5. DISCUSSION
5.1. A Postmodern view
Traditionally therapists have been trained and educated in such a way that the expectation associated with the role of the therapist is to know the emotional and psychological 'truths' about their clients (Thomas, 2002.). This is not an indictment on the profession of psychology rather an awareness of the structuralist views commonly held. A structuralist view is based on the premise that there are "fundamental, unchanging structures" that underlie everything (Thomas, 2002.). The implication for the therapist is the underlying notion that it is possible, through deep exploration and the uncovering of the emotional and psychological truths of the client, to know the client and understand her struggles. This notion is held to be the guiding principle in an effort to help the client and in fulfilling a service which a therapist is expected to provide. By gathering a full history from a client the trainee psychologist endeavors to begin this deep exploration of an individual and to facilitate the trainee psychologist in getting to know the client. The process of the first interview is semi-structured so as to gather information understood as being pertinent to this exploration.
The postmodern view challenges the idea that there are any fixed truths and indeed whether an individual can certainly be understood in an individual sense. Truths as presented by an individual are "local" truths and not necessarily universal or objective truths (Burns, Goodman &
Orman, 2013). The postmodern focus therefore is on understanding the individual within her context and the acceptance that an individual is socially constructed through socio-political discourses and multi-level interactions with others. Employing a postmodern view within this research project is an attempt to understand how a trainee psychologist manages sexual health content and what socially constructed framework informs the process. The postmodern framework may assist in understanding the trainee psychologists in relation to their context and in relation to current discourses around sexual health, and how these factors may impact the ability to manage with the sexual health segment of the first interview.
97 5.1.1. Understanding the paradigm shift
Although the structuralist approach has made substantial progress in understanding aspects ranging from universal concepts such as the cosmos to the most minute particles of the known world, the need to widen the lens to view people within their unique context propelled the postmodern shift. Diverse cultures and challenging socio-political discourses have fueled this need for an alternative view. Added to this shift is the move away from definitive descriptions of an individual and a move towards considering how the social construction of an individual influences the way in which an individual interacts and responds to others and to their social world. The emphasis is therefore that despite adequate training for trainee psychologists, the onus rests on the individual trainee psychologist to develop the ability to reflect on how she is socially constructed, how she comes to make meaning of concepts and how this construction affects the therapy process. The focus is thus on how those constructions assist or impinge the trainee psychologist's ability to manage the topic of sexual health during the intake interview.
Traditionally a common strategy used by many clinicians is to remain 'value-free' which posits that the clinician is able to leave her personal beliefs outside of the therapy room and to assume a non-judgmental stance. Challenging this, the postmodern view embraces the idea that it is this very awareness, the awareness of one's values and beliefs and that personal understandings are not objective and value-free that is paramount. The rationale is that to explore personal ideas and meanings is an imperative, due to the fact that an individual is a social construction and this is the salient feature of postmodern thought (Russell & Carey, 2004). Therefore, recent thinking challenges the concept of being value-free and instead beckons the clinician to be fully aware of her value and beliefs systems and how those may impact the process of therapy and the personal ethics which guide the line of enquiry during therapy. According to McWilliams (2004), a core skill for the trainee psychologist to develop is the knowhow of being able to integrate her personal style and her role as clinician. Hence a structuralist view and the structure of the interview may be an attempt to curtail the trainees ’ personal beliefs and provide a generic format. Yet the personal insight and acknowledgment of these beliefs may indeed be a panacea in confronting the challenges of different viewpoints between clinician and client and in dealing with ambiguity within the therapeutic context. During the training program it appears that
98 trainee psychologists require the opportunities to develop this insight in relation to personal beliefs and how they have come to make meaning regarding sexual health matters.
Diagram 3 : Postmodern Perspective
Taken-for- granted-truths
Gender
Age
Context
Discourses
Language Religous
beliefs Ethics
Self-doubt
Culture
A Postmodern Perspective
99 5.1.2. The trainee psychologist within her context
The postmodern view therefore seeks to view the individual as part of her context which includes the structures, politics and power ratios that may be part of her context. She makes meaning in accordance to the interactions she has within this multi-layered context. In order to get to 'know' her it is therefore important to become more familiar with how she makes meaning of this context and her relationships with others (McWilliams, 2004). Furthermore it is important to explore how her context influences her and this process of meaning making. As presented in the findings section (section 4.3.1. p. 73) many of the participants in this study were acutely aware of how their social structures had influenced their meaning attached to the topic of sexual health.
One participant describes this well as she shares her insight linking her personal context to the way in which she experienced and thought about therapy with a client. The following comment demonstrates how the current contexts of a clinician form her own thoughts and conceptualisation of a client.
Participant 4 (female): … in the first interview we spoke about the three kids and she didn’t speak about being pregnant and her birth and all of that in a relaxed open way. And as a side note, whether it was important or not… I was pregnant at the time so I obviously knew and from a personal experience how you have to talk about those things, think about those things, your body is going through all those things. She almost wormed around them, she was pregnant and had three kids, it just happened, the stork dropped them off and that was it, so the approach to having three kids was that the stork dropped them off.
Although sexual health and information pertaining to intimacy were discussed in some of the participants homes while growing up, it has emerged that more often than not it is done in the form of supplying facts and covering the fundamental facts only. In some homes the topic of sexual health was avoided completely as illustrated in the findings section (section 4.3.1. p. 73).
Within families the topic of sexual health seems to be limited to biological discussions and there appears to be a strong sense of it being uncomfortable for parents to discuss the topic with their children. This not only reinforces the positioning of sexual health within a medical framework, it further reinforces the idea that sexual health is a taboo subject. As indicated in the literature review, science, biology and medicine have made numerous attempts over the course of time to
100 demonstrate, in a mechanistic way how humans should ‘position’ themselves around thoughts of their body and how it works, as facts. What this science has failed to apply is that the logic based, evidence based positions hold less value when one has to address the make-up of something as dynamic as a human being. The chasm arises due to the fact that we are not merely a composition of the sum of our parts and that each individual interacts with these ‘parts’ in a biological, psychological, emotional and spiritual way, for example and that we make decisions of how we use these ‘parts’ in relation to the emotional states, religious beliefs and socio- political discourses. Hence mental health professionals are by default caught in the middle of the medical model on one side and the biopsychosocial model on the other. The implications are a deficit in developing the skills and vocabulary to adequately manage the topic beyond a medical understanding and a medical vocabulary.
Personal Reflections: My context has aided me in feeling more at ease with discussions about sexual matters. I was raised in a home where sexuality and sexual health was an ongoing conversation with my parents. Just as we had discussions about alcohol and drug use, political discussions, sex was another topic open for discussion. Being married and having three children has enabled me, through my relationships, to view sexuality as another part of me as a whole. Understanding my own experiences assisted me during the interview process as I was able to highlight how contextual differences form the meanings we attach to sexuality and the topic of sexual health. This was helpful in engaging in a conversation with each participant about the uniqueness of our views which are influenced by our individual contexts.