4. FINDINGS
4.1. Conceptual maps
4.1.2. Adequate preparation
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57 you’re trying to get the information, trying to assess the client, so yes that was the problem with that.
One participant felt overwhelmed by her own 'self-talk' and struggled to focus on the content due to intent focus on the process of the interview.
Participant 8 (female): … there was a lot of structure to it [the interview process] so we [peers]
spoke about a lot of self talk in the process of interviewing and sometimes that got in the way because you’d say: ‘I forgot to say this and I forgot to say that’.
Another participant felt that her past experience of working in a sexual assault unit had normalised the topic and vocabulary of sexual health resulting in her finding it easier to follow the process of the interview in its entirety. However, this participant felt that due to the diversity of the population it was doubtful if one could ever be completely prepared.
Participant 3 (female): I don’t think you are ever adequately prepared or feel confident enough so at the back of your mind you’re always thinking: I have to remember to ask certain questions, so you lose focus a bit.
The practical component of the Professional Program for Training requires that trainees have opportunities to practice their newly learnt skills of interviewing clients and becoming familiar with the process of the interview. One of the opportunities to practice these skills is during role- plays where groups of students are able to use the interview schedule and simulate an interview in a therapy room. During role-plays despite having the Morrison Interview schedule and being instructed to role-play the interview process it emerged that the full interview was not completed by many of the participants as most had avoided the topic of sexual health.
Participant 1 (female): … we did do practice rounds but… we did speak about it [in class] but everyone was wanting to avoid it, so we just said: let’s make it easy, we won’t make it awkward or anything like that… We re-watched it [recorded segments of the role-plays] in class, we didn't focus on that either, so I wasn’t really sure, we did mention it in class.
Participant 3 (female): …we did alcohol and drugs[questions during the role play] but not sexual history and sexual functioning, strange why we did not do that.
58 Participant 5 (male): [when asked whether the group had practiced talking about sexual health]
No. No never.
Participant 7 (female): No I avoided it even in role-play, even with the people who were in class with me, I know I avoided it.
One participant described how during role-plays the group focused more on the process and mechanics of the topic of sexual health than on how to manage the actual content of sexual health.
Participant 6 (female): …we practiced asking about it but I don’t think we really did it properly, because in our group we just focused on the wording aspect but not dealing with anything else, but purely of how we would say it, in terms of words we would use.
Content Issues
Although the participants felt prepared to some extent to conduct a first interview and understood the process there appeared to be ambivalent sentiments regarding preparedness for addressing sexual health content. Although learning through experience is invaluable, for the trainee psychologist this experiential data base may be limited, particularly regarding the topic of sexual health. Therefore it is important to develop as much theoretical data as possible in order to assist the trainee to adequately deal with incidents which may be confusing during the first therapy sessions (Fontaine & Hammond, 1994).
Participant 5 (Male): I think we were prepared [for the initial interview]. When it comes to the sexual history that is the main portion that I felt wasn’t really targeted, I wasn’t really happy with that, for example from my side the gender, the culture, the age. So looking at that I feel I wasn’t adequately prepared.
It appears that learning and following the process of the first interview is less challenging than attempting to manage the content of the interview.
Participant 8 (female): I didn’t see the need for it [to ask about sexual health], I just did it because I had to do it.
59 Participant 2 (male): Yes with all training and practicing I’m comfortable with but when it gets to issues around sexual history and suicide and that kind of sensitive stuff I’m not comfortable with.
One participant had role-played gathering a sexual history from a client and had managed the process of the interview adequately. However, it was due to the role-play experience that this participant was alerted to her own discomfort around the content of sexual health.
Participant 8 (female): I was stuck, at that point of the interview [during the role play]. I felt stuck I didn’t know how to word it correctly, I fumbled, mumbled, lost my eye contact, looked down, so I felt it wasn’t really addressed sufficiently, that specific area [questions about sexual health]. I didn’t realise how difficult it was to talk about until [I] was put on the spot.
Linking process and content
What has emerged is that despite the first interview being a challenging experience for many of the participants, the structure of the interview appears to assist the process. It lends itself to containing some of the task related anxiety and offers guidance to ensure a maximum amount of information is gathered from a new client. It seems that the difficulty arises when attempting to gather history around sensitive topics such as sexual health and that most of the participants struggled with how to manage the content.
Participant 7 (female): …in M1 [Master training in Psychology ] give me the interview sheet and go through that whole thing with me, tell me why are we asking about sexual history. If the client says this, what is the possibility of that meaning, yes so I think that would be helpful [to have understood why sexual health is required content].
The quote below illustrates the disconnect between process and content, that questions about sexual health are asked purely by default as being part of the process of the interview.
Participant 9 (female) : We asked it but we never did it in depth, it just didn’t seem relevant.
Personal Reflections: It was during this part of my training that I first became aware of the discomfort some trainee psychologists experience when talking about sexual matters. During our group role-play one of my peers struggled with finding any words that she was comfortable
60 with and wanted to avoid this line of questioning altogether. After the role-play she was visibly upset with the fact that she felt so limited in her understanding of sexual matters and her limited vocabulary regarding sex and sexual health. We seemed to be adequately prepared in understanding the interview process yet the segment of sexual health remained an area where most students did not know how to manage the content and feeling overwhelmed by the complexities of sexual health.