DRAFT_manual_15.01.16

["the Friendship Bench problem solving therapyExample:The counselor encourages S. to think of solutions. The counselor writes everythingdown. At this step, they do not discuss the solutions for their feasibility.Image III: S.\u2019 solution listCould keep on avoidingCould go to spiritual healer and ask what to doCould write letter to the man and ask himAsk pastor what to doTalk to the friend who told her she is + and ask her how to go about itPray harderNever see the man againLeave the city and move kumushajust stay in bed and never wake up againgo to the clinic in the neighbourhoodgo to a testing clinic in towntake a friend and go to the clinictake headache pills for the pain 101","the Friendship Bench problem solving therapy \t Problem solving should be done in several steps: 1.\t How does the client deal with problems? 2.\t How to recognize a problem? 3.\t How to select a problem, find the goal and define the problem? 4.\t How to brainstorm for solutions? 5.\t How to select a solution? 6.\t How to make a SMART action plan? 7.\t Did it work?5. \tHow to select a solution?\t (3 sub-steps: first selection, grouping, evaluating)Our client has probably come up with many possible solutions. We have to teach the client to sortthrough all these solutions. FIRST SELECTION At first, together with our client we check for solutions that can be discarded as they are unrealistic, pretty impossible or even dangerous for her or him. GROUPING The remaining solutions are looked at in terms of similarity and we encourage the client to group them. EVALUATING The clients looks at two or three of the groups (if there are that many) and assesses those according to feasibility, impact on her or his wellbeing, impact on others, time, effort, costs and benefits.\uf046\tHOW TO DO IT? FIRST SELECTION We ask our client: \u201cIs there any solution here on the list that appears not practical right away? Cross it out.\u201d GROUPING \u201cPlease look at all your solutions and see if any are similar, somehow belong together and can be grouped!\u201d EVALUATING \u201cCheck the group(s) for the best feasible solution! How feasible is it? How would it impact on your own wellbeing? What impact would it have on others? How long would it take? What would it cost you? What benefit would you have from it?\u201d 102","the Friendship Bench problem solving therapyExample:FIRST SELECTIONThe counselor discusses with S. if there is any solution on her list that appears notpractical or simply not clever.\t Image IV: S.\u2019 solution listCould keep on avoidingCould go to spiritual healer and ask what to doCould write letter to the man and ask himAsk pastor what to doTalk to the friend who told her she is + and ask her how to go about itPray harderNever see the man againLeave the city and move kumushaJust stay in bed and never wake up againGo to the clinic in the neighbourhoodGo to a testing clinic in townTake a friend and go to the clinicTake headache pills for the painGROUPINGThe counselor asks S. to see if any of her solution ideas are similar and can be grouped.S. has found two groups of possible solutions. She decides to leave the other optionsout. The one group stands for \u2018A: going to a clinic and getting tested\u2019, the other groupstands for \u2018getting help from a spiritual and\/or church person whom she trusts\u2019.\t Image V: S.\u2019 solution list with grouped options Could keep on avoiding Could go to spiritual healer and ask what to do Could write letter to the man and ask him Ask pastor what to do Talk to the friend who told her she is + and ask her how to go about it Pray harder Never see the man again Leave the city and move kumusha Just stay in bed and never wake up again Go to the clinic in the neighbourhood Go to a testing clinic in town Take a friend and go to the clinic Take headache pills for the pain 103","the Friendship Bench problem solving therapyEVALUATIONThe counselor asks her to judge both groups on their disadvantages and advantages.She also poses the following questions for S. to evaluate the solutions in more detail.Check the group(s) for the best feasible solution.\u2022 \u201cHow feasible is A?\u201d\t S. says she could go to the clinic, she knows where it is. She can walk there.\u2022 \u201cHow would it impact on your own wellbeing?\u201d\t S. says she is apprehensive, but nothing bad would really happen if she went.\u2022 \u201cWhat impact would it have on others?\u201d\t S. says her going to the clinic would not really impact others.\u2022 \u201cHow long would it take?\u201d\t S. says it would probably take her the whole morning.\u2022 \u201cWhat would it cost you?\u201d\t S. answers that it would not cost anything.\u2022 \u201cWhat benefit would you have from it?\u201d\t S. answers that she would be told about her HIV status and could then start \t\t\t taking medication if she had to. She expressed her worry around this topic.\uf0b6 \uf0b6Her counsellor takes a moment to inform her about HIV and ARVs. This helps S. a little. Questions we ask to assess these factors: \u2022\t How feasible is this solution? \u2022\t What impact will it have on you and on \t the people around you? \u2022\t How much time will it take? \u2022\t How much effort will it take? From whom? \u2022\t Are there any costs involved for you? \u2022\t How will it benefit you? 104","the Friendship Bench problem solving therapy\t Problem solving should be done in several steps:1.\t How does the client deal with problems?2.\t How to recognize a problem?3.\t How to select a problem, find the goal and define the problem?4.\t How to brainstorm for solutions?5.\t How to select a solution?6.\t How to make a SMART action plan?7.\t Did it work?6.\tHow to make a SMART action plan?This step evolves around figuring out exactly how to carry out the chosen solution. We have toencourage the client to make a very concrete action plan how she or he will go about solving her orhis problem. We will ask very specific questions and will also have to discuss what could get in theway of a possible solution.Once we have made the SMART action plan, we will write it on the FB card.The action plan has to be SMART which stands for The more the action plan\u2022\t Specific meets these criteria, the higher\u2022\t Measurable\u2022\t Achievable the chances of it being\u2022\t Realistic successful.\u2022\t Timely 105","the Friendship Bench problem solving therapy\uf046\tHOW TO DO IT? The following questions help the client to come up with a very precise plan on how to realize the action plan: \u2022\t How can you do it? \u2022\t When exactly can you do it? (which day, what time) \u2022\t Where exactly can you do it? How do you get there? \u2022\t Who can help you? Who can you do it with? \u2022\t What will you need to do it? \u2022\t What could get in the way of your plan and what can you do then?Example:The counselor asks S. how exactly she could go about her. Together they discuss all thedifferent aspects.\u2022 \u201cHow can you do it?\u201d\t S. plans to walk to the clinic.\u2022 \u201cWhen exactly can you do it?\u201d\t She will go on her own on Friday morning at 8am and will arrange to meet \t\t her friend in the afternoon. She doesn\u2019t need to take anything.\u2022 \u201cWho can help you?\u201d\t S. says she wants to meet her friend afterwards.\u2022 \u201cWhere exactly can you do it?\u201d\t She plans to go to the clinic in town where nobody knows her.Together with the counselor, they talk about possible obstacles such as someone seeingher and asking her where she goes \u2013 she would say that she goes to visit a friend.Another obstacle could be that it rains very heavily on Friday in which case she willtake some money from her savings and catch a bus. She already knows where to getoff the bus and how to get to the clinic.The most important information points are written on the FB card.The counselor is very happy with her progress and tells her so! 106","the Friendship Bench problem solving therapyImage VI: S.\u2019 FB card Date \t PID number \t Counsellor \t Clinic ZitaZuva Nhamba yemupangwi Nzvimbo wezano rachipangamazanoProblem that is worked on: Goals:avoid to know about \t need to know my statusH I V statusSmart action plan: Next appointment:Friday morning, walk to \t\t\tclinic, meet friend for \tsupport in afternoon at \t \t\t\t\ther houseAfter the action plan is done, we make a new appointment and send the client home to carry out theSMART action plan.We will also explain that it is important to come on time to the session and that she can contact us ifsomething comes up and she cannot make her appointment in which case we will make a new one.We stress that we really want to see the client again and hear about how it went for her. Do you need any more explanation? Or do you have any questions? Let's have a stretch, we've done alot of work getting through the first 6 problem solving steps , one more to go! 107","the Friendship Bench problem solving therapy \t Problem solving should be done in several steps: 1.\t How does the client deal with problems? 2.\t How to recognize a problem? 3.\t How to select a problem, find the goal and define the problem? 4.\t How to brainstorm for solutions? 5.\t How to select a solution? 6.\t How to make a SMART action plan? 7.\t Did it work?7.\t Did it work?We can only evaluate how the SMART action plan worked the next timewe see the client. The 2nd session: When we see the client again, we ask how carrying out the plan went. We want to know how it went and encourage the client to tell us details! If the client says that it went well, we explore the details and praise and reassure the client. We can now choose another problem of the problem list and repeat PST as described above. If the client says that she or he failed to carry out the SMART action plan, we explore what made it difficult. It is important to focus on the obstacles, treat them as \u2018problems\u2019 and find solutions for them. Obstacles can be of practical origin (i.e. the bus did not come) and also of emotional origin (i.e. was too scared). What counts for us is to empower the client enough for her or him to feel she or he can try it again. Most probably the SMART action plan has to be revised and discussed again.\uf046\tHOW TO DO IT?\t We can ask the client: \u201cHow did it go?\u201d\t \u201cWhat happened?\u201d 108","the Friendship Bench problem solving therapySpecial case:Many clients will come to us and say that they have no money.This is a very big issue for all of us. Such a big problem can make us feel very small and helpless,especially when we see how distressed our client is.The Friendship Bench Project does not give money nor does it have jobs for clients. It is importantto state this. We do not want to give false hope.We need to understand that we cannot solve the problem as it is presented to us. Therefore, we musttake this problem apart and find smaller, more solvable problems in it. Once we have been able to dothis, we can start working with our client using PST strategies.Questions that are helpful in this context are: 1. How have you been paying for your expenses so far? 2. What have you tried so far to make money? 3. What worked and what didn\u2019t work? 4. Why didn\u2019t some things work, what do you think? Just because one thing didn\u2019t work once, doesn\u2019t mean it cannot be tried again, maybe it needs to be modified and we can help the client to achieve this! 109","the Friendship Bench problem solving therapyExercise:B. was referred to the Bench. The LHW welcomes her and explains to her how theBench counselling is done. The counselor then invites her to share what is on hermind.B. is very upset and cries. She speaks about how she has no money for school fees forher children and not enough for food. She also has not paid the rent in two monthsand the landlord threatens to evict her. There is no income as she does not have ajob. Her husband has left her for another woman with whom he now has two morechildren.The counselor asks more questions about how B. has managed so far with nofinancial means. B. says that she got some money from an aunt ever so often andthat she had tried to sell tomatoes but that she felt that it was not worth her while asshe still could not make ends meet. She wonders if she maybe gave up too early withthe vegetable business. Right now she doesn\u2019t know what to do.While B. describes how miserable her life is at the moment, her counselor notices howB. seems very overwhelmed by the amount of problems she faces.She explains that she will teach B. a technique that helps to solve problems.Counselor and B. decide that it will help more to break the topic lack of moneydown into smaller topics and write all these down on a problem list\u20261.\t\t How does the client deal with problems?2.\t\t How to recognize a problem?3.\t\t How to select a problem, find the goal and define the problem?4.\t\t How to brainstorm for solutions?5.\t\t How to select a solution?6.\t\t How to make a SMART action plan?7.\t\t Did it work?In groups of 2-3 people with one councellor, one the client and one the observer,please go through the following questions and fill in:What problems will be on the list?\t No rent,\uf021Choose one problems of the problem list (meaningful, manageable, practical)\uf021 110","the Friendship Bench problem solving therapy Come up with a goal \uf021 Explore all details of the problem\uf021 Brainstorm solutions \uf021 Select a solution \uf021 SMART action plan \uf021 111","the Friendship Bench for your use\u2026Notes \u2026\uf021 112","the Friendship BenchChapter 10Questionnaires (FOR SSQ and PHQ-9)SSQ (Shona Symptoms Questionaire)H ere in Zimbabwe, we use the Shona Symptom Questionnaire (SSQ) to find out if someone is suffering from CMD.This is a questionnaire that has been developed and normed for Zimbabwe.We can also use the SSQ to find out if someone is getting better and PST is actually helping.Scoring explanationAll the questions can be answered with \u2018yes\u2019 or \u2018no\u2019.Every \u2018yes\u2019 answer counts one point. To score the questionnaire result, we simply add the \u2018yes\u2019answers. If someone has more than 9 points, we know that this person is very likely to suffer fromKufungisisa and needs treatment.Red flagSSQ question number 11 reads \u2018At times I felt like committing suicide\u2019. It is a very important questionaddressing the risk for suicidality. If a client answers this question with \u2018yes\u2019, we call this a redflag. This means that the person is even more at risk of suffering from CMD. We refer this personimmediately to our \\\"Helper\\\" Mubatsiri who can then refer to a higher level of care. The Mubatsiri canrefer to the nurse who will make a decision about referring on for medication and examination by adoctor. 113","the Friendship Bench\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0PID_________\t \u00a0\t \u00a0Interviewer________________________\t \u00a0\t \u00a0Date____________________\t \u00a0\t \u00a0 \t \u00a0 SSQ-\u00ad14\t \u00a0Now\t \u00a0 I\t \u00a0 am\t \u00a0 going\t \u00a0 to\t \u00a0 ask\t \u00a0 you\t \u00a0 how\t \u00a0 you\t \u00a0 have\t \u00a0 been\t \u00a0 feeling\t \u00a0 over\t \u00a0 the\t \u00a0 past\t \u00a0 week.\t \u00a0 Please\t \u00a0 respond\t \u00a0yes\/no\t \u00a0to\t \u00a0each\t \u00a0question.\t \u00a0Iye\t \u00a0zvino\t \u00a0ndichakubvunzai\t \u00a0kuti\t \u00a0mainzwa\t \u00a0sei\t \u00a0muvhiki\t \u00a0rapfuura.\t \u00a0Ndapota\t \u00a0pindurai\t \u00a0hongu\t \u00a0kana\t \u00a0kwete\t \u00a0pamubvunzo\t \u00a0umwe\t \u00a0neumwe.\t \u00a0\t \u00a0 \t \u00a0 Comments\t \u00a0\t \u00a0 \u2018In\t \u00a0the\t \u00a0past\t \u00a0week\t \u00a0\u2026\u2026.\u2019\t \u00a0 Mhinduro\t \u00a0 \t \u00a0\u2018Muvhiki\t \u00a0rapfuura\u2026\u2026..\u2019\t \u00a0513\t \u00a0 There\t \u00a0 were\t \u00a0 times\t \u00a0 in\t \u00a0 which\t \u00a0 I\t \u00a0 was\t \u00a0 thinking\t \u00a0 deeply\t \u00a0 or\t \u00a0 thinking\t \u00a0 about\t \u00a0 Yes\/No\t \u00a0 many\t \u00a0things.\t \u00a0 Pane\t \u00a0 pandaimboona\t \u00a0 ndichinyanya\t \u00a0 kufungisisa\t \u00a0 kana\t \u00a0 kufunga\t \u00a0 zvakawanda\t \u00a0524\t \u00a0 I\t \u00a0found\t \u00a0myself\t \u00a0sometimes\t \u00a0failing\t \u00a0to\t \u00a0concentrate\t \u00a0 Yes\/No\t \u00a0 Pane\t \u00a0pandaimbotadza\t \u00a0kuisa\t \u00a0pfungwa\t \u00a0dzangu\t \u00a0pamwechete\t \u00a0535\t \u00a0 I\t \u00a0lost\t \u00a0my\t \u00a0temper\t \u00a0or\t \u00a0got\t \u00a0annoyed\t \u00a0over\t \u00a0trivial\t \u00a0matters\t \u00a0 Yes\/No\t \u00a0 Pane\t \u00a0pandaimboshatirwa\t \u00a0kana\t \u00a0kuita\t \u00a0hasha\t \u00a0zvenhando\t \u00a0546\t \u00a0 I\t \u00a0had\t \u00a0nightmares\t \u00a0or\t \u00a0bad\t \u00a0dreams\t \u00a0 Yes\/No\t \u00a0 Pane\t \u00a0pandaimborota\t \u00a0hope\t \u00a0dzinotyisa\t \u00a0kana\t \u00a0dzisina\t \u00a0kunaka.\t \u00a0557\t \u00a0 I\t \u00a0sometimes\t \u00a0saw\t \u00a0or\t \u00a0heard\t \u00a0things\t \u00a0which\t \u00a0others\t \u00a0could\t \u00a0not\t \u00a0see\t \u00a0or\t \u00a0hear\t \u00a0 Yes\/No\t \u00a0 Pane\t \u00a0 pandaimboona\t \u00a0 kana\t \u00a0 kunzwa\t \u00a0 zvinhu\t \u00a0 zvaisaonekwa\t \u00a0 kana\t \u00a0 kunzwikwa\t \u00a0nevamwe\t \u00a0568\t \u00a0 My\t \u00a0stomach\t \u00a0was\t \u00a0aching\t \u00a0 Yes\/No\t \u00a0 Pane\t \u00a0pandaimborwadziwa\t \u00a0nemudumbu\t \u00a0579\t \u00a0 I\t \u00a0was\t \u00a0frightened\t \u00a0by\t \u00a0trivial\t \u00a0things\t \u00a0 Yes\/No\t \u00a0 Pane\t \u00a0pandaimbovhundutswa\t \u00a0nezvinhu\t \u00a0zvisina\t \u00a0mature\t \u00a0MRCZ\/A\/1732\t \u00a0 Page\t \u00a011\t \u00a0\t \u00a0 114","the Friendship Bench\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0PID_________\t \u00a0\t \u00a0Interviewer________________________\t \u00a0\t \u00a0Date____________________\t \u00a0\t \u00a0680\t \u00a0 I\t \u00a0sometimes\t \u00a0failed\t \u00a0to\t \u00a0sleep\t \u00a0or\t \u00a0lost\t \u00a0sleep\t \u00a0\t \u00a0 Yes\/No\t \u00a0 Pane\t \u00a0pandaimbotadza\t \u00a0kurara\t \u00a0kana\t \u00a0kushaya\t \u00a0hope\t \u00a0691\t \u00a0 There\t \u00a0 were\t \u00a0 moments\t \u00a0 when\t \u00a0 I\t \u00a0 felt\t \u00a0 life\t \u00a0 was\t \u00a0 so\t \u00a0 tough\t \u00a0 that\t \u00a0 I\t \u00a0 cried\t \u00a0 or\t \u00a0 Yes\/No\t \u00a0 wanted\t \u00a0to\t \u00a0cry\t \u00a0 Pane\t \u00a0 pandaimbonzwa\t \u00a0 kuomerwa\t \u00a0 neupenyu\t \u00a0 zvekuti\t \u00a0 ndaimbochema\t \u00a0 kana\t \u00a0kunzwa\t \u00a0kuda\t \u00a0kuchema\t \u00a06120\t \u00a0 I\t \u00a0felt\t \u00a0run\t \u00a0down\t \u00a0(tired)\t \u00a0 Yes\/No\t \u00a0 Pane\t \u00a0pandaimbonzwa\t \u00a0kuneta(kurukutika)\t \u00a06131\t \u00a0 At\t \u00a0times\t \u00a0I\t \u00a0felt\t \u00a0like\t \u00a0committing\t \u00a0suicide\t \u00a0 Yes\/No\t \u00a0 Pane\t \u00a0pandaimboita\t \u00a0pfungwa\t \u00a0dzekuda\t \u00a0kuzviuraya\t \u00a0\t \u00a06142\t \u00a0 I\t \u00a0was\t \u00a0generally\t \u00a0unhappy\t \u00a0with\t \u00a0things\t \u00a0that\t \u00a0I\t \u00a0would\t \u00a0be\t \u00a0doing\t \u00a0each\t \u00a0day\t \u00a0 Yes\/No\t \u00a0 Ndainzwa\t \u00a0kusafara\t \u00a0nezvinhu\t \u00a0zvandaiita\t \u00a0zuva\t \u00a0nezuva\t \u00a0\t \u00a06153\t \u00a0 My\t \u00a0work\t \u00a0was\t \u00a0lagging\t \u00a0behind\t \u00a0 Yes\/No\t \u00a0 Basa\t \u00a0rangu\t \u00a0rainge\t \u00a0rava\t \u00a0kusarira\t \u00a0mumashure\t \u00a06164\t \u00a0 I\t \u00a0felt\t \u00a0I\t \u00a0had\t \u00a0problems\t \u00a0in\t \u00a0deciding\t \u00a0what\t \u00a0to\t \u00a0do\t \u00a0 Yes\/No\t \u00a0 Ndainzwa\t \u00a0zvichindiomera\t \u00a0kuti\t \u00a0ndizive\t \u00a0kuti\t \u00a0ndoita\t \u00a0zvipi\t \u00a0\t \u00a0 \t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0MRCZ\/A\/1732\t \u00a0 Page\t \u00a012\t \u00a0\t \u00a0 115","the Friendship BenchPHQ-9 (Patient Health Questionnaire)The PHQ 9 (patient health questionnaire) is a questionnaire that can be used to assess the severity of kufungisisa (depression). If a person scored high (>12) and\/or answers 'Yes' to question 11 onthe SSQ (Pane pandamboita pfungwa dzekuda kuzviuraya. At times I feel like committing suicide.),we need to know how severe the kufungisisa of this patient is. The DHPO will therefore administerthe PHQ-9. The 9th question of the PHQ-9 also asks for suicidal intent. The patient will be asked toanswer the questions regarding the past 2 weeks.There is an added question 10 asking for the impact of Kufungisisa on the person's functioning atwork\/home and with other people.Question 10 goes like this:(If you checked off any problems, how difficult have these problems made it for you to do your work,take care of things at home or get along with other people?Kana muine matambudziko amakasangana nawo ari pamusoro, arikukutadzisai zvakadii kuitabasa renyu, kuona kuti zvinhu zviri mugwara kumba kana kuwirirana nevamwe vanengevakakukomberedzai?)Scoring explanationAll questions can be answered on a scale with four points: Kwete\/not at all - Mamwe Mazuva\/severaldays - Zviri pakati nepakati\/more than half the days - Zuva rega rega\/nearly every day.Not at all Several days More than half the days Nearly every day Kwete Zuva rega rega Mamwe mazuva Zviri pakati nepakati 301 2Depending on the answer, a score from 0 to 3 is given.For the total score the individual scores are added up, so a total of 27 points can be reached.Red flagThe PHQ-9 cut-off score is 20. If a person scores 20 and has at least 1 point on question 9, it isnecessary for the DHPO to refer to the nurse for further assessment and possible prescription of anti-depressant medication. 116","the Friendship Bench\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0PID_________\t \u00a0\t \u00a0Interviewer________________________\t \u00a0\t \u00a0Date____________________\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0PHQ9\t \u00a0Now\t \u00a0I\t \u00a0am\t \u00a0going\t \u00a0to\t \u00a0ask\t \u00a0you\t \u00a0how\t \u00a0you\t \u00a0have\t \u00a0been\t \u00a0feeling\t \u00a0over\t \u00a0the\t \u00a0past\t \u00a02\t \u00a0weeks\t \u00a0Iye\t \u00a0zvino\t \u00a0ndinoda\t \u00a0kunzwa\t \u00a0kuti\t \u00a0wainzwa\t \u00a0sei\t \u00a0mumavhiki\t \u00a0\t \u00a0maviri\t \u00a0apfuura\t \u00a0\t \u00a0Over\t \u00a0 the\t \u00a0 LAST\t \u00a0 2\t \u00a0 WEEKS,\t \u00a0 how\t \u00a0 often\t \u00a0 have\t \u00a0 you\t \u00a0 been\t \u00a0 Not\t \u00a0 at\t \u00a0 Several\t \u00a0 More\t \u00a0 Nearly\t \u00a0bothered\t \u00a0by\t \u00a0any\t \u00a0of\t \u00a0the\t \u00a0following\t \u00a0problems?\t \u00a0 all\t \u00a0 days\t \u00a0 than\t \u00a0 half\t \u00a0 every\t \u00a0MUMASVONDO\t \u00a0 MAVIRI\t \u00a0 apfuura\t \u00a0 makashungurudzwa\t \u00a0\t \u00a0 Kwete\t \u00a0 Mamwe\t \u00a0 the\t \u00a0days\t \u00a0 day\t \u00a0kangani\t \u00a0nematambudziko\t \u00a0anotevera\t \u00a0 mazuva\t \u00a0 Zviri\t \u00a0 Zuva\t \u00a0 pakati\t \u00a0 rega\t \u00a0 nepakati\t \u00a0 rega\t \u00a0 \t \u00a0167\t \u00a0 Little\t \u00a0interest\t \u00a0or\t \u00a0pleasure\t \u00a0in\t \u00a0doing\t \u00a0things.\t \u00a0 0\t \u00a0 1\t \u00a0 2\t \u00a0 3\t \u00a0 Kusanyatsova\t \u00a0nechido\t \u00a0chekuita\t \u00a0zvinhu\t \u00a0268\t \u00a0 Feeling\t \u00a0down,\t \u00a0depressed,\t \u00a0or\t \u00a0hopeless.\t \u00a0 0\t \u00a0 1\t \u00a0 2\t \u00a0 3\t \u00a0 Kusanyatsonzwa\t \u00a0 chido\t \u00a0 nezvehupenyu,\t \u00a0 kufunganya\t \u00a0 zvakapfuurikidza\t \u00a0kana\t \u00a0kushaya\t \u00a0tariro\t \u00a0muhupenyu\t \u00a0369\t \u00a0 Trouble\t \u00a0falling\t \u00a0or\t \u00a0staying\t \u00a0asleep,\t \u00a0or\t \u00a0sleeping\t \u00a0too\t \u00a0much.\t \u00a0 0\t \u00a0 1\t \u00a0 2\t \u00a0 3\t \u00a0 Kutadza\t \u00a0kuwana\t \u00a0hope\t \u00a0kana\t \u00a0kurara\t \u00a0zvakapfurikidza\t \u00a0470\t \u00a0 Feeling\t \u00a0tired\t \u00a0or\t \u00a0having\t \u00a0little\t \u00a0energy.\t \u00a0 0\t \u00a0 1\t \u00a0 2\t \u00a0 3\t \u00a0 Kunzwa\t \u00a0kuneta\t \u00a0uye\t \u00a0kuve\t \u00a0nesimba\t \u00a0shoma\t \u00a0rekuita\t \u00a0zvinhu\t \u00a0571\t \u00a0 Poor\t \u00a0appetite\t \u00a0or\t \u00a0overeating.\t \u00a0 0\t \u00a0 1\t \u00a0 2\t \u00a0 3\t \u00a0 Kusanyatsodya\t \u00a0zvakakwana\t \u00a0kana\t \u00a0kudyisa\t \u00a0672\t \u00a0 Feeling\t \u00a0bad\t \u00a0about\t \u00a0yourself\t \u00a0\u2014\t \u00a0or\t \u00a0that\t \u00a0you\t \u00a0are\t \u00a0a\t \u00a0failure\t \u00a0 0\t \u00a0 1\t \u00a0 2\t \u00a0 3\t \u00a0 or\t \u00a0have\t \u00a0let\t \u00a0yourself\t \u00a0or\t \u00a0your\t \u00a0family\t \u00a0down.\t \u00a0 Kuzvizvidza\t \u00a0 pachezvako-\u00adkana\t \u00a0 kuti\t \u00a0 kunzwa\t \u00a0 sekuti\t \u00a0 uri\t \u00a0 mukundikani\t \u00a0 muupenyu\t \u00a0 \t \u00a0 kana\t \u00a0 kutadza\t \u00a0 kuzadzikisa\t \u00a0 zvaitarisirwa\t \u00a0nevemhuri\t \u00a0yako\t \u00a0MRCZ\/A\/1732\t \u00a0 Page\t \u00a013\t \u00a0\t \u00a0 117","the Friendship Bench\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0\t \u00a0PID_________\t \u00a0\t \u00a0Interviewer________________________\t \u00a0\t \u00a0Date____________________\t \u00a0\t \u00a0773\t \u00a0 Trouble\t \u00a0 concentrating\t \u00a0 on\t \u00a0 things,\t \u00a0 such\t \u00a0 as\t \u00a0 reading\t \u00a0 the\t \u00a0 0\t \u00a0 1\t \u00a0 2\t \u00a0 3\t \u00a0 newspaper\t \u00a0or\t \u00a0watching\t \u00a0television.\t \u00a0 Kutadza\t \u00a0 kuita\t \u00a0 zvinhu\t \u00a0 zvakaita\t \u00a0 sekuverenga\t \u00a0 pepanhau\t \u00a0 nekuona\t \u00a0chivhitivhiti\t \u00a0pfungwa\t \u00a0dziri\t \u00a0pamwechete\t \u00a0874\t \u00a0 Moving\t \u00a0 or\t \u00a0 speaking\t \u00a0 so\t \u00a0 slowly\t \u00a0 that\t \u00a0 other\t \u00a0 people\t \u00a0 could\t \u00a0 0\t \u00a0 1\t \u00a0 2\t \u00a0 3\t \u00a0 have\t \u00a0 noticed?\t \u00a0 \t \u00a0 Or\t \u00a0 the\t \u00a0 opposite\t \u00a0 \u2014\t \u00a0 being\t \u00a0 so\t \u00a0 fidgety\t \u00a0 or\t \u00a0 restless\t \u00a0 that\t \u00a0 you\t \u00a0 has\t \u00a0 been\t \u00a0 moving\t \u00a0 around\t \u00a0 a\t \u00a0 lot\t \u00a0 more\t \u00a0 than\t \u00a0usual.\t \u00a0 Kufamba\t \u00a0 kana\t \u00a0 kutaura\t \u00a0 zvine\t \u00a0 kunonokera\t \u00a0 mukati\t \u00a0 zvekuti\t \u00a0 zvinogona\t \u00a0 zvakaonekwa\t \u00a0 nevamwe\t \u00a0 vakakutenderedza?\t \u00a0 Kana\t \u00a0 kuti\t \u00a0 kutadza\t \u00a0 kugarisika\t \u00a0 zvekuti\t \u00a0 wange\t \u00a0 urikufamba-\u00adfamba\t \u00a0 zvakapfuurikidza\t \u00a0 zvaunofanirwa\t \u00a0kunge\t \u00a0uchiita\t \u00a0795\t \u00a0 Thoughts\t \u00a0 that\t \u00a0 you\t \u00a0 would\t \u00a0 be\t \u00a0 better\t \u00a0 off\t \u00a0 dead\t \u00a0 or\t \u00a0 of\t \u00a0 0\t \u00a0 1\t \u00a0 2\t \u00a0 3\t \u00a0 hurting\t \u00a0yourself\t \u00a0in\t \u00a0some\t \u00a0way.\t \u00a0 Kuve\t \u00a0nendangariro\t \u00a0dzekuti\t \u00a0zvirinani\t \u00a0kuti\t \u00a0dai\t \u00a0wafa\t \u00a0zvako\t \u00a0 kana\t \u00a0kuda\t \u00a0kuzvikuvadza\t \u00a0neimwe\t \u00a0nzira\t \u00a0\t \u00a0 \t \u00a0 A11\t \u00a0 \u2013\t \u00a0 PHQ9\t \u00a0 total\t \u00a0 \t \u00a0 score\/zvibodzwa\t \u00a0 zvabatanidzwa\t \u00a0\t \u00a0 \t \u00a0 \t \u00a0 \t \u00a0 \t \u00a0 \t \u00a0\t \u00a0 Not\t \u00a0 Somewh Very\t \u00a0 Extreme76\t \u00a0 difficult\t \u00a0 at\t \u00a0 difficult\t \u00a0 ly\t \u00a0 at\t \u00a0all\t \u00a0 difficult\t \u00a0 Zvakany difficult\t \u00a0 Kana\t \u00a0 Zvishom anya\t \u00a0 Zvakany a\t \u00a0 anyisa\t \u00a0If\t \u00a0 you\t \u00a0 checked\t \u00a0 off\t \u00a0 any\t \u00a0 problems,\t \u00a0 how\t \u00a0 difficult\t \u00a0 have\t \u00a0 these\t \u00a0 \t \u00a0 \t \u00a0 \t \u00a0 \t \u00a0problems\t \u00a0 made\t \u00a0 it\t \u00a0 for\t \u00a0 you\t \u00a0 to\t \u00a0 do\t \u00a0 your\t \u00a0 work,\t \u00a0 take\t \u00a0 care\t \u00a0 of\t \u00a0 things\t \u00a0at\t \u00a0home\t \u00a0or\t \u00a0get\t \u00a0along\t \u00a0with\t \u00a0other\t \u00a0people?\t \u00a0Kana\t \u00a0 muine\t \u00a0 matambudziko\t \u00a0 amakasangana\t \u00a0 nawo\t \u00a0 ari\t \u00a0pamusoro,\t \u00a0 arikukutadzisai\t \u00a0 zvakadii\t \u00a0 kuita\t \u00a0 basa\t \u00a0 renyu,\t \u00a0 kuona\t \u00a0kuti\t \u00a0 zvinhu\t \u00a0 zviri\t \u00a0 mugwara\t \u00a0 kumba\t \u00a0 kana\t \u00a0 kuwirirana\t \u00a0 nevamwe\t \u00a0vanenge\t \u00a0vakakukomberedzai?\t \u00a0\t \u00a0 \t \u00a0 \t \u00a0 \t \u00a0 \t \u00a0 \t \u00a0 \t \u00a0 \t \u00a0 \t \u00a0MRCZ\/A\/1732\t \u00a0 Page\t \u00a014\t \u00a0\t \u00a0 118","the Friendship BenchChapter 11CounsellingSkills 119","the Friendship Bench Counselling techniquesConfidentialityO ne of the most important features of counselling is CONFIDENTIALITY. This means that the information we get from our clients cannot be shared with others. As counsellors we are boundto confidentiality. Our clients rely on us keeping their personal information for ourselves. We canonly create an atmosphere of trust if we can guarantee that a client can speak freely about her or histhoughts, and feelings etc. when she or he knows that any information about her or him is safe withus. Especially when we work in a community where people are linked to many other communitymembers (work, school, being related, \u2026), we have to follow the principle of confidentiality strictly.If a counsellor is found to break confidentiality without major reason, they will lose their status as counsellor andwill give counselling in general a bad name.We can speak to our Helper (\u2018Mubatsiri\u2019) about our clients, especially when we encounter moments where weneed help. Our Mubatsiri are also bound to confidentiality.Breaking confidentialityThe only reason to break confidentiality is given if our client tells us that she or he is at risk of harming herselfor himself. The SSQ asks for this and we will also assess tit with our client every time we speak to her or him.If this is the case, we refer the client to our Mubatsiri for more intense treatment.What is counselling?I n a counselling situation we help someone to find a solution to her or his problem. For this, it is important to recognize and understand the problem(s) very well.Counselling is not the same as giving advice or making decisions for the patient, nor do we judge and blame thepatient.In counselling, we want the person to learn how to solve her or his problems so that in future situations, she orhe is able to help herself or himself and becomes independent of the counsellor.Qualities of a good counsellorGroup discussion:\u00bb\u00bb What qualities does a good counsellor need to have?\u00bb\u00bb Write them down for yourself before you discuss in the group.\u00bb\u00bb Discuss in the group and make a list of the ones you find important.\u00bb\u00bb We probably came up with several characteristics that a good counsellor should have. 120","the Friendship Bench Counselling techniquesGROUP DISCUSSION NOTES: 121","the Friendship Bench Counselling techniquesLet us have a closer look at what we all found and compare them with the following ones:\u25cf\u25cf \t Self awareness\t Knowing oneself is very important. We need to be aware of our own beliefs, values and \t\t\t attitudes to be \table to address a patient\u2019s needs in an objective way. Exercise: How do you feel when you speak to someone who refuses to go for HIV testing? You might have convinced many people already to go for testing and for you it seems like you know exactly what you need to do, yet it is important to first listen to this particular patient and understand where she or he is coming from.\uf021\u25cf\u25cf \t Empathy\uf021 Empathy is the ability to put oneself in somebody else\u2019s situation and relate to what they might feel. It is important for the relationship between the counsellor and the client. The client will feel taken more seriously when she or he gets the impression that the counsellor is able to understand what the patient feels and why she or he feels the way she or he feels. Be genuine, ask before pretending to have understood. Avoid advising the patient to stay strong, not cry, etc. It is good to express emotions. Exercise: There are several ways of showing empathy. How would you show empathy? Write down for yourself what you thought of before you discuss in the group. Discuss in the group and make a list of the ones you find important. (examples are: -you seem upset\/\u2026., it sounds as if you are dealing with a lot of anger\/ frustration\/\u2026., if I understood you correctly, you feel\u2026., I am asking myself if you feel\u2026.) 122","the Friendship Bench Counselling techniques\u25cf\u25cf \t Ability to listen (active listening) The ability to listen actively is a good way of helping a person to feel heard. When a person feels heard, she or he will also feel safer to speak about what worries her or him. There are lots of ways of showing that we listen. We call this active listening. Active listening involves showing nonverbal signs of acknowledgment like nodding, recurrent eye contact (if culturally appropriate), showing an open facial expression or turning the upper body towards the client. Active listening also includes verbal acknowledgement such as expressions like \u2018yes, I see\u2019, \u2018handitika\u2019\u2026, \u2019mmh\u2019, \u2018ah\u2019, to name a few. Part of active listening is also summarizing what you have heard in your own words and checking with your clients whether you have really understood what they told you. If you did not understand what they said, let them tell you again and ask questions. Exercise: Practice this in pairs with one being the counsellor and one being the client. Give yourselves feedback and change roles.\uf021\u25cf\u25cf \t Being non-judgmental\uf021 We need to accept a patient just as she or he is and keep a non-judgmental attitude towards her or him. If we find that we are very uncomfortable when dealing with a certain person who has views and feelings that are very different from our own, it is best to refer to a colleague. We can also share the feelings about a patient with the Mubatsiri. Exercise: Think of opinions that you hold about certain things. Do you notice that the stronger your opinion is, the more difficult it is to tolerate a person who believes the opposite? (examples for strong opinions: A husband has the right to beat his wife. Girls do not need to go to school. It is the wife\u2019s fault if the husband drinks.) 123","the Friendship Bench Counselling techniques\u25cf\u25cf \t Patience Patience is an important characteristic in counselling. Imagine that a person coming for counselling is anxious and not sure what to expect. Patience will enable you to be able to help the client to open up and to encourage her or him to look at the issues she or he is dealing with and at the thoughts and feelings related to those issues. Exercise: Think of a situation when you managed to just patiently listen without offering your opinion or advice. Think about what makes that difficult. Discuss in your mini-group.\uf021\u25cf\u25cf \t Keeping an overview of what was said\/being professional\uf021 The counsellor is the person in the counselling process who has to keep track of what was said so far. Therefore it is best to take notes. The brief notes help the counsellor to come back to important issues, that although they might be uncomfortable for both client and counsellor, have to be discussed. Taking notes helps the counsellor to follow a counselling structure which is very important to not lose the aim of problem recognition out of sight. Exercise: In groups of 2 or 3, let one person speak about an experience and the other two have to take turns to summarize what was said. 124","the Friendship Bench Counselling techniques\u25cf\u25cf \t Keeping calm What your client tells you might disturb you. It is important that you keep calm (remain professional) and remember that you are there to help your client now. If something disturbs you, you must talk to your colleagues in the peer supervision sessions or to your Mubatsiri. In the session, the counsellor helps the client to break down the problem(s) into smaller chunks that can actually be addressed. If a \u2018problem chunk\u2019still seems unsolvable, it has to be broken down further.\uf021\u25cf\u25cf \t Assertiveness to guide the client through the counselling process\uf021 As the counsellor, we guide the client through the counselling process. We might have to remind the client to come back to the topic by asking further questions. We might have to console the client. We might have to reassure her or him that we want to hear more. We will always ask more questions to get a good overview of what the client is dealing with. Exercise: Work in pairs. Role play a session, the client is supposed to keep bringing up new issues and is generally very distraught, the therapist is supposed to stay calm, bring the client back to one main topic and stick to the counselling process. 125","the Friendship Bench Counselling techniquesHow to ask QuestionsA ppropriate and effective questions will allow a person to speak freely and help us gatherinformation. Sometimes, a client is talkativeand we do not need to ask a lot. It might still beimportant to ask for specific information.Open ended questionsOpen ended questions are mostly answered with afew words or sentences. Examples for open endedquestions are: How do you feel about this?What happened?Closed questionsClosed questions generally could be answered with\u2018yes\u2019 or \u2018no\u2019. They can help to focus on a certaintopic (\u2018Do you want to speak about this topic?\u2019) orto get some important facts (\u2018How old are you?\u2019).Guideline for collecting information\u00bb\u00bb Who is our client? What is her\/his background? Who are the significant people in her\/his life?\u00bb\u00bb What is the problem?\u00bb\u00bb When does the problem happen? What happens prior and after the problem occurring?\u00bb\u00bb Where and when does it occur?\u00bb\u00bb Why does it happen? What triggers it and what makes it better?\u00bb\u00bb What are the client\u2019s reactions and how does she or he feel about it?\u00bb\u00bb Chii chiri kunetsa?\u00bb\u00bb Who is there for the client?\u00bb\u00bb What impact has the issue had so far?\u00bb\u00bb What does the clientt want to happen? 126","the Friendship BenchChapter 12The FriendshipBench card Date \t PID number \t Counsellor \t Clinic FB Card for Zita summarisingZuva Nhamba yemupangwi Nzvimbo client notes. wezano rachipangamazanoProblem that is worked on: Goals:Smart action plan: Next appointment: 127","the Friendship Bench The Friendship Bench CardThe Friendship Bench card is a way of taking summarized notes. These are necessary for consecutive sessions. Only the most important facts go on the Friendship Bench card. While we can take asmany notes as we like in our book, we will summarize those notes and write them on the card togetherwith our client. In each session, we might add something to our FB cards. Our client will have heror his own card. The card will help the client to remember what she or he learned and agreed to dobetween sessions. The card is also important for the participation in the \u2018Kubatana Tose\u2019 (see Chapter14). Coming to those meetings will be noted on the back of the card.The card is divided in the 4 sections. Each section has a title, see below to learn how the card looks like. CASE Client M. comes to the bench and reports about the many problems she faces at home. Amongst not having an income, having difficulties finding the money for school fees for her 2 children, she also mentions her husband using his money to buy alcohol. The counsellor and the client decide that they will choose the husband\u2019s behaviour as the issue to write on both their cards in section 1. They now go about exploring ways how to address this issue. M. is asked to say w h a t goals she has (what would you like to achieve with counselling? What would you like to see happening?...). The most important goals are written down in the \u2018goals\u2019-section. During the counselling process, we use a technique (described in next chapter on PST) that helps the client to find her or his own solutions for some of the problems she or he experience.Important:\u00bb\u00bb The FB card holds a summary of our session notes.\u00bb\u00bb The client and the counsellor have a FB card.\u00bb\u00bb The client has to be reminded to bring the FB card every time she or he comes for a session. 128","the Friendship Bench for your use\u2026Notes \u2026\uf021 129","the Friendship BenchChapter 13emotionsNEGATIVE EMOTiONS POSITIVE EMOTIONSsad: kusuwa happy: kufarasad depressed: kusurikirwa content: kugutsikanasad alone: kusuwaunhappy: kushaya mufaromiserable: kushushikanaupset: kutsamwisalow: kusurukirwairritated: kubhowekana stable: kugadzikanajealous: kuvanegodo\/ calm: kudzikama relaxed: kuzororaenraged: kuvaneshanje kushatirwabitter:annoyed: zvakanyanyaangry: kuva nechigumbu kusvotwa kushatirwa 130","the Friendship Bench emotionsNEGATIVE EMOTiONS POSITIVE EMOTIONSalone: kuva ndega belonging: kunzwa kuti unotambirwalonely: kusurukirwa safe: nevamweisolated: kunzwa kunge usinavamwe\/ kuzvibvisa pane vamwe kuchengetedzekaashamed: kunzwa kunge wakashoreka\/ unoshorekahopeless: kushaya tariro hopeful: kuvanetarisiro yakanaka trusting: kutembahelpless: kupererwa active: kuva usina nungo strong: kusimbapowerless: kupera simbadiscouraged: kunzwa kudzikisirwaanxious: kusagadzikana muhana decisive: kuvaunokwanisainsecure: kusagutsikana kuzvisarudzira usingatyefearful: kutya proud: kana kusagutsikanaafraid: kutya confident: self assured: kudada kuva ne zenze kuzvisimbisabored: kushayazvekuita engaged: kuvauchiitira pamwe\/ zvinokunakidza kuva involved focused:unmotivated: kushaiwa shungu rekuita creative: kuvanechinangwa zvinhu interested: chaurikutevera kuvane husikisiki kuva nehanyacrazy: kupenga balanced: kumira usinga zungunutswe 131","the Friendship Bench emotions Is there a place on your body where you are feeling this? Could you show me? 132","the Friendship BenchChapter 14stabilizationwhat is it?Stabilization means to help a person to calm down.We want our clients to learn to calm down so they are able to think and solve problems. It is very difficult to think, when we feel very stressed, very angry, very sad, very afraid or simply veryoverwhelmed.There are several powerful ways of helping someone tocalm down again. We can combine all these exercises!Best is when we all learn to use these exercises. Wecan all need calming as life is complicated at times andwe need to have a calm brain to solve the problemsthat we are facing. 133","the Friendship Bench stabilization We can practice one or all of these exercises with our clients every time we see them. This way we strengthen their minds! \u00bb\u00bb Calm Breathing \u00bb\u00bb Concentration \u00bb\u00bb Grounding \u00bb\u00bb Remembering a good memory with all sensesCalm breathingWe want to teach our clients to breathe evenly as this will help them to reduce strongemotional reactions. Calm breathing is important as it will make sure that our body willget the oxygen it needs. We can teach them calm breathing like this: Imagine that your lungs are like a balloon in your favourite color that fills up when you inhale and deflates when you exhale. Fill it up slowly and evenly in your own pace, let it deflate in the same speed. Repeat. You can count if that helps to make your breathing even and calm. Count up to 3 or 5. When you get distracted, just go back to the exercise. Do this breathing exercise for up to 5 minutes. Never allow yourself to get out of breath. Slow even breathing is very important to keep our senses together. 134","the Friendship Bench stabilizationConcentration and focusWe can teach our clients to concentrate on what they are doing. We want to be veryaware of what we are doing. Let us take the example of the breathing exercise.We teach our clients to think words like these while they breathe:I am inhaling.I am exhaling.I am inhaling.I am exhaling.Repeat this for up to 5min.I am inhaling.I am exhaling.I am inhaling.I am exhaling.I am inhaling.I am exhaling.I am inhaling.I am exhaling.I am inhaling.I am exhaling.I am inhaling.I am exhaling.I am inhaling.I am exhaling.I am inhaling.I am exhaling. 5We can suggest to close the eyes to better concentrate.135","the Friendship Bench stabilizationGroundingGrounding means to bring a person back into the \u201chere and now\u201d. When we haveexperienced bad things and we are talking about those afterwards, we often feel thesame feelings of fear, sadness, anger, and being overwhelmed. We want our clients tobe able to think and learn how to solve problems.When a person is quite agitated, we can ask her or him where in the body he or she feels this feeling. It is rarethat people cannot name a place in the body where they have a sensation while they are very stressed. Somemight say that they feel it all over. That is fine too.We can help someone to feel grounded like this:We ask them these kinds of questions and let the person name what they see, hear, touch. They canfocus on the same things\/sounds or select new ones every time.\u00bb\u00bb\t \u201cWhere in your body do you feel this strong feeling \t\t\t that you are having?\u201d\u00bb\u00bb\t \u201cI will ask you a few questions, just try to answer \t\t\t\t as we go along with this exercise.\u201d Where in your body do you feel this strong feeling that you are having? What do you see right now? Tell me 5 things you see!5 What do you hear right now? Tell me 5 sounds you hear! What can you feel with your fingers? Touch 5 things! What do you see right now? Tell me 4 things you see!4 What do you hear right now? Tell me 4 sounds you hear! What can you feel with your fingers? Touch 4 things! 136","the Friendship Bench stabilization What do you see right now? Tell me 3 things you see! 3 What do you hear right now? Tell me 3 sounds you hear! What can you feel with your fingers? Touch 3 things! What do you see right now? Tell me 2 things you see!2 What do you hear right now? Tell me 2 sounds you hear! What can you feel with your fingers? Touch 2 things! What do you see right now? Tell me 1 thing you see!1 What do you hear right now? Tell me 1 sound you hear! What can you feel with your fingers? Touch 1 thing!\u00bb\u00bb\t \u201c What does the feeling in your body feel like now?\u201d Ask the person how she or he feels now and see for yourself that she or he will feel calmer. 137","the Friendship Bench stabilizationRemembering a good memorywith all sensesJust like we can remember the bad things, we can actively remember the good thingsthat have happened to us.Ask your client to tell you about a good memory:Invite your client to tell you about a time with a loved person, a moment of well beingor a time of personal achievement and let the person describe the moment in all detail.Observe your clients while they remember their good memory.Ask these kind of questions:\u00bb\u00bb Where were you?\u00bb\u00bb Who were you with?\u00bb\u00bb What were you doing?\u00bb\u00bb What did it look like there?\u00bb\u00bb What time of the day was it?\u00bb\u00bb What did you hear there?\u00bb\u00bb What did it smell like there?Tell me about a memory of a good time in yourlife! I want to know exactly what it was like! 138","the Friendship Bench Chapter 15Strong emotionalreactionsAperson who is suffering from Kufungisisa is vulnerable. She or he might never have spoken about what is weighing her or him down. Once getting the opportunity and finding the courageto speak out, our clients might show strong emotions. They might cry, silently or loudly, or expressother emotions such as anger or frustration.It is important for us to simply support our client and make sure she or he feels calmer towards the end ofthe session.In very difficult situations, we can suggest to contact a family member to come and support the client.\uf046\t HOW TO DO IT?\tEmpathize\/compassion:\u00bb\u00bb Just be with the client. The client expresses her or him emotions and we let her do this in \t\t\t\t safe environment. Acknowledge:\u00bb\u00bb We show understanding for the client expressing their emotions. We can do this by nodding, sounds \t\t of approval, or paraphrasing which means we repeat what we have heard in our own words. We can \t\t say \u201cIt sounds really difficult to deal with this all.\u201d, \u201cIt must be hard for you.\u201d\t Support\/comfort:\u00bb\u00bb We can give the client tissue paper when she cries. For reassurance, we can also touch the client\u2019s \t\t\t arm\/shoulder\/hand if it is culturally appropriate for us to do so. 139","the Friendship Bench mental illness Pray:\u00bb\u00bb Many of our clients will feel supported when we pray with them. We can suggest this. Normalize:\u00bb\u00bb We explain that it is normal to cry when someone feels overwhelmed and desperate, crying helps \t\t\t as it releases tension and shows others that we are in need of comfort. It helps as we are expressing our \t\t true emotions. Mwana asingacheme anofira mumbereko. \u2022\u2022\u2022\u2022\u2022 A baby who does not cry will die in a baby sling. 140","the Friendship BenchChapter 16Suicideassessment and managementKufungisisa can make people lose all hope. When people lose hope andonly feel despair, they might feel that there is no more point in living.Definition of suicidal behavioursWe speak of an attempted suicide when someone is harming herself or himself but this act is not fatal. Attempted suicides are more common in young women than inyoung men.Completed suicide is an act of knowingly and intentionally harming oneself resulting indeath. Different methods can be used to harming oneself\/committing suicide, common are drinkingpoisonous substances (i.e. pesticides, tablet overdose), hanging, inhaling gas, \u2026 141","the Friendship Bench suicide assessment and managementRisk of succeedingHaving attempted suicide in the past increases the risk of a person completing suicide at some stagein her or his life significantly. We need to assess a patient\u2019s risk very carefully and ask for previousattempts.MythsWe might feel uncomfortable speaking about suicide because we might have heard that this mightgive the person the idea to commit suicide. This is false.It is very important to get a person to express what she or he feels.Suicidal intent - Assessment\uf0b5\t SSQ \u2013 Question 11The SSQ asks a question (Q11) about someone\u2019s risk of harming herself or himself. If a clientanswers this question with \u2018yes\u2019, we will have to talk to the client about the seriousness of her or hiscondition.\u2606\t \t Questions to ask to assess the seriousness of our client\u2019s suicidal intent:\u2022\t \u201cHave you thought about taking your life?\u201d\u2022\t \u201cHave you made any kind of plans of how you would do this?\u201d\u2022\t \u201cHave you purchased items to actually carry out your plan?\u201d\u2022\t \u201cHave you made any kind of arrangements for your dependents for the time after your death?\u201dIf a client gives precise answers to these questions, we speak of a high suicide intent. The higher thesuicide intent, the more important it is to react and get help for the client.ReferralWhen someone is suicidal, she needs a lot of intense help. After we have talked to the client andassessed the situation, it is important that we refer the client to the DHPO and to the nurse who willdo further assessments and possibly prescribe an Antidepressant. 142","the Friendship Bench suicide assessment and managementManagement of clients with Suicide Intent\t What we need to acknowledge is:\u00bb\u00bb The client needs a lot of support from a strong counselor-client-relationship that is based on \t\t\t trust and understanding.\u00bb\u00bb The fact that the person is revealing her or his plans to the counselor shows good help \t\t\t\t seeking skills. We might be the first person to whom the client speaks to about her or his suicide intent.We want to further encourage the client to express her or his feelings.We are very supportive when the client becomes emotional and tearful.We want to especially discuss feelings around guilt, shame and hopelessness. We explain that\t hopelessness is a symptom of kufungisisa. Hopelessness is always part of kufungisisa.\u00bb\u00bb We must discuss: \u201cWhat has stopped you so far from attempting to take your life?\u201d This question \t\t\t aims to make the client aware of reasons to continue living.\u00bb\u00bb We must explore which family members can be involved to support and protect the client. We get all their details and discuss how we can make contact with the chosen family members. Our client should not be left alone and availability of means of suicide needs to be controlled. (Sometimes an inpatient stay at the hospital might be a way to ensure this.)\u00bb\u00bb We plan to see the client regularly to follow up closely. This could also be done via\thomevisits.\u2606 \t We take the client to the DHPO and to the nurse for further assessment and medication. 143","the Friendship Bench suicide assessment and management Checklist \uf0fe Assess suicide intent \uf0fe Encourage the client to express her or his feelings and be supportive \uf0fe Find reasons to continue living that can be seen as protective \uf0fe Establish family members who can be contacted and get their details \uf0fe Contact the family members \uf0fe Plan further contact with client \uf0fe Take client after the session to the DHPO and the nurseNotes \u2026\uf021 144","the Friendship BenchChapter 17SupervisionMubatsiri The mubatsiri helps us and together we aim to help the client! Amubatsiri is a person who has had more training and experience in counselling. A mubatsiri will guide us through difficult times and help us to continuously gain more skills. Amubatsiri reminds us how PST is done, what other counselling components we need to keep in mind and how to do our work well. The mubatsiri can only work with us though when we are honest about what is happening in the counselling sessions that we are conducting and how we feel about them. 145","the Friendship Bench supervisionHow is supervision done?We meet our mubatsiri regularly once a week. As we meet the mubatsiri together with our colleagues,we also learn from their experience.We will present cases in the following way. We can prepare this ahead of our supervision meeting:\u00bb\u00bb gender\u00bb\u00bb age\u00bb\u00bb relationship status\u00bb\u00bb HIV Status\/other chronic disease and medication yes\/no\u00bb\u00bb employment status\u00bb\u00bb topic that client seeks help for\u00bb\u00bb resources of the client\u00bb\u00bb what has LHW done in session (checklist)\u00bb\u00bb LHW question regarding the clientExample:LHW Sarah has a difficult client. She presents the case like this:\u201cP. is a 43y old woman, she is a widow. She suffers from Diabetes. She is unemployed.She came to the Bench because she was threatened to be kicked out of her room inthe flat she shares with her late husband\u2019s relatives. I have worked on the problemlist, she chose the problem \u201cfind new accommodation\u201d and now we are stuck.Her goal was to have a better living environment. She can\u2019t seem to find anysolution ideas. My question is what do I do now?\u201dMubatsiri asks some questions on the process, she asks for the problem list and theydiscuss the other problems and wonder if they should not rephrase the problem.\u201cfind new accommodation\u201d is probably too big a problem, it is not manageablealthough it is meaningful. The counselor decides she will take her client back to thebeginning, define the problem differently and apply the PST technique again.146","the Friendship Bench for your use\u2026Notes \u2026\uf021 147","the Friendship BenchChapter 18home visitsWe will usually see our clients on the Friendship Bench in the clinic. It is encouraged though to do at least 2 home visits in the time while we see our client. Homevisits only happen during the later phase of the intervention! The first two sessions must be held onthe Friendship Bench so that the counselling process can be established and carried out properly.Why are we doing a home visit?Home visits are done to reassure and reinforce the client.During a home visit, we can give our client words of encouragement (kusimbisa and kusimbisisa).Sometimes, we might also have to do a home visit as our client has not come to the planned sessionand we have experienced problems getting hold of the client. In such a case, it is recommended togo to the house of the client.It is best to discuss right in the beginning that you will also see the client in her home.How to handle the presence of the family in the client\u2019s home?If the client is very uncomfortable with us coming to her or his home, we should discuss this indetail.We can accommodate a client\u2019s wish for a certain time of the day for the visit. 148","",""]