Lazarus and Folkman (1984) argue that stress results from a subjective perception of the stressor, and it is therefore the perception of a stressor which plays a role in the experience of stress in this research.
As highlighted in chapter four, the majority of the interns reported that dealing with non-fatal suicidal clients is stressful. A variety ofstressors were identified in the previous chapter, but the majority of the interns described common variables. The data suggests that one of the main sources of stress for the interns is the perceived lack of practical training and experience. Some of the interns reported that they had never been exposed to suicidal clients before and that working with suicidal clients for the first time was stressful. This was deemed as anxiety provoking which exacerbated feelings of inadequacy and resulted in self-doubt and ultimately contributed significantly to the interns overall experience of stress.
According to Niemeyer, Fortner and Melby (200 I), experience in dealing with suicidal clients as well as exposure to suicidal clients has shown increased feelings of competence and decreased levels of stress on the part of the Mental Health Worker. They reported that a lack of experience and exposure to suicidal clients in previous training has resulted in stress amongst these students. This was also described as stress factor, and the interns reported feeling incompetent at times when having to deal with suicidal clients. This resulted in low self-esteem in terms of their abilities and skills. Interns also reported that they felt that they have no control over clients' behaviour, especially suicidal clients. This was also deemed to be a source of stress for the interns.
The majority of the interns also reported that academ ic stress pertaining to the Masters programme as well as the academic and competency based requirements were also resulting in stress. Most of the interns described the process of evaluation stressful. Expectations regarding performance were voiced by the supervisors at the beginning of the internship and the interns were told about the negative behaviour of the previous interns. This was reported as being highly stressful by the interns. Being evaluated was also identified as a stressor. The interns reported that being threatened with termination and extension was stressful. Bernard and Krupat (1994) stated that threatening situations can be stressful and may result in psychological "harm".
Although the majority of interns reported having a good relationship with their supervisors, a few of the interns felt that they were not always sure what was expected of them and were concerned that they were being evaluated negatively. According to Gmelch and Gates (1997), support and clear expectations regarding what is expected is critical in reducing the feelings of anxiety and stress in subjects. In terms of work load, interns reported that this was a source of stress. Work load included the number of clients the interns were seeing on a daily basis, administrative work, and academic and competency based requirements.
The working environment was also identified as a major source of stress. According to Lazarus &
Folkman (1984), constraints that may exist in the environment and be out of the control of the individual may thwart his/her best efforts to cope with stressful situations and events. The majority of interns reported the number of clients that they were seeing during the internship was a lot more that compared to MI and this was reported as a source of stress for the interns
For the interns in this study environmental constraints may refer to numerous factors. Specifically this may refer to the actual physical environment, in which they find themselves working in on a daily basis as well as the various structures and organisations which surround the intern and which may contribute to their experiences of stress. Interns reported that administration and work-load resulted in stress as well as admission facilities and certain work and inter-cultural issues.
Interns also reported experiencing language difficulties and cultural differences when dealing with non- fatal suicidal clients, which resulted in stress. Interns stated that they have to use translators at times when dealing with non-fatal suicidal clients and this was stressful due to the sensitive issues that needed to be discussed. Some of the interns felt that the translators did not always relay everything the client had said.
In terms of personal stress, interns reported a number of factors, which they felt were contributing to their stress levels. Accommodation changes and conflicts in personal relationships were identified as major sources of stress. Family and friends were deemed as sources of support at times, but at other times seemed to be perceived as stressful. Lazarus and Folkman (1984) state the personal constraints include factors such as personality, internal resources, past traumatic experiences, family conflict and support to name but a few. These have a direct influence on how an individual copes with stress.
The majority of interns felt that their personality style was impacting on their ability to cope with stress. Three of the interns felt that they were anxious by nature and were concerned that they were not performing. It was Hemenover (2001) who reported that individuals who displayed high levels of neuroticism and anxiety tend to be more stressed. A few of the interns reported feeling depressed and tired at times and one intern reported feeling physically ill in the mornings. Two of the interns reported not being able to forget about their clients and not being able to relax when they went home. Baglioni and Cooper (1988) reported that the home/work interface, which often resulted when individuals where unable to stop thinking about work, contributed to stress levels. According to Oubifia, Calvo and Rios (1997), psychologists may experience burn-out quicker than most other health professionals due to the nature of the problems they encounter.
They may feel that they have lim ited capacity to alter the course of certain disorders and behaviours of clients and as mentioned in the data collected, interns reported feeling responsible for the clients. This again reflects Lazarus and Folkman 's (1984) argument that stress arises when an individual estimates that environmental demands override his/her own adjustment resources.
Sources of stress therefore stem from all aspects of a person's life and as mentioned in the literature has a direct influence and impact on other domains. it is important to mention again that Lazarus and Folkman (1984) argue that it is one's subjective perception that determines one's response to any given stressor.