Friendship Bench

Domain V · Systemic, relational, group & community · Dixon Chibanda, Melanie Abas · 2011 · Harare, Zimbabwe

What it is

The Friendship Bench is a programme, not a psychotherapy school: a task-shifted, culturally adapted, six-session problem-solving therapy (PST) with a behavioural-activation component, delivered one-to-one on a wooden bench in a discreet spot in primary-care clinic grounds by trained, supervised lay…

Format

• Entry and triage. Clinic attenders are screened with the Shona Symptom Questionnaire (SSQ-14), a locally developed 14-item screen for common mental disorders. The trial cut-off was raised from 8 to 9 (out of 14) after revalidation in an HIV setting. People scoring above 11 also complete the PHQ-9…
• Format: individual, face to face on the bench, 30–45 minutes per session (the first up to 60 minutes). Six sessions, weekly in the trial table (the protocol text says over 4–6 weeks). Home visits are added when needed, and up to six weekly SMS messages or calls go to people who attend fewer than 3…

Who practises it, and how they are trained or regulated

• For a psychotherapist, the realistic roles are: (a) training, supervising and backing up LHWs (the role psychologists and psychiatrists play in Harare); (b) running or adapting the model in a service; (c) using its structure directly in brief low-intensity work. Delivery under the Friendship Bench name goes through the organisation, which supplies the manual and training on request (contacts on MHPSS.net). No public…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• fear of ending. Point to CKT as continued contact.
• vague global problems ("my life"). Break them down further.
• shared phones. Keep message content neutral and non-revealing.
• the task not done. Explore the obstacle without blame (see 4.10).
• plans that depend on others' behaviour, or are too big. Shrink them to the first step.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.