Structure of the Intervention Sessions
6 weeks > 1 session per week > 30 to 45 minutes each > home visits if needed
The intervention is structured over six weeks. Sessions are 30–45 min delivered through the Friendship Bench over 6 weeks, including home visits where deemed necessary. The first session is generally longer, lasting between 45 and 60 minutes. The first session includes 3 components called Opening the Mind (kuvhura pfungwa), Uplifting (kusimudzira), and Strengthening (kusimbisa), with subsequent sessions building on the first.
Sessions are structure in a 3 part action plan, as explained below.
Problem identification • KUVHURA PFUNGWA, OPENING THE MIND
• LHW screens the client with the Shona Symptom Questionnaire (SSQ-14) outlining symptoms of depression
• The client then shares their story with the LHW. The LHW actively listens and provides empathy. The LHW helps the client identify and list all the problems that they are facing and writes them down on the Friendship Bench Card.
Problem exploration • KUSIMUDZIRA, UPLIFTING
• Once the client has finished sharing their story, the LHW clearly reflects back to them a summary of what they have heard, the problems the client identified and checks if they have understood correctly or missed anything. Then the LHW helps the client prioritise their problems.
• Client and LHW brainstorm practical/feasible solutions from the problems listed, they outline options available (client is active in this), the LHW encourages the client to think over solutions of each problem before having the decide which one to focus on. The LHW helps the client to come up with an action plan of specific, measurable, achievable and realistic solutions (clients are not told what to do). They set an appointment date and time for their next meeting.
ReassurE AND ENCOURAGE • KUSIMBISA, STRENGTHENING
• The LHW can phone, send an SMS, or conduct a home visit before the second meeting if they feel the need to provide continued support and reassurance to their client.
• On the second session the LHW checks in with client on how the previous action plan went.
- If it went well, then they provide ongoing encouragement & reassurance. And discuss which problem to work on next.
- If there was no progress or new obstacle have come up then the client and LHW go back to PART 1; they redefine the problem and brainstorm, they explore what the obstacles are and they then carry on with PART 2; brainstorming and exploring solutions.
• If the client and LHW seem to both feel they are not managing to find solutions then the LHW supervisor is called to helo or take over with the client.
Peer Support Group • CIRCLE KUBATANA TOSE, HOLDING HANDS TOGETHER
After 4 individual sessions on the Friendship Bench, clients are invited to join a CKT circle.
These circles are peer led groups that provide women and men ongoing support. A circle is a safe space for people to come and share how they are coping with life or how they feel they aren't coping with life.
We have found, and research has proven, that it is important to listen to others' experiences and to share your own experiences as part of the recovery journey. There is so much wisdom to be learnt and passed on in lived experiences. When someone shares their problems and how they have overcome them or are managing to cope with them, it serves as hope for a peer who may be going through a similar experience but cannot see that it is possible to get through. Whether that is an HIV positive diagnosis, divorce, a lost child or depression, it helps to connect to someone who understands and who you can relate to. This bring a strong feeling of connection and belonging.
At the weekly meetings, a talking piece goes around which gives people time to share their personal experience without being interrupted and to indicate to the others in the circle that there should be a respectful silence so that the sharing person feels heard and their presence is acknowledged. What is said in a circle stays in the circle, confidentiality is stressed.
Another part of CKT and important for a person’s recovery is behavioural activation. This consists of teaching clients to crochet items such as bags, baskets, mats or purses made from recycled plastic materials, the latter being an income-generating skill for participants. Besides being a form of income it is also found that keeping busy, having purpose and feeling productive helps clients minds become more peaceful, they say when they crochet they 'don't think too much'. This is ideal for what we are working on, which is 'kufungisisa'- thinking too much.
Circles vary in size, age, gender, religion and mental health condition of the participants. When groups meet they are there for a common cause; and that is mental health recovery and support. Clients join the groups and although they start with a 'standard operating procedure' eventually they develop it to suit themselves, they unanimously agree on the time and date to meet, whether they like to open in prayer or prefer a song. It's about getting the people to take ownership and learn group decision making skills.
A brief intervention summary
When you visit a Friendship Bench you will be met by a lay health workers (LHW) who will deliver a problem solving intervention. All LHW have an average of 8 years of education, their previous training is in home based care for people living with HIV & AIDS, in community follow-up of persons on TB treatment and in delivering community health education and promotion.