Psychology interns' experiences of working with survivors of violence at psychiatric hospitals in Cape Town

Includes bibliographical references (leaves110-126).South Africa has very high rates of violence and many people who are treated within psychiatric hospitals have been exposed to interpersonal violence. However little has been documented about trauma interventions in the South African context. Twelve clinical psychology interns completing the second year of their clinical masters training at Valkenberg, Groote Schuur and Lentegeur Hospitals were interviewed. The interviews were recorded, transcribed, coded and analysed according to grounded theory methodology, in order to establish: the kinds of violent experiences to which patients are exposed; patients' presenting complaints and diagnostic trends that were noticed amongst patients; the therapeutic work that is being undertaken with patients by interns and the theoretical models on which their work is based; the various challenges that interns encounter in their work with survivors of violence, and the training issues that arose for interns during the course of their work. The findings were compared with the available literature regarding the impact of exposure to violence and models of intervention, which is based predominantly on research conducted in economically developed countries. It was established that rates of exposure to violence are very high amongst the psychiatric patients seen by these interns and multiple traumatisation was felt to contribute to the complexity of their patients' presentations. Despite having received some training in working with survivors of violence during the course of their generalist training, interns felt ill- equipped to work with many of these patients because of the degree of complexity of patients' problems, including the contextual issues which continue to impact on patients. Most interns reported that they would have benefited from more specialist training. Existing theoretical models formed the basis for the interns' understanding of the psychological impact of exposure to violence but established intervention models were felt to be mostly inadequate with this patient population. In light of these findings areas for further consideration and research are suggested