THE PROCESS OF PSYCHOTHERAPY FOR HELPING PROFESSIONALS: THE ROLE OF EMPIRICAL FINDINGS TO GUIDE PRACTICE

Ever since it achieved respectability as a modality of healing, the practice of psychotherapy hasbeen subjected to considerable discussion, debate and criticism. Often the therapist is attributed thestatus of an emotional saviour, a personal champion or a benevolent confidant. Despite the factthat counselling and psychological treatment feature prominently in modern health care, theinternal mechanisms of the therapeutic process are sometimes shrouded in mystery. Hence, theprofessional and ethical imperative is to lay bare the inner workings of therapist-client dynamicsthat lead to emotional healing and client change. This paper is an articulation of a process ofpsychotherapy and is aimed at identifying the sometimes hidden change processes that effectmental and emotional healing

THEORETICAL CONCERNS IN APPLYING THE DIAGNOSIS OF PTSD TO PERSONS WITH HIV AND AIDS

Increasingly, mental health professionals, including psychologists, counsellors and social workers, are called upon to assist persons living with HIV to negotiate the mental health consequences of their condition. It has been suggested that serious mental health consequences following diagnosis with HIV are likely to occur and that developing countries may be “heading towards a mental health and social disaster” (Freeman, 2004). Freeman (2004) has identified various categories of persons affected by HIV who may experience psychological difficulties, including those recently diagnosed with HIV. Among recently diagnosed persons, it is thought that several psychiatric conditions may ensue, namely major depressive disorder (Gore-Felton, Koopman, Spiegel, Vosvick, Brondino & Winningham, 2006), generalised anxiety disorder (Pence, Miller, Whetten, Eron & GaGaynes, 2006) and posttraumatic stress disorder (Myers & Durvasula, 1999; Martinez, Israelski, Walker & Koopman, 2002; Olley, Zeier, Seedat & Stein, 2005). This article examines some theoretical concerns regarding the viability of a diagnosis of PTSD for persons who have received a diagnosis of HIV in terms of its implications for mental health counselling

Treatment adherence among primary care patients in a historically disadvantaged community in the Western Cape : a qualititative study

Includes bibliographical references.The question of treatment adherence remains a concern that affects the health outcomes of patients attending public health clinics in South Africa. Patients with chronic illnesses who reside in impoverished communities face particular challenges in terms of managing the often complex aspects of their treatment. The sample for the study was selected from patients diagnosed with diabetes or hypertension attending public health clinics in the Boland area of the Western Cape. A total of 23 patients between the ages of 32 and 80 participated in the study. All participants were Afrikaans-speaking had been classified as Black or "Coloured" under the apartheid system and as such were all historically disadvantaged. Participants were selected by means of convenience sampling and were asked to participate in qualitative interviews under confidential conditions. The interviews addressed various aspects of the participants' experience of their illness and treatment and were conducted by two trained interviewers. Interviews were recorded, transcribed, and entered into Atlas.ti, a computer programme that assists in the analysis of textual data. The analysis of the data focused on the content of participants' concerns and difficulties associated with adhering to treatment recommendations. The themes that emerged from the study included participants' attribution of the origin of their illness, their experience of their illness and of the health care system, their own concerns about the consequences of poor adherence, financial and problems, psychosocial support, spirituality, alternative medicine, and patients' own understanding of the symptoms of poor adherence. The results of the study are discussed in terms of the often hierarchical relationship between health care workers and patients. Public health care workers often hold sceptical and suspicious views about their patients regarding their illness, symptoms, and level of adherence. As such, patients may be regarded in a paternalistic manner and in some cases even be admonished by health care workers for poor adherence. Yet, competing social realities often inhibit patient adherence. These include financial constraints, being labelled a patient, side effects of medication and family opposition to treatment. Adherence may also be related to the notion of responsibility for the causes of and solutions to medical problems. The results of the study were considered in terms of four models of attribution of responsibility for the origin of and solution to the medical problem as identified by Brickman, Rabinovits, Karuza, Coates, Cohn, and Kidder (1982). These models are the moral model, the compensatory model, the medical model, and the enlightenment model. The medical model is the most dominant in the South African public health system. Yet, in many instances, participants appeared to adopt other models of engaging with the causes and solutions to their illness conditions. The question of participants' understanding of the consequences of adherence is discussed in terms of the theoretical work by Pepper's (1942), who proposed four possible perspectives with which people may view the world. These world-views are formism, mechanism, contextualism, and organicism. In many instances adherence as a means of controlling somatic symptoms occurs as part of a logical and mechanistic understanding of health. However, in terms of an organismic worldview, adherence may represent an effort to restore equilibrium to the patient's constitution that has spiralled into disequilibrium as a result of disease

Exploring our understanding of fatigue among adolescents living with HIV:highlighting the unknown

Due to antiretroviral therapies, HIV is now a chronic illness rather than a terminal disease. Chronic symptoms, including fatigue, should be identified and managed to prevent or minimise their potential negative consequences. We apply a Symptom Management Model to conceptualise fatigue among adolescents with HIV. In the context of minimal research, we seek to identify a research agenda for resource-constrained contexts, where HIV prevalence remains high and treatment adherence is a significant problem. By better understanding and addressing the symptom of fatigue, treatment adherence, occupational, social and emotional functioning could be improved. We highlight conceptual, methodological and measurement-related caveats

WOMEN’S EXPERIENCES OF REPORTING RAPE TO THE POLICE: A QUALITATIVE STUDY

South Africa has the highest incidence of rape in the world among the countries that reportreliable crime statistics (Snyman, 2005). Between April 2006 and March 2007, 52 617 rapeswere reported to the police in South Africa (“Information management, South African PoliceServices”, n.d.). A national crime survey conducted by Statistics South Africa (SSA) found thatone out of two rape survivors reported the matter to the police (SSA, 2000), while a threeprovincesurvey by the Medical Research Council on violence against women found that onlyone in nine victims reported their rape experience (Jewkes, Penn-Kekana, Levin, Ratsaka &Schrieber, 2001)

Correlates of fatigue among South African adolescents living with HIV and receiving antiretroviral therapy

Fatigue among adolescents living with HIV is poorly understood. In this study, we examined the relationships between fatigue and demographic and psychosocial variables to further the understanding of the symptom experience and associated factors. We recruited consecutive attenders at ART clinics in the Western Cape, South Africa (N = 134, age 11–18 years). Participants completed a battery of questionnaires including measures of fatigue, insomnia and mood disturbance. Just under a quarter (24.6%) of adolescents reported elevated levels of fatigue that affected their functioning. The linear combination of age, depression, and insomnia explained 40.6% of the variance in fatigue. Amongst adolescents with HIV, fatigue seems a problematic symptom associated with poor sleep and mood disturbance. Timely identification and management of these potentially disabling symptoms are needed to attain better health outcomes and retention in care in this group. Interventions aimed at ameliorating these symptoms are needed

Correlates of fatigue among South African adolescents living with HIV and receiving antiretroviral therapy

Fatigue among adolescents living with HIV is poorly understood. In this study, we examined the relationships between fatigue and demographic and psychosocial variables to further the understanding of the symptom experience and associated factors. We recruited consecutive attenders at ART clinics in the Western Cape, South Africa (N = 134, age 11–18 years). Participants completed a battery of questionnaires including measures of fatigue, insomnia and mood disturbance. Just under a quarter (24.6%) of adolescents reported elevated levels of fatigue that affected their functioning. The linear combination of age, depression, and insomnia explained 40.6% of the variance in fatigue. Amongst adolescents with HIV, fatigue seems a problematic symptom associated with poor sleep and mood disturbance. Timely identification and management of these potentially disabling symptoms are needed to attain better health outcomes and retention in care in this group. Interventions aimed at ameliorating these symptoms are needed

The way I am treated is as if I am under my mother’s care : qualitative study of patients’ experiences of receiving hospice care services in South Africa

CITATION: Vasileiou, K., Smith, P. & Kagee, A. 2020. The way I am treated is as if I am under my mother’s care : qualitative study of patients’ experiences of receiving hospice care services in South Africa. BMC Palliative Care, 19:95, doi:10.1186/s12904-020-00605-1.The original publication is available at https://bmcpalliatcare.biomedcentral.comBackground: Research on the patient experience of receiving palliative care across a number of settings is increasing, but the majority of these investigations are situated within the context of developed countries. There is limited research from resource-limited countries, especially with regard to patients with cancer who receive hospice care. The present study explored the lived experience of attending hospice care facilities in South Africa to develop a bottom-up understanding from the perspectives of patients themselves. Methods: A qualitative cross-sectional study was designed to examine how patients experienced receiving hospice care We conducted in-depth, semi-structured interviews with thirteen, purposively selected patients living with terminal cancer and receiving in-patient or day care palliative services from a hospice organisation in South Africa. We used inductive thematic analysis to analyse the data. Results: We identified three themes that reflected a process of transformation that was experienced by participants during their engagement with the hospice services. The first theme describes participants’ initial reluctance to be linked to the hospice as a result of the stereotypic perceptions of hospice as being associated with death and dying. The second theme presents the perceived positive impact on patients’ physical and psychosocial wellbeing which resulted from the highly valued interactions with staff and other patients as well as patients’ engagement with creative activities. The final theme delineates the transformation of hospice into a second ‘family’ and ‘home’ and the restoration of an identity that expands beyond the ‘sick’ role. Conclusions: Receiving hospice care that sensitively attends to patients’ psychosocial and physical needs helps people to re-create a sense of homeliness within the world, re-orient themselves toward a meaningful life and reconfigure their relationship with self. Patient experience of receiving hospice care in South Africa does not appear dissimilar to that reported by patients in resource-rich countries, suggesting underlying commonalities. There is a need for raising awareness and educating the public about what palliative care can offer to those in need. Public health campaigns could help reduce the stigma attached to palliative care, deflect negative perceptions, and communicate the benefits for patients, families and communities in culturally sensitive ways.https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-020-00605-1Publishers' Versio

Fatigue among South Africa adolescents living with HIV: Is the Chalder Fatigue Questionnaire a suitable measure and how common is fatigue

Evidence suggests that HIV-infected adolescents experience elevated levels of fatigue that impacts their functioning at school and other important aspects of their lives. Yet, fatigue has not been measured amongst this population group. In this cross-sectional, mixed-methods study, we explored the psychometric properties of the 11-item Chalder Fatigue Questionnaire (CFQ) amongst 134 South African adolescents (11–18 years old) receiving antiretroviral therapy in the Western Cape. Using the Likert scoring method for the CFQ, the mean total score was 14.89 (SD = 3.83) and about a quarter (n = 33, 24.63%) of adolescents scored ≥18, indicating problematic levels of fatigue. The CFQ demonstrated good internal consistency with a Cronbach’s alpha of 0.83 (0.84, with item 11 deleted), which is comparable to other validation studies. On the first iteration of the principal component analysis (PCA) with a Varimax rotation, three factors accounted for 59.15% of the variance. However, the third factor consisted of one item only which we chose to remove from the analysis. On the second iteration of the PCA, a two-factor solution was retained that accounted for 54.24% of the variance. The first factor, ‘Physical fatigue’, represented the first eight items on the scale. The second factor, ‘Mental fatigue’, represented items 9 and 10. The CFQ also demonstrated modest content and construct validity. The CFQ is a short, easy-to-use and cost-effective measure of fatigue, and demonstrates reliability and validity amongst a South African sample of adolescents. Given the high rate of fatigue amongst our participants, we recommend that future interventions be developed to reduce fatigue among HIV-infected adolescents, which may ultimately lead to improvements in school performance and social functioning. Future research may include test–retest reliability of the CFQ in order to show stability over time