Afghanistan Dissemination Activities 2015

Report to ACBS on using ACT to train Lay Counselors in Afghanistan

Reported by Norman Gustavson, Phd

Feb. 17, 2016

First, thank you for your support and the ongoing work of ACBS

"Lay counseling" is a very new concept in Afghan communities attempting to deal with a vulnerable population dealing with many physical/structural demands and psychosocial issues.  In this project, in spite of the expected challenges, the volunteers who were trained were very determined in their community outreach and very enthusiastic about the tools that they acquired in the PARSA trainings.  This project demonstrated that the foundational work done this year has created the possibility of a healthy and effective community response to mental health issues. Methodology adapted from cognitive behavior therapy and Acceptance and Commitment Therapy (ACT) by Dr. Gustavson and Dr. Sabour proved effective in reaching clients in vulnerable communities.

During this period, three workshops on awareness of psychosocial problems and three trainings on “Introduction to Counseling Skills” were designed, developed and implemented in Kabul, Kandahar and Nangarhar provinces.

In the workshops on “Introduction to Counseling Skills” 53 people were certified as “Village Psychosocial Counselors” (VPSC) to provide counseling to clients in internal refugee camps in these three provinces on a volunteer basis.

These 53 VPSCs reached 793 people utilizing their "lay counseling" skills.

The first awareness workshop was held in Kabul in February 2015 for five days for 16 staff from WarChild-Canada (WCC). 

The second MH awarness training for staff of the WCC contract provider, “Organnization for Human Welfare” (OHW) in February for 17 participants, male and female staff of OHW.

The third staff development-awareness of MH issues workshop was conducted in Kandahar in April for staff of (OHW) with 17 staff participants.

The first trainings for Village Psychosocial Counselors (VSPC)was conducted in in April in Kabul’s Charahe Qambar “Internally Displace Persons” (IDP) refugee camp.

The second and third trainings for VPSCs were conducted in June in Kandahar and Jalalabad.  The training method included several hours of practical exercise from actual case studies as well as simplified case vignettes from the trainer’s clinics and International Assistance Mission (IAM) mental health clinic materials.

Methods:

Observing, listening without judging is a basic counseling skill that crosses many counseling methodologies as does “active listening” and form a basis for PARSA’s work.  What we have added are principles form Acceptance and Commitment Training (ACT), an evidence based program of training and therapy.  ACT does not focus on diagnosis but on the concerns of the client and helping the client to discover unworkable avoidance patterns that tend keep the client “stuck” in a “vicious cycle” that attempts to avoid painful, distressing feelings but that actually tend to keep the client focused on the painful emotions.  The focus of ACT is to foster acceptance of distress as it is while building on the clients stated (and elaborated values, i.e., who and what are truly important to the client.  The client is assisted to formulating behaviors they can take on that support these values.  Acceptance plus increases in valued behavior aid the client in improved functioning, i.e., living a more productive and valued life.  In this way an overview of psychosocial problems was developed for trainees without needing to go into great detail about psychopathology and diagnosis.  The orientation of counseling is pragmatic.

The model used to help trainees understand how clients get stuck in problematic patterns of behavior or “suffering” with negative emotions was drawn from the ACT approach known as “The Matrix” (“the ACT Matrix”, Edited by Kevin Polk, PhD and Benjamin Schoenhorff, MA, 2014, New Harbinger Publications, Inc.).

The Matrix was used to develop both a way of conceptualizing a clients issues; a focus on recognizing things that trigger problem behavioral reactions or emotions and a path for finding more productive behaviors while learning to accept negative feelings as they come up without getting fixated on them.  The basic approach has counselors help clients list what and who is really valuable to the client and then use these values to develop positive actions toward personal goals instead of getting caught in behaviors or feelings they have learned in an attempt to avoid unwanted feelings and reactions.  For example actions to engage in social activity that is valued, like doing things with friends and family instead of trying to avoid negative feelings by self-isolating, drug use or other escape behaviors.

Outcomes:

The success of this program is quantifiable and exceeded our expectations. Using 53 volunteers at a low level of education trained to be Village Psychosocial Counselors (VPSC's), PARSA has documented an outreach to 793 beneficiaries in IDP camps in Kabul, Kandahar, and Nangarhar by the completion of the first year program.

In Kabul the training started in two separate locations for male and female groups and was conducted for 10 women and 12 men.

The VPSC workshop in Kandahar was conducted May 30th through June 5th for 11 females, and in a concurrent but separate workshop during the same dates for 14 males.

In Jalalabad the VPSC workshop was conducted from June 13th through the 17th in concurrent groups for 16 females and 17 males.  The trainees were a group of men and women from districts where IDPs were living (Daman District).

In addition to traditional training components for lay counselors like “active listening” and taking a nonjudgmental stance in relation to the client with whom the counselor is working, the ACT Matrix was used to help the VPSCs to listen for and share with clients the experiential avoidance patters that clients revealed as their issues or “struggles”.  A (I believe) new exercise was also developed (shown in our Poster) called “this is not a tree”.  Here participants were asked to recall an early image of “tree” as they learned to associate the word with objects in their environment and then to draw their personal image of “tree”.  The next step was for them to add to the drawing an early experience associated with their “tree” (to other things and actions in the larger “frame” of their tree.  After sharing their tree and related story/frame the ‘take away’ from the exercise was for the trainees to see that no ones “tree” and framework is any better than anyone else’s.  no ones tree is more or less valid than any other person’s.  All points of view are valid.  This work supported other exercises to build a nonjudgmental stance in relation to their clients.  The exercise also helped to reinforce the idea of observing and giving feedback to clients on patterns of avoidance and behaviors that move toward who and what is important without advise giving, i.e., helping clients discover and sort out unworkable patterns of behavior from moves toward their stated values.

The matrix exercise was done with individuals creating their own matrix using pictures to past into the four quadrants of the matrix.  This was a very success process based on presentations each participant made to describe their own matrix of values, internal (mental) thoughts and feelings, actions to avoid these feelings (stuck places) and new behaviors to move toward values to enrich their lives.

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