An overview of the barriers to in-person therapy and viability of Internet-Based Cognitive Behavioural Therapy in the South African context : a counsellors’ perspective

Thesis (MA)--Stellenbosch University, 2022.ENGLISH SUMMARY: South African mental health care services are both underfunded and under-resourced. In addition to mental health services being largely unavailable, the South African context presents numerous barriers preventing individuals from accessing these services. These factors preventing South Africans from receiving mental health care are present throughout the different environments in which individuals live and operate. The result of having insufficient mental health professionals to address the mental health burden is known as the mental health gap. Internet-based treatment tools offer alternatives to in-person therapy. Internet-based Cognitive Behavioural Therapy (ICBT) is an example of one such internetbased treatment alternative and has been found effective in ameliorating symptoms of mental illness and extending the reach of mental health services. International research suggests that ICBT could be particularly beneficial in countries where resources are restricted. However, little research exists on the potential effectiveness of ICBT in the South African context. The primary aim of this study was to determine counsellor attitudes towards the viability of ICBT as a non-formal treatment tool in the South African context. The secondary aim was to determine what counsellors perceive as the barriers towards the implementation and treatment adoption of ICBT in South Africa. Qualitative semi-structured interviews were used to collect the views of 20 counsellors in Cape Town, South Africa. Drawing on thematic analysis to analyse the data, four categories and 11 themes emerged through which the data were presented and discussed. The results of the present study were conceptualised through Bronfenbrenner’s Ecological Systems Theory. As suggested by Bronfenbrenner’s theory, the present study assumes that the effectiveness of ICBT as well as the treatment uptake thereof could be impacted by several factors on a personal, interpersonal and environmental level in the South African context. The study found that counsellors had a predominantly positive attitude towards ICBT as a non-formal treatment alternative. Furthermore, counsellors suggested many recommendations that would need to be implemented to ensure an ICBT app that is relevant in the South African context, considering the country’s unique barriers that would prevent implementation and treatment uptake. Moreover, counsellors suggested that ICBT should be used as a supplementary tool to in-person counselling, and that it should not be used as a standalone tool. This study finds that ICBT has the potential to be a viable treatment alternative in the South African context. However, the recommendations included in this study would need to be implemented to ensure it is relevant to the South African context. Finally, this study concludes that ICBT has the potential to address the shortage of mental health professionals in South Africa and reduce the severity of the mental health gap.AFRIKAANS OPSOMMING: Suid-Afrikaanse geestesgesondheidsorg is onderbefonds en word belemmer deur ‘n gebrek aan hulpbronne. Buiten die algemene gebrekkige voorsiening van geestesgesondheidsorg in Suid-Afrika, veroorsaak die alledaagse realiteit van Suid-Afrikaanse samelewing verskeie verdere versperrings wat toegang tot beskikbare geestesgesondheidsorg verder beperk. Hierdie versperrende faktore kom voor in verskeie omgewings waarin Suid-Afrikaners leef en funksioneer. Die gevolg van gebrekkige voorsiening van geestesgesondheidsorg word na verwys as die geestesgesondheidsgaping. Geestesgesondheidsorg wat deur internet bronne voorsien word bied alterntiewe tot in-persoon terapie. Internet Gebaseerde Kognitiewe Gedragsterapie (IKGT) is een voorbeeld van so ‘n alternatief wat deur die internet gebied word en toon effektiewe verbetering in die simptome van geestesongesteldhede. Internasionale navorsing wat fokus op IKGT stel voor dat IKGT veral voordelig kan wees in lande waar die voorsiening van geestesgesondheidsorg onderbefonds is. Beperkte navorsing is egter beskikbaar oor die moontlike effektiwiteit van IKGT in die Suid-Afrika konteks. Die primêre doel van hierdie tesis is om die lewensvatbaarheid van IKGT as ‘n nie-formele behandelingshulpmiddel binne die Suid-Afrikaanse konteks te ondersoek. Die sekondêre doel is om vas te stel wat beraders as Suid-Afrika se grootste versperring tot die aanneem van IKGT as ‘n behandelingshulpmiddel beskou. Kwalitatiewe, semi-gestruktureerde onderhoude met 20 beraders in Kaapstad is gebruik om data in te samel. Deur ‘n tematiese analise van die data is vier oorhoofse kategorieё en elf temas geïdentifiseer en gebruik om die data te bespreek en oorweeg. Die resultate van die studie is gekonseptualiseer deur Bronfenbrenner se Ekologiese Sisteme Teorie as gevolg van die aanname dat die effektiwiteit van IKGT, asook die aanneming daarvan in terapie in Suid-Afrika, beïnvloed kan word deur verskeie persoonlike, interpersoonlike en ongewingsfaktore. Die resultate van die ondersoek dui aan dat beraders ‘n oorwegend positiewe houding teenoor IKGT as nie-formele behandelingshulpmiddel het. Tydens die onderhoude het beraders ook aanbevelings gemaak wat gevolg sal moet word vir ‘n IKGT mobiele toepassing om relevant te wees binne die Suid-Afrikaanse konteks. Beraders het oorwegend aanbeveel dat IKGT as ‘n aanvullende hulpmiddel tot in-persoon terapie gebruik word, en nie slegs as ‘n alleenstaande vorm van terapie nie. Hierdie studie vind dat IKGT die potensiaal het om ‘n lewensvatbare hulpmiddel te wees binne die Suid-Afrikaanse konteks. Die aanebevelings wvan beraders sal egter gevolg en geïmplementeer moet word om te verseker dat IKGT relevant is tot die ervarings van Suid-Afrikaanse pasiёnte. Indien die aanbevelings van beraders korrek geïmplementeer word kan IKGT die gesondheidsorg gaping in Suid-Afrika kleiner maak.Master