effectively in the contemporary interconnected and dynamic global context places exceptional demands on the biopsychosocial and spiritual qualities of trainees, practitioners and their training institutions” (p. 4). The ability to serve in a multi-layered context is imperative to serve all South Africans with “social consciousness” and “community-mindedness” (Pillay & Siyothula, 2008, p. 734) in order to counteract Apartheid’s legacy wherein psychology as a profession was
indicted as “elitist, inaccessible and classist” (Pillay & Siyothula, 2008, p. 732). After all, Cooper (2000, cited in 2014, p. 265) points out that “a mark of any discipline’s relevance is its ability to keep pace with social dynamics and emerge competent to describe its purview in terms of social relevance”.
2.9.3. South African Psychotherapeutic Development Studies of Trainee Psychologists.
Trainees’ studies of their personal psychotherapeutic development. From a systemic
orientation, trainees training to be clinical psychologists at Unisa, based in Pretoria, explored their personal journeys. Their accounts adopted a particular focus on their own development as psychotherapists (Clarke, 2002; Dlamini, 2005; Jansen, 2002; Lloyd, 2003; Makena, 2001; Prentice, 2002; Richards, 2003; Small, 2003; van der Merwe, 2013).
Clarke (2002) revealed that her personal experience of training to be a clinical psychologist within an ecosystemic orientation saw her having to shift from adhering to an absolute truth or answer to embracing multiple truths. She grew from a need for certainty to embracing uncertainty and doubt as her “intimate companions” (p. 73).
Dlamini (2005) explored her personal journey of becoming a psychotherapist in terms of negotiating the ecosystemic-orientated training context of Unisa and subsequently being
confronted with the hospital setting. As an intern clinical psychologist, in contrast to her training, she reported having to engage with the dominant discourse of a diagnostic model and
reductionistic views of patients’ concerns.
Jansen (2002) in interviewing six clinical psychology trainees and two trainers at Unisa found that an awareness of power dynamics became prominent when doing practical work at Agape an “open-air psychotherapy clinic” (Richards, 2003, p. 36). Trainees reported being
48 challenged to integrate the theories of postmodernism, systemic psychotherapy and African traditional healing into the way they conducted healing encounters or conversations with people within the community setting of Agape (Wichmann, 2012).
From a systemic perspective, Prentice (2002) examined the tensions and
incomprehensibility that clinical psychology training is often imbued with by reflecting on three stories of women in need of help, his own story of training at Unisa as well as interviewing five newly qualified clinical psychologists from five different universities regarding their masters training year(s) prior to internship (academic component at the university). From the viewpoint of a trainee, he contended that the choreography that occurs between the trainer, trainee and training context had far-reaching implications for the quality of clinical psychologist that served clients. He found that when the training context, authored by the trainer, was unreadable and therefore incoherent to the trainee, trainees could experience much discomfort and even psychological damage.
In reflecting on her personal journey of training to be a clinical psychologist through the lenses of developmental theories, Small (2003) outlined ‘the double-edged sword’ nature of training at Unisa where trainees were confronted with inherent paradoxes. For example, she revealed the complexity of managing different roles within the same person namely, “the trainee needs to acquire an understanding of the interpersonal boundaries of the supervisory relationship in order to distinguish between the paradoxical supervisor roles of “colleague” versus
“professor” and “supervisor” versus “psychotherapist” ” (p. 213). She also spoke of the
challenge to take personal risks when conducting psychotherapy to show that one is emotionally available to clients yet not be too emotionally porous in a therapeutic context. Such complexity in psychotherapy sessions requires the psychotherapist to be both a professional and an effective container. In the sense that “the suppression of emotions may give the appearance of a lack of empathy, but the unrestrained expression of emotions might be considered inappropriate and should perhaps be reserved for a therapeutic relationship outside the training context” (p. 212- 213). Small concluded,
it is the exposure to the thorny paths of the various training and therapeutic contexts and successful negotiation of the accompanying paradoxes that lead to growth and development, resulting in differentiation and integration of self...
49 However, the ultimate test of successful differentiation lies in the period after
formal training has ended (p. 213).
In a similar vein, Lloyd (2009) investigated the experiences of nineteen trainee clinical psychologists at Unisa. She, in her second year of the training, interviewed fellow trainees, namely, eight first year masters students, six second year masters students and five intern psychologists. She found that trainees found themselves in a ‘double bind’ experience when confronted with the implicit and explicit learning contexts of training which exacerbated feelings of confusion and powerlessness in trainees.
Makena (2001) examined the ethical sensitisation that occurred during his years of training at Unisa to become a systems-orientated clinical psychologist. He related how his personal history of growing up fatherless, poverty-stricken and having endured the death of his twin brothers had influenced how he related to people in general and how such hardships impacted on his ability to be a psychotherapist. He stated,
I not only dig deep into my own shadows as a guide to my ethical conduct in therapy, but also use self-questioning to look at how my own shadows can lead me to be unethical: a constant struggle of being self-critical… I feel that
continuous self-questioning is essential (p. 62).
Makena challenged psychotherapists to consider how they vicariously meet their own needs through a client’s psychotherapy and therefore how psychotherapists needed to be self- vigilant in terms of sometimes needing their clients more than the clients required their assistance. In the sense that the psychotherapist’s unmet needs constantly impact upon their therapeutic interactions with clients. Makena acknowledged the blending of the psychotherapist as professional helper and infallible human being with unique personal complexities requires the need for continual self-exploration and self-monitoring on the part of clinical psychologists. After all personal and professional experiences need to become integrated within the
psychotherapist (Klein et al., 2011).
Van der Merwe (2013), by means of autoenthnography, examined her journey of self- differentation during her two years of coursework (with a specific focus on the first 18 months) as a clinical psychologist within the context of Unisa’s systemic-orientated masters training programme. She found that her own process of differentiation (individuation and emotional connection with others) gave her the abilities and credibility to assist clients with their own
50 differentation processes. Key features of systemic training involved increased self-awareness and autonomy, acknowledging that trainers and trainess are co-responsible for the training context and outcomes.
From a postmodern social constructionist perspective, Hall (2004), Nabal (2009), and Naidoo (2005) examined personal experiences of becoming a psychotherapist when training to be clinical or counselling psychologist in South Africa. Naidoo (2005) explored the journey of becoming a counselling psychologist at NMMU with a focus on the self of the psychotherapist. She found that merely qualifying as a counselling psychologist was insufficient preparation to practice as a counselling psychologist. In that a psychotherapist is continually challenged to use their personal self within psychotherapy to the benefit of clients. She found by developing her use of self she underwent transformational growth that can be seen as acquiring “soul tattoos” (p. 3).
Hall (2004), as a trainee at UP, examined the impact that training to be a clinical psychologist had on personal relationships. The five intern clinical psychologists interviewed described a predominant feeling of being isolated from their personal relationships as they experienced “emotional overload” during their training (Hall, 2004, p. 100). Other themes that emerged were that participants found themselves becoming aware of their own personal unmet needs and having to express them and renegotiate existing relationships. Participants also spoke of managing simultaneously the observing role and the experiencing role in their personal relationships, as when remaining only in the observing role participants felt a loss of spontaneity in their interactions. Personally, Hall (2004, p. 103) added that for her, training to be a clinical psychologist involved her “own expulsion from Eden, of my own a loss of innocence” and yet her also having gained wisdom in the process.
Nabal (2009) explored the contradictions between the personal and professional aspects of training to be a psychotherapist by using her journey of becoming a counselling psychologist at UP. After having experienced the traumatic event of an armed robbery during her training she found her personal value of wanting to help people had become challenged, and that she needed to reconcile her professional and personal values. In this reconciliation process, Nabal found that she moved from understanding the profession of psychology in a “static hierarchical manner” (2009, p. 86) of codes and registration to incorporating her personal values into how she practiced as a psychotherapist in order to practice psychotherapy in an authentic manner.
51 Attending RU, Anema (1981) provided an autobiographical account of how she became a psychologist as a second career after first having a career as a psychiatric nurse and then
undergoing masters training to be a clinical psychologist. From a phenomenological stance, she particularly focused on the psychotherapeutic process of engaging with a client, and the aspects of her experience as a psychotherapist. She revealed that, “an attempt to hold a moment in psychotherapy became for me self-confrontation” (p. 112) which relied on the psychotherapist’s level of self-differentiation and the ability to explicate the psychotherapy sessions with a client without getting caught up in one’s shadow.
Kometsi (2001) provided a published account of personal experiences as a black clinical psychologist trainee in multi-racial clinical settings. Herein, Kometsi described incidents where two black patients at a student practical placement idealised the career of a psychologist
assuming that one achieved material gains, for example a car, by virtue of pursuing a career in psychology. In stark contrast, Kometsi verbalised the pain of a potential client rejecting and devaluing one’s therapeutic services outright on account of being a black therapist, as well as the subsequent pressure to succeed with a black patient. Kometsi’s account highlights that the lens of racial segregation is still evident in post-democratic South Africa. Within the broader profession of psychology as well as within private therapeutic consultations, Kometsi’s account also reveals how the painful frictions and schisms arouse deep-seated needs for a sense of belonging to one’s own kin in an attempt to offset the pain of alienation and continued racial ‘splitting’ in all
contexts, including healing contexts.
Indeed, the majority of trainees’ studies have provided an ‘inside look’ into the beginning stages of psychotherapist development within the complex South African context. However despite the rich experiences relayed by each account, each study is limited by the uniqueness of the account as the accounts confine themselves to a specific aspect e.g., a specific therapeutic process, or the impact of training on the personal relationships of the trainee. Trainee studies of one’s training process inherently confined themselves to a specific training context which makes the findings unable to provide a collective understanding of the psychotherapist development of the South African trainee psychologist, which is a much needed research endeavour.
Trainees’ studies of psychotherapeutic development of trainees. McGregor (2010)
examined psychotherapist development at the beginning stage with a particular focus on how trainees manage the first interview with a client. She found that trainees experienced anxiety and
52 verbalised an internal conflict between managing the twofold task of gathering relevant client information while simultaneously being attuned to their client while being scrutinised by their trainers.
Kay (1996), in a phenomenological study, explored the growth experiences of three clinical psychology masters students in their first year of training at SU. Participants verbalised personal growth, experiencing pressure to introspect, support from classmates and lecturers and undergoing a process of growth and development, and finding meaning within the training context.
While at UP, Kühn (2003), as an intern clinical psychologist herself, conducted a phenomenological study, exploring the experiences of four fellow clinical psychology masters students during their internship year. She found that interns experience a sense of apprehension, stress and fatigue. To cope interns drew upon family and friends and to a lesser extent sought out personal psychotherapy for emotional support. Supervision formed a major part of the internship experience. At the end of the year all participants reported feeling a sense of accomplishment despite the notable challenges during their internship year.
Ahrends (1995) interviewed intern clinical psychologists regarding multicultural aspects of their training. At the time of the study, a year after South Africans voted in democracy on the 27th of April 1994, participants voiced that similarities between people were emphasised in discussions as opposed to any differences between individuals and/or ethnic groups. Arguably, questions around the capacity of trainee psychologists to discuss multicultural issues within their training context is worth further investigation especially against the landscape of South African society two decades into democracy.
Through an interpretative lens together with critical theory, Nair (2008) specifically explored nineteen interns’ experiences of diversity in clinical training within the Western Cape region and found that race was still regarded as a complex, painful construct imbued with oppressive experiences for participants. The trainees reported that race became particularly foregrounded when working therapeutically in cross-racial dyads where difficulties were encountered. Trainees reportedly felt that they had inadequate multicultural training when undergoing masters training.
In a mixed-methods study, Gerber and Hoelson (2011) explored intern psychologists’ experiences at three different universities within three provinces of South Africa, in terms of
53 their levels of curiosity and feelings of uncertainty in their professional development. The
quantitative results reported that trainee psychologists had moderate to high levels of curiosity, and actively pursued acquiring new information, and opportunities to enhance their personal growth. The qualitative findings from subsequent interviews indicated that trainee psychologists actively found ways to manage their uncertainty regarding their professional development through a number of strategies namely through supervision, peer consultation, self-growth, augmenting their theoretical knowledge through for example reading professional literature, positive cognitive self-appraisals and by ensuring self-care through seeking social support and leisure activities.
In 2014, Teixeira, utilising the international developmental stage model of
psychotherapists’ professional development (Skovholt & Rønnestad, 2003a) interviewed three counselling psychology interns about their internship experiences in Grahamstown, in the Eastern Cape province. She reported that interns spoke of the highly supportive supervision experienced during their internship year at a counselling centre under the auspices of a university.
Other studies in South Africa have focused on the effects of personal psychotherapy upon the psychotherapist’s development. Ivey and Waldeck (2012) specifically explored the
significance of mandatory personal psychotherapy for nine psychodynamic clinical psychology trainees at the Wits, Johannesburg. Eight of the nine participants strongly endorsed mandatory personal psychotherapy seeing it as indicative of the psychotherapist holding themselves to a higher-order ethical principle beyond the rules of conduct stipulated by the PBP of the HPCSA, which does not make personal psychotherapy for psychologists mandatory within South Africa. Furthermore participants reported that initially they had found going to psychotherapy as rather difficult but over time they found that they had claimed their psychotherapy as personally beneficial beyond a professional training requirement of their university.
Additionally, all participants in Ivey and Waldeck’s (2012) study reported that their personal psychotherapy benefitted their training and professional development as clinical psychologists, especially as their personal psychotherapy enhanced their understanding of the psychotherapeutic process. Experiencing the vulnerability of being a patient enhanced the participants’ empathy towards their own patients, led to a greater understanding of patients experiencing ambivalence towards psychotherapy and an awareness of the countertransference
54 process. An identificatory learning process also occurred where participants found themselves modelling their psychotherapist’s body language, word phrases and techniques from having enjoyed “a first-hand experience of watching a therapist in action” and as one participant noted, “He was comfortable in his chair, comfortable in his skin, there were things I really wanted to internalise… to emulate as a therapist” (Ivey & Waldeck, 2012, p. 11). Overall, Ivey and Waldeck found that personal psychotherapy for trainees is seen as an “indispensable part of professional development by those who have experienced it” (2012, p. 17).
Trainers’ studies of the psychotherapeutic development of trainees. As a trainer, Human
(2006, 2013) examined the influence of adventure-based experiences during masters training on the development of counselling psychology trainees. He found that experiential learning through a physical activity such as a rope course or river-rafting uniquely enhanced trainees’ awareness of personal anxiety and understandings of group dynamics. Which, in turn, highlighted for trainees the importance of boundaries and role definition in therapeutic work and in other interpersonal contexts.
As clinical psychology trainers, Kottler and Swartz (2004) explored training as a rite of passage at UCT in relation to clinical psychology students under their guidance as trainers. Pertinently, three phases were identified in terms of progressing from a lay person to a
professional psychologist, in that training to be a psychologist “asks for a shift in identity” (2004, p. 69), and encompasses a number of transitions. Kottler and Swartz identified the transition from student to trainee, trainee with no clients to trainee working therapeutically with clients, from being trained at the university to functioning as a burgeoning psychologist in the role of intern clinical psychologist amongst other professionals in a professional setting, from trainee to qualified clinical psychologist fit to offer independent services to the public.
The first phase identified the trainees separating themselves from other university students, family and friends due to the confidential and almost initially mysterious nature of psychological work. Feelings of detachment and unpredictability were often felt as trainees become separate from their ‘previous’ life prior to training and become preoccupied with and absorbed in the training.
The second phase was characterised by trainees straddling their status as a student and simultaneously seeing themselves as having a professional identity as a clinical psychologist. Within this marginal phase of symbolic death, “each initiate experiences the annihilation of his
55 or her own sense of identity and all that he or she has come to know about himself or herself and the way he or she operates in the world… initiates have to find a way of constructing a new identity-a painful process of re-birth” (Kottler & Swartz, 2004, p. 58). Trainees in a sense find themselves “living a destabilised existence in the margins between two identities” (2004, p. 60).
The third phase saw the trainees reintegrating back into society as a qualified clinical psychologist. Kottler and Swartz (2004) argue that this three-phase transitional process of clinical psychology trainees can be viewed as an arduous rite of passage, an initiation (Turner, 1969).
Furthermore, Kottler and Swartz observed that trainees often identify strongly with one another and may even be rebellious as a group towards the training programme at times due to underlying anxieties about becoming a professional clinical psychologist. In light of the dynamics of this personal-professional process, Kottler and Swartz caution that there is “a fine line between a creative marginality in which psychological structure is fluid enough to
accommodate substantial change and a potentially more damaging state in which little creative learning is possible” (2004, p. 68). Clinical psychology trainers at Wits, Eagle, Haynes, and Long (2007) note that trainees often “feel overwhelmed and threatened” by the nature of the clinical work that they are confronted within the South African context that of “clients who have experienced multiple losses, violence, abuse, deprivation and grinding poverty” (p. 136).