Mental health counselling for abused women tional and realistic and change self-defeating and stress-producing thoughts to those that are more self-enhancing and reduce stress reactions. The fi- nal component of this model encourages clients’ behaviours and strategies to enhance their overall well-being to buffer the effects of future stressors and life changes. To the extent possible, the following guidelines for feminist therapy were followed in implementing the framework described above: (a) exploring the prescribed roles for women in society and contra- dictions within the context of the woman’s story. For example, in Bangladeshi families, a husband is generally supposed to be the income-earner, and a wife is supposed to perform household chores. Even if the husband fails to bring home food, he may beat his wife for not having a meal ready. Fol- lowing the feminist theory, these explorations of contradictions are expected to help validate the ex- perience of the woman and shift the responsibility from the victim to the perpetrator (26); (b) making the session a shared inquiry between paramedic and client, where the paramedic uses a participatory ap- proach based on an equal relationship (27-29); and (c) recognizing the importance of empowerment of the woman following feminist therapists (29-30) and defining it as a process whereby the woman was encouraged to make her own decision, hon- our her own feelings, and choose her own action. Women were given opportunities to explore their inherent coping abilities and capacity for self-heal- ing. As Yam notes that it is important to view the woman as a person who can make decisions and collaborate with others to solve her problem, allow- ing the woman to express her feelings to a non- judgemental and empathetic person and make her own decisions about the future (31). Mental health counselling was provided to women reporting physical or sexual violence or suicidal idea- tion or attempt. Counselling service was offered during March 2004–June 2005, and women who agreed to come for the first session were assigned an appointment. All the women who attended the counselling session did so at least several months after the delivery. Women who reported both physical and sexual violence and suicidal ideation or attempt during the interview were invited first for an individual counselling session. Once this list of women was exhausted, women exposed to only one of the forms of violence and suicidal ideation were invit- ed for the session. Women exposed to any one of Volume 27 | Number 4 | August 2009 Naved RT et al. the forms of violence but not reporting any suicidal behaviour, i.e. suicidal ideation or attempt, were in- vited to the session at the final stage. Counselling service was offered and provided until the funds for providing such service were exhausted. ICDDR,B arranged transport for bringing women from home to the subcentres for the first session. In total, 416 women were contacted, and 410 women attended the first session. The paramedics were instructed to request the women to contact the Community Health Research Workers of ICDDR,B to make an appointment for a consecutive session. No trans- port was provided or conveyance was paid for con- secutive sessions. Refreshments were arranged in all the sessions. In total, 402 women attended one ses- sion; nine women came for a second session; two women came for a third session; and one woman came for the fourth session. The counselling service was provided once a week at four ICDDR,B local clinics in Matlab known as subcentres. A maximum of three counselling ses- sions were conducted per day. Counselling was provided under close supervision of a trained mental health counsellor having a master’s degree in psychology. For the first six months, debrief- ing sessions were conducted at the end of each counselling day. Challenges in providing counsel- ling and possible ways of overcoming these were discussed with the paramedics. Weekly group meetings were held with paramedics for sharing of experience and guidance by the supervisor. A counselling expert and academician with long experience in conducting counselling sessions for abused women worked as an advisor to the proj- ect. The supervisor regularly consulted the advisor. The advisor conducted several discussion meet- ings with the whole team. This study evaluated this service through follow-up of women who availed of it. Specific objectives of the study included assessment of: (a) organizational aspects of the session, such as timing, waiting time, and the length of the session; (b) ethical guidelines followed in the intervention, such as maintenance of privacy and confidentiality; and (c) paramedic performance, measured by attitude and behaviour, ability to understand participant’s narratives, en- couragement for exploring a way out of violence; (d) usefulness of the service; and (e) determinants of usefulness of such service for abused women. MATERIALS AND METHODS Both qualitative and quantitative research methods 479