Role identities and shifts
To understand counselors’ personal expectations in their new formal counseling roles and their perceived counselor identity, participants were asked what they thought it means to be a TP counselor and to discuss key personal qualities of a TP counselor. Their developing sense of “professional identity” was important to understand because their new formal role and training were not officially announced to the community but only to the individual families they worked with. Across all groups, participants described a TP counselor as someone who is a good listener, empathetic, ready, flexible, has good communication skills, “takes their time,” and is a responsible leader. They noted specifically that a TP counselor differs from community elders in that TP counselors are not judgmental in their advice-giving; instead, they help families identify their own solutions. Finally, being a TP counselor was described as being a role model in the community because “nobody will love your work if your actions are not straight” (Male, 46, Moderate Group).
Participants described that before TP training, they offered advice and counsel anywhere they went: after church, on the streets, while running errands, or wherever they met someone in need. Their advice focused on encouraging or teaching from Bible scriptures, drawing from personal experiences, passing along wisdom from elders, praying with others, and giving direct advice on how to solve a specific problem. Recipients of their “advising,” as they often called it, were either people who sought their advice directly or those referred to them by someone else.
Consistent with role identity theory, when counselors began to integrate their new formal counselor role, they experienced some positive role shifts as well as tensions between roles. Some described that their new counseling skills generalized in ways that enhanced their performance in related professional or volunteer positions. For instance, “TP has affected me to some extent because I cannot use law enforcement like before; I no longer take people to the police so easily, and I try to solve the disputes” (Male, 46, Moderate Group). In some cases, counselors described this resulting in increased respect and appreciation from others. On a personal level, counselors described improvements in their roles within their families as they applied the TP skills to their own lives (described below).
The majority of TP counselors reported few problems with balancing roles because of the required responsibilities of the counselor role itself, suggesting the counseling role fit with their ongoing routines without significant interruptions. However, there were some cases where taking on the role of TP counselor sometimes conflicted with responsibilities associated with their other roles, especially when logistical challenges, like scheduling problems, required additional time. Counselors described “sacrificing time” to engage in counseling, leaving less time to fulfill their many other responsibilities. One pastor described that “one cannot really have time to prepare a sermon, visit members of the congregation, and have time for your own family” (Male, 58, Minimal Group). Though not mentioned frequently, one female counselor described making sure that counseling did not interfere with income-generating activities, saying, “when I am helping others, I should not forget about my own family… Since I am the sole provider for my children, if I don’t work, what will they eat?” (Female, 55, Moderate Group). Though the TP intervention was designed so that counselors were not spending more total time on counseling, the shift to meeting with the same families on a regular basis restructured time demands in ways that necessitated shifts in how they balanced multiple roles.
Motivation
When asked why they became counselors, participants typically discussed intrinsic motivations first. As expected, every experience group mentioned a general desire to help others: “I was never happy at heart to see people languishing in their sorrows. I could never abandon or neglect them. I had to do something about it” (Male, 28, Training Only). Participants from each experience group also mentioned a deep-rooted calling from God and a passion for counseling and serving people after observing widespread community problems. The belief that they were making a difference and fulfilling God’s work was highly motivating. When families engaged in counseling, attended sessions, and showed positive changes or outcomes, the counselors were motivated to continue working.
Many expressed that receiving training improved motivation to counsel families because they had increased knowledge and new skills to handle a broader set of cases. This in turn increased their sense of self-efficacy and helped sustain them even through challenges or negative feedback. Participants also noted increased motivation after seeing the impact of applying some of the skills to their own lives, as described further below. Additionally, counselors reported receiving encouragement, respect, and empowerment from supervisors and fellow counselors, as well as from family and community members. These were especially helpful in maintaining motivation when client families were struggling, not progressing, or having problems scheduling sessions. One counselor noted, “I really loved the fact that I wasn’t left alone after the training… I got a lot of encouragement to continue” (Male, 63, Minimal Group).
Self-efficacy
To explore self-efficacy, counselors were asked about their feelings of preparedness and perceived ability to meet expectations. The resounding narrative was that counselors felt empowered in their abilities to fulfill their counselor role after completing TP training. With this improved self-confidence and empowerment from training came a change in how counselors viewed their counselor role. When discussing their counseling approach before, many described their role as “shallow,” “reckless,” and having “no consistency.” Now, counselors felt they were more “professional” and were able to meet the expectations of their client families: “Before, we were practicing in the dark, unlike now, we are working in the light. TP has given us knowledge, equipped us, and widened our minds” (Female, 47, Moderate Group).
Despite overall improvements in self-efficacy, it was tested and often fluctuated based on client family trust, openness, and progress through therapy. Though they clearly experienced expanded counseling capacity, the counselors consistently requested that TP continue to provide more trainings. They expressed a persistent desire to improve their counseling abilities to handle an even wider breadth of problems.
Stress
The stress map (Fig. 1) helped identify top stress areas for each counselor experience group. As described in the methods, a top stress area is one that has both high prevalence (proportion of group listing the stressor) and severity (rated more stressful overall).
For all counselor experience groups, a top stress category was poverty, describing both personal (e.g., acquiring daily provisions, paying school fees) and community (e.g., lack of employment, people not taking children to school) sources. Another top category across multiple groups was family, describing both personal (e.g., marriage disputes) and community sources (e.g., homeless individuals, substance abuse). A third category was counseling, describing challenges with being a TP counselor both logistically and emotionally. The specific prevalence and severity of these stressors were different between experience groups. The top stress areas for moderate experience counselors were poverty, family, and poor parenting. For minimal experience counselors, they were counseling, education, poverty, and role balance. For training only counselors, they were family, informal counseling (not TP), and poverty.
Although participants mentioned a broad range of stressors in free-listing, they focused on a smaller set during individual interviews, as questions aimed to understand counseling-related stressors in depth. Participants across groups expressed similar stressors related to therapy scheduling, family attendance and engagement, and perceptions of the family’s progress. Stress first came from becoming accustomed to their new formal counseling role and logistics, such as providing reports, recording sessions, and making follow-ups. Then, family attendance problems were stressful, as family members were sometimes busy with other priorities or avoided counseling when it became difficult. Counselors described arriving to empty, padlocked houses or wasting time waiting for family members to show up. At times, they questioned if they had done something wrong to cause a disinterest or avoidance of sessions.
During therapy sessions, counselors noted stress if they perceived lack of family engagement, which was essential for conducting the counseling. One counselor noted difficulty “getting them to open up; it takes a lot of time sometimes when none of them believed that their problems will remain confidential” (Female, 57, Moderate Group). One possibility raised by a counselor was research-specific activities (e.g., recordings and documents) might have made it harder for counselors to build rapport and trust. It was also difficult to maintain engagement and progress when families were undergoing acute hardships, which made it hard for them to focus on longer-term goals during the sessions. Examples included losing a job, not having enough money to buy food, or experiencing a medical emergency.
Participants also noted stress when trying to navigate counseling across gender and age differences, such as a woman counselor advising a man, a younger counselor counseling elders, or a counselor attempting to facilitate inter-generational communication in the family.
Burnout
The interviewer used a “spring metaphor,” developed with the Kenyan team during interview guide revisions, to help describe experiences of burnout. Counselors were asked to think about any times they felt so compressed or stretched by their TP counseling work, they felt they could not continue working. Twelve of the 20 counselors endorsed feeling this way at times, including counselors from all experience groups. When discussing burnout, counselors often described instances where stress piled on continually without relief. This was most commonly discussed in connection to the scheduling and attendance stressors described previously. During times of burnout, counselors experienced pronounced negative thoughts or emotions related to these challenges that interfered with their drive to continue: “You find they are not there; then when you go there again, they tell you they are not ready for you; then it happens again…you feel like you are tired. That is what can make you lose hope” (Male, 47, Moderate Group). Additionally, some counselors experienced burnout when feeling like they could not meet the expectations of their supervisors, which led to hopelessness and the desire to avoid supervision—a required activity for counselors.
Participants were asked to reflect on how such situations made them feel in their head, heart, and body. All counselor groups expressed physical experiences of fatigue, pain, or feelings of sickness during such instances of overwhelming stress: “[It] makes you feel troubled. You lack peace. You feel even more tired as though you have been digging a shamba [field]” (Male, 47, Moderate Group). Counselors also expressed thoughts related to self-doubt and questioning of their capabilities as a counselor. At the core of the burnout experience was a struggle caused by the sincere desire to help—and belief that they had the skills to help—juxtaposed against families not engaging or making progress. In these situations, counselors noted “questioning myself” as they judged their counseling capabilities. Emotionally, participants described an overall lack of peace, loss of hope, and feeling “burdened in my heart.”
Coping and supports
Coping with stress and burnout
Participants described similar coping mechanisms for dealing with both stress and burnout. For many counselors within all experience groups, stress relief came in the form of religious practices. These included praying, reading the Bible because it “makes the burden lighter,” and gospel music because “the songs have encouraging words” or “help me remove my mind from the issues” (Male, 47, Moderate Group). In addition, counselors invested in personal relationships, including talking to their family, spouse, or friends; playing with children; and “sharing ideas” with others.
Stress was also relieved by accessing support provided through TP, including information, supervisors, and peers. They described reviewing the therapy manual to reassure themselves they knew what they were doing, calling their supervisor, and meeting with other counselors. Some also mentioned that returning to their other roles outside of counseling was helpful as a coping strategy because such actions helped counselors distract and distance themselves from the situation. One counselor said, “They [other tasks] help me to remove my mind from the issues that the family [is] going through and not dwell on it” (Male, 47, Moderate Group). Some counselors also mentioned reframing stressors as a way to cope, alongside reminding themselves that they are likely temporary: “The whole world encounters diverse challenges and stresses; for me, I have decided to take it as a normal thing” (Female, 47, Moderate Group).
In instances of burnout, counselors tended to focus on techniques that renewed their motivation and distracted them. They mentioned reviewing training documents to reassure themselves they were implementing the counseling correctly, as well as their case notes, which often showed some progress had been made. These strategies often restored feelings of self-efficacy. Beyond these strategies counselors could perform, burnout also began to resolve if a family finally attended a session or showed progress; this often gave a sense of renewal and relief: “Now I am feeling okay. You know when you help a family and they get healed, you feel even much better” (Male, 47, Moderate Group). Even if such progress does not occur, counselors usually remained actively engaged in counseling despite feelings of burnout because of the strong convictions that led them to become a TP counselor or a strong sense of duty to TP: “I used to feel bad. I wasn’t happy; it was really hurting. Though it was something that I had decided that I would do, whether it be bad or good, I would push through to the end” (Male, 44, Minimal Group).
For the eight counselors who reported not experiencing burnout, we asked them why they thought they avoided the experience of overwhelming stress. The first protective factor was a strong sense of self-efficacy because of having gone through training, having their capacity widened, and being “built up” in counseling skills. This was connected to intrinsic confidence in one’s counseling capabilities. Some described a feeling of imperviousness to burnout, with one saying he “never felt that they [a family] could overwhelm me” (Male, 50, Moderate Group): “No, I didn’t feel like that [burnout]. We underwent thorough training where my knowledge and capacity was widened. I have learned how to handle a lot of issues” (Male, 46, Moderate Group).
A second protective factor was supervision, received in person or via phone. These counselors felt they could receive help when needed, and supervision made them feel part of a team and appreciated and recognized for their hard work: “We have all the resources we need to use during the process like the mobile phone. We are also given constant advice on challenges we face. The team is also doing good in checking on us through phone calls” (Male, 63, Minimal Group). A third protective factor was having a strict schedule for activities so that they could best manage their time. This helped the counselors better balance their multiple responsibilities and roles and perhaps even compartmentalize stress in a positive way: “I always try to ensure that I have a schedule of work so that I don’t overstretch myself… There are days I have set for counseling, and there are days that I have set for my own work.” (Female, 55, Moderate Group). A final protective factor was maintaining motivation based on the potential for overall improvement in a counselor’s community, even when dealing with stressors related to a specific family. They took pride in being part of making their community more welcoming and harmonious.
Personal skills application
All counselor groups described applying TP counseling concepts to their own lives. Some saw this as a necessary step for becoming role models and gaining credibility, and the changes they made contributed to positive role shifts on a personal level. Counselors most commonly reported changing the ways they interacted with their own families, including their behavior toward their spouses and how they disciplined their children. They described using the problem-solving processes and communication skills taught in TP, which they noticed helped them to control their reactions to negative emotions. Several counselors reported this led to positive relationship changes, such as increased love and togetherness in their home because of less quarreling and more open discussions, overall interactions, and time together. One counselor described reductions in marital conflict:
The training that I got from TP helped me reflect in my life and of my relation with my spouse whereby [in the past] we would quarrel at the top of our voices, not caring, disclosing family issues to the public. Our togetherness as a result of that change so far has helped us accomplish a lot. (Female, 47, Moderate Group)
Another counselor described applying his new counseling skills directly to his spouse and children:
I can say that I used to be very harsh and judgmental, giving final answers to issues; unlike now I know where I have come to learn that counseling is a process… now I can sit with my wife and children as a family and I listen to them so that I can be able to help them, because as a parent, I am also a counselor at home. (Male, 40, Moderate Group)
In addition to family improvements, a few counselors also noted becoming more approachable, getting along easier, and having stronger bonds within their church and community, and subsequently receiving increased respect, encouragement, and appreciation—again contributing to positive role shifts.
Interactions among stress, burnout, motivation, and self-efficacy
We identified a common cycle the counselors reported experiencing over time (Fig. 2). Following TP training, counselors experience an increase in self-efficacy because of their improved counseling abilities. The TP skills and manual made them feel that they could be more systematic when helping families and that they had an expanded scope of situations with which they could help. This high self-efficacy was accompanied by an increase in motivation to counsel because of a sense of readiness and preparation. After being assigned a family, counselors experienced the first challenges of formal counseling despite their preparations and increased self-efficacy: personal challenges from balancing roles in trying to make time for counseling and therapy-related challenges of engagement and slow (or no) progress in early sessions. For some, these caused stress to increase while motivation and self-efficacy decreased.
With persistent challenges, the stress increased and persisted until a counselor could begin to experience burnout. This was driven by even further decreases in motivation and self-efficacy as a counselor questioned the commitment of the family they were counseling and their own capabilities. The struggles related to balancing roles as counselors with other responsibilities also continued, contributing to this negative cycle. When counselors had access to and engaged support and coping strategies, or the counseled family made progress, the negative effects of the challenges could be reduced. This included reduction in stress and burnout and an upswing in motivation and self-efficacy. Notably, sometimes this cycle repeated multiple times during the course of counseling for just one family.
Finally, in most cases, families graduated from counseling, having succeeded in reaching some or all of their counseling goals. At this point, both those who had experienced more support and coping, as well as those who had experienced more prolonged stress, often reported feeling a sense of accomplishment reflected in reduced feelings of stress and burnout and restoration of motivation and self-efficacy.