The past in the present: Professional psychology in South Africa

Wahbie Long
Department of Psychology UCT 12 September 2013

Readings
Required:
Ahmed, R. & Pillay , A.L. (2004). Reviewing clinical psychology training in the postapartheid period: Have we made any progress? South African Journal of Psychology, 34(4), 630-656. Abel, E. & Louw, J. (2009). Registered counsellors and professional work in South African psychology. South African Journal of Psychology, 39(1), 99-108.

Recommended:
Cooper, S., Nicholas, L.J., Seedat, M. & Statman, J.M. (1990). Psychology and apartheid: The struggle for psychology in South Africa. In L.J. Nicholas and S. Cooper (eds), Psychology and apartheid (pp. 1-21). Johannesburg: Vision/Madiba. Petersen, I. (2004). Primary level psychological services in South Africa: Can a new psychological professional fill the gap? Health Policy and Planning, 19(1), 33-40.

Professional psychology in South Africa

Categories of practice
Psychometrist
4-year degree in psychology 6-month practicum Core competencies include administration, scoring, interpretation and giving feedback on test results

Psychologist
Masters degree in psychology 1-year internship 1 year of community service Board exam Core competencies include assessment, intervention and referral expertise

Professional psychology in South Africa

Categories of practice
Registered counsellor
4-year degree in psychology 6 month / 720 hour face-to-face practicum (included in 4-year degree, in neither psychiatric nor private practice setting) Core competencies include
Screening and identification of mental health challenges; Containment of presenting difficulties; Providing preventative, developmental counselling services and interventions; Psycho-education and training; Promotion of primary psycho-social well being; Referral to appropriate professionals or other appropriate resources (know when to refer to a Psychiatrist or Psychologist); Working in a context appropriate, multi professional team; and Assessments (intellectual assessment, basic functioning, kinetic figure drawing) Community-based care

Excludes psychotherapeutic intervention

Registered counselling: Selection criteria

Intra and interpersonal skills; Potential to learn necessary skills of a Registered Counsellor; Ability to work in a team; Psycho social wellness; Ability to work under pressure; Ability to work in a community; Ability to work with diversity; and Academic reading and writing.

Registered counselling: Training areas

Professional ethics and conduct; Interviewing techniques; Client observation skills; Basic counselling skills; Development of preventative and developmental programmes; Report writing; Conceptualisation skills, bio-psychosocial and systems theory as appropriate for community interventions; Structured trauma counselling; Community understanding and intervention; Psychometric competencies (within their scope of practice); Cultural beliefs and diversity; Language sensitivity; Entrepreneurial skills; Psycho-educational skills; and A thorough grounding in the Ethical Code, the Bill of Rights and other relevant legislation.

Do we need registered counsellors?

Post-apartheid government policy
Integrate services for serious mental disorders at PHC level

Criticisms
Common mental disorders need to be addressed too 24% weighted prevalences for anxiety and depression in SA Scholastic problems / mental retardation PHC nurses have neither the time / expertise

The solution?
The registered counsellor
Designer of preventive programmes Provider of supportive counselling Purveyor of psychometric services

The registered counsellor in SA

The Professional Boards rationale for introducing the category in 2003:
to make basic primary psychological counselling services available to previously disadvantaged communities in South Africa (Abel & Louw, 2009: 100) The registered counsellor is to be deployed in underserviced areas, with competencies in psychometrics and counselling

Counsellors are not registering with the HPCSA, compared to psychologists Of those that do register, only 46% are actually working as counsellors The category is white- and female-dominated Most counsellors work in urban areas For half of RCs, its a stepping stone to becoming a psychologist Negative perceptions about the category and the HPCSA ... the promise of public sector jobs simply did not materialise (Abel & Louw, 2009: 106)

Why arent things changing?

Apartheid practices (poorly resourced secondary schools) Tertiary institution training policies (e.g. 1st year admission criteria) Slow pace of transformation in professional psychology Discussions of equity have largely been exercises in political correctness and lip-service nothing more.
In 2000, the Professional Board adopted a resolution that intake ratios for graduate professional psychology programmes be 50 : 50 (black : white) by 1 January 2004, yet were still nowhere close to that. By the end of 2006, more than half of black African psychologists who trained in the post-apartheid years, trained at historically black universities (more than during the apartheid years). Home-language mental health care services is a human rights issue. Since universities are publically funded institutions, what are the ethics of training students who will not be servicing the mental health needs of the majority of the population?

Basic statistics
SA has a black majority of 90% 79.6% of South Africans are black African (Stats SA, 2006) 46% of the population lives in non-urban areas 16% of the nation is covered by medical aid 40% speak isiXhosa or isiZulu as a home language 80-90% of registered psychologists speak exclusively English and/or Afrikaans 14.2% of psychologists are black African (2006)
The distribution of mental health care resources... is skewed in favour of an urban, white, middle-class English- or Afrikaansspeaking minority
(Ahmed & Pillay, 2004: 634)