This study explored and described the perception of clinical psychologists regarding thebarriers to the provision of psychological services in urban public health settings for people with first-episode schizophrenia. The qualitative research study utilised an explorative, descriptive interpretive research design. Purposive sampling was utilised to gain access to clinical psychologists, who had at least two years of public health experience working with people recently diagnosed with schizophrenia. Data was gathered from 11 participants from the Nelson Mandela Bay Health District of the Eastern Cape by means of in-depth interviews that were conducted in English by the researcher until data saturation had occurred. A computer-assisted qualitative thematic analysis of the collected data was conducted using NVIVO software. The findings have been categorised according to three broad domains: 1)contextual barriers 2)health care system-related barriers and 3)first-episode schizophrenia syndrome-related barriers. Several specific sub-themes were identified for each of these main domains allowing for recommendations and suggestions to be provided for attending to and overcoming these perceived barriers.

Considering the high incidence of suicide in the South African context, the fact that suicide is considered an occupational hazard for psychologists, with more than half experiencing the suicide of a patient in their career and the dearth of post-suicide qualitative research among psychologists, the purpose of this study is to explore and describe the experience of psychologists after the suicide of their patient, and to develop guidelines as a framework of reference to assist psychologists in dealing with the suicide of their patient. In keeping with a social constructionist ontological and ecosystemic epistemological theoretical framework, data was collected by means of meaning-making conversations with six purposively selected psychologists, with a minimum of five years‟ experience and at least one year having passed after the suicide of their patient. The data was analysed independently by the researcher and an independent coder using Tesch‟s open and descriptive method. The present study found that, following the suicide of their patient, the participants were propelled into a myriad of acutely distressing emotions. They often described a suffocating sense of responsibility for the suicide and the lingering presence of their patient. The participants experienced feelings of guilt and self-doubt, often questioning their own professional competence. The post-suicide process was described as being both a personally and professionally isolating event, due to the sense of having to carry the burden of the suicide alone for ethical reasons and fear of social stigmatisation. The participants appeared to grapple with the paradoxical dance between their personal emotional realities and what they perceived to be “clinically” or “professionally” acceptable. Having gone through the traumatic experience of losing a patient to suicide, most of the participants eventually found new wisdom, which helped them become wounded healers. Based on these findings, post-vention guidelines with practical actions were developed to assist psychologists in dealing with the suicide of their patient. Recommendations are made with regard to suicidology research, suicide education and psychologists‟ practice. / Psychology / M.A. (Clinical Psychology)

Clients diagnosed with Borderline Personality Disorder (BPD) interact with healthcare professionals in compelling ways. By virtue of the symptoms that define BPD, it is likely that the client will challenge the therapist with regards to their theoretical approach or therapeutic style. In addition, clients with BPD are likely to project their need for a therapeutic interaction that is both genuine, empathic and at the same time, flexible. In light of this, it is not uncommon for healthcare practitioners to consider clients with BPD as “difficult” in some way or the other. This study explores how clinical psychologists in Gauteng conceptualise and manage a “difficult” client presenting with Borderline Personality Disorder. Further, coping strategies of the clinician will also be explored. The qualitative study, couched in a social constructionist paradigm, involved interviewing seven clinical psychologists practicing in Gauteng, South Africa. The transcripts of the semi-structured interviews were thematically analysed. The findings of the current study indicated that the difficulties experienced are reflective of the general criteria of the disorder. The picture of the difficult client is painted by personal experience, as well as stereotypes gained from interactions with colleagues and other healthcare professionals. It was further found that management of these patients were viewed and implemented based on the nature of the disorder. In addition, management by the clinician often included supervision and leisure activities. / Psychology / M.A. (Clinical Psychology)

Disputes concerning care and contact arrangements for the minor children of divorcing couples present special challenges for professionals in the legal and psychological professions. Care and contact (custody) disputes, which are complex undertakings, are a point of debate in the professional arena in South Africa. Clinical psychologists are often included in the professional cohort that assists the high court, as the upper guardian of minor children, in the decision making process regarding contested care arrangements of children. This field is further challenged by the lack of training programmes and practice guidelines, the intense adversarial nature of disputes and litigation processes, as well as the increase in board complaints levelled against psychologists at the Health Professions Council of South Africa. These challenges contribute to the reluctance of psychologists to become involved in care and contact matters. This study therefore aimed first to explore the current practices and contributions of clinical psychologists in care and contact disputes in South Africa, and second to evaluate the procedures used by clinical psychologists to inform their recommendations to the court. In such matters, clinical psychologists adhere to the best interest of the child (BIC) principle. The final aim of the study was to identify and propose guidelines for a model of better practice. The study was guided by a Constructivist Epistemology and a Social Constructionist paradigmatic framework. A qualitative research approach was employed. Data were collected through face- to-face interviews with clinical psychologists and advocates and were analysed using Thematic Network Analysis of Attride-Stirling. The findings, which indicated that that the practices of psychologists are plenteous, revealed significant shortfalls in current practices. In addition, the findings designated that creating a universal model for care and contact evaluations to fit with the legal professions’ empiricist tendency poses a paradigmatic dilemma and a practical challenge. A position of observer-dependence and a reflective position on the part of the psychologist is instead indicated. / Psychology / Ph. D. (Psychology)