May 23, 2025 • 54 mins
In this episode, Dr. Dixon Chibanda explores from benches to breakthroughs: a new approach to mental health. He explains why storytelling, radical empathy, and solving daily-life problems often outperform medication-first approaches; how three simple steps—opening the mind, uplifting, strengthening—turn elders into community healers; and why hope, not symptom checklists, is the truest measure of success. Along the way, you’ll hear how ancestral wisdom blends with clinical science, how labels can hinder more than help, and how the very grandmothers Dixon trained ended up transforming him.
Key Takeaways:
- Discussion on anxiety and its management through personal values and positive actions.
- Importance of human connection and storytelling in mental health care.
- Overview of the Friendship Bench initiative and its origins in Zimbabwe.
- Role of trained grandmothers in providing mental health support within communities.
- Need for accessible mental health care and addressing social determinants of health.
- Integration of Western psychiatric principles with African cultural practices.
- Significance of empathy and nonverbal communication in building therapeutic relationships.
- Training process for grandmothers in cognitive behavioral therapy and effective communication.
- Use of support groups to foster community and shared healing experiences.
- Emphasis on the power of storytelling and vulnerability in the therapeutic process.
If you enjoyed this conversation with Dr. Dixon Chibanda, check out these other episodes:
Why We Need to Rethink Mental Health with Eric Maisel
Insights on Mental Health and Resilience with Andrew Solomon
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Hi everyone. One of the things that I know many
of you struggle with is anxiety, and very recently I
shared some tips on managing anxiety in our newsletter. Specifically,
I shared a practice on clarifying your values. In the practice,
you write down one or two of your core values
and then identify one action step that aligns with them.
(00:20):
I find that taking one positive action towards things that
matter to me really helps reduce anxiety. Also, I have
a reflection question, what positive experiences have you had today
that you could focus on instead of your anxiety. Every Wednesday,
I send out a newsletter called a Weekly by to
Wisdom for a wiser, happier You, And in it I
(00:41):
give tips and reflections like you just got And it's
an opportunity for you to pause, reflect, and practice. It's
a way to stay focused on what's important and meaningful
to you. Each month we focus on a theme. This
month's theme is anxiety, and next month we'll be focusing
on acceptance. To say sign up for these bits of
weekly wisdom, go to Goodwolf dot me slash newsletter.
Speaker 2 (01:06):
Human beings will connect. If this genuine expressed empathy, which
is anchored in deep storytelling.
Speaker 3 (01:18):
Wow, welcome to the one you feed. Throughout time, great
thinkers have recognized the importance of the thoughts we have.
Quotes like garbage in, garbage out, or you are what
you think, ring true. And yet for many of us,
our thoughts don't strengthen or empower us. We tend toward negativity,
(01:40):
self pity, jealousy or fear. We see what we don't
have instead of what we do. We think things that
hold us back and dampen our spirit. But it's not
just about thinking. Our actions matter. It takes conscious, consistent
and creative effort to make a life worth living. This
podcast is about how other keep themselves moving in the
(02:01):
right direction, how they feed their good wolf.
Speaker 1 (02:07):
It's a heartbreaking truth. Someone can know they need help,
even want help, and still not get it simply because
they can't afford the bus fare. Today's guest, doctor Dixon Chabanda,
lost a patient to suicide for that very reason, a
loss that changed the course of his life. Out of
(02:27):
that heartbreak, he started something quietly radical, the friendship Bench. Now,
grandmothers trained in basic therapy offer life changing care from
wooden benches across Zimbabwe and increasingly the world. In this conversation.
We explore how Dixon weave's clinical science with ancestral wisdom
(02:48):
and how human connection, not just diagnosis, can unlock healing.
We talk about the power of storytelling, the danger of labels,
and how even Dixon himself was transformed by the very
grandmothers he trained. I'm Eric Zimmer and this is the
one you feed Hi Dixon, Welcome to the show.
Speaker 2 (03:09):
Thank you, Eric, Thank you for having me.
Speaker 1 (03:10):
I'm excited to have you on. We're going to talk
about your book called The Friendship Bench, how fourteen grandmothers
inspired a mental health revolution, and talk about this movement
in general, which I think is one of the more
beautiful things I've read in a long time. But before
we get into that, we'll start, like we always do,
with the parable. And in the Parable, there's a grandparent
(03:33):
who's talking with their grandchild. They say, in life, there
are two wolves inside of us that are always at battle.
One is a good wolf, which represents things like kindness
and bravery and love, and the other is a bad wolf,
which represents things like greed and hatred and fear. And
the grandchild stops. They think about it for a second.
(03:53):
They look up at their grandparent and they say, well,
which one wins? And the grandparent says, the one you feed.
So I'd like to start off by asking you what
that parable means to you in your life and in
the work that you do.
Speaker 2 (04:07):
Thanks Eric for me. It means being constantly immersed in
the stories the lives of the people who have shaped
my journey, not only around the work that I do
at Friendship Bench, but in my career as well. So
in this particular instance, that would be I guess the
(04:30):
fourteen grandmothers that I started this project with, they have
profoundly influenced the course of my life and career.
Speaker 1 (04:39):
Beautiful, why don't we start with you telling us about
the Friendship Bench for people who aren't familiar with it.
Speaker 2 (04:47):
Great, So, the Friendship Bench in essence is really a
brief psychological therapy or talk therapy that is evidence based
but is delivered by trained community grandmothers. Starter off in Zimbabwe,
the trained community grandmothers, who are trained in the basics
(05:08):
of what we call cognitive behavioral therapy, are located a
wooden park bench in their community. We facilitate referrals to
the bench of people who are lonely, people who are
depressed and those referrals can come through social media, through schools,
through the police station, you know, in cases of for instance,
(05:31):
intimate partner violence. And the grandmas on the bench provide
this structured therapy usually for the six sessions, and after
those sessions on the bench, people are then encouraged to
join a support group in their community. So that, in essence,
is what the friendship bench is in a nutshell.
Speaker 1 (05:50):
Let me set the table a little bit for listeners here.
You were a psychiatrist in Zimbabwe and I think you
at one point quoted a statistic like it was something
like one psychiatrist for every several million people, yeah, in
the world, right, and that obviously is problematic. And as
(06:12):
an attempt to try and solve this problem a little bit,
to try and say how can we actually provide more
care to more people, you, through working with different people,
came up with this idea that these grandmothers who are
not trained psychiatrists, trained psychologists in the academic sense that
(06:33):
we normally would think of them, but they were trusted
members of the community that they could, with a little
bit of training, provide really good support to the members
of the community.
Speaker 2 (06:47):
Yes, so you know, during my formative years of you know,
working in a large hospital as a psychiatrist. I lost
a patient of mine to suicide. Eric was her name,
you know, I write about in my book. Erica had
been under my care for just over two years when
she took her own life. And I distinctly remember the
(07:09):
day that Erica's mother called me to tell me that
Erica had taken her own life. Erica had hanged herself
from a mango tree in the family garden. I was
devastated Eric, But I think what really hit me hard
about Erica's death was the fact that both Erica's parents
(07:32):
knew that Erica needed help, and Erica herself knew that
she needed help, but they didn't have, you know, the
equivalent of ten US dollars to get onto a bus
to bring Erica to the hospital where I worked. Erica's
parents were literally trying to save up for bus fear
(07:53):
to bring Erica, who was severely depressed she'd had a
relapse to the hospital. And it was during that process
of trying to save up the equivalent of ten US
dollars that she actually took her own life. And so
that story hit me so hard, and at the same
time you know, I kind of got into this soul
searching journey, and I realized then that I needed to
(08:18):
find a way of making it possible for people to
get evidence based care or talk therapy from the community
where they lived, as opposed to come into the hospital.
And so that was really the beginning of the idea
of Friendship Bedge. So, you know, Friendship Bench was born
out of a tragic event.
Speaker 1 (08:38):
Talk to me about the origins. How did you arrive
at this idea?
Speaker 2 (08:43):
Well, after the loss of Erica and getting into I
think I actually got into a depression myself, you know,
in this soul searching journey, trying to figure out what
to do with my life with my career as a psychiatrist,
you know, and talking to a lot of people. I
then realized that actually one of the most reliable resource
(09:08):
that we have in communities across the world are grandmothers,
you know. And I realized from talking to people that,
you know, grandmothers are like the custodians of our local
culture and wisdom and knowledge. And I thought, how about
if we could train grandmas in the basics of cognitive
(09:32):
behavior therapy and provide them with the skills to reach
out to those in their communities who need therapy. And
so that's really how it started. And in my book,
I talk about the first fourteen grandmothers because when I
started this project, it was just the fourteen grandmothers that
(09:52):
I had. Of course, now we have in Zimbabwe alone,
we have over three thousand grandmas, and we have a
presence in in many different parts of the world. But
you know, I'm just kind of zeroing in on the
first fourteen and it was those first fourteen grandmas that
really helped me to understand the power of human connection
and the power of embedding healing in stories, you know.
(10:18):
And so this is how Friendship Bench really started, and
it's been shaped by those fourteen grandmas. At the moment,
there are only six of them left. But it's just
really been a tremendous learning opportunity for me, both as
a psychiatrist then as a human being.
Speaker 1 (10:36):
I think that's the beautiful thing. Well, there's many beautiful
things about this, but one of them is that you
brought Okay, I've got a psychiatrist, Western trained view of
mental health, and so I'm bringing that to the table.
The cognitive behavioral therapy part that you're talking about but
they met you with lots and lots of their own
(10:59):
ideas as an own wisdom that emerge out of the
actual culture. And I think it's the combination of those
two things coming together is part of I think probably
what makes it so successful. If you had just said
everybody do CBT, that may not have been really nearly
as effective. Or on the other hand, if it had
only been you know, the contributions of individual grandmothers without
(11:23):
a little bit of you know, guidance in mental health practices.
But when they both came together, you created this thing
that seems really special.
Speaker 2 (11:32):
Yeah, yeah, that is so right, Eric. I often refer
to the journey of the Friendship Bench as striking a balance,
you know, equipoise between you know, Western models of care
and African cultural heritage and bringing all of that together
in a way that produces the results that are acceptable
(11:56):
not only within an African context, but in a Northern
Hemisphere context as well. I'll give you an example. You know,
when I first started Friendship Bench with the first fourteen grandmothers, naturally,
being a psychiatrist, I thought this whole model would be
based on, you know, the principles of DSM five. You know,
(12:19):
where you focus on a diagnosis, you know, you focus
on the symptoms, you come up with a diagnosis, and
then you establish a treatment plan, you know. And the
grandmas were like, no, you need to focus on the story,
because human beings connect through stories, and through those human connections,
(12:39):
that's when healing begins to emerge. And so with time,
I realized that we had to find a way of
connecting stories and DSM five and really creating a sort
of way of harmony between the two, if you like,
and that my journey has consistantly been about that. And
(13:02):
I'll just share one more example about this, this sort
of equid poison. You know, when I started Friendship Bench,
I being a psychiatrist, I wanted to call the initiative
the mental health bench, you know, I was, I was
thinking as a psychiatrist, and the grandma's you know where, like,
you know, that's not really going to work in this community,
(13:23):
and I resisted. And interestingly, Eric, when we started with
the mental health bench, nobody actually wanted to come and
sit on a mental health bench until we changed the
name to friendship Bench, and all of a sudden, everybody
wanted to sit on a friendship bench. And I learned
my first big lesson. You know, the names that we
(13:46):
ascribed to things can make or break those things, you know,
So I really became sensitive to the language that we
use around mental health. And I also realized that a
lot of what we use as profits can fuel stigma
in mental health. So we really have to be careful
with labeling people. This room for that. But oftentimes what
(14:10):
is more important is the story that people bring, you know,
to the bench, not the diagnosis.
Speaker 1 (14:16):
So a big part of what made this work in
Zimbabwe was that these grandmothers were steeped in a culture
that they could bring to the table. And I'm curious
about what do you see in more westernized places where
the culture has devolved in their lifetime. A lot it's
very different, or there isn't the same cultural reference point,
(14:39):
and there isn't necessarily the same respect for the elderly
that there might be in places that are a little
bit more traditional. What do you see as you try
and take this different places?
Speaker 2 (14:50):
Eric, You know, when we first started taking Friendship Bench
through different parts of the world, our hypothesis was the
northern hemisphere, particularly the div developed countries, would be very different.
And I am increasingly surprised at how similar communities are
(15:11):
across the world and how people even in Washington, DC,
or in New Orleans, or in London, in Germany, these
are places where we're introducing friendship bench. You find that
intergenerational connectedness, when given the right space, is extremely powerful
because the elderly or the grandmas are addressing loneliness. Through
(15:36):
this work, young people by engaging and interacting with the grandmas,
are addressing this sense of belonging which a lot of
our young people have lost because you know, our world
has become so disconnected. We're always in front of our devices.
But when you bring the two together, you have this
(15:57):
amazing intergenerational connectedness which is so powerful. So actually, you know,
there's a lot more that connects us as human beings
across the globe that separates us or divides us. Last
year in October, we were in El Salvador and we
were pleasantly surprised to see that the way people relates
(16:18):
to the elderly, the way people connect with their grandmas,
is more different than in Zimbabwe, or in Tanzania, or
in Liberia and all these other places where we're doing
this model. So I really think at the very core
of what we do. The most fundamental human connection that
we see is stories. Yeah, all human beings across the
(16:41):
globe connect through stories. It doesn't matter which culture you're
coming from, and that's fundamentally what friendship bench brings. You know,
that connecting human beings through stories.
Speaker 1 (16:51):
I'm glad that your hypothesis and mind were similar about
how this would work in the Western world, and everything
you're saying makes sense, right. I think we do know
uni versally that one of the most healing things that
can happen is simply one person really listening to another.
A lot of modern studies, you know, trying to figure
out like what therapy is most effective, and it seems
(17:14):
like the answer often is the one which the person
has the best rapport with a therapist leads to the
best outcome. Like that's the single most important thing. I
want to ask a question about stories. So when you
say stories, there's obviously the stories that the client comes with.
I don't know what what do you call people who
come to the friendship bench for her.
Speaker 2 (17:34):
Well, it's you know, it depends where you are. In Zimbabwe,
they are called grandchildren because you know, it's just an
affectionate way of referring to them. But in New York City,
for instance, people who came to the bench were called
clients or benchers. You know, it varies.
Speaker 1 (17:49):
Yeah, I like grandchild. So the grandchildren come, and there's
obviously the story that they bring, but there's the stories
that the grandmothers bring. And I'm curious, does that emerge
completely organically out of each grandmother's experience or are there
connective healing stories that are taught to grandmothers that are
(18:12):
part of what they use.
Speaker 2 (18:15):
Yeah, that's a great question. So when we train the grandmas,
we leaning to their stories.
Speaker 4 (18:24):
You know, as you may imagine, someone who has lived
for several decades has a rich history, has a rich
lived experience.
Speaker 2 (18:35):
You know, these grandmas, I like to say that, you know,
they carry the battle scars of life with grace and dignity,
and they bring those battle scars to the bench. And
one of the things that I learned as a psychiatrist
is the importance of sharing your own story as a
way of connecting with clients. Naturally, you have to respect
(18:58):
certain boundaries as you do so, you know, but the
grandmas bring their own stories, but what we emphasize is
the use of empathy or expressed empathy, which is their
ability to make people feel respected and understood when they
open up to share their stories. We emphasize you know,
(19:20):
nonverbal communication, the use of eye contact, the use of
silence as a tool. You know, most human beings feel
extremely uncomfortable when there's silence, you know. In fact, you know,
for a lot of people's silence makes them feel kind
of awkward. But with the Friendship Bench, the first level
training is really all about using all of those sort
(19:41):
of intuitive non verbal strategies that you can use to
engage with another human beings. It's really, as you say, Eric,
it's about building that rapport we call that therapeutic alliance.
That is the most important part of the work that
we do at Friendship Bench, and that's what we really
emphasize in the first level training. You know, our training
as three levels level one, two and three.
Speaker 1 (20:03):
Yeah. How much training does a grandmother go through before
she's sort of put on a bench.
Speaker 2 (20:10):
That usually varies depending on the level of education or
the grandma. The more educated, the less time they may need. Okay,
so we work with grandmas who have minimal education. In Zimbabwe,
most of them have you know, the equivalent of junior
school education, and it takes a month for them to
be able to understand the basic components of the therapy,
(20:34):
which is, you know, problem solving, behavior activation, activity, scheduling,
and psycho education. You know, those are sort of the
active ingredients of Friendship Bench. And anchored in all of
that is that the rich storytelling component, their ability to
get people to feel comfortable with feeling vulnerable. You know. Again,
(20:57):
that was one of the big lessons I learned from
the Grandma's You know, if there's one thing we do
at the Friendship Bench is make people feel comfortable to
feel vulnerable because it's through that vulnerability that they share
their stories and it's through that sharing of story that
connect and the healing process begins. Yeah, so we trained
(21:20):
for a month, but after the month of training, they
are then encouraged to have practical exercises under supervision, and
that supervision can be under a clinical psychologist or a
mental health nurse. And then once they go through that
supervision and they pass that supervision, they are then allowed
(21:41):
to see clients on their own. But again it varies
depending on where we're training. I mean, we recently trained
folks in London, and that training only took seven days
because the people we were training already had some experience
of counseling.
Speaker 1 (21:56):
This, in my mind, is similar to an emergence we're
seeing in the West, at least a little bit more
of which is peer support. The purest model of it
is the one that I sort of came of age in,
which was twelve step programs. I'm a recovering heroin addict,
and so you know, that's obviously all peer support. There's
no training, No, there's just nothing. It's just you just
(22:18):
all end up in a room and there's a few
guidelines and hopefully it all goes well. I also think though,
that there's a more of a peer support movement emerging
where people are trained a little bit to provide a
little bit more support than they might know how to
do natively. Yeah, Now, in a lot of those what
ends up being part of the binding connection is that
(22:41):
for me, if I'm going to a twelve step meeting
and I'm talking about addiction, I'm talking about addiction with
other addicts. If somebody is giving peer support for bipolar
as an example, they share that in common. Is there
any attempt to put certain people with certain grandmothers based
on life experience.
Speaker 2 (22:59):
Oh yeah, we have that. You know. Over time, what
we've done is the grandmas, amongst themselves, have become experts
of very specific issues. You will have grandmas who just
focus on clients who come to the bench with intimate
partner violence issues. You have grandmas who focus on people
(23:23):
who are living with HIV because the grandma herself is
living with HIV. So yes, we do that exactly, you know.
But ultimately, regardless of that peer to peer component, human
beings will connect if there's genuine express empathy, which is
anchored in deep storytelling.
Speaker 1 (24:01):
I think that when you match people in shared experience,
that's like a potential extra But to your point, I mean,
we've seen this in our programs we do. Connection around
certain values, are wanting to improve or be different can
happen amongst very disparate people given the right environment. One
of the things I thought was very interesting was you
(24:22):
say in the book that most people coming to the
bench don't want treatment for depression. They want treatment for
their problems with money and people. I think in the
Western world we tend to suddenly go, oh, you're feeling
that way, you have depression, So we're going to treat
the depression. And it seems like there was a very
clear orientation from the beginning that very often the reason
(24:46):
they feel lousy is they have legitimate life problems, and
any attempt to help them needs to be rooted in
helping them address the actual problems.
Speaker 2 (24:57):
That is so true, you know. And interestingly, when I
first started Friendship Bench, and I write about this in
the book, you know, I wanted to focus on the symptoms,
you know, like hey, because the grandmas were taught how
to use screening tools, you know, like the PHQ nine,
which is used globally, and I was emphasizing focusing on
those symptoms, and it was the grandma who were like,
(25:20):
you know, those symptoms actually happen as a result of
these social determinants of health, like you know, intimate partner violence, poverty,
you know, living with HIV, And so that becomes the focus.
And when you address the problem, as you rightly say,
the symptoms get better, so you don't have to worry
(25:42):
about the symptoms. Focus on the issues that people bring
to the bench, you know, And that is what we
really focus on. Although you know, we can, for instance,
establish that a person might be going through a social
issue and as a result of that they have major depression.
(26:03):
According to DSM five, we certainly do that, but we
also understand that that depression is largely fueled by those
social circumstances that need to be addressed.
Speaker 1 (26:14):
Right because you have a process in which a grandma,
they're very early in the process, can say, hey, this
person needs more care, then we're going to be able
to provide here, or we need to refer them on
if there's more serious psychiatric disorder. And I think you're
not saying that there's not a place for westernized approaches
(26:35):
to medicine where we use certain medicines, you know, antidepressants
or other things to treat people. It's just that I
think we've gotten things in a lot of cases backwards
here in that I think the way most people are
treated for depression or anxiety today is they go to
their primary care doctor usually and say oh, I'm depressed,
(26:57):
and they get an antidepressant or a lot of primary
care doctors these days hand you some version of that
screen question you're talking about, You fill it out and
you may leave with a prescription. And there are some
ways in which I think that this filtering down to
primary care physicians has been a value for our society.
(27:17):
But there are plenty of ways in which I think
it is problematic, And I think the problematic thing is,
to your point, it's worth trying to address the global
situation first. Like in someone's life. It's the same sort
of thing, like trying to ferret out whether what somebody
is dealing with is natural grief over something and when
(27:37):
does it turn into depression? And you know, tweezing these
things apart is not simple.
Speaker 2 (27:42):
Yeah, it definitely is not simple. And this is why
at friendship banks we use algorithms. We use these screening tools.
For instance, a common phrase that we use is red
flag to identify clients who might be severely depressed or suicidal.
You know, when clients present with such severe symptoms, they
(28:04):
are stepped up, you know, to see a grandma who
is more experienced and normally what would happen is that.
For instance, I'll give you a classical example, someone comes
to the friendship mention they're suicidal. They respond yes to
the question on suicide or thoughts. She's question eleven on
our screening tool. If a grandma who is engaging with
(28:25):
that client is not comfortable with dealing with suicidality. She
will refer to the next level, you know, to a
grandma who actually focuses on that, and that grandma will
use a more precise screening tool to establish whether those
suicidal thoughts are really serious or not. Very basic questions,
(28:50):
you know, have you thought of when you would do it,
how would you do it? The usual stuff that any
therapist will kind of ask. But in all of that,
there's still the person's story. And what we find at
Friendship Bench is that you know, over eighty percent of
the people presenting with suicidal ideation crying out for help,
(29:14):
and when you give them that space to genuinely share
their story, healing begins. We discourage our grandmas from immediately
referring unless somebody is a genuine red flag. And you know,
the other thing about Friendship Bench, which I have to
just mention Eric, if you don't mind, is that everything
(29:34):
that we do at Friendship Bench is rooted in rigorous research.
We have over one hundred peer reviewed scientific publications, including
clinical trials, which show that these grandmas are effective therapists.
So it's not just something that you know, we just
wake up and think about like that we actually test
(29:54):
all these things through these rigorous studies which are published
in peer review journals, scientific journals.
Speaker 1 (30:01):
Yeah. I think that's a really interesting part because that's
not how it started.
Speaker 2 (30:05):
Obviously.
Speaker 1 (30:05):
It started as an experiment, right like you're like, okay,
let's go, oh, yeah, do this. But since it's gone
on and been successful enough in a eye test sort
of way, like looking at it like wow, this seems
to really be working, you were then able to say,
all right, now, let's apply academic methods of research to
this to see is it really And the answer seems
(30:26):
pretty convincingly that indeed it is. I wanted to ask
you about there's three steps that you address in the book.
And I'm not even going to attempt to pronounce these
words because I butcher English words on a regular basis.
But the three steps are opening the mind, uplifting, and
strengthen And I was wondering if you could speak the
(30:48):
I assume there's zimbabwe In words for them, and then
tell us about what each of those are.
Speaker 2 (30:53):
Yeah. So the first level training is called opening the
mind in the local language that is Kuvupour, and essentially
these terms or the pillars of the friendship bench really
terms that the grandma's you know, conceived and all I
did was put them together. But these were ideas based on,
(31:14):
you know, the wisdom and knowledge that these grandmas have
that have defined the program. So opening the mind, as
we call it in Shonna, literally means creating space for
people to feel comfortable to share their stories, you know,
for people to feel comfortable with being vulnerable, and that
(31:37):
is really the first level, and that is achieved by
using some of the you know, earlier terms I shared,
like expressed empathy. You know, I'm now using the English equivalent,
you know, expressed empathy, which is really making people feel
respected and understood, using eye contact, using nonverbal communication, using
(31:59):
silence as a tool. All of that is embedded in
that first level training because we strongly believe at Friendship
Bench that when you make people feel comfortable in that
first level where their mind is opened, they then begin
to see things that they were not able to see
prior to that, you know, and that's when healing begins.
(32:23):
You know. In a lot of therapies out there, Eric,
we measure success on the basis of reduction of symptoms,
which is, you know, the most sort of common thing
when you're thinking of you know, clinical psychiatry or psychology
based on DSM five or the ICD ten. At Friendship Bench,
you know, we measure success based on hope. Yes, we
(32:46):
do have all these other screening tools, but for us,
success is when we instill hope in a person. And
oftentimes when you instill hope, you haven't necessarily removed all
symptoms of the depression, but that hope makes a person
feel that they can carry on, they still have a chance,
(33:08):
you know, And so we focus very much on that
element and that is built in that level one with
KUV opening the mind, and the level two is you know,
the uplifting level, and that is where we begin to
go into some of the most structured components of how
to use screening tools to identify people who are genuinely suicidal,
(33:33):
or who are psychotic and need to be referred to
a psychiatrist, or people who have severe depression and may
benefit not only from the talk therapy but also from
an antidepressant, you know. And then level three is now
the structured therapy around problem solving, behavior activation, and activity scheduling.
(33:55):
So this is how the training actually runs. And if
you ask me BA on the years of working with
a grandma's I still think that first level training of
opening the mind is the most important because that really
sort of creates that space for healing.
Speaker 1 (34:12):
One of the things that you talk about is that
the grandmother has described this to you, which was that
clients get overwhelmed by multiple problems, and so part of
what they do is help clients focus on one problem
at a time. Say more about that.
Speaker 2 (34:28):
Yeah, you know, typically people who come to the Friendship
Bench have numerous challenges. So, for instance, I can give
you an example, and this is a real life example.
You know, a woman comes to the Friendship Bench. She's
feeling suicidal because she's unemployed, she's HIV positive, she's in
an abusive relationship, she has no money to send her
(34:49):
child to school, and so she's just completely overwhelmed with
all of these challenges. And she comes to the bench
and what typically happens is she opens up to the grandma,
she shares, she talks about all of these things, all
the issues that are affecting her in her life. And
what we've found over the years is oftentimes when people
(35:09):
have numerous challenges, they struggle. They actually struggle to figure
out which of those problems to start working on, you know,
and that is something that the grandma's and sort of
work with a client on. And we use a term
called the ping pole to describe the interaction between the
(35:29):
grandma and the client because often when the grandma summarizes,
which is part of the problem solve? When the grandma
will summarize this story, and again that summary of the
story is an indication of being anchored in the present,
you know. So we test the grandmas in terms of
their ability to reflect back to the client what they've heard.
(35:51):
And that is so powerful because it makes a person
realize that someone is listening to me, you know. Anyway,
so when the grandma's reflect the story, the grandma will
then say, so, which one of these views would you
like to start working on? Your average client will say,
I don't know, you decide, you tell me which one
I should start working on. And we always train our
(36:14):
grandmothers never to select the problem. The grandma simply throws
it back to the client, you know, by saying something like,
you know, I wouldn't possibly be able to stand in
your shoes. I'm here to help you select one problem.
And so you have this exchange which can take thirty
forty minutes until a client suddenly decides, you know, I
(36:37):
want to focus on making sure that my child goes
to school. And then the grandma will say, all right,
if that's what you want to focus on, let's work
on that. And the interesting thing, Eric is that people
that come to the bench will select problems to focus on,
which I, as a clinician, as a psychiatrist, may think
(36:59):
this doesn't makes sense. Like, for instance, if someone is
HIV positive, my instinctive focus should be, hey, we need
to put you on medication for HIV. You know. So
in this particular case, this woman is HIV positive, but
she is interested in focusing on getting her child to school.
(37:19):
And when you deep deeper into the story, you find
that if she gets her child to go to school,
she will then have time to go to the primary
health care facility and address the next problem, you know.
And so we never actually assume that what we think
is the biggest problem is what we should tell the
(37:40):
client to focus on, because clients will always come up
with something which is completely out of the box in
terms of what they think is a priority. And so
that's the level too. And then after that, when a
problem is selected, they will then brainstorm together for solutions,
and we train the grandmas on how to use what
(38:02):
we call the smart action plan, which essentially stands for,
you know, coming up with something that specific, measurable, achievable, realistic,
and timely, you know, And so the grandmas have to
go through all of that because you know, when you
come up with a solution, the more it addresses the
smart sort of elements, the more likely it's going to work,
(38:23):
you know. Yeah, yeah, so it's in a nutshell, you know,
those are some of the components that we kind of
focus on.
Speaker 1 (38:28):
Yet I'm a big believer in that a lot of
the value that we can offer to people is helping
them create a plan that will work. And often think
of it in this way. You've probably heard of like
the trance theoretical model of change, the stages of change model, right,
and it posits that there are at least three steps
(38:50):
before the action step. Right, there's a pre contemplation, there's
a contemplation, there's a planning, but all of us immediately
try and jump right into the action step. That is
so true, which doesn't end well, yeah, because there's no good, coherent,
structural plan and so you know, having the grandmothers deliver
that is really valuable. I want to talk for a
(39:11):
minute about how the grandmothers helped heal you.
Speaker 2 (39:16):
Yes, you know, I shared earlier on about the loss
of Erica, my patient who took her own life by suicide.
And I hadn't actually shared Erica's story with anyone. I
kept it inside me because I was struggling with the guilt,
you know, and the feelings of imposter syndrome, even after
(39:36):
I'd started working with the grandma's, you know. But you know,
over the first year or two of working with the
first fourteen grandmothers and watching them interacting with clients, I
began to realize that I needed to open up about
my own pain, about my own story. And it wasn't
planned at all. It actually happened one morning when we
(39:59):
were having a debriefing session, and I write about it
in the book. So I only started talking about my pain,
the loss of Eric Carr. And it was the response
from their grandmothers that really kind of made me realize
how powerful what they were doing was. Because after I
shared my story and I cried in front of the grandmothers,
(40:22):
you know, what they did was they broke down into
a song. You know, they started to sing this song,
this soothing, you know, Shana song, each one of those
fourteen grandmothers just knowing where to place her voice, and
they sang that song for me, which was almost like
(40:43):
ten to fifteen minutes. And after that they prayed for me.
That is all they did.
Speaker 1 (40:48):
Eric.
Speaker 2 (40:48):
They sang and prayed for me while I was in
the middle them in a sort of circle, and you know,
it just broke down. But when it was all over,
I felt this sense of immense relief. And after that
I was able to share Erica's story and then, you know,
(41:09):
I subsequently went on to talk about Erica at ted
in New Orleans. And I think that was only made
possible because the grandmothers had taught me about, you know,
the power of being comfortable with being vulnerable in situations
like that. So yeah, that was really a powerful moment
for me.
Speaker 1 (41:45):
We're going to try something here that I don't know
if it's gonna work, but we're gonna try it. It
occurs to me that the best way to try this
would actually be to have the grandmother here and Karen here,
and we have neither of them. But what I'd like
to do is I'd like to read a listener question
that we got. We've recently started taking in some listener
questions and I'm trying to get them answered in various shows.
(42:09):
Now again, I think this is only going to be
so useful because there can't be the back and forth
that we might want. But I'm going to read the question,
and I just wonder if you could sort of give
us a sense of how a grandmother might approach this. Sure, Okay,
this comes from Karen, and Karen says, about five years ago,
I divorced from my ex of forty years, and I
(42:32):
felt liberated and tried loads of new things. However, recently
I met and fell in love with a married man.
It was intense for both of us, but it ended
when he was caught between two lives. He had other
issues and he took an overdose. He survived, but the
next day he decided to return to his family and
immediately cut off all communication with me. Since then, I
(42:52):
have been completely stuck. I've tried to go back to
my life and put energy into it, tried to get
out and about, and it's not working. I feel completely
without energy and self belief, and I've withdrawn from work.
I've tried so many things. I've also been doing some therapy,
and I'm reading a lot, but I'm still really stuck.
So any suggestions would be extremely helpful.
Speaker 2 (43:14):
If a grandma was listening to this story, the response
I didn't mention this, but this is something we train
all our grandmothers to always start off by saying, would
you like to share your story? So let's say this
story has been shared yea, As a grandma, I would
want Karen to tell me more, you know, I would say, Karen,
(43:38):
I would like you to share more. Start from wherever
you want to start, but I would like to know
a little bit more so I can be in a
better position to help you. So I would then listen
to Karen. And by listening to Karen, you can see
where the emphasis is. She might subconscious not know where
(44:01):
the emphasis should be. But as we tell our stories,
the areas that are really hurting us the most tend
to emerge. You tend to see these patterns in the
story as it's coming out, and we train the grandmothers
in what we call the rule of three. What are
the three most salient features of the story that are
(44:22):
coming out? And so those three most salient features are
in this case, I wouldn't know what they would be.
The grandma would at some point then say, if I
heard you correctly, you are struggling to come to terms
with this breakup. It's affecting your sleep, it's affecting the
way you are you're interacting and relating with other people
(44:42):
in your life. Would you like to share more? And
you see where it goes. So it's really eric about
tapping into a story which has not yet been told,
but it's there inside her Because what she's shared is
very much the surface. There's a deeper element in those
(45:04):
different components of a story that need to come out,
and as it comes out, so does the healing element.
So I would encourage Karen to share more, you know,
That's what I would do. The other thing is the
grandmas don't tell you what to do. Friendship bench is
not about telling you what to do, but it's about
unpacking what's happening and you realizing on your own. As
(45:28):
you unpack, you know, get you hit that aha moment
and you're like, oh my goodness, this is what it is.
You know, that's what normally happens. And the other thing
as well, Before I forget, you know. Apart from doing
all of that, a grandma would also intuitively ask the
questions that are part of our screening tools, you know,
to establish whether Karen is actually struggling with major depression
(45:56):
or she's you know, struggling to come to terms with
a loss, but she's notinly depressed. So that's also important.
Speaker 1 (46:03):
Yeah, because there's elements in this story that could point
towards that. Potentially, if you've sort of grieved the loss,
but you're really still stuck with no energy, you know,
no self belief. I'm not saying that Karen is depressed.
I am certainly I'm not even grandmother level trained, so
I will stay far away from the DSM five. I
(46:23):
could say from my own experience, however, that describes often
for me what depression has looked like. I've dealt with
the initial thing, but something about that shock sent my
in my case, my depression prone system into a spiral.
There is another term that comes out of your language's shona, Shona. Yes,
(46:47):
I'm not gonna attempt to say this either, because I'm
glad I didn't try before, because I was so far
off it might have been embarrassing. What is thinking too
much in Shona.
Speaker 2 (46:57):
Thinking too much in Shona is kufungisi.
Speaker 1 (47:00):
I would have been closer on that one. Talk to
me about why that was part of what the grandmothers
identified and why that was a key part of the therapy.
Speaker 2 (47:10):
So one of the things that we've done at Friendship Bench,
you know, as we expanded, you know, we validated screening tools,
we came up with the most appropriate terms, and the
whole process of coming up with the term kufungi sisa
involved not only discussing with the grandmothers but with clients
(47:30):
as well, you know, to come up with the common
terms that resonated with both grandmothers and clients. And we
found that kofungi sisa very often when it was serious,
severe kufungi sisa I had the elements or symptoms of
your DSM five criteria for depression. And so that's why
(47:54):
we shifted to the term kufungi sisa, which resonated with
with the community. But our kofungi sisa has different levels.
This kofungi sisa, which is really like your DSM five
major depression, which needs attention more than just what the
grandmothers can give, you know, maybe medication and stuff like that,
but the mild, moderate versions of depression could then be handled.
(48:18):
So kofungi sisa really is a reflection of how people
identify the emotional struggles which I guess we could say
are linked to the DSM five diagnosis or depression and
anxiety as well, you know, together with ICD ten.
Speaker 1 (48:34):
Yeah, back to your point about the mental health bench
versus the friendship bench. Terms that resonate with our lived
experience are always so helpful, you know. I think the
Western term that we might use for that that I
know a lot of people listening to the show and
people I've worked with have identified with, is the term rumination. Right,
you just going around and round the same thoughts again
(48:57):
and again. It's not like you're thinking too much novel
in creative ways. It's just you're thinking about the exact
same thing again and again and again and again.
Speaker 2 (49:07):
That's exactly what it is. Yeah, you know, and we
always place a time frame to it as well, you know,
just like in DSM five, if you had these symptoms
for more than two weeks, you know, so kufun gi sisa,
which is like for a day or two, it cannot
meet diagnostic criteria of DSM five or ICD ten. You know,
so duration is also important.
Speaker 1 (49:27):
So it sounds like the initial friendship bench lasts, did
you say six weeks? Yeah, and then you encourage people
to go into sort of an ongoing support type group.
Speaker 2 (49:39):
Yeah. So what we do is, after the experience on
the bench, folks are encouraged to join support groups. So
in essence, you know, it's a little bit like you
have people who've had the same experience on the bench,
they've gone through those three levels of opening the mind, uplifting,
and strengthening. They are then brought together in smaller groups.
(50:03):
You know, often these are groups of fifteen, twenty maximum
thirty people in a community, and they then use the
same skills that they got from the bench to collectively
address larger issues that they may be facing. But here's
the beauty of what happens in these circles or support groups.
(50:24):
Every member of a circle, it's a little bit like AA. Actually,
every member in the circle has an opportunity to share
how they're doing and what they're struggling with and what
they think is a priority issue for them. And so
each group has what we call it talking piece, so
only the person who has the talking piece can speak,
(50:47):
and so after everybody has shared, what then happens in
these groups is they collectively designed on which problem or
problems they want to focus on. It can be a
problem that a single person is facing, or it can
be a problem that several people are facing, and they
(51:07):
collectively bring our resources together. They are with them together,
and sometimes the problem could be something that is financial
and they all get together to help each other. So
these support groups have been running for more than ten years,
you know, some of them, you know, and so it's
really a powerful way of sustaining the model. After a
(51:29):
sessions on the bench.
Speaker 1 (51:31):
Yeah, and that makes a lot of sense to me,
because a question I was going to ask and then
I remembered that you have these support groups was lots
of people, if I use Western experience, go to a
therapist six times, and they still got a long way
to go after the end of those successions. And my
experience is that true change happens a little bit by
(51:51):
little bit, right, That's the way most change happens. And
one of the things that stops a lot of change
is that we get discouraged part way through or we
just sort of slide off paying attention to it. And
so for that reason, you know, support groups or communities
of practice or different things like that are real ways
(52:15):
to in essence, keep going, keep making improvement beyond just
working with a therapist. And one of the things I've
thought that I found in my own life is really
interesting is I have had a fair amount of healing
that has happened by talking to a trained therapist. I
have probably now not probably, I have definitely had more
(52:37):
healing happen in group dynamics. There is something about that
that a lot of us don't want because we're nervous
about it. But my experience has been it's incredibly powerful
to have that group dynamic. It brings something else to
the table that you don't get when you're just talking
with one other person.
Speaker 2 (52:57):
Oh yeah, that is that is so so true. What
I think happens, That is what I've observed at Friendship
Bench is it helps to build that sense of community,
that sense of belonging, which is so powerful. When you
have that sense of belonging, you then get hope. Yeap,
you know you have hope.
Speaker 1 (53:17):
I just want to read a sentence to you and
let you reflect on it as a way of heading
out of here. You say, at the core of the
model is anchored in the power of storytelling, which we've
talked about to transform us from the inside out, and
the belief about empathetic presence. But this is what I love.
It says it can create a ripple effect of healing,
beauty and goodness. Say anything you would like in response
(53:41):
to that as a way of wrapping.
Speaker 2 (53:42):
Up well in essence, that makes us comfortable with feeling
vulnerable in the presence of other people. And that's really
sort of the foundational healing.
Speaker 1 (53:55):
That's beautiful, and there is no doubt that what you've
done has created a ripple effect of healing, beauty and
goodness and addressing a problem that our world really does have,
which is lack of availability to getting help with our struggles.
And so it's a beautiful thing you've done. And I
genuinely appreciate you joining us on the show.
Speaker 2 (54:15):
Thank you for having me, Eric, Thank you very much.
Speaker 1 (54:17):
Thank you so much for listening to the show. If
you found this conversation helpful, inspiring, or thought provoking, I'd
love for you to share it with a friend. Sharing
from one person to another is the lifeblood of what
we do. We don't have a big budget, and I'm
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and that's you. Just hit the share button on your
(54:39):
podcast app or send a quick text with the episode
link to someone who might enjoy it. Your support means
the world, and together we can spread wisdom one episode
at a time. Thank you for being part of the
one you Feed community.
Hi everyone. One of the things that I know many
of you struggle with is anxiety, and very recently I
shared some tips on managing anxiety in our newsletter. Specifically,
I shared a practice on clarifying your values. In the practice,
you write down one or two of your core values
and then identify one action step that aligns with them.
(00:20):
I find that taking one positive action towards things that
matter to me really helps reduce anxiety. Also, I have
a reflection question, what positive experiences have you had today
that you could focus on instead of your anxiety. Every Wednesday,
I send out a newsletter called a Weekly by to
Wisdom for a wiser, happier You, And in it I
(00:41):
give tips and reflections like you just got And it's
an opportunity for you to pause, reflect, and practice. It's
a way to stay focused on what's important and meaningful
to you. Each month we focus on a theme. This
month's theme is anxiety, and next month we'll be focusing
on acceptance. To say sign up for these bits of
weekly wisdom, go to Goodwolf dot me slash newsletter.
Speaker 2 (01:06):
Human beings will connect. If this genuine expressed empathy, which
is anchored in deep storytelling.
Speaker 3 (01:18):
Wow, welcome to the one you feed. Throughout time, great
thinkers have recognized the importance of the thoughts we have.
Quotes like garbage in, garbage out, or you are what
you think, ring true. And yet for many of us,
our thoughts don't strengthen or empower us. We tend toward negativity,
(01:40):
self pity, jealousy or fear. We see what we don't
have instead of what we do. We think things that
hold us back and dampen our spirit. But it's not
just about thinking. Our actions matter. It takes conscious, consistent
and creative effort to make a life worth living. This
podcast is about how other keep themselves moving in the
(02:01):
right direction, how they feed their good wolf.
Speaker 1 (02:07):
It's a heartbreaking truth. Someone can know they need help,
even want help, and still not get it simply because
they can't afford the bus fare. Today's guest, doctor Dixon Chabanda,
lost a patient to suicide for that very reason, a
loss that changed the course of his life. Out of
(02:27):
that heartbreak, he started something quietly radical, the friendship Bench. Now,
grandmothers trained in basic therapy offer life changing care from
wooden benches across Zimbabwe and increasingly the world. In this conversation.
We explore how Dixon weave's clinical science with ancestral wisdom
(02:48):
and how human connection, not just diagnosis, can unlock healing.
We talk about the power of storytelling, the danger of labels,
and how even Dixon himself was transformed by the very
grandmothers he trained. I'm Eric Zimmer and this is the
one you feed Hi Dixon, Welcome to the show.
Speaker 2 (03:09):
Thank you, Eric, Thank you for having me.
Speaker 1 (03:10):
I'm excited to have you on. We're going to talk
about your book called The Friendship Bench, how fourteen grandmothers
inspired a mental health revolution, and talk about this movement
in general, which I think is one of the more
beautiful things I've read in a long time. But before
we get into that, we'll start, like we always do,
with the parable. And in the Parable, there's a grandparent
(03:33):
who's talking with their grandchild. They say, in life, there
are two wolves inside of us that are always at battle.
One is a good wolf, which represents things like kindness
and bravery and love, and the other is a bad wolf,
which represents things like greed and hatred and fear. And
the grandchild stops. They think about it for a second.
(03:53):
They look up at their grandparent and they say, well,
which one wins? And the grandparent says, the one you feed.
So I'd like to start off by asking you what
that parable means to you in your life and in
the work that you do.
Speaker 2 (04:07):
Thanks Eric for me. It means being constantly immersed in
the stories the lives of the people who have shaped
my journey, not only around the work that I do
at Friendship Bench, but in my career as well. So
in this particular instance, that would be I guess the
(04:30):
fourteen grandmothers that I started this project with, they have
profoundly influenced the course of my life and career.
Speaker 1 (04:39):
Beautiful, why don't we start with you telling us about
the Friendship Bench for people who aren't familiar with it.
Speaker 2 (04:47):
Great, So, the Friendship Bench in essence is really a
brief psychological therapy or talk therapy that is evidence based
but is delivered by trained community grandmothers. Starter off in Zimbabwe,
the trained community grandmothers, who are trained in the basics
(05:08):
of what we call cognitive behavioral therapy, are located a
wooden park bench in their community. We facilitate referrals to
the bench of people who are lonely, people who are
depressed and those referrals can come through social media, through schools,
through the police station, you know, in cases of for instance,
(05:31):
intimate partner violence. And the grandmas on the bench provide
this structured therapy usually for the six sessions, and after
those sessions on the bench, people are then encouraged to
join a support group in their community. So that, in essence,
is what the friendship bench is in a nutshell.
Speaker 1 (05:50):
Let me set the table a little bit for listeners here.
You were a psychiatrist in Zimbabwe and I think you
at one point quoted a statistic like it was something
like one psychiatrist for every several million people, yeah, in
the world, right, and that obviously is problematic. And as
(06:12):
an attempt to try and solve this problem a little bit,
to try and say how can we actually provide more
care to more people, you, through working with different people,
came up with this idea that these grandmothers who are
not trained psychiatrists, trained psychologists in the academic sense that
(06:33):
we normally would think of them, but they were trusted
members of the community that they could, with a little
bit of training, provide really good support to the members
of the community.
Speaker 2 (06:47):
Yes, so you know, during my formative years of you know,
working in a large hospital as a psychiatrist. I lost
a patient of mine to suicide. Eric was her name,
you know, I write about in my book. Erica had
been under my care for just over two years when
she took her own life. And I distinctly remember the
(07:09):
day that Erica's mother called me to tell me that
Erica had taken her own life. Erica had hanged herself
from a mango tree in the family garden. I was
devastated Eric, But I think what really hit me hard
about Erica's death was the fact that both Erica's parents
(07:32):
knew that Erica needed help, and Erica herself knew that
she needed help, but they didn't have, you know, the
equivalent of ten US dollars to get onto a bus
to bring Erica to the hospital where I worked. Erica's
parents were literally trying to save up for bus fear
(07:53):
to bring Erica, who was severely depressed she'd had a
relapse to the hospital. And it was during that process
of trying to save up the equivalent of ten US
dollars that she actually took her own life. And so
that story hit me so hard, and at the same
time you know, I kind of got into this soul
searching journey, and I realized then that I needed to
(08:18):
find a way of making it possible for people to
get evidence based care or talk therapy from the community
where they lived, as opposed to come into the hospital.
And so that was really the beginning of the idea
of Friendship Bedge. So, you know, Friendship Bench was born
out of a tragic event.
Speaker 1 (08:38):
Talk to me about the origins. How did you arrive
at this idea?
Speaker 2 (08:43):
Well, after the loss of Erica and getting into I
think I actually got into a depression myself, you know,
in this soul searching journey, trying to figure out what
to do with my life with my career as a psychiatrist,
you know, and talking to a lot of people. I
then realized that actually one of the most reliable resource
(09:08):
that we have in communities across the world are grandmothers,
you know. And I realized from talking to people that,
you know, grandmothers are like the custodians of our local
culture and wisdom and knowledge. And I thought, how about
if we could train grandmas in the basics of cognitive
(09:32):
behavior therapy and provide them with the skills to reach
out to those in their communities who need therapy. And
so that's really how it started. And in my book,
I talk about the first fourteen grandmothers because when I
started this project, it was just the fourteen grandmothers that
(09:52):
I had. Of course, now we have in Zimbabwe alone,
we have over three thousand grandmas, and we have a
presence in in many different parts of the world. But
you know, I'm just kind of zeroing in on the
first fourteen and it was those first fourteen grandmas that
really helped me to understand the power of human connection
and the power of embedding healing in stories, you know.
(10:18):
And so this is how Friendship Bench really started, and
it's been shaped by those fourteen grandmas. At the moment,
there are only six of them left. But it's just
really been a tremendous learning opportunity for me, both as
a psychiatrist then as a human being.
Speaker 1 (10:36):
I think that's the beautiful thing. Well, there's many beautiful
things about this, but one of them is that you
brought Okay, I've got a psychiatrist, Western trained view of
mental health, and so I'm bringing that to the table.
The cognitive behavioral therapy part that you're talking about but
they met you with lots and lots of their own
(10:59):
ideas as an own wisdom that emerge out of the
actual culture. And I think it's the combination of those
two things coming together is part of I think probably
what makes it so successful. If you had just said
everybody do CBT, that may not have been really nearly
as effective. Or on the other hand, if it had
only been you know, the contributions of individual grandmothers without
(11:23):
a little bit of you know, guidance in mental health practices.
But when they both came together, you created this thing
that seems really special.
Speaker 2 (11:32):
Yeah, yeah, that is so right, Eric. I often refer
to the journey of the Friendship Bench as striking a balance,
you know, equipoise between you know, Western models of care
and African cultural heritage and bringing all of that together
in a way that produces the results that are acceptable
(11:56):
not only within an African context, but in a Northern
Hemisphere context as well. I'll give you an example. You know,
when I first started Friendship Bench with the first fourteen grandmothers, naturally,
being a psychiatrist, I thought this whole model would be
based on, you know, the principles of DSM five. You know,
(12:19):
where you focus on a diagnosis, you know, you focus
on the symptoms, you come up with a diagnosis, and
then you establish a treatment plan, you know. And the
grandmas were like, no, you need to focus on the story,
because human beings connect through stories, and through those human connections,
(12:39):
that's when healing begins to emerge. And so with time,
I realized that we had to find a way of
connecting stories and DSM five and really creating a sort
of way of harmony between the two, if you like,
and that my journey has consistantly been about that. And
(13:02):
I'll just share one more example about this, this sort
of equid poison. You know, when I started Friendship Bench,
I being a psychiatrist, I wanted to call the initiative
the mental health bench, you know, I was, I was
thinking as a psychiatrist, and the grandma's you know where, like,
you know, that's not really going to work in this community,
(13:23):
and I resisted. And interestingly, Eric, when we started with
the mental health bench, nobody actually wanted to come and
sit on a mental health bench until we changed the
name to friendship Bench, and all of a sudden, everybody
wanted to sit on a friendship bench. And I learned
my first big lesson. You know, the names that we
(13:46):
ascribed to things can make or break those things, you know,
So I really became sensitive to the language that we
use around mental health. And I also realized that a
lot of what we use as profits can fuel stigma
in mental health. So we really have to be careful
with labeling people. This room for that. But oftentimes what
(14:10):
is more important is the story that people bring, you know,
to the bench, not the diagnosis.
Speaker 1 (14:16):
So a big part of what made this work in
Zimbabwe was that these grandmothers were steeped in a culture
that they could bring to the table. And I'm curious
about what do you see in more westernized places where
the culture has devolved in their lifetime. A lot it's
very different, or there isn't the same cultural reference point,
(14:39):
and there isn't necessarily the same respect for the elderly
that there might be in places that are a little
bit more traditional. What do you see as you try
and take this different places?
Speaker 2 (14:50):
Eric, You know, when we first started taking Friendship Bench
through different parts of the world, our hypothesis was the
northern hemisphere, particularly the div developed countries, would be very different.
And I am increasingly surprised at how similar communities are
(15:11):
across the world and how people even in Washington, DC,
or in New Orleans, or in London, in Germany, these
are places where we're introducing friendship bench. You find that
intergenerational connectedness, when given the right space, is extremely powerful
because the elderly or the grandmas are addressing loneliness. Through
(15:36):
this work, young people by engaging and interacting with the grandmas,
are addressing this sense of belonging which a lot of
our young people have lost because you know, our world
has become so disconnected. We're always in front of our devices.
But when you bring the two together, you have this
(15:57):
amazing intergenerational connectedness which is so powerful. So actually, you know,
there's a lot more that connects us as human beings
across the globe that separates us or divides us. Last
year in October, we were in El Salvador and we
were pleasantly surprised to see that the way people relates
(16:18):
to the elderly, the way people connect with their grandmas,
is more different than in Zimbabwe, or in Tanzania, or
in Liberia and all these other places where we're doing
this model. So I really think at the very core
of what we do. The most fundamental human connection that
we see is stories. Yeah, all human beings across the
(16:41):
globe connect through stories. It doesn't matter which culture you're
coming from, and that's fundamentally what friendship bench brings. You know,
that connecting human beings through stories.
Speaker 1 (16:51):
I'm glad that your hypothesis and mind were similar about
how this would work in the Western world, and everything
you're saying makes sense, right. I think we do know
uni versally that one of the most healing things that
can happen is simply one person really listening to another.
A lot of modern studies, you know, trying to figure
out like what therapy is most effective, and it seems
(17:14):
like the answer often is the one which the person
has the best rapport with a therapist leads to the
best outcome. Like that's the single most important thing. I
want to ask a question about stories. So when you
say stories, there's obviously the stories that the client comes with.
I don't know what what do you call people who
come to the friendship bench for her.
Speaker 2 (17:34):
Well, it's you know, it depends where you are. In Zimbabwe,
they are called grandchildren because you know, it's just an
affectionate way of referring to them. But in New York City,
for instance, people who came to the bench were called
clients or benchers. You know, it varies.
Speaker 1 (17:49):
Yeah, I like grandchild. So the grandchildren come, and there's
obviously the story that they bring, but there's the stories
that the grandmothers bring. And I'm curious, does that emerge
completely organically out of each grandmother's experience or are there
connective healing stories that are taught to grandmothers that are
(18:12):
part of what they use.
Speaker 2 (18:15):
Yeah, that's a great question. So when we train the grandmas,
we leaning to their stories.
Speaker 4 (18:24):
You know, as you may imagine, someone who has lived
for several decades has a rich history, has a rich
lived experience.
Speaker 2 (18:35):
You know, these grandmas, I like to say that, you know,
they carry the battle scars of life with grace and dignity,
and they bring those battle scars to the bench. And
one of the things that I learned as a psychiatrist
is the importance of sharing your own story as a
way of connecting with clients. Naturally, you have to respect
(18:58):
certain boundaries as you do so, you know, but the
grandmas bring their own stories, but what we emphasize is
the use of empathy or expressed empathy, which is their
ability to make people feel respected and understood when they
open up to share their stories. We emphasize you know,
(19:20):
nonverbal communication, the use of eye contact, the use of
silence as a tool. You know, most human beings feel
extremely uncomfortable when there's silence, you know. In fact, you know,
for a lot of people's silence makes them feel kind
of awkward. But with the Friendship Bench, the first level
training is really all about using all of those sort
(19:41):
of intuitive non verbal strategies that you can use to
engage with another human beings. It's really, as you say, Eric,
it's about building that rapport we call that therapeutic alliance.
That is the most important part of the work that
we do at Friendship Bench, and that's what we really
emphasize in the first level training. You know, our training
as three levels level one, two and three.
Speaker 1 (20:03):
Yeah. How much training does a grandmother go through before
she's sort of put on a bench.
Speaker 2 (20:10):
That usually varies depending on the level of education or
the grandma. The more educated, the less time they may need. Okay,
so we work with grandmas who have minimal education. In Zimbabwe,
most of them have you know, the equivalent of junior
school education, and it takes a month for them to
be able to understand the basic components of the therapy,
(20:34):
which is, you know, problem solving, behavior activation, activity, scheduling,
and psycho education. You know, those are sort of the
active ingredients of Friendship Bench. And anchored in all of
that is that the rich storytelling component, their ability to
get people to feel comfortable with feeling vulnerable. You know. Again,
(20:57):
that was one of the big lessons I learned from
the Grandma's You know, if there's one thing we do
at the Friendship Bench is make people feel comfortable to
feel vulnerable because it's through that vulnerability that they share
their stories and it's through that sharing of story that
connect and the healing process begins. Yeah, so we trained
(21:20):
for a month, but after the month of training, they
are then encouraged to have practical exercises under supervision, and
that supervision can be under a clinical psychologist or a
mental health nurse. And then once they go through that
supervision and they pass that supervision, they are then allowed
(21:41):
to see clients on their own. But again it varies
depending on where we're training. I mean, we recently trained
folks in London, and that training only took seven days
because the people we were training already had some experience
of counseling.
Speaker 1 (21:56):
This, in my mind, is similar to an emergence we're
seeing in the West, at least a little bit more
of which is peer support. The purest model of it
is the one that I sort of came of age in,
which was twelve step programs. I'm a recovering heroin addict,
and so you know, that's obviously all peer support. There's
no training, No, there's just nothing. It's just you just
(22:18):
all end up in a room and there's a few
guidelines and hopefully it all goes well. I also think though,
that there's a more of a peer support movement emerging
where people are trained a little bit to provide a
little bit more support than they might know how to
do natively. Yeah, Now, in a lot of those what
ends up being part of the binding connection is that
(22:41):
for me, if I'm going to a twelve step meeting
and I'm talking about addiction, I'm talking about addiction with
other addicts. If somebody is giving peer support for bipolar
as an example, they share that in common. Is there
any attempt to put certain people with certain grandmothers based
on life experience.
Speaker 2 (22:59):
Oh yeah, we have that. You know. Over time, what
we've done is the grandmas, amongst themselves, have become experts
of very specific issues. You will have grandmas who just
focus on clients who come to the bench with intimate
partner violence issues. You have grandmas who focus on people
(23:23):
who are living with HIV because the grandma herself is
living with HIV. So yes, we do that exactly, you know.
But ultimately, regardless of that peer to peer component, human
beings will connect if there's genuine express empathy, which is
anchored in deep storytelling.
Speaker 1 (24:01):
I think that when you match people in shared experience,
that's like a potential extra But to your point, I mean,
we've seen this in our programs we do. Connection around
certain values, are wanting to improve or be different can
happen amongst very disparate people given the right environment. One
of the things I thought was very interesting was you
(24:22):
say in the book that most people coming to the
bench don't want treatment for depression. They want treatment for
their problems with money and people. I think in the
Western world we tend to suddenly go, oh, you're feeling
that way, you have depression, So we're going to treat
the depression. And it seems like there was a very
clear orientation from the beginning that very often the reason
(24:46):
they feel lousy is they have legitimate life problems, and
any attempt to help them needs to be rooted in
helping them address the actual problems.
Speaker 2 (24:57):
That is so true, you know. And interestingly, when I
first started Friendship Bench, and I write about this in
the book, you know, I wanted to focus on the symptoms,
you know, like hey, because the grandmas were taught how
to use screening tools, you know, like the PHQ nine,
which is used globally, and I was emphasizing focusing on
those symptoms, and it was the grandma who were like,
(25:20):
you know, those symptoms actually happen as a result of
these social determinants of health, like you know, intimate partner violence, poverty,
you know, living with HIV, And so that becomes the focus.
And when you address the problem, as you rightly say,
the symptoms get better, so you don't have to worry
(25:42):
about the symptoms. Focus on the issues that people bring
to the bench, you know, And that is what we
really focus on. Although you know, we can, for instance,
establish that a person might be going through a social
issue and as a result of that they have major depression.
(26:03):
According to DSM five, we certainly do that, but we
also understand that that depression is largely fueled by those
social circumstances that need to be addressed.
Speaker 1 (26:14):
Right because you have a process in which a grandma,
they're very early in the process, can say, hey, this
person needs more care, then we're going to be able
to provide here, or we need to refer them on
if there's more serious psychiatric disorder. And I think you're
not saying that there's not a place for westernized approaches
(26:35):
to medicine where we use certain medicines, you know, antidepressants
or other things to treat people. It's just that I
think we've gotten things in a lot of cases backwards
here in that I think the way most people are
treated for depression or anxiety today is they go to
their primary care doctor usually and say oh, I'm depressed,
(26:57):
and they get an antidepressant or a lot of primary
care doctors these days hand you some version of that
screen question you're talking about, You fill it out and
you may leave with a prescription. And there are some
ways in which I think that this filtering down to
primary care physicians has been a value for our society.
(27:17):
But there are plenty of ways in which I think
it is problematic, And I think the problematic thing is,
to your point, it's worth trying to address the global
situation first. Like in someone's life. It's the same sort
of thing, like trying to ferret out whether what somebody
is dealing with is natural grief over something and when
(27:37):
does it turn into depression? And you know, tweezing these
things apart is not simple.
Speaker 2 (27:42):
Yeah, it definitely is not simple. And this is why
at friendship banks we use algorithms. We use these screening tools.
For instance, a common phrase that we use is red
flag to identify clients who might be severely depressed or suicidal.
You know, when clients present with such severe symptoms, they
(28:04):
are stepped up, you know, to see a grandma who
is more experienced and normally what would happen is that.
For instance, I'll give you a classical example, someone comes
to the friendship mention they're suicidal. They respond yes to
the question on suicide or thoughts. She's question eleven on
our screening tool. If a grandma who is engaging with
(28:25):
that client is not comfortable with dealing with suicidality. She
will refer to the next level, you know, to a
grandma who actually focuses on that, and that grandma will
use a more precise screening tool to establish whether those
suicidal thoughts are really serious or not. Very basic questions,
(28:50):
you know, have you thought of when you would do it,
how would you do it? The usual stuff that any
therapist will kind of ask. But in all of that,
there's still the person's story. And what we find at
Friendship Bench is that you know, over eighty percent of
the people presenting with suicidal ideation crying out for help,
(29:14):
and when you give them that space to genuinely share
their story, healing begins. We discourage our grandmas from immediately
referring unless somebody is a genuine red flag. And you know,
the other thing about Friendship Bench, which I have to
just mention Eric, if you don't mind, is that everything
(29:34):
that we do at Friendship Bench is rooted in rigorous research.
We have over one hundred peer reviewed scientific publications, including
clinical trials, which show that these grandmas are effective therapists.
So it's not just something that you know, we just
wake up and think about like that we actually test
(29:54):
all these things through these rigorous studies which are published
in peer review journals, scientific journals.
Speaker 1 (30:01):
Yeah. I think that's a really interesting part because that's
not how it started.
Speaker 2 (30:05):
Obviously.
Speaker 1 (30:05):
It started as an experiment, right like you're like, okay,
let's go, oh, yeah, do this. But since it's gone
on and been successful enough in a eye test sort
of way, like looking at it like wow, this seems
to really be working, you were then able to say,
all right, now, let's apply academic methods of research to
this to see is it really And the answer seems
(30:26):
pretty convincingly that indeed it is. I wanted to ask
you about there's three steps that you address in the book.
And I'm not even going to attempt to pronounce these
words because I butcher English words on a regular basis.
But the three steps are opening the mind, uplifting, and
strengthen And I was wondering if you could speak the
(30:48):
I assume there's zimbabwe In words for them, and then
tell us about what each of those are.
Speaker 2 (30:53):
Yeah. So the first level training is called opening the
mind in the local language that is Kuvupour, and essentially
these terms or the pillars of the friendship bench really
terms that the grandma's you know, conceived and all I
did was put them together. But these were ideas based on,
(31:14):
you know, the wisdom and knowledge that these grandmas have
that have defined the program. So opening the mind, as
we call it in Shonna, literally means creating space for
people to feel comfortable to share their stories, you know,
for people to feel comfortable with being vulnerable, and that
(31:37):
is really the first level, and that is achieved by
using some of the you know, earlier terms I shared,
like expressed empathy. You know, I'm now using the English equivalent,
you know, expressed empathy, which is really making people feel
respected and understood, using eye contact, using nonverbal communication, using
(31:59):
silence as a tool. All of that is embedded in
that first level training because we strongly believe at Friendship
Bench that when you make people feel comfortable in that
first level where their mind is opened, they then begin
to see things that they were not able to see
prior to that, you know, and that's when healing begins.
(32:23):
You know. In a lot of therapies out there, Eric,
we measure success on the basis of reduction of symptoms,
which is, you know, the most sort of common thing
when you're thinking of you know, clinical psychiatry or psychology
based on DSM five or the ICD ten. At Friendship Bench,
you know, we measure success based on hope. Yes, we
(32:46):
do have all these other screening tools, but for us,
success is when we instill hope in a person. And
oftentimes when you instill hope, you haven't necessarily removed all
symptoms of the depression, but that hope makes a person
feel that they can carry on, they still have a chance,
(33:08):
you know, And so we focus very much on that
element and that is built in that level one with
KUV opening the mind, and the level two is you know,
the uplifting level, and that is where we begin to
go into some of the most structured components of how
to use screening tools to identify people who are genuinely suicidal,
(33:33):
or who are psychotic and need to be referred to
a psychiatrist, or people who have severe depression and may
benefit not only from the talk therapy but also from
an antidepressant, you know. And then level three is now
the structured therapy around problem solving, behavior activation, and activity scheduling.
(33:55):
So this is how the training actually runs. And if
you ask me BA on the years of working with
a grandma's I still think that first level training of
opening the mind is the most important because that really
sort of creates that space for healing.
Speaker 1 (34:12):
One of the things that you talk about is that
the grandmother has described this to you, which was that
clients get overwhelmed by multiple problems, and so part of
what they do is help clients focus on one problem
at a time. Say more about that.
Speaker 2 (34:28):
Yeah, you know, typically people who come to the Friendship
Bench have numerous challenges. So, for instance, I can give
you an example, and this is a real life example.
You know, a woman comes to the Friendship Bench. She's
feeling suicidal because she's unemployed, she's HIV positive, she's in
an abusive relationship, she has no money to send her
(34:49):
child to school, and so she's just completely overwhelmed with
all of these challenges. And she comes to the bench
and what typically happens is she opens up to the grandma,
she shares, she talks about all of these things, all
the issues that are affecting her in her life. And
what we've found over the years is oftentimes when people
(35:09):
have numerous challenges, they struggle. They actually struggle to figure
out which of those problems to start working on, you know,
and that is something that the grandma's and sort of
work with a client on. And we use a term
called the ping pole to describe the interaction between the
(35:29):
grandma and the client because often when the grandma summarizes,
which is part of the problem solve? When the grandma
will summarize this story, and again that summary of the
story is an indication of being anchored in the present,
you know. So we test the grandmas in terms of
their ability to reflect back to the client what they've heard.
(35:51):
And that is so powerful because it makes a person
realize that someone is listening to me, you know. Anyway,
so when the grandma's reflect the story, the grandma will
then say, so, which one of these views would you
like to start working on? Your average client will say,
I don't know, you decide, you tell me which one
I should start working on. And we always train our
(36:14):
grandmothers never to select the problem. The grandma simply throws
it back to the client, you know, by saying something like,
you know, I wouldn't possibly be able to stand in
your shoes. I'm here to help you select one problem.
And so you have this exchange which can take thirty
forty minutes until a client suddenly decides, you know, I
(36:37):
want to focus on making sure that my child goes
to school. And then the grandma will say, all right,
if that's what you want to focus on, let's work
on that. And the interesting thing, Eric is that people
that come to the bench will select problems to focus on,
which I, as a clinician, as a psychiatrist, may think
(36:59):
this doesn't makes sense. Like, for instance, if someone is
HIV positive, my instinctive focus should be, hey, we need
to put you on medication for HIV. You know. So
in this particular case, this woman is HIV positive, but
she is interested in focusing on getting her child to school.
(37:19):
And when you deep deeper into the story, you find
that if she gets her child to go to school,
she will then have time to go to the primary
health care facility and address the next problem, you know.
And so we never actually assume that what we think
is the biggest problem is what we should tell the
(37:40):
client to focus on, because clients will always come up
with something which is completely out of the box in
terms of what they think is a priority. And so
that's the level too. And then after that, when a
problem is selected, they will then brainstorm together for solutions,
and we train the grandmas on how to use what
(38:02):
we call the smart action plan, which essentially stands for,
you know, coming up with something that specific, measurable, achievable, realistic,
and timely, you know, And so the grandmas have to
go through all of that because you know, when you
come up with a solution, the more it addresses the
smart sort of elements, the more likely it's going to work,
(38:23):
you know. Yeah, yeah, so it's in a nutshell, you know,
those are some of the components that we kind of
focus on.
Speaker 1 (38:28):
Yet I'm a big believer in that a lot of
the value that we can offer to people is helping
them create a plan that will work. And often think
of it in this way. You've probably heard of like
the trance theoretical model of change, the stages of change model, right,
and it posits that there are at least three steps
(38:50):
before the action step. Right, there's a pre contemplation, there's
a contemplation, there's a planning, but all of us immediately
try and jump right into the action step. That is
so true, which doesn't end well, yeah, because there's no good, coherent,
structural plan and so you know, having the grandmothers deliver
that is really valuable. I want to talk for a
(39:11):
minute about how the grandmothers helped heal you.
Speaker 2 (39:16):
Yes, you know, I shared earlier on about the loss
of Erica, my patient who took her own life by suicide.
And I hadn't actually shared Erica's story with anyone. I
kept it inside me because I was struggling with the guilt,
you know, and the feelings of imposter syndrome, even after
(39:36):
I'd started working with the grandma's, you know. But you know,
over the first year or two of working with the
first fourteen grandmothers and watching them interacting with clients, I
began to realize that I needed to open up about
my own pain, about my own story. And it wasn't
planned at all. It actually happened one morning when we
(39:59):
were having a debriefing session, and I write about it
in the book. So I only started talking about my pain,
the loss of Eric Carr. And it was the response
from their grandmothers that really kind of made me realize
how powerful what they were doing was. Because after I
shared my story and I cried in front of the grandmothers,
(40:22):
you know, what they did was they broke down into
a song. You know, they started to sing this song,
this soothing, you know, Shana song, each one of those
fourteen grandmothers just knowing where to place her voice, and
they sang that song for me, which was almost like
(40:43):
ten to fifteen minutes. And after that they prayed for me.
That is all they did.
Speaker 1 (40:48):
Eric.
Speaker 2 (40:48):
They sang and prayed for me while I was in
the middle them in a sort of circle, and you know,
it just broke down. But when it was all over,
I felt this sense of immense relief. And after that
I was able to share Erica's story and then, you know,
(41:09):
I subsequently went on to talk about Erica at ted
in New Orleans. And I think that was only made
possible because the grandmothers had taught me about, you know,
the power of being comfortable with being vulnerable in situations
like that. So yeah, that was really a powerful moment
for me.
Speaker 1 (41:45):
We're going to try something here that I don't know
if it's gonna work, but we're gonna try it. It
occurs to me that the best way to try this
would actually be to have the grandmother here and Karen here,
and we have neither of them. But what I'd like
to do is I'd like to read a listener question
that we got. We've recently started taking in some listener
questions and I'm trying to get them answered in various shows.
(42:09):
Now again, I think this is only going to be
so useful because there can't be the back and forth
that we might want. But I'm going to read the question,
and I just wonder if you could sort of give
us a sense of how a grandmother might approach this. Sure, Okay,
this comes from Karen, and Karen says, about five years ago,
I divorced from my ex of forty years, and I
(42:32):
felt liberated and tried loads of new things. However, recently
I met and fell in love with a married man.
It was intense for both of us, but it ended
when he was caught between two lives. He had other
issues and he took an overdose. He survived, but the
next day he decided to return to his family and
immediately cut off all communication with me. Since then, I
(42:52):
have been completely stuck. I've tried to go back to
my life and put energy into it, tried to get
out and about, and it's not working. I feel completely
without energy and self belief, and I've withdrawn from work.
I've tried so many things. I've also been doing some therapy,
and I'm reading a lot, but I'm still really stuck.
So any suggestions would be extremely helpful.
Speaker 2 (43:14):
If a grandma was listening to this story, the response
I didn't mention this, but this is something we train
all our grandmothers to always start off by saying, would
you like to share your story? So let's say this
story has been shared yea, As a grandma, I would
want Karen to tell me more, you know, I would say, Karen,
(43:38):
I would like you to share more. Start from wherever
you want to start, but I would like to know
a little bit more so I can be in a
better position to help you. So I would then listen
to Karen. And by listening to Karen, you can see
where the emphasis is. She might subconscious not know where
(44:01):
the emphasis should be. But as we tell our stories,
the areas that are really hurting us the most tend
to emerge. You tend to see these patterns in the
story as it's coming out, and we train the grandmothers
in what we call the rule of three. What are
the three most salient features of the story that are
(44:22):
coming out? And so those three most salient features are
in this case, I wouldn't know what they would be.
The grandma would at some point then say, if I
heard you correctly, you are struggling to come to terms
with this breakup. It's affecting your sleep, it's affecting the
way you are you're interacting and relating with other people
(44:42):
in your life. Would you like to share more? And
you see where it goes. So it's really eric about
tapping into a story which has not yet been told,
but it's there inside her Because what she's shared is
very much the surface. There's a deeper element in those
(45:04):
different components of a story that need to come out,
and as it comes out, so does the healing element.
So I would encourage Karen to share more, you know,
That's what I would do. The other thing is the
grandmas don't tell you what to do. Friendship bench is
not about telling you what to do, but it's about
unpacking what's happening and you realizing on your own. As
(45:28):
you unpack, you know, get you hit that aha moment
and you're like, oh my goodness, this is what it is.
You know, that's what normally happens. And the other thing
as well, Before I forget, you know. Apart from doing
all of that, a grandma would also intuitively ask the
questions that are part of our screening tools, you know,
to establish whether Karen is actually struggling with major depression
(45:56):
or she's you know, struggling to come to terms with
a loss, but she's notinly depressed. So that's also important.
Speaker 1 (46:03):
Yeah, because there's elements in this story that could point
towards that. Potentially, if you've sort of grieved the loss,
but you're really still stuck with no energy, you know,
no self belief. I'm not saying that Karen is depressed.
I am certainly I'm not even grandmother level trained, so
I will stay far away from the DSM five. I
(46:23):
could say from my own experience, however, that describes often
for me what depression has looked like. I've dealt with
the initial thing, but something about that shock sent my
in my case, my depression prone system into a spiral.
There is another term that comes out of your language's shona, Shona. Yes,
(46:47):
I'm not gonna attempt to say this either, because I'm
glad I didn't try before, because I was so far
off it might have been embarrassing. What is thinking too
much in Shona.
Speaker 2 (46:57):
Thinking too much in Shona is kufungisi.
Speaker 1 (47:00):
I would have been closer on that one. Talk to
me about why that was part of what the grandmothers
identified and why that was a key part of the therapy.
Speaker 2 (47:10):
So one of the things that we've done at Friendship Bench,
you know, as we expanded, you know, we validated screening tools,
we came up with the most appropriate terms, and the
whole process of coming up with the term kufungi sisa
involved not only discussing with the grandmothers but with clients
(47:30):
as well, you know, to come up with the common
terms that resonated with both grandmothers and clients. And we
found that kofungi sisa very often when it was serious,
severe kufungi sisa I had the elements or symptoms of
your DSM five criteria for depression. And so that's why
(47:54):
we shifted to the term kufungi sisa, which resonated with
with the community. But our kofungi sisa has different levels.
This kofungi sisa, which is really like your DSM five
major depression, which needs attention more than just what the
grandmothers can give, you know, maybe medication and stuff like that,
but the mild, moderate versions of depression could then be handled.
(48:18):
So kofungi sisa really is a reflection of how people
identify the emotional struggles which I guess we could say
are linked to the DSM five diagnosis or depression and
anxiety as well, you know, together with ICD ten.
Speaker 1 (48:34):
Yeah, back to your point about the mental health bench
versus the friendship bench. Terms that resonate with our lived
experience are always so helpful, you know. I think the
Western term that we might use for that that I
know a lot of people listening to the show and
people I've worked with have identified with, is the term rumination. Right,
you just going around and round the same thoughts again
(48:57):
and again. It's not like you're thinking too much novel
in creative ways. It's just you're thinking about the exact
same thing again and again and again and again.
Speaker 2 (49:07):
That's exactly what it is. Yeah, you know, and we
always place a time frame to it as well, you know,
just like in DSM five, if you had these symptoms
for more than two weeks, you know, so kufun gi sisa,
which is like for a day or two, it cannot
meet diagnostic criteria of DSM five or ICD ten. You know,
so duration is also important.
Speaker 1 (49:27):
So it sounds like the initial friendship bench lasts, did
you say six weeks? Yeah, and then you encourage people
to go into sort of an ongoing support type group.
Speaker 2 (49:39):
Yeah. So what we do is, after the experience on
the bench, folks are encouraged to join support groups. So
in essence, you know, it's a little bit like you
have people who've had the same experience on the bench,
they've gone through those three levels of opening the mind, uplifting,
and strengthening. They are then brought together in smaller groups.
(50:03):
You know, often these are groups of fifteen, twenty maximum
thirty people in a community, and they then use the
same skills that they got from the bench to collectively
address larger issues that they may be facing. But here's
the beauty of what happens in these circles or support groups.
(50:24):
Every member of a circle, it's a little bit like AA. Actually,
every member in the circle has an opportunity to share
how they're doing and what they're struggling with and what
they think is a priority issue for them. And so
each group has what we call it talking piece, so
only the person who has the talking piece can speak,
(50:47):
and so after everybody has shared, what then happens in
these groups is they collectively designed on which problem or
problems they want to focus on. It can be a
problem that a single person is facing, or it can
be a problem that several people are facing, and they
(51:07):
collectively bring our resources together. They are with them together,
and sometimes the problem could be something that is financial
and they all get together to help each other. So
these support groups have been running for more than ten years,
you know, some of them, you know, and so it's
really a powerful way of sustaining the model. After a
(51:29):
sessions on the bench.
Speaker 1 (51:31):
Yeah, and that makes a lot of sense to me,
because a question I was going to ask and then
I remembered that you have these support groups was lots
of people, if I use Western experience, go to a
therapist six times, and they still got a long way
to go after the end of those successions. And my
experience is that true change happens a little bit by
(51:51):
little bit, right, That's the way most change happens. And
one of the things that stops a lot of change
is that we get discouraged part way through or we
just sort of slide off paying attention to it. And
so for that reason, you know, support groups or communities
of practice or different things like that are real ways
(52:15):
to in essence, keep going, keep making improvement beyond just
working with a therapist. And one of the things I've
thought that I found in my own life is really
interesting is I have had a fair amount of healing
that has happened by talking to a trained therapist. I
have probably now not probably, I have definitely had more
(52:37):
healing happen in group dynamics. There is something about that
that a lot of us don't want because we're nervous
about it. But my experience has been it's incredibly powerful
to have that group dynamic. It brings something else to
the table that you don't get when you're just talking
with one other person.
Speaker 2 (52:57):
Oh yeah, that is that is so so true. What
I think happens, That is what I've observed at Friendship
Bench is it helps to build that sense of community,
that sense of belonging, which is so powerful. When you
have that sense of belonging, you then get hope. Yeap,
you know you have hope.
Speaker 1 (53:17):
I just want to read a sentence to you and
let you reflect on it as a way of heading
out of here. You say, at the core of the
model is anchored in the power of storytelling, which we've
talked about to transform us from the inside out, and
the belief about empathetic presence. But this is what I love.
It says it can create a ripple effect of healing,
beauty and goodness. Say anything you would like in response
(53:41):
to that as a way of wrapping.
Speaker 2 (53:42):
Up well in essence, that makes us comfortable with feeling
vulnerable in the presence of other people. And that's really
sort of the foundational healing.
Speaker 1 (53:55):
That's beautiful, and there is no doubt that what you've
done has created a ripple effect of healing, beauty and
goodness and addressing a problem that our world really does have,
which is lack of availability to getting help with our struggles.
And so it's a beautiful thing you've done. And I
genuinely appreciate you joining us on the show.
Speaker 2 (54:15):
Thank you for having me, Eric, Thank you very much.
Speaker 1 (54:17):
Thank you so much for listening to the show. If
you found this conversation helpful, inspiring, or thought provoking, I'd
love for you to share it with a friend. Sharing
from one person to another is the lifeblood of what
we do. We don't have a big budget, and I'm
certainly not a celebrity, but we have something even better,
and that's you. Just hit the share button on your
(54:39):
podcast app or send a quick text with the episode
link to someone who might enjoy it. Your support means
the world, and together we can spread wisdom one episode
at a time. Thank you for being part of the
one you Feed community.
Host
Eric Zimmer
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