Treatment Issues: Newsletter of Current Issues in HIV/AIDS - Volume 18, Number 3 & 4, March / April 2004
Betty Kohlenberg

"Making a Plan" (MAP) is a career counseling program for closed groups of eight to twelve clients who attend a two-hour session weekly for eight weeks. The MAP group counseling program began as a project of the Positive Resource Center (PRC), a San Francisco agency offering employment services exclusively for people living with HIV/AIDS. The groups were a response to an increased client need within an environment of limited staff availability, stemming from a recognition that among the barriers that keep people with HIV/AIDS from returning to the workplace is the problem of insufficient career counseling resources to adequately serve those clients who wish to expand their personal options and develop new work goals. MAP programs at PRC are repeated approximately four to five times annually.

The group counseling program offers people with HIV career counseling support while they identify and plan training and employment goals in a series of eight weekly group sessions. The development of a personal plan for pursuing training and employment is an explicit goal of program participation, though there are also a range of somewhat more implicit goals of psychosocial support and amelioration of cognitive and affective barriers to considering work. All participants are expected to focus on employment, as is indicated by the group name — "Making a Plan" — which was proposed and adopted by the first group's participants. The weeks' activities are structured, focusing on exploration of the individual's characteristics leading to the choice of a job goal, and further exploration of the needs of the world of work. The most common result is a plan of the steps needed to prepare the individual for entry into the chosen field.

While the activities are structured, the outcomes of the program are not. A wide range of outcomes — as long as they are made on an informed basis — is acceptable at the end of MAP, including: starting a new work situation; removing the pressure to return to work; deciding not to change the work situation; deciding to defer a decision to change the work situation; or resolving the pressure to change through non-work means.

During the period September 1999 through February 2004, 20 MAP groups were conducted at Positive Resource Center with a total of 210 participants. The MAP groups were advertised and made available to all clients of PRC who could commit themselves to attending eight weekly two-hour sessions. Service Coordinators at PRC specifically recommended participation to clients whom they identified as in need of and ready for the structured support of the program. Clients who were not interested in working, who were not physically or psychologically able to work or who would not be consistently available during the eight scheduled weeks were encouraged to enroll in later groups. No one who self-identified as interested and willing to participate was excluded from participation.

The MAP groups are based on the "Client-Focused Model for Considering Work for People with HIV," an approach that takes into account a full range of life concerns, categorized as 1) medical, 2) legal/financial, 3) psychosocial and 4) vocational domains.

Consideration of all four domains of influence allows a person thinking about work to understand the effects of employment decisions on all aspects of his or her life and allows him or her to make an informed decision. Not weighing the consequences of entering the work force on each of these domains could potentially cause serious harm to a person living with HIV/AIDS, since work-related activity and income can trigger the loss of important benefits, including income, health insurance, housing and medical care. Loss of benefits can be particularly serious in the event of subsequent deterioration in health status. People who begin to think about work are often overwhelmed by the complexity of considering all of these aspects of their lives simultaneously and often find themselves swirling in indecision and lack of information, unable to move ahead.

As a closed career counseling group of limited duration, the MAP program focuses on increasing participants' awareness of the specific inter-related factors involved in making a decision about employment and positively impacting those factors. This format can be an efficient way of conducting counseling, particularly where staff resources are limited.

For more information: www.bkohlenberg.com

Betty Kohlenberg, M.S., CRC, ABVE, counsels people in career transitions in the San Francisco Bay area.

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