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

Multiproduct firms and outward foreign direct investment

Includes bibliographical referencesThis paper investigates the relationship between internationalisation of firms and the firm's domestic product scope. The investigation is applied to Indian firms. Thus, the insights of a new dataset is added to the growing (but still infant) literature in this field. Indian firms that invest abroad are the most productive firms in the home country. The most productive firms in the home country have the greatest scope of products. This paper shows that outward investor firms have the greatest range of products in the home country. As a result of engaging in OFDI, these outward investor firms consolidate their product range and their product scope shrinks

MULTICULTURAL ASPECTS OF SUPERVISION: CONSIDERATIONS FOR SOUTH AFRICAN SUPERVISORS IN THE HELPING PROFESSIONS

MULTICULTURAL ASPECTS OF SUPERVISION IN POST-APARTHEID SOUTHAFRICAClinical supervision in psychology and social work is challenged with addressing the variouscultural, social and political factors that affect therapeutic and supervisory relationships. In thecontext of present-day South Africa with its emphasis on recruiting supervisees into the helpingprofessions from diverse racial and ethnic backgrounds, questions of race, ethnicity and culture inclinical supervision have become of considerable importance. This paper examines the literaturepertinent to supervision and presents a theoretical framework for conceptualising themulticultural development of supervisors and supervisees with a specific emphasis on the SouthAfrican context. It highlights some of the potential problems that might arise in supervisoryrelationships in which the supervisor and supervisee are racially disparate and outlinesrecommendations for clinicians to consider in their practice. Most of the research on inter-racialclinical supervision has been conducted in the United States and other countries wheremulticulturalism is part of the national landscape. This article uses this international literature andapplies it to the present post-apartheid conte

Treatment adherence in South African primary health care

Patient non-adherence to medical treatment regimens is a pressing problem in South African primary health care. The absence of a cogent research base in the South African context has meant that solutions to the problem of non-adherence continue to elude clinicians. This paper offers an understanding of patient non-adherence from the perspective of behavioural science. It focuses on the way in which adherence is conceptualised and assessed, and examines the social, economic and psychological factors associated with patient behaviour. Psychological issues that are highlighted as affecting adherence include health locus of control, self-efficacy, psychological morbidity, health literacy and quality of life. Commonly used intervention strategies to enhance treatment adherence are examined and health workers are alerted to the contributions of behavioural science in understanding this aspect of patient behaviour. SA Fam Pract 2004;46(10): 26-3

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

Addressing psychosocial problems among persons living with HIV

The large number of persons living with HIV in Southern Africa has implications for mental health services for this population. Data have emerged in recent years showing that a substantial number of persons living with HIV also have mental health problems. Yet, the practice of routine screening for psychiatric disorders in the context of HIV care is controversial. Moreover, common mental health problems, if left undetected and untreated, may have severe consequences for adherence to antiretroviral therapy (ART), which in turn will likely lead to severe health consequences for patients. There are high costs associated with employing professional psychologists, counsellors, and social workers to provide psychosocial support to ART users. As a result, in many contexts lay counsellors and patient advocates have been employed as a less costly alternative. High standards of training of laycounsellors, as well as on-going supervision and support to patient advocates is necessary to ensure optimal outcomes/ result

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

Screening for HIV-related PTSD: Sensitivity and specificity of the 17-item Posttraumatic Stress Diagnostic Scale (PDS) in identifying HIV-related PTSD among a South African sample

Objectives: The identification of HIV-positive patients who exhibit criteria for Post traumatic Stress Disorder (PTSD) and related trauma symptomatology is of clinical importance in the maintenance of their overall wellbeing. This study assessed the sensitivity and specificity of the 17-item Post traumatic Stress Diagnostic Scale (PDS), a self-report instrument, in the detection of HIVrelated PTSD. An adapted version of the PTSD module of the Composite International Diagnostic Interview (CIDI) served as the gold standard. Method: 85 HIV-positive patients diagnosed with HIV within the year preceding data collection were recruited by means of convenience sampling from three HIV clinics within primary health care facilities in the Boland region of South Africa. Results: A significant association was found between the 17-item PDS and the adapted PTSD module of the CIDI. A ROC curve analysis indicated that the 17-item PDS correctly discriminated between PTSD caseness and non-caseness 74.9% of the time. Moreover, a PDS cut-off point of ≥ 15 yielded adequate sensitivity (68%) and 1-specificity (65%). The 17-item PDS demonstrated a PPV of 76.0% and a NPV of 56.7%. Conclusion: The 17-item PDS can be used as a brief screening measure for the detection of HIV-related PTSD among HIV-positive patients in South Africa.Key Words: ROC analysis; Posttraumatic Stress Diagnostic Scale (PDS); Composite International Diagnostic Interview (CIDI); South Afric

Dietary and fluid adherence among haemodialysis patients attending public sector hospitals in the Western Cape

Objective There has been considerable debate about the extent to which social cognitive models of health behaviour apply in developing countries. The purpose of this paper was to determine the applicability of the Theory of Planned Behaviour (TPB) in predicting dietary and fluid adherence among a sample of haemodialysis patients attending public sector hospitals in the Western Cape. Design and methods A sample of 62 historically disadvantaged patients undergoing haemodialysis completed a battery of psychometric instruments measuring attitudes, subjective norms, perceived behavioural control regarding dietary and fluid adherence, health literacy, perceived social support, and self-reported dietary and fluid adherence. Interdialytic weight gain (IDWG), predialytic serum potassium levels, and predialytic serum phosphate levels served as biochemical indicators of dietary and fluid adherence. Results Regression analyses indicated that the linear combination of attitudes and perceived behavioural control significantly accounted for 15.5% of the variance in self-reported adherence (a medium-effect size) and 11.4% of the variance in IDWG (a modest-effect size). No significant predictors were identified for predialytic serum potassium and predialytic serum phosphate levels. Interpretation and conclusions The results indicate that, while the TPB may not function in the same manner as it does in Western samples, it may have some nuanced applicability among haemodialysis patients attending public sector hospitals in the Western Cape. SAJCN Vol. 21 (2) 2008: pp. 7-1