Mental health counselling for abused women in Bangladesh never discussed their experience of spousal violence with anyone (2). Sixty percent of urban and 51% of rural abused women never re- ceived any help in addressing violence. Only 2% ever sought help from institutional sources, from where support was not forthcoming. Although mental health counselling services are ef- fective in increasing the efficacy of abused women, strengthening the coping skills of women, and en- hancing their decision-making ability in other set- tings (15-20), so far mental health of abused wom- en has remained an area inadequately addressed by any policy or programme in Bangladesh. Counsel- ling expertise in the area of domestic violence has only begun to be developed in Bangladesh, and currently, only a few mental health counsellors in the country have been trained in counselling of abused women. These counsellors are mostly city- based. Even the government initiative to provide some mental health services to abused women through One Stop Crisis Centres are based in di- visional hospitals only. Thus, a huge imbalance exists between the available supply and the need throughout the country, particularly in rural areas. Given the resource constraints making available, a team of professional counsellors providing services to abused women throughout Bangladesh does not seem to be practical. In this scenario, in 2001, ICDDR,B became part of an initiative for developing a group of counsellors for providing service to abused women in Bangla- desh. Counselling was provided to abused women as part of a larger study known as Maternal and In- fant Nutrition Interventions in Matlab (MINIMat). The MINIMat study enrolled all pregnant women in Matlab from 2001 to 2003. The questionnaire on violence was administered at the clinic-visit during 30th week of gestation. A modified version of con- flict tactic scale (CTS) was used for exploring expo- sure of women to violence (21). The self-reporting questionnaire with 20 items (SRQ-20) developed by the World Health Organization was used for mea- suring mental stress. The possible answers were on a yes/no basis. For a ‘yes’ response, the respondent was given a score of 1 and for a ‘no’ response the score given was 0. Thus, the range of scores on the SRQ-20 varied from 0 to 20, with 0 representing no mental health problems and 20 representing severe problems. The MINIMat trained ICDDR,B’s paramedics based in Matlab—a rural area—in mental health counsel- ling for abused women. A six-day training, followed 478 Naved RT et al. by two sessions of refresher training of paramedics, was conducted. A mental health counselling team initiated by Naripokkho-ICDDR,B trained the fe- male paramedics. One of the trainers had a PhD in psychology, five had master’s degree in clinical psy- chology, and two had master’s degree in psychol- ogy. All the trainers had special training in mental health counselling of abused women and experi- ence in conducting counselling sessions. The paramedics trained in counselling had a mini- mum grade 12 education and 18 months of training as Family Welfare Visitors. Their work experience ranged from 8 to 29 years. The usual responsibility of the paramedics at ICDDR,B included manage- ment of outpatient department (OPD), emergency care, delivery, antenatal care, postnatal care, and ultrasonography in four ICDDR,B clinics. In total, eight paramedics were trained. The four paramed- ics who ranked best during the training started conducting the session. A fifth one was assigned this responsibility when one of the paramedics pro- viding counselling left ICDDR,B. The training focused on gender-based violence against women, its root causes and determinants, psychosocial consequences of this violence, basics of counselling, and how to help abused women to manage stress, improve coping, and enhance well-being following the framework developed by Romano (22). This framework includes three com- ponents: (a) increasing awareness of behaviours and reactions associated with a stressful situation, (b) improving coping strategies, and (c) strength- ening well-being. Increasing awareness of personal responses to stressful situations, such as violent behaviour, is important. Stress reactions largely de- pend on appraisal of a situation (23-24), and a dis- cussion of the role of private thoughts in stress reac- tions is essential as people usually understand from discussion of their own experience how thinking behaviours influence their emotions. Analyses of thoughts surrounding stressful situa- tions help in more accurate appraisals of stress (25) and facilitate an awareness of irrational and distorted thoughts (e.g. blaming self for being abused) and that can contribute to stress reactions. Clients need to be helped in changing, improving, or strengthening their coping strategies to better manage a stressful situation. The main emphasis in such counselling is given to cognitive change in the form of cognitive restructuring, in which clients are facilitated to replace irrational and distorted beliefs and thoughts with self-statements that are more ra- JHPN