Guatemala is a lower-middle income country (World Bank, 2018) that is affected by structural problems of inequality, exclusion, and extreme poverty. Guatemala is exposed to regular natural disasters and humanitarian crises. Violence and high levels of organised crime activity leave many vulnerable. According to the Pan American Health Organisation (PAHO 2015), 23.4% of the population lives in extreme poverty, with 34.2% of the potential workforce being unemployed. Although an officially approved mental health policy exists (WHO, 2014), only 1.46% of the total government health budget is spent on mental health.
Guatemala is a culturally and socioeconomically diverse country. According to Grazioso, Keller, Swazo, and Consoli (2013), this is reflected in the vast differences in the way in which counselling services are delivered, with one type of counselling carried out by indigenous shamans, religious, and community leaders and the other through formal counselling training. While counselling has its origins in clinical and psychological disciplines, it is now emerging as an autonomous profession.
Toro-Alfonso (2009) describe counselling services being provided for family planning, HIV/AIDS, posttraumatic stress disorder for either natural disasters or violence, addictions, and intra-family violence. Grazioso et al. (2013) describe a further divide between rural and urban counselling services with urban services delivered in private practice settings by psychologists or professional counsellors with formal education and training. In rural settings, people are generally living in poverty and counselling is delivered by an elder, or leader, of a town or village. Payment is often by way of a donation of a good or service.