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Eric Maisel, PhD, is the author of more than 40 books, including Why Smart People Hurt, Making Your Creating Mark, The Future of Mental Health, The VanGogh Blues, Mastering Creative Anxiety, and Creativity for Life. Dr. Maisel is at the forefront of the movement to rethink mental health. He writes the Rethinking Psychology blog for Psychology Today.

Eric and Dr. Maisel discuss his books Overcoming Your Difficult Family:  8 Skills for Thriving in Any Family Situation and The Future of Mental Health

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.

Dixon Chibanda, MD, is the author of The Friendship Bench: How Fourteen Grandmothers Inspired a Mental Health Revolution.  He is a professor of psychiatry at the University of Zimbabwe and the London School of Hygiene & Tropical Medicine and director of the African Mental Health Research Initiative (AMARI). His “Why I Train Grandmothers to Treat Depression,” TEDx talk has been viewed over 3.2 million times and the Friendship Bench project he founded has been featured in major media like The PBS News Hour, New York Times, LA Times, BBC World Service, and more.

Dr. Dixon Chibanda:  Website | Instagram

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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Episode Transcript:

Eric Zimmer 00:02:07  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, Dr. Dixon Kharbanda, lost a patient to suicide for that very reason, a loss that changed the course of his life.

Eric Zimmer 00:02:27  Out of 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 weaves clinical science with ancestral wisdom and how human connection, not just diagnosis, can unlock healing. We talk about the power of storytelling, the danger of labels, and how even Dickson himself was transformed by the very grandmothers he trained. I’m Eric Zimmer and this is the one you feed. Hi, Dickson, welcome to the show.

Dixon Chibanda 00:03:08  Thank you. Eric, thank you for having me.

Eric Zimmer 00:03:10  I’m excited to have you on. We’re going to talk about your book called The Friendship Bench How 14 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 who’s talking with their grandchild, and they say, in life there are two wolves inside of us that are always at battle.

Eric Zimmer 00:03:40  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. 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.

Dixon Chibanda 00:04:07  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 14 grandmothers that I started this project with. They have profoundly influenced the course of my life and career.

Eric Zimmer 00:04:39  Beautiful. Why don’t we start with you telling us about the friendship bench for people who aren’t familiar with it?

Dixon Chibanda 00:04:47  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. Started off in Zimbabwe. The trained community grandmothers who are trained in the basics 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, intimate partner violence and the grandmothers on the bench provide this structured therapy, usually 4 to 6 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.

Eric Zimmer 00:05:50  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 in the world.

Eric Zimmer 00:06:08  Right. And that obviously is problematic. And as 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 psychiatrist, trained psychologists in the academic sense that 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.

Dixon Chibanda 00:06:47  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. Erica was her name. You know, I write about Erica 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 day that Erica’s mother called me to tell me that, that Erica had taken her own life. Erica had hanged herself from a mango tree in the family garden.

Dixon Chibanda 00:07:21  I was devastated, Eric. But I think what really hit me hard about Erica’s death was the fact that both Erica’s parents knew that Erica needed help, and Erica herself knew that she needed help. But they didn’t have, you know, the equivalent of 10 USD 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 fare 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 10 USD 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 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 coming to the hospital. And so that was really the beginning of the idea of friendship. So, you know, Friendship Bench was born out of a tragic event.

Eric Zimmer 00:08:38  Talk to me about the origins. How did you arrive at this idea?

Dixon Chibanda 00:08:43  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 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 behavioral 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 14 grandmothers Because when I started this project, it was just the 14 grandmothers that I had. Of course, now we have in Zimbabwe alone, we have over 3000 grandmas and we have a presence in many different parts of the world.

Dixon Chibanda 00:10:01  But, you know, I’m just kind of zeroing in on the first 14. And it was those first 14 grandmas that really helped me to understand the power of human connection and the power of embedding healing in stories, you know. And so this is how Friendship Bench really started. And it’s been shaped by those 14 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 and as a human being.

Eric Zimmer 00:10:36  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 ideas and 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.

Eric Zimmer 00:11:12  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 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.

Dixon Chibanda 00:11:32  Yeah. Yeah, that 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 an African cultural heritage, and bringing all of that together in a way that produces the results that are acceptable 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 a friendship bench with the first 14 grandmothers, naturally, being a psychiatrist, I thought this whole model would be based on, you know, the principles of, of DSM five, you know, where you focus on a diagnosis.

Dixon Chibanda 00:12:22  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. 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 my journey has consistently been about that. And I’ll just share one more example about this, this sort of equipoise. 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 grandmas, you know, were like, you know, that’s not really going to work in this community. 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.

Dixon Chibanda 00:13:38  And all of a sudden everybody wanted to sit on a friendship bench. And I learned my first big lesson, you know, are the names that we ascribe 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 professionals can fuel stigma in mental health. So we really have to be careful with labeling people. there’s room for that. But oftentimes what is more important is the story that people bring, you know, to the bench, not the diagnosis.

Eric Zimmer 00:14:16  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 is devolved in their lifetime a lot. It’s very different, or there isn’t the same cultural reference point, 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?

Dixon Chibanda 00:14:50  Eric, you know, when we first started taking friendship Bench to different parts of the world, our hypothesis was the northern hemisphere, particularly the developed countries, would be very different. And I am increasingly surprised at how similar communities are across the world and how people even in Washington, D.C., 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 this work. Yes, 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 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 than separates us or divides us.

Dixon Chibanda 00:16:11  Last year in October, we were in El Salvador, and we were pleasantly surprised to see that the way people relate to the elderly, the way people connect with their grandmas, is no 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, Yet all human beings across the 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.

Eric Zimmer 00:16:51  I’m glad that your hypothesis and mine were similar about how this would work in the Western world. And everything you’re saying makes sense, right? I think we do know universally, that one of the most healing things that can happen is simply one person really listening to another. Yeah, a lot of modern studies, you know, trying to figure out like, what therapy is most effective. And it seems like the answer often is the one in which the person has the best rapport with the therapist leads to the best outcome.

Eric Zimmer 00:17:20  Like, that’s the single most important thing. Yeah. 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 help?

Dixon Chibanda 00:17:34  You know, it depends where you are. In Zimbabwe, they are called, Grandchildren because it’s, 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 benches. You know, it varies.

Eric Zimmer 00:17:49  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 part of what they use?

Dixon Chibanda 00:18:15  Yeah, that’s a great question. So when we train the grandmas, we lean into their stories. As you know, as you may imagine, someone who has lived for several decades has a rich history, has a rich lived experience.

Dixon Chibanda 00:18:35  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 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 the ability to make people feel respected and understood when they open up to share their stories. We emphasize, you know, nonverbal communication, the use of eye contact, the use of silence as a tool. You know, most human beings feel extremely uncomfortable when they silence. You know, in fact, you know, for a lot of people, 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 of intuitive non-verbal strategies that you can use to engage with other human beings.

Dixon Chibanda 00:19:48  It’s really, as you said, 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. In our training as three levels, level one, two and three. Yeah.

Eric Zimmer 00:20:04  How much training does a grandmother go through before she’s sort of put on on a bench?

Dixon Chibanda 00:20:10  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, which is, you know, problem solving, behavior activation, activity scheduling, and psychoeducation. You know, those are sort of the active ingredients of of friendship bench and anchored in all of that. Is that the rich storytelling component, the ability to get people to feel comfortable with feeling vulnerable.

Dixon Chibanda 00:20:56  You know, again, that was one of the big lessons I learned from the grandmas. 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 connects and the healing process begins. Yeah. So we train 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 to see clients on their own. But again, it varies depending on where we’re training. I mean, we recently trained folks in in London, and that training only took seven days because the people we were training already had some experience of counselling. Yeah.

Eric Zimmer 00:21:56  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.

Eric Zimmer 00:22:05  The purest model of it is the one that I sort of came of age in, which was 12 step programs. I’m a recovering heroin addict. And so, you know, that’s obviously all peer support. There’s no training. There’s no there’s just nothing. It’s just you just 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 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 for me, if I’m going to a 12 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?

Dixon Chibanda 00:22:59  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.

Dixon Chibanda 00:23:10  You will have grandmas who just focus on, clients who come to the bench with intimate partner violence issues. Got it. You have grandmas who focus on people 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.

Eric Zimmer 00:24:01  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 or 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 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.

Eric Zimmer 00:24:36  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 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.

Dixon Chibanda 00:24:57  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 and I was emphasizing focusing on those symptoms. And it was the grandma who were like, 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 about the symptoms.

Dixon Chibanda 00:25:44  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, 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.

Eric Zimmer 00:26:14  Right. Because you have a process in which a grandmother very early in the process can say, hey, this person needs more care than 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 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 and they get an antidepressant or a lot of primary care doctors these days hand you some version of that screening question you’re talking about.

Eric Zimmer 00:27:04  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. 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 does it turn into depression? And, you know, tweezing these things apart is not simple.

Dixon Chibanda 00:27:42  Yeah, it definitely is not simple. And this is why at friendship bench 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 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.

Dixon Chibanda 00:28:13  Someone comes to the friendship bench in their suicidal. They respond yes to the question on suicidal thoughts, which is question 11 on our screening tool. If a grandma who is engaging with 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. You know, have you thought of when you would do it? How would you do it? The usual stuff that any, any therapist will kind of ask. But in all of that they still the person’s story. Yeah. And what we find at Friendship Bench is that, you know, over 80% of the people presenting with suicidal ideation crying out for help. 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. Yeah. And you know the other thing about friendship, which I have to just mention, Eric, if you don’t mind, is that everything that we do at Friendship Bench is rooted in rigorous research.

Dixon Chibanda 00:29:38  We have over 100 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 all these things through these rigorous studies, which are published in peer reviewed journals, scientific journals.

Eric Zimmer 00:30:01  Yeah, I think that’s a really interesting part because that’s not how it started. Obviously, it started as an experiment, right. Like you’re like, okay, let’s go do this. But since it’s gone on and been successful enough in a I 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 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.

Eric Zimmer 00:30:41  But the three steps are opening the mind, uplifting and strengthening. And I was wondering if you could speak the I assume there’s Zimbabwean words for them, and then tell us about what each of those are.

Dixon Chibanda 00:30:53  Yeah. So the first level training is called opening the mind in the local language that is covered up for. And essentially these terms or the pillars of the friendship bench are really terms that the grandmas, you know, conceived. And all I did was put them together. But these were ideas based on, you know, the wisdom and knowledge that these grandmas have that have defined the program. So opening the mind or As we call it in Shona, 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 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.

Dixon Chibanda 00:31:54  Using eye contact. Using nonverbal communication. Using silence as a tool. All of that is embedded in that first level training, because we strongly believe that friendship banks, 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. 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 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 the symptoms of the depression. But that hope makes a person feel that they can carry on.

Dixon Chibanda 00:33:06  They still have a chance, you know? And so we focus very much on on that element. And that is built in that level one with 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 more structured components of how to use screening tools to identify people who are genuinely suicidal 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. So this is how the training actually runs. And if you ask me, based on the years of working with the grandmas, 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.

Eric Zimmer 00:34:12  One of the things that you talk about is that the grandmothers described this to you, which was that clients get overwhelmed by multiple problems.

Eric Zimmer 00:34:21  And so part of what they do is help clients focus on one problem at a time. Say more about that.

Dixon Chibanda 00:34:28  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 and 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 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, is oftentimes when people 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 grandmas are sort of work with a client on.

Dixon Chibanda 00:35:24  And we use a term called the ping pong to describe the interaction between the grandma and the client, because often when the grandma summarizes which is part of the problem solving, 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. And that is so powerful because it makes a person realize that someone is listening to me, you know? Anyway, so so when the grandmas reflect the story, the grandma will then say, so which one of these issues 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 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.

Dixon Chibanda 00:36:26  I’m here to help you select one problem. And so you have this exchange, which can take 30 or 40 minutes until a client suddenly decides, you know, I 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 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 this doesn’t make 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. And when you dig 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.

Dixon Chibanda 00:37:34  You know, and so we never actually assume that what we think is the biggest problem is what we should tell the 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 two. 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 we call the smart action plan, which essentially stands for, you know, coming up with something that’s 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, you know? Yeah. Yeah. So it’s not in a nutshell. You know, those are some of the components that we kind of focus on. Yeah.

Eric Zimmer 00:38:28  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. I often think of it in this way. You’ve probably heard of, like the trans theoretical model of change, the stages of change model, right? And it posits that there are at least three steps 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.

Eric Zimmer 00:38:59  Which usually doesn’t end well 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 minute about how the grandmothers helped heal you?

Dixon Chibanda 00:39:16  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, in the feelings of imposter syndrome.

Dixon Chibanda 00:39:36  Even after I started working with the grandmas, you know, but, you know, over the first year or two of working with the first 14 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 were having a debriefing session, and I write about it in the book. I only started talking about my pain, the loss of Erica. And it was the response from the 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, you know, what they did was they broke down into a song. You know, they started to sing this song, this soothing, you know, Shona song. Each one of those 14 grandmothers just knowing where to place her voice. And they sang that song for me, which was almost like ten, 15 minutes.

Dixon Chibanda 00:40:44  And after that they prayed for me. That is all they did, Eric. They sang and prayed for me while I was in the middle of them, in a in a sort of circle. And, and, you know, I 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, you know, 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.

Eric Zimmer 00:41:45  We’re going to try something here that I don’t know if it’s going to work, but we’re going to 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.

Eric Zimmer 00:42:03  We’ve recently started taking in some listener questions, and I’m trying to get them answered in various shows. 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, sure. Okay. This comes from Karen. And Karen says, about five years ago, I divorced from my ex of 40 years, and I 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 have been completely stuck. I’ve tried to go back to my life and put energy into it, trying to get out and about, but it’s not working.

Eric Zimmer 00:43:01  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.

Dixon Chibanda 00:43:14  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. Yeah. As a grandma, I would want Karen to tell me more. You know, I would say, Karen, 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 subconsciously not know where the emphasis should be. But as we tell our stories, The areas that are really hurting us the most tend to emerge.

Dixon Chibanda 00:44:10  You tend to see these patterns in the story as it’s coming out, and we trained the grandmothers in what we call the rule of three. What are the three most salient features of this story that are 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 in your life. Would you like to share more and you see where it goes? So it’s 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 in those 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.

Dixon Chibanda 00:45:16  The other thing is that grandmas don’t tell you what to do. Friendship is not about telling you what to do, but it’s about unpacking what’s happening and you realizing on your own. As you unpack, you know, you get, you hit that 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. Yeah. You know, to establish whether Karen is actually struggling with major depression. Yep. Or she’s, you know, struggling to come to terms with the loss, but she’s not clinically depressed. So that’s also important.

Eric Zimmer 00:46:02  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.

Eric Zimmer 00:46:20  So I will stay far away from the DSM five. I can 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 languages Shona.

Dixon Chibanda 00:46:45  Shona. Yes.

Eric Zimmer 00:46:47  I’m not going to 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?

Dixon Chibanda 00:46:57  Thinking too much in Shona is.

Eric Zimmer 00:47:00  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.

Dixon Chibanda 00:47:10  So one of the things that we’ve done on 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 involved, not only discussing with the grandmothers, but with clients as well, you know, to come up with a common terms that resonated with both grandmothers and clients.

Dixon Chibanda 00:47:37  And we found that fungi, very often when it was serious, severe, I had the elements or symptoms of your DSM five criteria for depression. And so that’s why we shifted to the term fungi, which resonated with with the community, but then our CSR has different levels. This CSR, 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. So this really is a reflection of how people identify the emotional struggles, which I guess we could say are linked to the DSM five diagnosis of depression and anxiety as well. You know, together with ICD ten.

Eric Zimmer 00:48:34  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 this show and people I’ve worked with have identified with is the term rumination, right? It’s you just going around and around the same thoughts again and again.

Eric Zimmer 00:48:58  It’s not like you’re thinking too much in novel and creative ways. It’s just you’re thinking about the exact same thing again and again and again and again.

Dixon Chibanda 00:49:07  That’s exactly what it is.

Dixon Chibanda 00:49:09  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 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.

Eric Zimmer 00:49:27  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.

Dixon Chibanda 00:49:39  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.

Dixon Chibanda 00:50:00  They are then brought together in smaller groups. You know, often these are groups of 15, 20 maximum 30 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. Every member of the 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 a talking piece. So only the person who has the talking piece can speak. And so after everybody has shared, what then happens in these groups is they collectively decide 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 collectively bring our resources together. They are with them together. And sometimes the problem could be something that is financial and they will.

Dixon Chibanda 00:51:16  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 sessions on the bench.

Eric Zimmer 00:51:31  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 sessions. And my experience is that true change happens a little bit by 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 partway through, or we just sort of slide off paying attention to it. And and so for that reason, you know, support groups or communities of practice or different things like that are are real ways to, in essence, keep going, keep making improvement beyond just working with a therapist.

Eric Zimmer 00:52:23  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 no, not probably. I have definitely had more 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.

Dixon Chibanda 00:52:57  Oh, yeah. That is that is so, so true. Eric, 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. Yeah. You know, you have hope.

Eric Zimmer 00:53:17  I just want to read a sentence to you and let you reflect on it as a way of heading out of here.

Eric Zimmer 00:53:23  You say at the core, 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 to that as a way of wrapping up.

Dixon Chibanda 00:53:43  Well, in essence, that makes us comfortable with feeling vulnerable in the presence of other people. And that’s really sort of the foundation of healing.

Eric Zimmer 00:53:55  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.

Dixon Chibanda 00:54:15  Thank you for having me, Eric. Thank you very much.

Eric Zimmer 00:54:17  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.

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