Research to examine, understand, and improve the usefulness and effectiveness of HIV counseling and testing (HIV CT) has been challenging, to some extent because of a less than fully articulated conceptual framework. The goal of this article is to place HIV CT in a conceptual and theoretical context, not only of counseling and psychotherapy but also of a larger framework of models of behavior change. Counseling approaches are also compared with respect to how well they address five tasks of HIV counseling: relationship building, risk assessment, dissemination of information, behavior change, and emotional and coping support. No single counseling approach was found to meet all of these tasks. Behavioral and cognitive-behavioral approaches were considered most relevant to the tasks of HIV counseling, whereas client-centered and crisis counseling approaches were appropriate for the relationship building and emotional/coping support components of HIV counseling. In addition, this article provides a more differentiated view of HIV CT and suggests how further research into the effectiveness of HIV counseling can be informed by primary underlying counseling theories.