The Elements of Counseling Counseling about family planning and other reproductive health matters often has 6 elements. You can remember the 6 elements with the letters in the English word GATHER. Or you can find words in other languages to help you remember. Counseling should suit each client. Not all clients need to be counseled in this order. Not all clients need all 6 GATHER elements. Some will need an element repeated. Counseling should change to fit the client's needs.
G	Greet Clients Give clients your full attention as soon as you meet them. Be polite, friendly, and respectful: greet clients, introduce yourself, and offer them seats. Ask how you can help. Tell clients that you will not tell others what they say. Explain what will happen during the visit. Conduct counseling where no one else can hear. Click here for more about Greeting.
A	Ask Clients About Themselves Ask clients about their reasons for coming. Help clients decide what decisions they face. Help clients express their feelings, needs, wants, and any doubts, concerns, or questions. Ask clients about their experience with the reproductive health matter that concerns them. Keep questions open, simple, and brief. Look at your client as you speak. Ask clients what they want to do. Listen actively to what the client says. Follow where the client leads the discussion. Show your interest and understanding at all times. Express empathy. Avoid judgments and opinions. Ask for any information needed to complete client records. Click here for more about Asking.
T	Tell Clients About Their Choices To make informed choices and good decisions, clients need clear, accurate, specific information about the range of their choices. Help clients understand their possible choices. Information should be tailored—that is, important to the client’s decision. Information should be personalized—that is, put in terms of the client’s own life. If clients are choosing a family planning method: Ask which methods interest them. If no medical reason prevents it, clients should get the methods they want. Ask what they know about these methods. (If a client has important information wrong, gently correct the mistake.) Briefly describe the client’s preferred method. Be sure to tell about:       1) Effectiveness as commonly used,       2) Briefly, how to use the method,       3) Advantages and disadvantages,       4) Possible side effects and complications. Mention other available methods that might interest the client now or later. Ask if the client wants to learn more. Use samples and other audiovisual materials if possible. Explain that condoms are the only family planning method that offers reliable protection against STDs. Click here for more about Telling.
H	Help Clients Choose Tell clients that the choice is theirs. Offer advice as a health expert, but avoid making the clients’ decisions for them. To help clients choose, ask them to think about their plans and family situations. Help clients think about the results of each possible choice. For family planning methods, some key questions may be:       1) “Are you breastfeeding?”       2) “Do you and your partner want (more) children?”       3) “Do you or your partner have sex with anyone else?” (To gauge STD risk) Ask what the client’s sex partner might want. Ask if the client wants anything made clearer. Reword and repeat information as needed. Explain that some family planning methods may not be safe for clients with certain medical conditions. Once a client states a choice, ask about these conditions (see yellow chart). If a method would not be safe, clearly explain why. Then help the client choose another method. Check whether the client has made a clear decision. Specifically ask, “What have you decided to do?” Wait for the client to answer. Click here for more about Helping.
E	Explain What to Do After the client has made a choice: Give supplies, if appropriate. If the method or services cannot be given at once, tell the client how, when, and where they will be provided. For voluntary sterilization, the client may have to sign a consent form. The form says that the client wants the method, has been given information about it, and understands that information. Help the client understand the consent form before signing. Explain how to use the method or follow other instructions. As much as possible, show how. Describe possible side effects and what to do if they occur. Explain when to come back for routine follow-up or more supplies, if needed. Explain any medical reasons to return. Ask the client to repeat instructions. Make sure the client remembers and understands. If possible, give the client printed material to take home. Mention emergency oral contraception (see emergency oral contraception). Tell clients to come back whenever they wish, or if side effects bother them, or if there are medical reasons to return. Click here for more about Explaining.
R	Return for Follow-Up At a follow-up visit: Ask if the client has any questions or anything to discuss. Treat all concerns seriously. Ask if the client is satisfied. Have there been problems? Help the client handle any problems. Ask if any health problems have come up since the last visit. Check if these problems make it better to choose another method or treatment. Refer clients who need care for health problems. Check if the client is using the method or treatment correctly. Check whether the client might need STD protection now. If a client is not satisfied with a temporary family planning method, ask if she or he wants to try another method. Help the client choose, and explain how to use. Remember—changing methods is normal. No one really can decide on a method without trying it. Also, a person’s situation can change, making another method a better choice. If a woman wants her IUD or implants taken out, arrange for this. If she plans pregnancy, suggest where to get prenatal care. Click here for more about Returning.

GATHER Elements:	Greet	Ask	Tell	Help	Explain	Return	Charts	Contents