Browsing by Subject "Clinical Psychology"

Now showing 1 - 20 of 270
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    A Social Psychological Exploration of Tenure Reform in a Cape Town Housing Project
    (2021) Brusser, Paul; Long, Wahbie
    Research into tenure reform in South Africa, in the form of allocating private property rights in the form of title deeds, has yielded unclear results in terms of economic upliftment of communities. There is a lack of qualitative information about how communities engage with land titling projects, with existing research being largely survey based. This research involved semi-structured interviews with a sample of twelve participants from a land titling project in Vukuzenzele, Cape Town, with the aim of understanding their decision-making process around whether to get their title deeds. Interviews were subjected to a thematic analysis, out of which nine themes emerged: Trust, Security of Ownership, Tyranny and Authority, Money and Cost, Community Mentality and Support, Capacity for Agency, Forms and Norms, Struggle, and Self-Ownership. While land titling has been justified in neoliberal economic terms, this research showed that capital gains were not the primary motivation of participants. The material and psychosocial possibility of security of ownership emerged as a primary motivation. In order to attain that security, the community had to navigate new areas of knowledge and norms, renegotiating social representations of trust and authority. This research could assist stakeholders in understanding how to approach communities and by what metrics the outcome of titling projects could be assessed.
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    A systematic review of interventions for emotionally dysregulated children
    (University of Cape Town, 2020) Timakwe, Ayabonga Mbalentle; Ward, Catherine
    Emotion regulatory problems in children, such as uncontrollable tantrums, kicking, and screaming, are a concern for parents. When parents and caregivers have no tools at their disposal to deal effectively with this, they may resort to physical measures of discipline, which may lead to physical abuse and also have negative effects on the wellbeing of the child. There is a need for a set of skills for what to do during these crisis moments. However, the state of evidence on this is unknown. Thus, a systematic review of interventions for emotionally dysregulated children was conducted in order to ascertain the state of evidence and to provide parents, teachers, hospital staff and caregivers with a "toolbox" of skills they can use. The findings of the studies indicated that the skills worked when used in a noncoercive manner. Overall the quality of the studies was weak: most were single-case studies. This review provides tentative suggestions of skills that parents and caregivers may find useful with dysregulated children, but further research into the effectiveness of these skills is needed.
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    Accounting for child sexual abuse : male discourses
    (1990) Sterling, Carolyn Dawn; Levett, Ann
    This study explores discourses which relate to child sexual abuse and which seek to excuse or justify it. It is hypothesized that these discourses are wide-spread and are not held simply by a small minority of offenders. Similar discourses emerged in two very different groups of male subjects. The first comprised 45 male second year University of Cape Town students in the Department of Psychology in 1986, who enrolled for a gender socialization course credit option. The second consists of 26 alleged child sexual abusers admitted to Valkenberg Hospital for psychiatric observation in 1988/9. A discourse analysis methodology is used to analyse essays written by the students and transcripts of audiotaped groups in which they participated, as well as accounts of the alleged offence contained in the clinical records of the observation cases. Ten discoqrse1;i, relating to excuses or justifications for child sexual abuse, were identified by their repeated occurrence in the research material. Identified justifications of child sexual abuse are victim blaming, the belief that men are unable to control their sexual drive, the assertion of power, perceived rights over women, and doubting the evidence of girls and women. Illustrations of these discourses, which are present in both students' essays and groups, as well as in the alleged offenders' accounts, are discussed. These five discourses appear to be pervasive and may be indicative of generally held beliefs which relate to the different positions in which men and women are placed in society.
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    Adolescents' perspectives on their treatment as inpatients
    (2013) Benjamin, Amy; Ward, Catherine
    Adolescent inpatient psychiatric care is an accepted intervention for acute adolescent behavioural and emotional problems, yet little is known about patient experiences of this care. This study explores former patients’ views of the therapeutic factors involved in the treatment they received at Kenilworth Clinic’s Adolescent inpatient unit in Cape Town, South Africa. Twelve ex-patients were interviewed using a semi-structured interview schedule; the interviews were recorded, transcribed and analysed qualitatively using template analysis. In line with Yalom and Leszcz’s (2005) work on the therapeutic factors in group work, some of these therapeutic factors featured as major themes in the interviews, specifically: the imparting of information, universality, group cohesiveness, interpersonal learning and catharsis. Other factors featured minimally or not at all; an attempt is made to understand this as well as the potential value of these factors. In addition to these therapeutic factors, patients generally perceived family sessions as both helpful and difficult. Concerns raised by participants about their treatment experience included underage smoking at the unit, confidentiality in aftercare group and a desire for individual therapy by participants. The recommendations made were for the staff at the unit to maximise the therapeutic space for the factors highlighted as important to the patients, to continue to endeavour to prevent patients without consent from smoking and to use rule-breaking therapeutically as far as possible, and to discuss confidentiality rules and concerns in the aftercare group at every session. Ideas for future research were discussed, these included a questionnaire-based study where both staff and patients rank the therapeutic factors involved in treatment according to perceived value and an outcomes study.
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    AIDS/representation and psychological practice : (inter)subjectivity in HIV counselling
    (1996) Sandenbergh, Rob; Kottler, Amanda
    This study undertakes a discourse analysis of a counselling session with an HIV positive man. Literature, informed by post-structuralism, on the representations and practices that surround the HIV/AIDS epidemic is examined as a background to the study. Self psychological theory concerning mourning, the psychodynamic consequences of having AIDS and selfobject phantasies is examined. This theory is criticised for ignoring the content of phantasies as well as the imbrication of the subject within the social. In an attempt to address these gaps theorisation of stigma and gendered development is introduced, as well as Hollway's (1984) broadly Foucauldian notions of investment in subject positionings. A multiple theoretical position conceptualising counselling as (inter)subjective process re-producing particular subject positionings is developed. The relations between various subject positions are described, drawing on self psychological theory to consider the investments the participants in the session may have had in each position. The analytic reading suggests that in the elaboration of particular selfobject phantasies the HIV positive client is able to cohese his sense of self and to disavow a knowing of himself as a stigmatised person with AIDS. The counsellor, through subject positionings which are in conjuncture with those of the client, disavows a knowing of the client as a person with AIDS. Through these positionings a necessary allusion of attunement is produced, allowing the counsellor to mirror the client. From this analysis various implications for consultation, supervision and training are drawn. The study .suggests that multiple ways in which HIV I AIDS is represented requires psychologists to explore their own positionings with regards to salient HIV/AIDS related issues, as these positionings have effects in work in this field.
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    All about 'attacks' and remaining 'mindless' to feelings - psychoanalytic reflections in playtherapy
    (1996) Valentini, Valentina; Anderson, Rod
    This dissertation has attempted to illustrate by way of a cross-section of selected clinical material from particular phases in one long-term playtherapy, the relationship between the phenomenon of non-verbal and verbal attacks on the therapist, the therapeutic process and Bion's concept of projective identification. It is maintained that these attacks illustrate Bion's psychoanalytic thoughts concerning projective identification as a primitive mode of communication of unbearable feelings which cannot be tolerated, but at the same time unconsciously desire expression. Providing the theory for this is Bion's formulation of the container - contained model of early object relations and his explicit appreciation of the importance of the nurturing object, originally the mother and now the therapist, in helping the infant/child process their experience by making their thoughts thinkable, rather than remaining mindless to emotional experiences. How children communicate their experiences in therapy is frequently beyond words and can only be gauged by means of symbolic expressions, nonverbal responses, and primitive projective identification processes. The therapist's countertransference responses served as a core diagnostic tool for evaluating the nature of the child's communications. Furthermore countertransference responses, provided a valuable tool in dealing with, and containing, the concrete quality of these projective identifications by offering transformative experiences through meaningful interpretations. It is speculated that the repeated experience of the therapist remaining a repository for the child's projective identifications, in spite of the relentless attacks, played a major role in the gradual steps towards integrating the containing aspects of both the therapist as a modified figure and the therapeutic process.
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    An Exploration of How Working-Class Substance Users in the Western Cape Understand Their Addiction
    (2023) Kara, Tashmira; Long, Wahbie
    The study aims to explore how substance users from poor and working-class backgrounds in the Western Cape, South Africa, understand the development of their patterns of substance use. Using a mono-method qualitative research design under an intersectional theoretical framework, 11 face-to-face interviews were conducted. The interviews were transcribed and analysed using thematic analysis. Six themes were identified: addiction and agency; substance use as a coping mechanism; unmet attachment needs; societal factors influencing substance use; the psychology of active addiction; and recovery. The results of this study correspond to existing literature on substance abuse; however, this study is unique in that it relates problematic substance use to violence and poverty, through the mechanism of shame, in a South African context. Future research should aim to conduct interviews in participants' home languages to aid in capturing more nuanced narratives. Moreover, a more gender-balanced sample should be interviewed which would allow the female voice to come through more consistently.
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    An exploration of South African university students utilization of and engagement with mental health-related information on Instagram
    (2023) Lekgothoane, Lesego; Kaminer, Debra
    Mental health difficulties are prevalent among university students in South Africa and globally, but help-seeking is low due to a variety of structural and attitudinal barriers. It is therefore important to find novel ways of offering mental health information and support through modalities that are both accessible and acceptable to students. Although there has been much concern about the role of social networking sites (SNS) in creating risk for mental health difficulties, SNS are also increasingly being utilized by young adults to access mental health-related content for purposes of education, awareness, and support. However, there has not been any research to date on how university students in South Africa use and engage with mental health-related content on SNS. The current mixed methods study explored South African university students' experiences of accessing and using mental health-related information on Instagram. In the first phase of the study, an online survey was administered to Psychology students (n= 335) at a South African university, exploring use of Instagram to access mental health content. A content analysis was then performed on the ten most commonly accessed mental health-related Instagram accounts listed by survey participants. Finally, seven participants who completed the survey took part in semi-structured interviews to further explore their experiences of using Instagram to access mental health content. A combination of descriptive statistics and thematic analysis was used to analyze data across the three phases. The most common types of mental health content accessed by participants included mental health awareness and psycho-education, inspiration, coping strategies, as well as memes and humour. The most significant qualitative themes from the findings included using Instagram to improve awareness and management of one's own and other people's mental health symptoms, develop better coping mechanisms, find self-care tips, experience connectedness and social support, normalise mental health difficulties and validate and alleviate negative feelings. A small minority of participants reported that accessing mental health-related content on Instagram was unhelpful or triggering. Overall, the findings indicate that Instagram offers an accessible and acceptable source of mental health information, coping strategies, connectedness and validation for participants struggling with mental health issues. Limitations of the study and directions for future research are discussed.
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    An investigation of the psychological, physiological and endocrinological factors underlying two types of alcoholism
    (1978) Loebenstein, Larry
    Fifteen delta and eleven gamma alcoholics were given a moderate dose of alcohoL Changes in extroversion, neuroticism, anxiety, assertiveness, Basal Skin Conductance and urinary levels of epinephrine and norepinephrine were measured. The changes that significantly differentiated the gamma group from the delta group were those measured by the psychological variables. In the sober state, measures of extroversion, anxiety and assertiveness, also differentiated the two groups. Although the physiological and biochemical changes were significant within each group, their differential responses were not significant. The results have therapeutic implications.
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    An analysis of client trends in gay and lesbian counselling service
    (2001) Clayton, Janine Lydia; De la Rey, Cheryl
    Due to experiences of homophobia encountered within mainstream mental health services, sexual minorities have established mental health services that address their needs. This study explored client patterns and trends at Triangle Project, a counselling service, aimed at gay, lesbian, bisexual and transgendered (GLBT) individuals. The data was collected and analysed by examining existing documentation that contained clients’ information. This method of secondary analysis also included looking at the organisation's annual reports and an evaluation report. The findings indicated that GLBT communities favour counselling services aimed specifically at meeting their needs. Furthermore, GLBT individuals do not necessarily present with concerns relating to their sexuality, but there are commonalities with heterosexual individuals’ presenting concerns. In addition, it was apparent that gay men and lesbians presented with different concerns. Lesbians expressed their primary concern as relationship difficulties, followed by depression, while gay men reported issues such loneliness and other situational concerns. White gay men made use of services more so than other sexual minorities of colour. The findings also revealed that youth, lesbians and gay men of colour, were not well represented, and that youth, particularly, were at risk of possibly experiencing mental ill health. This study recommends that it is crucial for mental health workers to be equipped to provide effective mental health services for GLBT communities and that interventions are designed to facilitate and promote the mental health of GLBT individuals. It is also imperative that the GLBT community is not viewed as a monolithic group and that mental health workers are sensitive to differences of culture and ethnicity.
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    An analysis of psychological and legal conceptions of the defence of non-pathological criminal incapacity
    (2000) Africa, Adelene R; Tredoux, Colin
    The defence of non-pathological capacity presents challenges for both law and psychology because it acknowledges that psychological factors other than mental illness, are grounds for complete exculpation. In this sense, South African law differs from its Anglo-American counterparts as it recognises that non-pathological factors playa role in negating criminal responsibility. Legal and mental health professionals are instrumental in the application of the defence, but both case law and literature reflect differences in the way in which the defence is understood and applied. Disagreement within and between disciplines adds to the controversial nature of the defence. This study examines the interpretation and practical application of the defence by mental health professionals and lawyers. It explores how participants' understanding of the defence informs its application in practice. A sample of ten participants including mental health professionals (comprising psychologists and psychiatrists) and lawyers (comprising advocates) was chosen, in order that a comparison be drawn between the two groups. Semi-structured interviews were conducted so as to enable in-depth exploration of issues regarding conceptions of criminal responsibility, the role of expert testimony and the conceptual understanding and application of the defence.
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    An analysis of therapeutic failure in psychotherapy with a deaf client : a training psychologist's experience
    (2011) Srubisky, Catherine Filippa; Kaminer, Debbie
    This mini dissertation attempts to understand the early stages of a psychotherapeutic process between a trainee psychologist and a Deaf client. Both a social constructionist perspective of the experience of being disabled/Deaf, and an intersubjective lens, have been utilized in order to understand the nature of the therapeutic failures that occurred and how they functioned. A psychoanalytic case methodology was used to analyse the first eight sessions in the psychotherapeutic process with a Deaf client and members of her family.
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    An archival study of an adolescent day patient unit with a particular focus on risk-taking behaviour and suicidality
    (2002) Kometsi, Molelekoa J; Dawes, Andrew
    This study was conducted with the following three objectives: 1, to construct a profile of patients admitted to William Slater Hospital day-patient program during a three-year period (1998-2000). 2, To study the prevalence of suicide and risk-taking behaviour among this sample population, and thus making a comparison with Cummins and Allwood's (1984) study. 3 To explore the extent to which risk-taking behaviour is associated with suicidal hebaviour in this clinical population. Archival research method was used to achieve these objectives.
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    Are you sure we're talking about the same person? different professional perspectives on a single patient : challenges for an integrative approach within the primary mental health care system
    (2000) Brandt, Anneliese; Gibson, Kerry
    In 1999 a system of placing intern psychologists in primary health care centres was introduced by the Department of Psychiatry of the University of Cape Town. This allowed interns the opportunity of experiencing and evaluating psychiatric services in situ at clinic level within the primary mental health care system. My own experience as an intern working at a clinic served to highlight some areas of difficulty in offering an integrated approach at a primary level. They are in particular the different perspectives brought to the provision of mental health care by the professionals, and the inequalities in status and work conditions of the partners in mental health care service provision. The differing professional perspectives and their implications for case management are explored through a case study of a single patient and her experience of the service. The study illustrates the way in which effective service provision may be compromised by the inherent differences in the perspectives of the disciplines represented by the professionals, as well as by the failure to recognise the extent and importance of the role played by the psychiatric nursing personnel. It is suggested that the system could be significantly improved by the introduction of a system of consultation between all of the partners to coordinate the care of patients in order to maximise the benefits they derive.
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    Aspects of translation in psychological and psychiatric cross-cultural research
    (1992) Drennan, Gerard; Levett, Ann
    This study investigates the process of translating English-language questionnaires and interview formats into Black African languages. The details of translation are invariably glossed in reports and publications on the use of translated psychological and psychiatric instruments. This results in a lack of clarity on how these translated instruments are produced and what difficulties are encountered in their development and use, suggesting the need for a detailed examination of the translation process. Researchers working in South Africa were interviewed with a semi-structured format in 1989. Extracts of the data gathered in eleven interviews is presented here with a focus on two aspects of the translation process. Firstly, problems in the evaluation of translation quality and the interpretation of the successful use of a translation are identified. It appears that theoretical confusion results in the under-utilisation of the opportunity for translation quality evaluation presented by translation strategies. An additional exploration of discourses tacit in the use of translated instruments with interpreters, and a consideration of the role of power and resistance in these contexts is undertaken. Secondly, a rationale for researchers' use of different types of translators is presented. Unexamined assumptions about cultural expertise implicit in the decision-making process associated with translation are identified. Recommendations are made as to areas that require further research and clarification.
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    Assessment for psychotherapy within local psychiatric training units : some guidelines
    (1983) Dickman, Beverley Jo; Levett, Ann
    Assessment for psychotherapy is an area of crucial importance for positive outcome of therapy and hence should be an integral part of the training of intern psychologists. This thesis attempts to develop guidelines for the assessment of patients for psychotherapy in the local hospital setting, and is informed by a survey of the circumstances in the various training units. Quantitative work on psychotherapy outcome is reviewed in an attempt to derive such guidelines. The review is highly selective, focusing on areas relevant to the local context. Although some useful pointers emerged, at the present time this body of work is somewhat disparate, and hence not particularly helpful in the development of an integrated set of guidelines. Therefore, greater reliance was placed on literature based on work in the clinical tradition. The focus is on short-term forms of intervention. The approaches included within this rubric are categorised into reconstructive, reeducative and supportive modes (Walberg, 1977), and selection criteria were presented for each of these. Perhaps the most complex area is the assessment of ego function, which is given detailed attention. The literature on assessment of ego function derives mainly from the reconstructive tradition, but has relevance for reeducative and supportive approaches as well. It is argued that comprehensive assessment, particularly for reconstructive forms of intervention, is a complex process requiring considerable skill. Although guidelines have an important role to play, the process of assessment, like all aspects of psychotherapy, can only be learned through practice under careful supervision. The implications for training in the local psychiatric units are discussed.
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    Assessment of children for brief psychodynamic psychotherapy : training implications
    (1991) Levy, Lisa-Ann; Swartz, Sally
    The aim of this study is to develop a framework for the assessment of children for short-term psychodynamic psychotherapy, with a particular emphasis on the training of child therapists. For this purpose the literature on brief child psychotherapy is reviewed, and selection criteria mentioned in the literature are collated and summarized. These criteria are then applied to 5 cases seen by trainees or newly qualified clinicians in order to assess their usefulness in a training setting. Potential sources of difficulty for inexperienced clinicians in the assessment for and process of this specialized form of child psychotherapy are considered, and guidelines as to how this approach could be usefully employed in a training institute are suggested. On the basis of the literature and case discussions, a format for the assessment of children for brief psychotherapy is devised in order to assist the trainee.
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    The association between grandparental involvement and adolescent psychological well-being independent of parental involvement
    (2012) Gaibie, Fairuz; Wild, Lauren
    Background and objective: Grandparents have the potential to play a supportive and nurturing role in the lives of their grandchildren. Grandparents have always had an important role to play in South African society. Traditionally, developmental psychology has not focussed much attention on the role grandparents have to play in the adjustment of children and adolescents. The current study aimed to determine: (a) whether there is an association between grandparental involvement and adolescent well-being; and (b) whether that association remained when parental involvement was taken into consideration. Method: Cross-sectional survey data was collected from a convenience sample of 217 adolescents, aged 13 to 15 years of age. Grade eight and Grade nine learners were purposively selected from a single school. Correlational and multiple regression analyses tested relationships between a grandparent involvement measure, scores on the five sub-scales of the self-rated version of the Strengths and Difficulties Questionnaire (SDQ) for 11- to 17-year-olds, and a parental involvement measure. The SDQ was used for the measure of adolescent well-being.
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    Attachment styles, parenting styles and theory of mind: an exploration of their relationships with social deficits in Autism Spectrum Disorder
    (2016) Bailey, Nakeeta Catherine; Malcolm-Smith, Susan
    Autism Spectrum Disorder (ASD) is fundamentally characterised by social deficits. It is thus important to understand social functioning and what contributes to social development in children on the spectrum. It is widely accepted that ASD has a neurobiological basis, however research on understanding the lack of social skills found in ASD individuals remains indefinite and controversial. In this thesis we explored attachment styles, parenting styles and ToM to discern how they relate to social deficits in ASD. The literature for typically developing children has illustrated important relationships however there is a lack of exploration in the ASD populace. This protocol was divided into two studies. Study 1 assessed social deficits, attachment and parenting styles in 46 children with ASD aged 4 – 14 years and included both verbal (n = 19) and non-verbal (n = 27) children. The ADOS-2, Attachment Style Classification Questionnaire, and Parenting Style Dimension Questionnaire were used to measure these variables. Study 2 assessed ToM capacity and its relationship with parenting styles and social deficits in verbal children with ASD. In Study 1 we found verbal and non-verbal subgroups differed on social deficits. The aims for exploring attachment and parenting styles were to discern 1) what style dominates; 2) whether attachment and parenting styles differ between verbal and non-verbal children and 3) whether these variables relate to social deficits. We found odd patterns of attachment with no clear dominant style in our full sample. Only the non-verbal subgroup showed a relationship between secure attachment and reduced social deficits. In terms of parenting, the authoritative style was reported to be mostly employed by our parents and it related to reduced social deficits in both the full sample and the verbal subgroup. In Study 2 we explored 1) the extent of ToM deficits in ASD; 2) how parenting styles relate to ToM and 3) whether better ToM and parenting in combination related to reduced social deficits. We found severe ToM deficits in our sample which suggests delayed development. Authoritative parenting was significantly related to better ToM capacities. Furthermore, a regression of positive parenting and ToM abilities in combination with social deficits indicated that only ToM and age predicted less social deficits. This current study suggests that specifically authoritative parenting and ToM skills may be important underlying mechanisms for better social abilities in ASD. Most notably, it stresses that ASD cannot be regarded as a homogenous population as a clear distinction between the verbal and non-verbal subgroups is reported herein; a currently underestimated notion. Although still in its preliminary stages, the work reported in this thesis opens up a new line of thinking that could, in principle prove to be beneficial to research in the area of ASD.
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    Attitudes to food and weight : a survey in a women's residence at the University of Cape Town
    (1986) Robinson, Christopher John; Swartz, Leslie
    Epidemiological research in the past decade has indicated that clinical and subclinical eating disorders are widespread amongst the female population of many Western countries. Following an introductory overview of some of the literature on anorexia nervosa and bulimia, highlighting the lack of diagnostic clarity in this area, previous epidemiological findings are reviewed. The eating attitudes and dietary behaviour of a female student population in a residence at the University of Cape Town are then detailed. The sample comprised 123 women, shown to be a representative sample of the residence population, and data were collected by means of the Eating Attitudes Test (Garner and Garfinkel, 1979). Results indicate that 13.8% of the sample population scored above the threshold score of 30 on this test; results are discussed with particular focus on specific attitudes and behaviours possibly indicative of anorexic or bulimic symptomatology, and which are elicited by EAT responses. Clinical interviews were conducted with those women who scored over 30 and who supplied their names (9 students); qualitative data obtained from these interviews augment the quantitative analysis of the EAT data, particularly with respect to the phenomenon of binge-eating behaviour. Findings of the present study accord overall with results obtained elsewhere amongst similar populations. The study does, however, call into question presently held assumptions about the nature of binge-eating, and the diagnostic criteria for anorexia nervosa and bulimia.