South African clinical psychology practice: The challenge of local contextual change.

Abstract

Since South Africa became a democracy in 1994, there have been concerted efforts to change health care in a range of ways, making health care more accessible to a diverse population in a very unequal country. Part of these efforts involves changing the demographics of the healthcare workforce which in fields like psychology and medicine was predominantly white. We report here on the experiences of two authors of their work as clinical psychologists in a large urban general hospital in South Africa catering for Black South Africans most of whom speak isiXhosa as a first language. The first author is white and does not speak isiXhosa, and has been the only psychologist at the hospital for some time. The second author, a Black, first language isiXhosa speaker, joined the clinical team amid expectations that she would provide more culturally appropriate care. We draw on extensive reflections from these authors about their experiences, which demonstrate numerous obstacles to this care, and even resistance by Black patients to receiving treatment from a Black psychologist. We use decolonial theory to understand these experiences, and we conclude that health systems and the practice of clinical psychology in South Africa cannot transform fully without substantial social change. Public Significance StatementThis article demonstrates the complexity of change processes in the practice of clinical psychology in a public hospital in South Africa, highlighting difficulties and challenges related to questions of race and ethnicity of members of the clinical psychology workforce. The authors show that the work of racial transformation in clinical psychology is profoundly affected by the broader social context, and suggest that psychologists need to engage with issues of inequality, exclusion, and the internalization of oppression, beyond the confines of the professional work of psychology as narrowly understood.