Basic HTML Version
Special attention needs to be placed on the assessment and mental status exami-
nation. About 40–50% of patients with HIV develop neurological symptoms (Levy,
1987). Abnormalities of cognition and behaviour are frequent side-effects of these
conditions. This AIDS dementia complex is a constellation of cognitive, motor and
behavioural abnormalities. On routine mental status examination the extent of the
cognitive impairment may not be readily apparent. Poor judgement and concrete
thinking may be noted. The HIV clinic at Hopkins reports that 20% of its patients
suffer from major depression at initial presentation (Treisman et al., 1994).
Anecdotal history from the client and concerned caretakers may present a recent his-
tory of increased isolation, loss of interest in friends and daily activities, neglect of
personal appearance, and decrease in spontaneous speech. Symptoms of AIDS
dementia complex have been mistaken for depression (Navia et al., 1986), but on
direct questioning clients will frequently deny subjective feelings of depression.
(2) Transition
The transitional stage occurs after the denial of the initial stage has dissipated.
Individuals are likely to present for treatment without any specific precipitating
events. Strong emotional responses are common, with behaviours that are not unlike
the traditional grief and loss reactions. Of particular concern during this phase is the
possibility of suicide, as feelings of desperation, isolation and hopelessness come to
the fore as the denial fades. Other issues may include social rejection from traditional
support systems, and the possibility of dementia with the sudden onset of mental
deterioration.
Treatment goals for this phase aim to maximize psychosocial function by supporting
adaptation and exploration of feelings. There are significant behavioural goals to be
met as well. Some of these goals include stress reduction, the decrease or alleviation of
drug and alcohol use, and an active investment in a personal wellness regime.
Hypnotic treatment in this stage frequently involves a metaphorical journey.
Metaphors that are often helpful are evolutionary topics such as the transformation
of a chrysalis to a butterfly.
(3) Acceptance
Clients are not as likely to present for therapy in the crisis matrix at this juncture.
They are likely to be in therapy already and to have accessed appropriate psychoso-
cial support. The acceptance phase is generally a long-term event as acceptance of
one’s HIV status is not a one-time event but a process. For those clients who do
achieve a measure of acceptance, the focus of the intervention shifts to ‘living’ and
maintaining psychosocial gains in the face of repeated challenges on all fronts: social,
economic, physical and spiritual. This is done in the face of the knowledge that there
will be further physical setbacks. The approach of this phase is to implement a philos-
ophy of supported empowerment.
(4) Preparation for death
In this stage of the crisis matrix the focus of the intervention completely changes. In
the previous three stages the emphasis has been on living. The spectre of death has
always been in evidence, but in this stage it comes to the forefront of the therapeutic
arena. Many of the interventions at this time may be of a concrete social nature. The
clinician may have to help the client with making a will and funeral preparations.
There may also be the opportunity to help the client through their death and dying
process, through visualization and hypnosis.
Hypnosis and HIV/AIDS
107