9 - Psychotherapy

Summary

Introduction

HIV infection presents a series of challenges to the psychotherapist, testing his or her ability to respond compassionately and sensitively. The psychiatrist will often benefit from a thorough working knowledge of the issues faced by people infected with HIV.

In most ways, people living with HIV do not differ significantly from other psychotherapy patients. The main differences are:

1. the ongoing possibility of crisis

2. uncertainty about the future

3. The complex nature of HIV disease expression, antiretroviral treatments and associated side-effects

4. the strong countertransference reactions these patients may evoke.

Therapists should try to adapt the psychotherapy method they are most comfortable with to the special needs of the person living with HIV. Although most forms of psychotherapy are likely to be helpful for people living with HIV, a psychiatrist's formulation of the case and knowledge of differential therapeutics should inform the method choice.

Due to its potentially fatal outcome, HIV disease has the effect of imposing time pressure on patients, which may serve as a catalyst for work in therapy and make brief models ideally suited to this group of patients. They may feel more comfortable doing one or more successive “pieces of work” in therapy as they progress through different stages of the illness and their needs change. On the other hand, with the advent of HAART, people living with HIV now have indeterminate life expectancies and may benefit from the insight and knowledge gained from open-ended psychotherapy.