Value Based Counselling was designed as short-term psychological support in emergency situations when other services were not available. Today, its method of using shared cultural backgrounds and experiences amongst counsellors and clients is also used to provide support for migrants in Europe. Placed between psychiatry or psychotherapy services and wider community-based interventions, it can help prevent serious deterioration of mental health and significantly improve health and wellbeing.
By Inge Missmahl
What is Value Based Counselling?
Value Based Counselling (VBC) is proven to help people who deal with high levels of stress and who suffer from mental health problems or related symptoms to improve their ability to function in everyday life significantly. It is a short-term intervention which falls between community-based interventions and specialised mental health care.
The practice was originally designed as a short-term psychodynamic intervention suitable for post-war contexts and the aftermath of natural disasters when ‘regular’ psychotherapy is largely unavailable. Value-based counselling takes a salutogenic approach; it aims to improve the sense of coherence and self-efficacy of clients over the course of a non-directive but carefully structured conversation. The approach avoids classing as abnormal (pathologising) the clinical symptoms related to internal (intrapsychic) or interpersonal conflicts, traumatic experiences, a disruptive social environment, or difficult life transitions such as migration or loss of livelihoods. Instead, it seeks to understand the meaning of these symptoms as an expression of unresolved social stress. VBC is based on the experience that we can discover scope for change if we understand our emotional reaction to a situation. To be able to do this, we need to become conscious of the hierarchy of our own values that triggers this emotional reaction, as well as of the values of concerned parties.
Value-Based Counselling evolved from the work and experience of the Jungian psychoanalyst Inge Missmahl, Founder of the humanitarian non-profit organization ‘International Psycho-Social Organization’ (Ipso), which specialises in Health and Psychosocial Support Services (MHPSS) and in sociocultural dialogue to promote peace and social cohesion.
The effectiveness of VBC heavily depends on counsellors entering a relationship as an equal ‘at eye level’ to their clients. To achieve this, counsellors need to be able to change perspective, to be non-judgmental and to be supportive through empathetic understanding. Building a relationship at eye level in an intercultural setting can be demanding. An open mind does not substitute for an in-depth understanding of how a client sees the world through a particular cultural lens, therefore results can be limited. Value-Based Counselling follows an intra-cultural rather than inter-cultural approach and therefore requires Psychosocial Counselors to speak the native language of a client, and to have the same cultural background. This approach avoids the need for specifically trained translators amongst other problems.
From Afghanistan to Germany
In 2009 the Afghan Ministry of Health included VBC in its Basic Package of Health Services, Essential Package of Hospital Services, and National Mental Health Strategy, the first ‘generation’ of more than 400 counsellors was trained by Ipso to work in primary health care. The transfer of knowledge and skills included the training of supervisors, trainers and master-trainers to ensure ownership by counsellors and to make this new psychosocial component of the Afghan health care services sustainable.
In 2016 Ipso began to engage with refugees and migrants in Germany and has now trained 122 counsellors from 17 different countries. Today, 40 of them provide counselling services in Ipso Care Centres in Berlin, Erfurt and Hamburg and through Ipso’s online counselling platform. This platform was originally developed to extend the outreach of the service in Afghanistan by providing low-threshold access in remote or dangerous areas which do not allow for face-to-face counselling. It includes features that allow clients to register with an alias, to make appointments with a counsellor, and to rate sessions afterwards. Today, online counselling is available in 16 languages: Amharic, Arabic, Farsi/Dari, French, German, Italian, Kurdish/Kurmanji, Maninka, Pashto, Pulaar, Russian, Somali, Sussu, Tigrinya, Turkish, Ukrainian. In Afghanistan, Ipso uses the platform www.ipso-ecare.com, while counsellors in Germany use www.ipso-care.com to serve refugees and migrants across Europe and beyond.
Evaluation and future growth
A study carried out in a clinic in the north of Afghanistan in 2009 – 2010 came to the conclusion that VBC led to a significant reduction of participants’ symptoms and psychosocial stressors. An efficacy study of the counselling approach funded by the German Ministry of Health in cooperation with Charité and carried out in 2018-19 examined the effectiveness of VBC in a trial with participants from various nations who had sought shelter in Germany. The participants, having being randomised into a group in need of immediate counselling and a waiting list, received three counselling sessions on average. The study carried out three diagnostic assessments pre- and post-counselling and a follow-up after three months. The assessments of 103 participants indicated a significantly greater reduction of clinical symptoms, daily functionality impairment, and significant improvement of resilience among participants who had received counselling compared to those on the waiting list. Follow-up assessments of counselled participants after three months indicated that these improvements had lasted for the period.
VBC was originally designed as a short-term psychodynamic intervention suitable for post-war contexts and the aftermath of natural disasters but could also play an important role in the public health systems of industrialised western countries. It provides a level of care that can be embedded in health care systems directly below psychotherapy. It would allow people with severe mental health burdens to be identified at an early stage and to be given faster access to appropriate care. In cases in which mental health symptoms decrease significantly as a result of VBC, demand for longer-term psychotherapy is decreased but this level of care remains an option.