Mental Health, Religion & Culture
ISSN: 1367-4676 (Print) 1469-9737 (Online) Journal homepage: https://www.tandfonline.com/loi/cmhr20
Common presenting problems in religious lay
counselling practice in Ghana
Annabella Osei-Tutu, Vivian Afi Dzokoto & Adjeiwa Akosua Affram
To cite this article: Annabella Osei-Tutu, Vivian Afi Dzokoto & Adjeiwa Akosua Affram (2019):
Common presenting problems in religious lay counselling practice in Ghana, Mental Health,
Religion & Culture, DOI: 10.1080/13674676.2019.1666096
To link to this article:  https://doi.org/10.1080/13674676.2019.1666096
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MENTAL HEALTH, RELIGION & CULTURE
https://doi.org/10.1080/13674676.2019.1666096
Common presenting problems in religious lay counselling
practice in Ghana
Annabella Osei-Tutua, Vivian Afi Dzokotob and Adjeiwa Akosua Afframa
aDepartment of Psychology, University of Ghana, Accra, Ghana; bDepartment of African American Studies,
Virginia Commonwealth University, Richmond, VA, USA
ABSTRACT ARTICLE HISTORY
Mental help systems in Ghana are overwhelmed with severe and Received 8 August 2019
chronic mental health issues. Yet, rapid urbanisation is Accepted 6 September 2019
contributing to a weakening of traditional help systems. Religious
organisations offer a viable option through counselling ministries KEYWORDSLay counselling; counselling
and groups. To understand the role lay counselling plays in the situations; religious
help system in Ghana, we interviewed one hundred (N = 100; age counselling; marital
range: 24–80) lay counsellors practising mainly in Christian and counselling
Islamic religious contexts across four urban centres in Ghana. The
purpose was to examine what people seek counselling for; and
assess how this legitimatises lay counselling as part of the existing
system of care in Ghana. Findings show that most presenting
problems are interpersonal in nature and are typically low level,
non-life threatening issues. Presenting problems did not focus on
mental disorders. The implications of these findings are discussed
along with directions for future studies.
Introduction
People seek help for a variety of reasons including physical, mental, and spiritual health.
Previous work suggests that for mental health needs, people in Ghana utilise biomedical,
traditional indigenous medicine, as well as spiritual resources (Asamoah, Osafo, &
Agyapong, 2014; Kpobi & Swartz, 2018, 2019). Biomedical help can primarily be obtained
from general and psychiatric hospitals (Nartey et al., 2019). People who desire herbal medi-
cine may engage the services of indigenous medicine practitioners (Kpobi & Swartz, 2018;
Ragosta, Harris, Gyakari, Otoo, & Asase, 2015). Those who desire both herbal and spiritual
help utilise faith-based care in prayer camps (Ofori-Atta, Attafuah, Jack, Baning, &
Rosenheck, 2018); churches (Asamoah et al., 2014), or Islamic faith healers (Kpobi &
Swartz, 2019). For physical ailments, the literature shows that people seek help from
both biomedical and traditional medicine sources (Nyaaba, Masana, de-Graft Aikins,
Stronks, & Agyemang, 2018). This pattern of help seeking reflects the mental health
system in Ghana which is driven by belief systems and culture. These factors influence con-
ceptualisation of mental illness and choice of treatment (For review see Ofori-Atta et al.,
2018; Opare-Henaku & Utsey, 2017).
CONTACT Annabella Osei-Tutu aopare-henaku@ug.edu.gh
© 2019 Informa UK Limited, trading as Taylor & Francis Group
2 A. OSEI-TUTU ET AL.
This current study focuses on a different facet of help seeking. It examines help for low
level, non-clinical issues that people may encounter in their daily life and may seek help
from a lay counsellor. Lay counselling is provided by anyone who does not have professional
training as a mental health practitioner. The study was undertaken within a religious context.
Specifically, we investigated how religious spaces provide personal support for everyday pro-
blems; beyond their typical role of providing spaces forworship and spiritual guidance. Litera-
ture frombothphysical health care (de-GraftAikins, 2005, 2018) andmental health care (Ofori-
Atta et al., 2018) acknowledge the role of religion in health care in Ghana. Most Ghanaians
report affiliation with religion; 71.2% are affiliated with Christianity, 17.6% with Islam, and
5.2% with African Traditional Religion (Ghana Statistical Service, 2012).
Helping in Ghanaian settings
In traditional Ghanaian contexts, psychological care resources are available within extended
family contexts, as well as from elders who serve as community counsellors (Esen, 1973; Van
der Geest, 2015). The extended family provides help through several sources: uncles, aunts,
older siblings, and cousins whomake it their concern to provide help; sometimes unsolicited.
Esen (1973) observes that theextended family arrangementensures there is “always someone
to turn to in the family, in case of problems” (p. 209). Further, people draw on the wisdom of
elders in their communitieswhen dealingwith problems. It is believed that elders, by virtue of
their knowledge acquired in life, wisdom, and life experience, can offer needed help (Van der
Geest, 2015). Elders may be part of the extended family or community. They provide help
mainly through advising – where they provide information with the aim of helping the
help seeker resolve a problem. Primarily, the elder aims at teaching life’s lessons based on
his or her wisdom and knowledge (Van der Geest, 2015).
Recently, Ghana has been witnessing rapid urbanisation with more people living in a few
urban areas of the country (Yankson&Bertrand, 2012).Oneof the effects of urbanisation is the
weakening of social ties (Ardayfio-Schandorf, 2012a, 2012b; Assimeng, 1999) and diminishing
roles of traditional help systems. This happens as people move away frommembers of their
extended families such that extended families are nowmore dispersed than they previously
were.
Paradoxically, urban living is associated with stress, overcrowding, interpersonal alien-
ation, crime, and poverty (Ardayfio-Schandorf, 2012a, 2012b; Yankson & Bertrand, 2012). In
the absence of strong traditional systems of care, people may seek help from other net-
works such as those made available through their religious organisations. One of the
ways religious organisations provide help is through the use of lay counsellors. In religious
contexts, lay counsellors may include pastors, clerics, elders, lay ministers, and laity. The
current study investigated help seeking within Christian and Islamic religious contexts
in four urban settings in Ghana. Knowledge of who is providing what services is needed
for professional practice and policy planning. It is useful to know what help people
receive from lay counselling, prayer camps, as well as from psychologists. Examining pre-
senting problems is one way of understanding why people seek help from various sources.
Religion and healing
Major religions in the world lay claim to the power to provide healing (Anand, 2009;
Eneborg, 2013; Gunther Brown, 2011; Ndoua & Vaghar, 2018; Ranganathan, 2015). Religion
MENTAL HEALTH, RELIGION & CULTURE 3
can be a source of different forms of healing: spiritual (Gunther Brown, 2011; McGuire,
1998; Watts, 2011); psychological (Anand, 2009; Oman & Lukoff, 2018); and physical
(Krause, 2018; Powell, Shahabi, & Thoresen, 2003). Spiritual healing relates to healing for
spiritual aspects of the person, that makes use of spiritual practices, or explained as part
of a spiritual process (Watts, 2011). Psychological healing is linked to the mental health
benefits derived from engagement in religious practices (Oman & Lukoff, 2018; Roger &
Hatala, 2017). Studies have reported a positive relationship between religiousness and
mental health outcomes such as depression, anxiety, and suicide (e.g., VanderWeele,
2017; Whitehead, 2018).
The rich literature on religion and healing has paid limited attention to the role religion
plays in helping people deal with personal problems despite the evidence showing that
most religious faithful often take their personal problems to their religious leaders
(Krause, Ellison, & Wulff, 1998). In most African and African American contexts, where
mental health resources are scarce, religious organisations take an active role in providing
help for the personal ills of the congregants (Aholou, Gale, & Slater, 2011; Campbell et al.,
2007). Activities such as physical activity, smoking cessation, HIV counselling and testing
may be provided through health ministries and counselling units of religious organisation
to support members (Campbell et al., 2007; Tagai et al., 2018; Van Dijk, 2013). Aholou et al.
(2011) observed that African American clergy utilised the opportunity for premarital
counselling to provide sexual health and HIV prevention interventions. Within African
spaces, religious groups assume a prominent role in providing medical screening and
sex education through the avenue of premarital counselling (Van Dijk, 2013).
In a highly religious country such as Ghana where formal help systems are over-
whelmed, a vast majority of the people utilise help available from religious groups and
organisations (Asamoah et al., 2014; Lo & Dzokoto, 2005). This study examines this facet
of healing conducted via lay counselling in religious spaces in Ghana. We included Chris-
tian and Muslim lay counsellors to provide a broad, rather than an exclusionary, overview
of lay counselling in religious settings. The guiding research questions are: what do people
seek counselling for; and how does this legitimatise the role of lay counsellors as part of
the existing system of care in Ghana?
Methods
We conducted qualitative interviews with one hundred (N = 100) lay counsellors in four
urban centres in Ghana: Accra (n = 29), Kumasi (n = 29); Koforidua (n = 31), and Cape
Coast (n = 11). Accra is the capital of Ghana. Kumasi, Koforidua, and Cape Coast are
regional capitals.
Research participants
We used purposively convenient sampling to select participants for the study. We adopted
multiple strategies to reach prospective participants. We approached some participants
through their religious institutions. Others were contacted via snowballing techniques;
participants who completed the interview referred us to others. Yet, other participants
were recruited following their attendance at a workshop for lay counsellors. To be
included in the study, prospective participants were to be 18 years old or older; and
4 A. OSEI-TUTU ET AL.
should provide lay counselling within a religious institution. One hundred participants
took part in the study with majority being males (n = 75). The reason for this rather
large sample size is that we aimed to include varied Christian and Muslim denominations.
Participants were affiliated with 29 different religious denominations. Participants’ age
ranged been 24 and 80 (Mean: 51.18; SD: 12.69); and were highly educated. More than
half of the participants had tertiary level education. Most of the participants (n = 79)
were married. Majority (n = 81) of the participants self-identified as Christian and the
remaining (n = 19) were Muslims. Thirty-seven (37) participants identified with one of
the following religious leadership designations: priest, reverend minister, pastor,
deacon, or Islamic cleric. Participants had been practising for between 1 and 40 years
(Mean: 13.38; SD: 9.72). Table 1 provides participants’ demographic information as well
as their practice history.
Table 1. Participants’ demographic information (N = 100).
Variable N
Gender
Male 75
Female 25
Age
20–29 4
30–39 14
40–49 25
50–59 24
60–69 22
70–79 6
80 1
No data 4
Education
No formal education 1
Basic 7
Secondary 25
Tertiary 64
No data 3
Marital status
Single 10
Married 79
Divorce 2
Widowed 2
Declined 1
No data 6
Years of practice
1–5 24
6–10 30
11–15 11
16–20 17
21–25 7
26–30 4
31–35 2
36–40 4
No data 1
Procedure
Interviews were conducted between September 2017 and October 2018 by eight individ-
uals comprising six females and two males. They had a minimum of college degree. Par-
ticipants were informed that the study was seeking information on their practice
MENTAL HEALTH, RELIGION & CULTURE 5
experiences as lay counsellors. Some participants agreed to be interviewed after first
contact; others scheduled for a more convenient time. Interviews were conducted in
public locations that were quiet and also allowed for privacy. This study is part of a
larger project aimed at learning about religious counsellors in Ghana. This particular
study is based on a subset of questions selected to address the research questions.
Interviews lasted between 20 and 120 min (Mean: 52.12; SD: 19.36). Participants had a
choice of using English or any Ghanaian language they were fluent in. Majority of the par-
ticipants used English, a few used Twi, a local Ghanaian language. A few used a blend of
English and Twi. Interviewers were bilingual speakers. It is not uncommon for people in
Ghana to adopt a blend of English and a local language in everyday conversation. All inter-
views were conducted as individual interviews; and were recorded with participant’s
permission.
Data analyses
English interviews were transcribed verbatim. Twi interviews were translated and tran-
scribed simultaneously by native Twi speakers. Thematic analysis was used to analyse
the data, following the step-by-step guide outlined by Attride-Stirling (2001) comprising
identification of (i) basic themes, (ii) organising themes; and (iii) global themes. Two doc-
toral students independently familiarised themselves with the data and identified basic
themes (e.g., infidelity, conflicts); and organising themes (e.g., marital problems, academic
issues) that were recurrent in the data. The themes were further situated in the global
theme of counselling situations. For validation purposes, two coders with masters’
degree in clinical psychology reviewed the data using the generated basic and organising
themes. Through the validation process, two additional basic themes, financial problems in
marriage, and additional wife, were identified. Meaning saturation was reached during the
analyses. Coders consistently observed similar codes when they compared themes across
participants’ transcripts.
Findings
The study examined presenting problems religious lay counsellors encounter in their prac-
tice in Ghana. We observed four main counselling situations: (i) Premarital and in-marriage
problems; (ii) Parenthood concerns; (iii) Psychological problems; and (iv) Academic and
career issues. Other aspects regarding how the lay counsellors address these problems
are being published elsewhere.
Pre- and in-marriage problems
Majority of the participants (n = 72) narrated presenting problems we categorised under
premarital and in-marriage issues. Prior marriage issues were mainly about differences
in social background of prospective couple (n = 17); mate selection (n = 10); and lack of
parental consent (n = 9). Concerns of differences in social background include education,
finance, and age of prospective mates. Issues about mate selection focused on partner
preference and arranged or forced marriage.
6 A. OSEI-TUTU ET AL.
The lady’s educational level was higher than the man… The woman was a senior high school
teacher who has completed [one of the elite senior high schools in the country] but the man
didn’t complete senior high school (Christian woman, 15 years of practice).
[Her] parents introduced a man to her to marry; in fact a very rich man… she is also trying to
look for a young man too, but all of a sudden her parents slapped her with this old man…
(Muslim woman, 15 years of practice)
A lady who came to see me because she wanted to get married… the man she wanted to
marry, her parents were not in support of the marriage. (Christian man, 6 years of practice)
In-marriage problems participants worked on include spousal conflicts; finances; sex;
infidelity; and domestic violence. Spousal conflicts (n = 20) focused on roles and division of
household chores. The quotes below exemplify presenting concerns about spousal roles:
The marriage nearly collapsed and when they came to me, the woman even packed all her
items and kept it with her friend…What went on is about their responsibility; they didn’t
know their responsibility in the marriage in the first place. (Muslim man, 20 years of practice)
After about six months [of marriage] the woman came to tell me that the man is not helping
her with the household chores. (Christian man; 10 years of practice)
Other conflicts were related to work–family balance, as well as lack of affection and care
as illustrated in the quotes below:
Both of them [the couple] were working at the [XXX] firm; they have been married for a year.
The woman was coming home at 10 pm, the man at 11 pm and they didn’t have a life of their
own so the next morning they will all hurriedly leave the house for work. (Christian woman, 30
years of practice)
The man was complaining that the woman was not taking very good care of him, he is sick…
but the woman doesn’t care. (Christian man, 10 years of practice)
A certain lady came tomewith thecomplain thather husband is not in talking termswith her after
several years of marriage and does not treat her with affection. (Muslimman, 3 years of practice)
A unique source of conflict was related by participants working with Muslim clients. They pre-
sented concerns that are associated with the selection of an additional wife. The conflicts were
related to husbands’ decision to marry an additional wife; as well as the dynamic between the
husband and wives. Islamic tradition permits the practice of polygamy (Kaniki, 1976).
… a man and his wife who have been sleeping in the same room for seven years without
talking to each other… she wanted her husband to know that she has more power than
him because he has gone to marry another person without her consent (Muslim woman,
10 years of practice).
A husband felt embittered about the wife’s treatment; he feels the wife is not cooperating and
doesn’t do what he wants… so finally the man decided to marry another woman… instead of
him sharing for them, maybe I will be here on these days and then I will go to the second wife,
he didn’t do that but he stick to the new wife… finally the old wife has packed off. (Muslim
man, 15 years of practice)
Financial problems in marriage that the participants (n = 17) encountered include
changes in the financial situation of the couple, distrust about partner’s finances, and dis-
putes about property acquired in the marriage.
MENTAL HEALTH, RELIGION & CULTURE 7
Before their marriage, she knew his income but shortly after marriage, he could not meet all
her financial demands because he was repaying a loan. (Muslim man, 12 years of practice)
There was one concerning someone and her husband… The man had not made the woman
aware of his earnings so the woman assumed the husband had money and was trying to hide
it. (Christian woman, 3 years of practice)
The woman has a land and she has used her money for it but the man is claiming that his
money is part. (Christian man, 7 years of practice)
A number of the participants (n = 16) had worked with people on sex issues in marriage.
Typically, people sort help regarding partner’s sex potency and sexual demands. Two
examples are presented below:
A certain lady came to me with the complaint that her husband [was] not sexually potent; he
can’t have sex with her. (Muslim man, 2 years of practice)
… the man said he wants anal sex from the wife and the wife refused. We try [sic] solving the
issue but to no avail and in all the man even said when he has sex with his wife he doesn’t get
any pleasure. (Christian woman, 18 years of practice)
Infidelity was another issue that the participants (n = 12) encountered. The concerns
were often related to a spouse engaging in extra-marital intercourse. The quotes below
showcase that both men and women sort help from lay counsellors when they had
issues with their respective partner being involved in extra-marital intercourse:
Her husband was a womanizer so she wanted to divorce the man… she came to tell me that
she wanted to divorce the man. (Christian man, 3 years of practice)
Someone came with a problem in which his wife was promiscuous… it was reported to him
by someone that his wife has entered someone’s room and had an affair with the person…
(Muslim man, 2 years of practice)
The type of domestic violence participants (n = 7) encountered was mainly spousal
beating; and the perpetrators were reportedly husbands. The following quotes illustrate
some of the cases participants narrated:
… the man beat the wife… the wife was pregnant and the man beat the wife so the wife
came to me. (Muslim man, 7 years of practice)
There was this married couple who came to me. The man was an alcoholic. Whenever the
woman complained, he beats her. He sometimes beat her without having any memory the
next morning that he did that. (Christian man, 4 years of practice)
Parenthood
Some of the counselling situations participants (n = 35) reported were related to childbirth
and parenting responsibilities, and parent–child conflicts. The two examples below typify
cases where couples sought help for infertility:
[A] man came to see me about his wife… they were having problems making babies. (Chris-
tian man, 20 years of practice)
The issue was about childbirth. They have been married for three years and they had no child.
(Christian man, 13 years of practice)
8 A. OSEI-TUTU ET AL.
Presenting issues on parenting were typically about conflict in the parent–child relation-
ship, problems in the step-family dynamics, and choice of friends.
The parents are saying the lady doesn’t respect; that whatever they are saying she doesn’t
listen to them…When the parent talks she talks back. (Christian man, 3 years of practice)
There was this one about aman and the wife and a child living together. Theman had divorced
his wife and one of the children was living with him… the woman, that is the man’s new wife,
sees the child as a bad boywhowants to collapse themarriage. Theman also sees thewife to be
bad because of how she was treating the child. (Christian man, 6 years of practice)
There was a young boy who his parents brought to me that he wanted to join those fraud
boys. So they brought him here and we discussed the issue. (Christian woman, 3 years of
practice)
Psychological problems
A small number of participants (n = 12) related encountering psychological problems such
as substance abuse and unspecified mental health issues:
A childwas reported tomeabout a smoking behaviour. Hewas a student… at junior high school.
Theparent came to confide inme that the childwas awee [marijuana] smoker and theway things
were going, if care was not taken things might get worse. (Christian woman, 10 years of practice)
Someone came to me that she feels burning sensations in her head. I thought it was spiritual
… I made her to go to the hospital. It was found that she has a mental disorder. (Christian man,
10 years of practice)
Academic and career issues
Academic and career-related situations were reported by a few participants (n = 11). Issues
presented include academic performance, financing education, and choice of subjects to
read at the senior high school level. Career issues were about career trajectory after com-
pletion of national service, a compulsory service which is often completed after one’s ter-
tiary education.
The mother told me the child was first doing very well but when she noticed the performance
dipped and erh the child goes to school late… (Muslim man, 10 years of practice)
She chose Science as her profession and then unfortunately she was given Agricultural
Science to study as a program in the Secondary School and she flopped horribly… I
checked from the basic school results, she was rather good in the Arts. (Muslim man, 30
years of practice)
One guy came here, he has finished national service and doesn’t know whether to pursue the
masters or… he wasn’t certain of getting a job, so he was torn between searching for job and
getting themasters… or maybe starting his own business. (Christianman, 10 years of practice)
Discussions
The purpose of this study was to find out what people seek help for within the facility of lay
counselling available in Christian and Muslims religious spaces in four urban areas in
Ghana. Professional helping systems are overwhelmed with severe and chronic mental
MENTAL HEALTH, RELIGION & CULTURE 9
health issues in Ghana (Ofori-Atta et al., 2018). In addition, because of rapid urbanisation,
social ties and traditional help systems appear weak and unable to support many urban
dwellers (Ardayfio-Schandorf, 2012a, 2012b; Yankson & Bertrand, 2012).
Our investigation of the practices of one hundred lay counsellors in four urban settings
in Ghana revealed that the presenting concerns are predominantly interpersonal in nature.
Presenting concerns were related to marriage and parenthood. These issues mirror the
social context of Ghana. Marriage is a highly esteemed institution in Ghana (Anarfi,
2006; Gyekye, 1998) and a large percentage (approximately 43%) of adults are married
(Ghana Statistical Service, 2012). Although our participants practice in urban settings,
the issues in marriage are rooted in traditional values aroundmarriage. Although Ghanaian
societies are changing (Assimeng, 1999), vestiges of traditional considerations about par-
ental involvement in mate selection and parental consent are still seen in the presenting
problems. Assimeng (1999) argues that until recently, parental consideration in mate
selection was deemed proper. However, due to social change, some of these parental con-
siderations are being contested. Related to parental considerations for the marriage itself,
there are traditional considerations for children in every Ghanaian marriage. In most Gha-
naian societies, the primary reason for marriage is for producing children. The value placed
on children is so high that failure to produce children could be grounds for divorce
(Abraham, 2010). The presenting concerns reflected this expectation for children.
The presenting concerns on infidelity, domestic violence, sex, and financial disputes are
consistent with recent observations about common transgressions in Ghanaian marriages
(Osei-Tutu, Dzokoto, & Belgrave, 2019). To complement the study by Osei-Tutu et al. which
only examined the types of transgressions in marriage, the current study provides insight
into where people seek help for these transgressions.
A few presenting concerns were on psychological problems. This finding does not
mean that lay counsellors do not work on psychological problems. Rather, it is possible
that they are unable to diagnose less obvious cases of disorders because they do not
have the requisite competence. Further, presenting concerns about careers and academic
concerns were few. It is possible that people use other help sources available to them such
as the schools to address academic and career concerns.
With a few exceptions, such as domestic violence, most of the presenting concerns may
be considered as low level and non-life threatening in nature. These are issues that ordi-
narily will not end up in the clinical or medical systems of care. Because they may be con-
sidered low threshold, and not disorder related, it is possible that people may not seek
professional help. However, it seems that people visiting the lay counsellors we inter-
viewed believed that they could obtain the needed help from this source. Even where a
presenting concern may have been disorder-related, it seems that people felt empowered
to seek help from this non-threatening source. In most Ghanaian settings, mental health
stigma is high (Mfoafo-M’Carthy, Sottie, & Gyan, 2016; Tawiah, Adongo, & Aikins, 2015).
However, research suggests that visiting a religious counsellor may not attract the same
level of stigma as going to see a professional (Crosby & Bossley, 2012).
The presenting concerns revealed that people are using the space provided in lay coun-
selling to address their social problems; and that lay counselling is a viable resource for
people seeking help for their personal issues. In the past, and in some rural settings in con-
temporary Ghana, people would typically consult an elder, a respected member of the
family, or someone of good social standing in their community (Van der Geest, 2015).
10 A. OSEI-TUTU ET AL.
However, in some African spaces, such as Ghana, religious groups have taken on this role
by providing community counselling. Van Dijk (2013) observed that in Botswana, the
church took an active part in counselling and thus regulated relationship modalities in
that country. Rather than perceiving religious lay counselling as a new phenomenon in
Ghana and other African contexts, we consider it as an old practice, which has found a
new place of operation.
Our findings suggest that religious organisations are tapping into a natural resource
available in most African contexts. It has been argued that Africans have a “care syndrome”
(Esen, 1973) – a disposition to care about others and the expectation that one will be cared
for in case of a problem. The care syndrome is pervasive so much so that it is not uncom-
mon for people to provide unsolicited advice. It is interesting that religious organisations
are utilising this resource for developing lay counselling units and ministries to respond to
the growing needs and demands of urban dwellers in Ghana. Hence, although traditional
systems may have weakened, religious institutions are using the same resources that
would have otherwise been used by the extended family systems of care. The use of
lay counsellors is not unique to Ghana (Healy, Kaiser, & Puffer, 2018). A number of innova-
tive approaches that involve lay counsellors as help providers such as the friendship bench
programme (Chibanda, Verhey, Munetsi, Cowan, & Lund, 2016) and the community-
embedded lay provider model (Puffer, Friis-Healy, Giusto, Stafford, & Ayuku, 2019) have
been developed across low and middle income countries in Africa.
Limitations of the study and future research
The findings of this study provide important insight into the practices of religious lay counsel-
lors in Ghana. However, there are limitations. First, even though our sample of one hundred is
considered large for a qualitative study, the findings may not capture every foci of lay coun-
selling in Ghana. Second, we requested for counselling situations retrospectively as most of
the lay counsellors we interviewed did not keep a written record of their practice. It is possible
that the cases they narrated were based on what they recalled in the moment and did not
capture the full breadth of cases they had worked on in their entire practice.
We are aware of the potential for abuse in religious lay counselling, but we did not
examine this issue. Studies are needed to examine this critical issue. Studies are also
needed to explore the efficacy of lay counselling as well as user satisfaction. Lay counsel-
lors may experience negative interactions from those they help. Prospective studies could
examine how lay counsellors deal with unpleasant experiences in their practice, their
coping approaches, and use of supervision.
Implications of the study
Religious lay counselling is a global phenomenon. In Ghana, religious lay counsellors
mainly address personal problems that are related to marriage and parenthood. The ser-
vices lay counsellors provide are especially important in urban settings where local
systems of care are weak and mental health systems of care are overwhelmed. Lay coun-
selling can be an important channel for implementing parenthood and mental health pro-
motion interventions. Mental health professionals can collaborate with lay counsellors to
develop a system of referral.
MENTAL HEALTH, RELIGION & CULTURE 11
Conclusion
This study is one of the first to examine lay counselling in both Christian and Muslim con-
texts in contemporary Ghana. We examined the nature of problems people seek help for
from lay counsellors within selected Christian and Islamic religious spaces across four
major urban centres in Southern Ghana. The findings show that people are using religion
to solve every day problems; supporting the argument that religious organisations are
substituting for extended families in caring for the personal problems of urban dwellers.
Findings highlight the potential role of lay counselling as a resource and a legitimate
part of the help system in Ghana.
Disclosure statement
No potential conflict of interest was reported by the authors.
Funding
This work was supported by the Volkswagen Foundation [grant number 89863].
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