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Individual Psychotherapy as Treatment of Choice: Preliminary Findings from the UCT Child Guidance Clinic
Abstract
Individual psychotherapeutic interventions conducted at the University of Cape Town Child Guidance Clinic (CGC) between 2000 and 2009 were investigated quantitatively with a view to offering informed conclusions on the current nature of clinical practice at the Clinic. Considering relevant socio-economic, political and pedagogical contexts of the Clinic's work, some observations are also offered on the applicability of such individual psychotherapeutic practice more generally in the local South African setting today. The 156 individual case files that make up the sample were reviewed and a broad range of clinical information was collated including data on clients' demographics, their presenting difficulties and interventions employed, as well as on clients' apparent clinical outcomes. Results indicated that clients' social class had little or no effect on clinical outcomes. The majority of clients in the sample appeared to have positive outcomes upon termination, despite a significant proportion of clients reporting histories of childhood sexual abuse and othertrauma. Trainee clinicians at the CGC appear to manage well, achieving what appear to be generally positive clinical results over relatively short time frames despite clinical inexperience and clients' often severe presenting difficulties. This, it is argued, attests to the power of individual work to unlock individual potential in the local context.
... Contemporaneamente, a infância passou a ser reconhecida como um período da constituição humana, que necessita de preparo e cuidados. Assim, considera-se fundamental compreender e escutar as crianças frente às suas experiências, com o intuito de acessar a sua vivência, de maneira contextualizada (Haubert & Vieira, 2014;Telles, 2014). Dentre os diversos contextos de escuta, destaca-se nesse trabalho a psicoterapia. ...
... Na psicoterapia humanista, se o contato que estabelecido com a criança não se dá através da abertura à sua diferença, mas a partir de uma objetivação ou de conceitos prévios, a sua alteridade pode se absorver no que já é conhecido. É preciso compreender a experiência da criança que se apresenta para possibilitar o acesso a ela em sua absoluta singularidade (Botha & Dunn, 2009;Brito & Paiva, 2012;Brito & Freire, 2014;Telles, 2014). (Prebianchi, 2011;Haubert & Vieira, 2014;Rodrigues, Sei & Arruda, 2013;Accurso & Garland, 2015). ...
Resumo: A psicoterapia destaca-se como modalidade de atendimento à criança. Ressalta-se a importância de discutir sobre a psicoterapia infantil, pelo aumento da procura por esse serviço. Com o objetivo de reconhecer como a psicoterapia infantil tem sido conceituada e exercida, foi realizada uma revisão sistemática nas bases de dados BVS, Science Direct e SAGE Pubs, no período entre 2008 e 2018. Dos estudos encontrados, 67 artigos atenderam aos critérios de inclusão. Constatou-se que a psicoterapia infantil vem se configurando como uma prática fundamental frente às demandas existentes, bem como um campo de produção científica e de práxis voltada às demandas em cada cultura. Verificou-se que as vivências infantis têm sido olhadas com mais cuidado e com uma compreensão mais abrangente nesse campo de atuação. Conclui-se que há abrangente discussão sobre os avanços da psicoterapia infantil, assim como a permanente necessidade de investigação e de aprimoramento. Palavras-chave: psicologia clínica; psicoterapia; psicoterapia infantil; revisão sistemática. Abstract: Psychotherapy stands out as a modality of childcare. It is important to discuss child psychotherapy, by the increased demand for this service. To recognize how child psychotherapy has been conceptualized and exercised, a systematic review on BVS, Science Direct and SAGE Pubs databases was conducted in the period between 2008 and 2018. Of the studies found, 67 articles met the inclusion criteria. It was verified that child psychotherapy has been configured as a fundamental practice face of the existing demands, as well as a field of scientific production and praxis focused on the demands in each culture. It was verified that children's experiences have been looked more carefully and with a more comprehensive understanding in this field. It is concluded that there is a wide-ranging discussion on the advances of child psychotherapy, as well as the permanent need for research and improvement. Keywords:clinical psychology; psychotherapy; child psychotherapy; systematic review
... Contemporaneamente, a infância passou a ser reconhecida como um período da constituição humana, que necessita de preparo e cuidados. Assim, considera-se fundamental compreender e escutar as crianças frente às suas experiências, com o intuito de acessar a sua vivência, de maneira contextualizada (Haubert & Vieira, 2014;Telles, 2014). Dentre os diversos contextos de escuta, destaca-se nesse trabalho a psicoterapia. ...
... Na psicoterapia humanista, se o contato que estabelecido com a criança não se dá através da abertura à sua diferença, mas a partir de uma objetivação ou de conceitos prévios, a sua alteridade pode se absorver no que já é conhecido. É preciso compreender a experiência da criança que se apresenta para possibilitar o acesso a ela em sua absoluta singularidade (Botha & Dunn, 2009;Brito & Paiva, 2012;Brito & Freire, 2014;Telles, 2014). (Prebianchi, 2011;Haubert & Vieira, 2014;Rodrigues, Sei & Arruda, 2013;Accurso & Garland, 2015). ...
A psicoterapia destaca-se como modalidade de atendimento à criança. Ressalta-se a importância de discutir sobre a psicoterapia infantil, pelo aumento da procura por esse serviço. Com o objetivo de reconhecer como a psicoterapia infantil tem sido conceituada e exercida, foi realizada uma revisão sistemática nas bases de dados BVS, Science Direct e SAGE Pubs, no período entre 2008 e 2018. Dos estudos encontrados, 67 artigos atenderam aos critérios de inclusão. Constatou-se que a psicoterapia infantil vem se configurando como uma prática fundamental frente às demandas existentes, bem como um campo de produção científica e de práxis voltada às demandas em cada cultura. Verificou-se que as vivências infantis têm sido olhadas com mais cuidado e com uma compreensão mais abrangente nesse campo de atuação. Conclui-se que há abrangente discussão sobre os avanços da psicoterapia infantil, assim como a permanente necessidade de investigação e de aprimoramento.
A number of scholars during the 1980s and early 1990s questioned the relevance of psy-chology in South Africa. In this paper we characterise the nature of what became known as the 'relevance debate', and then investigate whether South African psychology has become more relevant during the nation's first ten years of democracy. Themes which are identified with respect to this issue include the apparent increasing representation of marginalised groups within South African psychology, the conscious responsiveness of psychologists to post-apartheid policy imperatives and issues, their alignment with international theoretical trends, and finally, an increasing recognition of the political nature of South African psychol-ogy. The authors conclude that a more productive approach within future debates regarding relevance in psychology would be to examine the nature of knowledge production within the discipline. From the latter half of the 1980s into the early 1990s many South African psychologists earnestly debated the question of how psychology could become more relevant to the local socio-political context. Such was the fervour of the debates among some groups of psychologists that it was labelled 'a state of crisis' (Shefer, 1988, p. 31). This refer-ence to a crisis was not uniquely South African. A crisis was identified within the international arena as well, concerning the degree to which the Eurocentric 'Western' tradition of positivistic empiricism in psychology could be regarded as relevant to the everyday lives of people living in vastly different social contexts.
The aim of this study was to identify variables that distinguish mothers who broke the cycle of abuse from mothers who were abused as children and who also abused their own children. Based on maternal interviews and questionnaires completed over a 64-month period, measures of mothers' past and current relationship experiences, stressful life events, and personality characteristics were obtained. Abused mothers who were able to break the abusive cycle were significantly more likely to have received emotional support from a nonabusive adult during childhood, participated in therapy during any period of their lives, and to have had a nonabusive and more stable, emotionally supportive, and satisfying relationship with a mate. Abused mothers who reenacted their maltreatment with their own children experienced significantly more life stress and were more anxious, dependent, immature, and depressed.
This paper discusses tensions and contradictions experienced by a group of psychologists in post-1994 South Africa as we struggled to develop an MA program in community psychology. Situating our work within the history of the subdiscipline and the historical context confronting South Africans in the "wake of apartheid," we explore models of community psychology that informed praxis under apartheid and contemporary challenges confronting a country in transition. We discuss three tensions that inform the ongoing program development. These include (1) the construction and deconstruction of Western and indigenous knowledge systems; (2) assessment and intervention at multiple levels and from differing value perspectives; and (3) paradoxes experienced by a team of university-educated, primarily White academic staff committed to challenging oppression. We conclude our discussion by suggesting that, within these shifting sands of economic, political, cultural, and institutional change community psychology must, of necessity, resist rigid self-definition and seek to position itself as a "work-in-progress." We suggest that this seemingly anomalous self-description may be suggestive for other community psychologists-in-the-making facing similar challenges within the majority world.
This paper discusses tensions and contradictions experienced by a group of psychologists in post‐1994 South Africa as we struggled to develop an MA program in community psychology. Situating our work within the history of the subdiscipline and the historical context confronting South Africans in the “wake of apartheid,” we explore models of community psychology that informed praxis under apartheid and contemporary challenges confronting a country in transition. We discuss three tensions that inform the ongoing program development. These include (1) the construction and deconstruction of Western and indigenous knowledge systems; (2) assessment and intervention at multiple levels and from differing value perspectives; and (3) paradoxes experienced by a team of university‐educated, primarily White academic staff committed to challenging oppression. We conclude our discussion by suggesting that, within these shifting sands of economic, political, cultural, and institutional change community psychology must, of necessity, resist rigid self‐definition and seek to position itself as a “work‐in‐progress.” We suggest that this seemingly anomalous self‐description may be suggestive for other community psychologists‐in‐the‐making facing similar challenges within the majority world.
This paper introduces the special section reviewing the controversy resulting from the work of the Task Force on Promotion and Dissemination of Psychological Procedures (1995; Chambless et al., 1996) of the Division of Clinical Psychology, American Psychological Association). This task force established a set of criteria for identifying Empirically Supported Treatments (ESTs), plus a list of psychosocial treatments for specific problems or disorders. Parallel projects are underway elsewhere, including Germany and the United Kingdom. This paper offers a “reader’s guide” to the subsequent controversy over the “EST project, ” summarizing the numerous arguments in favor of and opposed. It concludes with a summary of the main practical options which have emerged for dealing with the controversy, including recommendations for research and proposals for improving or broadening the EST project. Further dialogue on these issues is encouraged.
Given the racialization of subjective, material and historical realities in South Africa, psychological training and practice in community raise crucial and often thorny ethical, epistemological and methodological questions. This article appraises the strengths and limitations of using Rapid Assessment Procedures (RAP) (Afonja, 1992) in the field training of postgraduate students in community-counseling psychology. Rooted in an activist participatory action research framework (Lykes, 1997), RAP provide a framework for the collective exploration of locally constructed representations of a community's needs and resources; joining the ‘community’ (negotiating a dialogical form of communication and a respect for the insider-outsider dialectic); working through one's ‘situated otherness’; and deracializing psychological training and practice.
While a rich body of research exists to inform the practice of clinical psychology, South African mental health professionals have failed to incorporate empirical findings in their clinical work. This article argues that South African psychology has become increasingly devoid of an empirical base, to the detriment of the clients it purports to serve. A fundamental epistemological problem that faces clinical psychology is the credibility it bestows on non-falsifiable theories. As such, practitioners have been led to rely to an inordinate degree on so-called clinical intuition and experience. Yet, the application of both of these practices yields demonstrably inferior treatment outcomes when compared with actuarial methods of judgement and prediction, and empirically supported interventions. While the notion of empirically supported treatments and its emphasis on randomised controlled trials are not unproblematic, far worse is the practice of giving credibility to clinical practices based on folklore and theoretical dogma in the absence of evidence. The argument presented in this article is that if South African clinical psychology is to make itself relevant to the needs of contemporary society, it needs to abandon non-falsifiable theoretical tenets and adhere more vigorously to the criteria of evidence when dispensing clinical services.
The aim of this archival epidemiological study was to identify gender and racial patterns of psychiatric diagnosis and management in admissions to mental hospitals. The hospital records of a random, stratified sample (N =2110) of all patients admitted to the three public psychiatric hospitals in the Western Cape for a calendar year were studied for gender and racial differences regarding demographics, admission-related variables, diagnosis and management, both during hospitalisation and on discharge. Analysis was done for race groups within females and males and differ-ences between groups were tested by chi-square tests. Consistently significant differences in psychiatric diagnosis and management across race and gender were found, many in line with other international and African studies. Anomalies of diagnosis and treatment reflect past inequities of South African society and suggest the role of both social factors and bias in psychiatric hospital practice. Implications for future mental health research, training and practice are raised.
The current political changes in South Africa and the realization that there is a need to transform many institutions have resulted in strident calls for changes to mental health policies. However, it is also recognized that these changes must be coherent, and should enjoy the support of all interested constituencies. The authors surveyed members of the mental health professions, namely, Clinical and Counselling Psychologists to elicit their opińions regarding these changes. The aim was to obtain data on their current practice patterns and attitudes to change in mental health policies designed to meet the needs of the majority of South Africans. In this article the authors discuss results of the survey and emphasize some of the issues that need to be addressed if the mental health needs of the population are to be met.
Die huidige politieke veranderinge in Suid-Afrika en die besef dat daar 'n behoefte is om instellings te transformeer het gelei tot ernstige beroepe om die geestegesondheidsbeleid ter verander. Nietemin word daar besef dat die veranderinge samehangend moet wees, en moet die ondersteuning van alle belangstellende groepe geniet. Om die nodige standpunte van hierdie verskillende groepe te bekom, was die lede van die Kliniese en Raadgewende Sielkundiges oor hul meinings gevra. Die doel was om data te bekom oor die huidige modelle en houdinge in die uitoefening van die beroep met betrekking tot veranderinge tot geestgesondheidsbeleid wat geruk is op die geestegesondheids behoeftes van die meerheid van Suid-Afrikaners. In hierdie artikel bespreek die outeurs die resultante van hierdie ondersoek en beklemtoon sommige van die vraagstukke waarmee rekening gehou moet word indien aan die geestegesondheidsbeloftes van die meerderheid van die bevolking voldoen moet word.
The paper describes a programme for disadvantaged children with learning problems (due to factors other than cognitive deficits), at the University of Cape Town (UCT) Child Guidance Clinic, developed in the absence of subsidised services for children in need of remediation of scholastic skills. In collaboration with teacher trainees from the Cape Technikon, the programme intervenes on a cognitive and an emotional level. The learning problem is conceptualised in the context of the dysfunctional systems in which the children have been raised — the post apartheid socio-cultural environment, the family and the school. The paper illustrates the complexities in working with learning problems and focuses on the emotional aspects of the problem in particular. It highlights the importance of the development of the capacity to self regulate, and the containment of feelings in all the systems involved — the family, the school and the staff in the program. The aim is to further each child's ability to learn, in relation to his potential.
In South Africa, counselling training poses two related difficulties: working in a situation of ubiquitous, ongoing violence, and offering training to people who have minimal or no qualifications and are often overwhelmed by enormous workload. In this context, there is a temptation either to give up hope in the face of the enormity of the task, or defensively to package counselling as a set of techniques which can be taught without much self-reflection. In this article we discuss, by contrast, an intervention which used psychodynamic principles to develop learner-centred training drawing on trainees' own experiences. We consider the benefits of this approach even in a context of violence and meagre resources.
This paper attempts to re-create the flavour and the atmosphere that is evoked when counsellor and client meet with prior agreement to engage in a piece of very brief counselling work. The context is an informal self-referral service operating on the boundary of a large psychiatric clinic which specializes in psychoanalytic and systemic work.The situation provides a transitional space for both counsellor and client to observe and to learn from their own responses to each other and in so doing to concentrate their minds on the essential core anxieties that the client is currently experiencing. In this way the area of difficulty can be named and become available for thought.
Family processes affecting the socioemotional functioning of children living in poor families and families experiencing economic decline are reviewed. Black children are of primary interest in the article because they experience disproportionate shares of the burden of poverty and economic loss and are at substantially higher risk than white children of experiencing attendant socioemotional problems. It is argued that (a) poverty and economic loss diminish the capacity for supportive, consistent, and involved parenting and render parents more vulnerable to the debilitating effects of negative life events, (b) a major mediator of the link between economic hardship and parenting behavior is psychological distress deriving from an excess of negative life events, undesirable chronic conditions, and the absence and disruption of marital bonds, (c) economic hardship adversely affects children's socioemotional functioning in part through its impact on the parent's behavior toward the child, and (d) father-child relations under conditions of economic hardship depend on the quality of relations between the mother and father. The extent to which psychological distress is a source of race differences in parenting behavior is considered. Finally, attention is given to the mechanisms by which parents' social networks reduce emotional strain, lessen the tendency toward punitive, coercive, and inconsistent parenting behavior, and, in turn, foster positive socioemotional development in economically deprived children.
In this paper the authors argue that Euro-American mainstream models of psychological intervention have limited value in the context of South African apartheid. Given the unique nature of political oppression and economic disparity, apartheid in South Africa is a contributing etiological factor in the onset of psychological difficulties. The case is made that counselling and psychotherapy must go beyond merely dealing with intrapsychic phenomena, toward a mandate to address political, economic and social variables which influence behavior. Reformulations have occurred in the nature and form of apartheid resulting in a dynamic political and economic system that promises further shifts in the future. Given the undeniable delay between legal and political change on one hand, and the fundamental transformation of South Africa from a position of racism and violence to a democratic, non-racial society on the other hand, the search for alternative psychological intervention models will remain an imperative.
Family processes affecting the socioemotional functioning of children living in poor families and families experiencing economic decline are reviewed. Black children are of primary interest in the article because they experience disproportionate shares of the burden of poverty and economic loss and are at substantially higher risk than white children of experiencing attendant socioemotional problems. It is argued that (a) poverty and economic loss diminish the capacity for supportive, consistent, and involved parenting and render parents more vulnerable to the debilitating effects of negative life events, (b) a major mediator of the link between economic hardship and parenting behavior is psychological distress deriving from an excess of negative life events, undesirable chronic conditions, and the absence and disruption of marital bonds, (c) economic hardship adversely affects children's socioemotional functioning in part through its impact on the parent's behavior toward the child, and (d) father-child relations under conditions of economic hardship depend on the quality of relations between the mother and father. The extent to which psychological distress is a source of race differences in parenting behavior is considered. Finally, attention is given to the mechanisms by which parents' social networks reduce emotional strain, lessen the tendency toward punitive, coercive, and inconsistent parenting behavior, and, in turn, foster positive socioemotional development in economically deprived children.
The relationship between stressful life events and psychological status in Black South African women was explored, using a semistructured interview that consisted of a demographic questionnaire; the Xhosa Life Event Scale (XLES; Swartz, Elk, Teggin, & Gillis, 1983), which comprises mainly personal stressors; the Township Life Event Scale (TLES; Bluen & Odesnik, 1988), which comprises mainly sociopolitical stressors; and the General Health Questionnaire (GHQ, Goldberg, 1972, 1978). The participants were a random sample of 100 Black women living in a South African township. There were significant positive correlations between psychological distress and (a) undesirable life changes, (b) recurring stressful events of a sociopolitical nature (but not of a personal nature), and (c) continuous stressful events of a sociopolitical nature (but not of a personal nature). The results indicated that adverse sociopolitical conditions and the stress that accompanied them had a stronger negative effect than stressful events of a personal nature did on the women's mental health.
The goal of the current review is to examine the evidence for the efficacy of dynamic psychotherapy, primarily focusing on studies that meet the rigorous criteria proposed by Chambless & Hollon (1998). We examine whether any progress has been made over the past decade in evaluating the efficacy of dynamic psychotherapy using well-controlled randomized designs. Over the past decade, multiple studies have been published supporting the efficacy of dynamic psychotherapy for the treatment of specific mental disorders. Dynamic psychotherapy should now be included as a possibly efficacious treatment for panic disorder and borderline personality disorder, as well as the original designation of possibly efficacious in the treatment of opiate dependence. In the context of medication usage, dynamic psychotherapy should be considered efficacious in the treatment of major depressive disorder (MDD). Studies suggest that dynamic psychotherapy has great promise as a monotherapy for MDD and alcohol dependence and thus should be evaluated further.