Furthermore, the importance of a relational understanding of the trainee and the client in relation to dominant discourses. A positive step towards deepening their own understanding of the relevance of questioning clients about sexuality and their own meanings attached to sexual health.
Rationale and background of the study
Introduction
Personal reflections: At first, many research participants felt uncomfortable with the topic of sexual health. Many felt that the interview provoked or encouraged further exploration of the topic of sexual health.
Terminology
Trainee Psychologist
Sexual Health
Working Alliance
Media
Postmodernism
Anxiety
Subjective experiences
Discourses
The use of pronouns
Colloquial terms
LITERATURE REVIEW
The development of the professional
These demands are not only academically demanding, but also put pressure on the intern's personal development in a way that Pascual-Leone et al. Farnsworth (2013, p. 206) emphasizes the intern's ability to develop a continue to provide service to the client.
The initial interview
- Taking sexual history
This would result in a situation where the focus becomes the trainee's discomfort rather than the client's reason for requiring psychological help (Farnsworth & Callahan, 2013). Very often the subject of sexual health is difficult to bring up, and there is often discomfort around the subject, which can be felt more acutely in the trainee psychologist.
The Working Alliance
Sexuality is closely related to intense emotions, self-image and self-awareness. Sexual health is not the absence of sexual problems. 24 As the working alliance emerges, it is important to nurture a transparent agenda regardless of the topic being discussed, including aspects related to sexual health.
Sexuality
- Human sexuality and wellness
- The relevance of sexual health information
Perel (2007) and Orbach (2009) both point to the importance and complexity of expanding sexual health information options and the need to include a view of all aspects of the individual. However, by incorporating a more thoughtful approach to the body and sexuality, it promotes a deeper and richer view of the person (Orbach, 2009).
Gender complexities
- Gender and the individual's context
- Gender differences in a therapeutic context
Recent research by DeGeorge et al. 2013) found similar results indicating that gender roles and the expectations of those roles are strongly influenced or dictated by the gender of the therapist and the client. 31 gender role stereotypes in the last three decades and the shift towards more equitable job creation, there continues to be a tendency to have preferences for a therapist that depend on traditional gender qualities (DeGeorge et al. 2013).
Socio-political discourses
- Patriarchy and Feminism
There has been much commentary on the fact that there appears to be an increase in the display of stereotypical masculinity in modern times (Orbach, 2009). In the past, men and women used their bodies as tools for their physical work of running the household.
Cultural considerations
For psychotherapy to be relevant, it requires the clinician to be able to respond and manage clients while recognizing and respecting the multiple levels that culture encompasses (Tseng, 2005). 35 behavior as well as being able to practice different styles of service provision to meet the required needs (Mirsu-Paun et al. 2010).
The influence of age
The psychologist in training is expected to handle sexual matters carefully, keeping in mind that sexual health should be the same. The psychologist in training is expected to be able to meet the client at an appropriate level of communication so that mutual understanding can arise.
The impact of the media
The contradictions of sexuality are difficult to navigate as the external body is physically seen as a sexual landscape and this is reinforced in the media and at the same time modern man seems to be losing touch with a language about sex and emotions, desire and erotica (Orbach, 2009). However, there seems to be no balance in this discourse, and a reinforcement of this disconnect between a focus on the physical, sexual being and the profound lack of a vocabulary to articulate discourses about sexual health (Perel, 2007).
A post modern view
40 and intimacy is overwhelmed by the modern era to reduce things to quantifiable variables and the subjective experience is replaced by a list of criteria or symptoms (Perel, 2007). However, this can be difficult to achieve in practice and the attempt to maintain neutrality can in itself give rise to conflict and cause the therapist to remain unaware of her own personal beliefs and the impact of those beliefs within a therapeutic context.
Reflexivity
So it's not the subject of sex itself, it's the power and the abuse. So yeah it's a bit strange, I don't know if it's the way the questions are asked.
RESEARCH METHODOLOGY
Introduction
The requirement of questioning around sensitive topics, such as sexual health, combined with the discomfort that seems to be present in many trainee psychologists creates an interesting space to ask the question: How does the trainee navigate a path through this complexity. This research is therefore an exploration of how the pupil deals with this line of questions in search of an exploration and retrospective look at the experiences and feelings of those moments with the aim of thematic understanding of some of the meanings attached to these challenges , to extrapolate.
Aim
The research explores the impact of these questions on the working alliance and the ability required to address any practitioner or client concerns during the process. The objective is to understand what factors can cause interpersonal distress or escalate performance anxiety, and what factors the trainee can use to overcome these challenges.
Research Questions
Focus on exploring the experiences of trainee psychologists when asking clients about sexual health during the first interview. Generating new ideas and understanding of trainee psychologists' lived experiences of sexual health history questions.
Methodology
- Research Design
- A Qualitative Study
- Brief Structured Recall
- Validity and generalisability of qualitative data
This method is particularly suitable for this study as it is the segment of the interview related to sexual health that is required for the purpose of this study. 34; conceptual and operational definitions" of the particular construct and that it is appropriate to collect the data required for the research project (Terreblance et al. 1999).
Sample description and motivation
For the phenomena to be studied in its real context, which increases the "ecological validity". The participants must be part of the study focusing on their adult clients aged 18 and over.
Instrument Development
47 selected population and suitable for research purposes (Terreblance et al. 1999). 48 participant to explore and be curious about their experiences that recalled the interview segment and that the conversation emerges through the experience of sitting with the interviewer.
Data collection
Procedure
Informed consent forms were provided to participants which briefly explained who the researcher is, the purpose and importance of the study. Since the participants are part of the Professional Program at UKZN, this is a procedure that the students will be familiar with.
Data Analysis
It is necessary to read the interview transcripts several times in order to know where to find information and how the data can support interpretation (Terreblance et al. 1999). At this stage, the researcher is asked to reflect on all the themes and sub-themes that have emerged and to provide a sense and context to the data (Terreblance et al. 1999).
Ethical Considerations
Cost Estimates
Limitations
Reflexivity is an important part of the research project and where appropriate I have added my personal experiences or insights. The importance of this is to include how my presence, thoughts and context affect the research process.
FINDINGS
Conceptual maps
- The first clinical interview
- Adequate preparation
- Orienting the client and interest in sexual health information
- Perceived discomfort
One participant role-played the client's sexual history and guided the interview process accordingly. Despite some anxiety associated with the task of conducting the first interview, the structure of the interview.
The Working Alliance
- The perception of the working alliance
- Impact on the working alliance
The quote below indicates how aware the psychologist in training is of the working alliance and that it is the relationship between client and practitioner that influences disclosure, rather than the subject itself. However, the conversations that emerged seemed to indicate that there was minimal impact on the working alliance and that any discomfort experienced was the subjective experience of the trainee.
Obstacles to emerge: Contextual factors
- Family background and societal norms
- Gender
- Age
- Power ratios
- Culture
- Language
- Religious beliefs
Interviewer: So is the expectation that if you talk about sex, that he might think it's an invitation? If I'm talking to someone and they're talking about my "partner", I get that, so again it's about language, language gives away so much.
Strategies employed by trainee psychologists when faced with obstacles
- Avoidance
- Restrained ability to enquire about sexual health
- Employing a medical paradigm
- Personal development through self education
- Normalising
- Retrospective and current life experience
It turned out that many of the participants would avoid the topic of sexual health altogether if they could. It appears that the psychology students who were more comfortable dealing with the topic of sexual health had explored and questioned their own assumptions and discomforts regarding sexual health.
Looking to the future: in the words of the participants
Opportunities to have discussions in a safe environment with the aim of challenging stereotypes and exploring the similarities and differences, as well as the social constructs of other cultures. Not because I was forced to do so, but because I am the type of person that when given a challenge, I will not give up, I will try to overcome it.
The participants reflect back on the research interview
DISCUSSION
- A Postmodern view
- Understanding the paradigm shift
- The trainee psychologist within her context
- Taken-for-granted-truths
- Perceived differences between sensitive topics
- The taboo of discussing sex
- Invasion: Gender is in the room
- Age: a dominant discourse
- Power imbalances
- Cultural diversity
- The use of language and the power of words
- Religious beliefs: taken-for-granted truth
- Understanding the relevance of sexual health
- Self - doubt
- A question of ethics in relation to sexual health information
- Collaborative strategies
- Assuming a 'not knowing stance'
- Developing reflexive skills and broadening knowledge base
- The skill of questioning
- Collaboration with peers and supervisors
- An epistemological question
- Synopsis of results
- Obstacles faced by the trainee psychologists when gathering sexual health information
- Obstacles in relation to the self: Personal discomfort of the trainee psychologist
- Obstacles in relation to limited understanding of the topic: sexual health
- Obstacles in relation to the working alliance
- Strategies used to overcome the obstacles
- The need to expose taken-for-granted-truths
- Multi-factor implications: Spotlight on gender
- Paradox of modern era and a censorship of sexual discussions
The primary obstacle faced by the psychology students was related to subjective discomfort and personal meanings attached to the topic of sexual health. Sexual health is a big topic and the meanings attached to the topic are very complex.
Implications and Limitations
- Future directions: preliminary reflections on future development
- Future directions for professional practice
- Future directions for training
- Future directions for research
- Limitations of the study
- Generalisability
- Availability of participants
- Personal reflections
- Possible contributions of the study
- Addition to psychological knowledge regarding sexual health information
- Encouraging a reflexive stance and personal growth
I realize that during the research interviews I encouraged more than I intended, as some of the participants initially struggled with the topic of sexual health and reason limited. I have used him when I have commented directly about one of the male participants in this study.
The purpose of this research is to explore how trainee psychologists gather a complete psychosocial history of a new client, including sensitive topics such as sexual health. Probe: Knowledge and skills to draw on; framing the topic of sexual health; maintaining the working alliance.
150
So it's quite difficult because it's a challenge for you and you know you have to do it. Is there also an expectation that if you talk about sex, he might think it's an invitation.
158
Do you think gender is an issue for you… that it might be easier to talk to a man? So if you're thinking about asking about sex, do you think it's an invasion of privacy?
164
I think it was very easy for me to ask because I used to work in a sexual assault unit so it's not a sensitive topic for me anymore so I would just ask. No, that was just the asking part, that's just the acting part, so no, not at all.
169
172 So it seems like you are saying that it should be treated in a way that is normal. I think it's so interesting to have that narrative workshop, I'm always throwing myself into it.
179
So do you think your client's ability to disclose is an invasion of privacy? It is quite complicated to ask about suicide: why do you want to take your life.
187
If not, I think it should be done later, it is not critical unless they are being sexually abused. I don't even think that if you had seminar after seminar to practice it, it's again for a forced situation.
197
No, it wasn't for training, it must have been a comfort to me to ask the question and hide my anxiety about asking sensitive questions. I think the problem was that I didn't have the right to ask the question at the time, and it was also difficult to talk to someone who was completely new to me about something that was such an intimate part of their lives.
204
212
224
232
