crisis and the fear that their infection and their feelings inspire in their therapist, people living with HIV are indistinguishable from other patients.(Le VIH et la psychiatrie, 1997, pp. 64)
Characteristics of a person in crisis :
(Roberts (1990), p. 9)
Process of working through the crisis event so that the person is assisted in exploring the traumatic experience and his or her reaction to it.
(Roberts (1990). Crisis intervention handbook, p. 11)
(Roberts (1990), p. 12)
Fear of disclosure
Viral load & T4 count results
Concerns about negotiating safer sex and/or needle use
First opportunistic infection
Confronting losses and death
etc.Events that might trigger a crisis
Medical treatment for HIV infection is one important source of hope because it offers a chance to live longer with a better quality of life. Medical breakthroughs in treating HIV/AIDS have occurred on two fronts:
a) the prophylaxis and treatment of opportunistic illnesses that develop when the immune system becomes severely compromised
b) the treatment of HIV infection itself. Since the beginning of AIDS, advances in medical treatment have doubled the life expectancy for people living with HIV (Kalichman, Ostrow & Ramachandran,1998).
A non-progressor is a person with HIV whose infection does not appear to progress toward AIDS after 10 or more years of infection (O’Connor, 1997).
When treatment fails, psychotherapy may return to focus on processes of grieving and loss
Our attitudes, beliefs, experiences about: