Making practice visible : analysing the interactional tasks of voluntary counselling and testing.

Abstract

Voluntary counselling and testing, the cornerstone of HIV/AIDS prevention efforts worldwide, is at the centre of a policy debate rega rding its effectiveness. Informed by social constructionism and drawing on various tools from ethnomethodology and conversation analysis, a sample of twenty-seven vid eotaped simulated counselling interactions in South Africa was analysed. The aim was to assess how the interactional tasks of the voluntary counselling and testing sess ion were worked through by clients and counsellors, and how this was done against the publ ic health and counselling frameworks that inform voluntary counselling and testing pract ice. The goal of the analysis was not to examine practitioners’ competencies, but to exam ine their unfolding actions in the situation and to consider the interactional functio ns these actions might serve. The results show that of the three interactional ta sks of voluntary counselling and testing, information-giving lays the foundation upon which the advice and support goals are realised. It is constructed as critical to client a nd counsellor identities and is a powerful tool through which hope is dispensed. Both the info rmation-giving and support tasks of voluntary counselling and testing combine to manage client distress into more concrete and manageable terms that encourage client coping. Counsellors draw on a range of advice-giving strategies – those that place the onu s of responsibility on the client to those that view the counsellor as the moral guide able to direct client change – in order to encourage clients to reflect on their risk behaviou r. In general, voluntary counselling and testing is framed as a moral activity, and this is most evident in the advice-giving segments. The public health and counselling framewo rks that inform voluntary counselling and testing create a dilemma for counse llors. In practice, counsellors orient towards a directive and health-advising role rather than a non-directive, client-centred counselling role. The implication of this research is that voluntary counselling and testing needs to be defined and framed more clearly – i.e. as a public health intervention with preferred outcomes that draws on a set of client-centred skills. Reconceptualisations of voluntary counselling and testing need to acknowledge the mor al framework under which it operates. Clear implementation guidelines (and training) on what voluntary counselling and testing is and that define its goals more clearly will be useful in assisting counsellors to implement the policies that govern their practice.