HIV: Therapeutic Strategies for Guilt, Uncertainty, and Taking Control

On this track and the next track, we will discuss managing emotions.  Clearly, your HIV positive client may be emotionally upset in some of the same ways as Chad.  Some of the emotions Chad, age 28, experienced were anger, depression, fear, guilt, and uncertainty.  Chad had contracted HIV through anal sex with another man.  The reasons for Chad’s emotions were clear to me without much explanation.  As you listen to this track, consider how traditional emotional management techniques can be changed to apply to HIV positive clients.

#1  Anger
The first of several emotions that Chad experienced after learning that he was HIV positive was anger.  As you know, anger is a normal response for many people when faced with a difficult change.  Chad stated, "It’s just not fair!  I know people who do the same things I did, and they tested negative.  The frustration just keeps building because I see all these people walking around who aren’t sick.  I know they aren’t to blame, but I’m mad enough already without blaming myself!" 

Think of your Chad.  Does your HIV positive client find it easier to feel anger than shame, guilt, resentment, or sadness?  I stated to Chad, "Anger may not feel as bad as some other emotions like resentment, guilt, or sadness.  You can yell and scream at others and it somehow becomes someone else’s problem." Clearly, anger is a justifiable response to an HIV infection.  Chad benefited from allowing himself to be angry, but redirecting his anger became the goal. 

-- I stated to Chad, "First, try to separate the anger from the erroneous or wrong target."  Chad had targeted himself and people that were close to him.  Chad stated, "I’m not really mad at anyone in particular.  I guess I’m actually mad at the disease and the circumstances." 
-- Second, Chad found alternative mechanisms to discharge his anger. Clearly, alternatives to angry expressions differ for each client. 

Some clients benefit from exercise, meditation, or talking to family members and close friends.  Chad began jogging initially, but as his HIV progressed, Chad began to tire easily. Chad then began a journal in which he could write out his anger. Could your HIV positive client benefit from an anger journal?  What other alternatives could you suggest.

#2  Depression
The same frustration that led to Chad’s anger later led to his second emotional experience which was depression.  Chad stated, "HIV is in my dreams!  It just festers in my mind and turns to hopelessness."  For clients dealing with an HIV infection like Chad, depression, like anger, is a reasonable emotional response.  Chad’s depression was also caused by the inevitable symptoms of HIV.  Chad stated, "I have to go to this clinic for treatment and other people with HIV are there!  Man, they are so much worse off than me!  It’s so depressing to think that I’m going to be one of them one day!" 

To help Chad deal with his depression, I stated, "Mild depression as a natural response to HIV infection usually runs its course within days or weeks, and then goes away.  For some clients, depression goes away without intervention.  However, activity can help dispel mild depression.  Physical activity like boating or fishing works.  Also, mental activities like reading or theater can help take the edge off your depression." 

Think of your Chad.  Could activity help your client with depression?  I realize this is a common treatment for depression, but some times I know I need to be reminded of the obvious. 

 I also asked Chad to consider accomplishing something.  I stated, "No matter how small, a sense of accomplishment can be a great weapon against depression.  One small accomplishment can lead to the hopefulness to embark on the next small accomplishment and so on until you recover your normal habits of life."  Chad later stated, "Cleaning off a part of a shelf in my closet actually did make me feel better, so tomorrow I’m going to clean off another part of that same shelf."  Could your HIV client benefit from an increase in accomplishments?  If so what small accomplishment could he or she set?

Though using activities and accomplishments to redirect a client’s attention away from internal problems and HIV may be sufficient for treating mild depression, your client may experience more severe depression. Obviously if your diagnose your HIV positive client as being clinically depressed, the previously techniques may need to be substituted for more aggressive treatment measures such as medication.  Would you agree? 

Also, as you know, if certain medication treatments for HIV or AIDS related dementia causes your client’s depression, changes in dosage or additional medications are available. Does your client experience anger or mild depression as a result of an HIV infection?  Could the techniques on this track be adapted to benefit your client in dealing with depression or anger?

On this track we have discussed managing emotions.  Two emotions commonly experienced by HIV positive clients are anger and depression.

On the next track we will continue our discussion on managing emotions.  Three additional emotions we will discuss are fear, guilt, and uncertainty.

Online Continuing Education QUESTION 1
How can an HIV positive client productively redirect anger? To select and enter your answer go to CEU Answer Booklet.