Grasping the thorn: The impact and supervision of traumatic stress therapy in the South African context

Abstract

The article examines the usefulness of existing theory for the supervision of clinical trainees at a Johannesburg trauma clinic, a context beset by particular sets of tensions. Concepts that contribute to a practical understanding of how therapists engage with and are affected by trauma clients in South Africa include vicarious traumatisation and countertransference, and the identification of whether therapist responses are evoked by features of the case and the traumatic event or are particular to the individual therapist. Limitations or gaps in existing conceptualisations are identified related to the sociopolitical demands of the context, including questions related to the pairing of client and therapist in terms of race, class and gender features. Factors that interfere with the provision of adequate containment in both supervision and psychotherapy include socioeconomic deprivation, inadequacies in the criminal justice system and the high prevalence of violent crime. Case examples of therapist responses in practice and of supervisory dilemmas are used to illustrate these problems. The article concludes with recommendations for the supervision of traumatic stress psychotherapy in such contexts, including strategies for preparing students for such work, for bringing up sensitive topics for discussion, for managing vicarious traumatisation and for supervisor self-care.

Keywords: traumatic stress, psychotherapy, supervision

Journal of Psychology in Africa 2005, 15(2): 197–207