South Africa currently lacks HIV counselling interventions that are youth-specific and that meet the psychosocial needs of young people living with HIV/AIDS. Indigenous strategies and interventions need to be developed that cater for the psychosocial needs of South African youth living with HIV/AIDS. By using Participatory Action Research (PAR) a Cognitive-behavioural-based Counselling Intervention Programme (CBCIP) was developed for use in a rural South African town. This article discusses the participatory action process involved in the development of the CBCIP. It shows how PAR theory relates to practice by highlighting the benefits, challenges and caveats in applying PAR within a rural setting. The lessons that were learned in the development of the CBCIP may provide future researchers with useful insight and foresight in the development of HIV counselling interventions for young people living with HIV/AIDS in South Africa.