4. FINDINGS
4.1. Conceptual maps
4.1.3. Orienting the client and interest in sexual health information
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.
61 Adjusting the interview highlights the importance of dynamic questioning rather than straight forward questions and answers. Linear questioning can at times shut down the conversational tone of therapy (Markovic, 2013). The importance of dynamic questioning and assessing each client and therapy as unique is highlighted by a participant who raises these issues as well as questioning the client's response.
Participant 7 (female): I think it’s relevant always and I think rapport is really important in questioning. However, when it comes to certain presentations in front of you, you have a certain obligation as to whether this person is able to provide you with truthful and responsible account of what it is that you want to know and not just something that is going to end it... the topic.
Examples of further orienting the client to the possibility of difficult questions:
Participant 1 (female): Yes I do say that some things might be a bit sensitive and they [the client] might be a bit uncomfortable at times but they must be honest and open, and not talk about things that are too uncomfortable at that moment.
Participant 2 (male): Yes I do follow the form and tell them it’s going to be a process of asking questions and to be as honest as we can be.
Participant 3 (female): I just said that some of the questions might seem irrelevant or might seem strange, I didn’t use the word ‘sensitive’ at all…
One participant indicated how the idea of dynamic questioning was already a concept she felt would assist her when dealing with any difficulties that may arise during the interview.
Participant 4 (female): I didn’t have a specific plan for sensitive topics but I think that for me you can’t really prepare for this, probably better if you don’t prepare for it because you’re going to handle it in a more real kind of way, I guess my plan just to take it and work with each person.
Yet another participant had no expectation about how to manage sensitive topics such as sexual health.
Participant 5 (male): I didn’t have much expectation….I didn’t know how to ask it [sexual health questions].
62 Observations made by some of the participants were that they did not understand the relevance of asking about sexual health or gathering a sexual history during the intake interview. There seemed to be a disconnect between how this information may be useful and how the information may be used by the trainee to expand her understanding of the client. It seems that the structure and using the information schedule is a way not only to contain anxiety but also serves the purpose of being a justification to enquire about sexual health. Questions about sexual health are at times framed as a medical requirement to rationalise why such sensitive or intimate questions may be asked. This seems to be in relation to where the field of psychological practice is currently positioned (Markovic, 2013). The assumption that sexual health falls within a biomedical model and allied health is perpetuated by the belief system that wellness is the absence of illness. Thus the absence of sexual health problems implies wellness in that area. In the field of psychology expression of sexuality, sexual preference and issues around sexual functioning have had the unfortunate position, historically, of being considered to be pathological when not conforming to moral standards of society (Foucault, 1980). It would appear that asking about sexual health is deemed more appropriate if it is directly related to the referral question.
Participant 10 (male): It would depend on the problem she came in for, I would try and probe and ask questions around it, indirectly it’s not something I feel comfortable with asking directly, sexual history is something I feel very uncomfortable speaking about it.
Contrary to this view one participant expressed her understanding that by positioning the topic of sexual health alongside and with equal emphasis as all other areas of inquiry may actually ease the discomfort felt by herself and her client.
Participant 3 (female): I ask it in such a way that it may come across as just part of the questionnaire which I have done before, so if I’m awkward about it that would have an adverse reaction. For example the client even though she was of a similar age to me, she felt good, because the questionnaire followed structure it became less awkward. I was thinking that she felt: let’s just continue answering the questions. So I think that makes a difference because it’s in a structure. If I had to zone in on it, it would make it more sensitive, I presume, I’m just guessing now.
63 It is worth considering that it would be time consuming to have to explain to every client the role of sexual history and broadening the view of the client, and to rationalise any enquiries concerning the subject, in relation to the client's reason for coming to see a psychologist.
However, if the trainee psychologist understands the relevance of this area of enquiry, then this inevitably informs her judgment as to how to proceed with it using dynamic questioning.
Participant 5 (male): When you are going to speak about those sensitive issues it’s going to be uncomfortable so I’m not going to talk about this until we get there, I don’t want to anticipate that bridge until we get there, it’s [the segment of sexual health] not the entire session.
Participant 6 (female): … I didn’t want to alert them [the client] to the fact that it was sensitive because it makes it more difficult for me to ask. So no I didn’t [orientate about sensitive topics]
Orienting the client seems to be linked with being able to build rapport with a client and is succinctly summarised as follows:
Participant 7 (female): I think orienting them is very very important, each person’s structure is entirely different, through orientation rapport is being built, so although we may end up talking about something sensitive today it is important that they come back and with consistency rapport is being built and assists with sensitive topics.
Personal Reflections: During this part of the interview with some of the participants, I shared some of my understandings of why this information could be useful. As indicated in the literature review there are many factors such as relationships with others, body image and self- esteem issues that may point to this line of questioning as being relevant and useful. This has been an area of personal interest due to the fact that sexuality is often only understood within a medical framework hinging on symptoms and diagnoses. My interest is in seeing the person as a whole, within their context and including all facets of their lived experience.