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The Lived Experiences of South African Clinical Psychologists in their Relationships
with Psychiatrists in Private Practice.
by
Daniel S. Rabinowitz
A minor dissertation submitted in partial requirement for the degree of
MASTER OF ARTS
in
CLINICAL PSYCHOLOGY
in the
FACULTY OF HUMANITIES
at the
UNIVERSITY OF JOHANNESBURG
SUPERVISOR: LARISE DU PLESSIS
NOVEMBER 2012
2
ACKNOWLEDGEMENTS
I dedicate this research to the memory of my late sister, Talia Kim Rabinowitz, who was just
26 years old when she committed suicide at Tara, a mental health institution in Johannesburg.
Her memory permeates every word of this dissertation.
I also dedicate this research to the strongest and most courageous woman I know, my mother,
Rosalie Kruger, who experienced the devastation of losing both her daughter (my late sister)
and her husband (my late father) to suicide. Both deaths were ramifications of mental illness.
Her exceptional strength in the wake of their passing has not only galvanised me with the
diligence required to pursue a Master‟s degree, but has also equipped me to see the hope in
life beyond the despair. She continues to be my rock.
3
ABSTRACT
Although they both concur that they treat similar mental health concerns, the professions of
clinical psychology and psychiatry have differed since antiquity. The professions have
separate epistemological underpinnings that have become increasingly divergent over time so
that hostility is rife in the current relationship, particularly concerning the prescriptive
privileges divide. To comprehensively understand the lived experiences of the relationship
between South African clinical psychologists and psychiatrists in private practice, three
clinical psychologists were interviewed and an interpretative phenomenological analysis was
conducted. Four superordinate themes and two idiographic themes were educed from the
interviews: the participants professed to have good relationships with psychiatrists; they
observed that different professional settings affect the relationship; they acknowledged that
differing mental health epistemologies affect the relationship; they recognised that time and
money contribute to incongruence in the clinical psychologist-psychiatrist relationship. The
two idiographic themes that emerged from the transcripts are that clinical psychologists fear
their engagement with psychiatrists, and that some clinical psychologists choose not to
identify with the conventions of the medical paradigm. It is concluded that the six educed
themes not only describe the thematic divergence in the professional relationship, but that
they also characterise six ways in which the professionals can reciprocally strive for
congruence to eschew hostility in the relationship in the interest of ameliorated client care.
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TABLE OF CONTENTS
ACKNOWLEDGEMENTS ....................................................................................................... 2
ABSTRACT ............................................................................................................................... 3
TABLE OF CONTENTS ........................................................................................................... 4
Chapter 1: Introduction, Aim and Orientation ......................................................................... 10
1.1. Structure of the Research .............................................................................................. 10
1.2. Conceptualisation of the Distinction between Clinical psychologist and Psychiatrist . 13
1.3. The Argument for Congruence in the Lived Experience of the Professional
Relationship between Clinical psychologist and Psychiatrist ............................................. 16
Chapter 2: Literature Review of the Lived Experiences of South African Clinical
Psychologists in their Relationships with Psychiatrists in Private Practice ............................. 20
2.1. Introduction ................................................................................................................... 20
2.2. Historical Development of Clinical Psychology and Psychiatry .................................. 21
2.2.1. Proto-psychology and proto-psychiatry. ................................................................ 22
2.2.2. The Middle Ages and the interpretation of mental states. ..................................... 23
2.2.3. The Renaissance - A rude awakening. ................................................................... 24
2.2.4. The Age of Enlightenment – The divergence of clinical psychology and
psychiatry. ........................................................................................................................ 25
2.2.5. Romantic clinical psychology and psychiatry. ...................................................... 27
2.2.6. 20th century developments. ................................................................................... 28
5
2.2.8. Summary of the historical development of the relationship between clinical
psychology and psychiatry. .............................................................................................. 30
2.3. Contemporary Literature of the Relationship between Clinical Psychologists and
Psychiatrists in Private Practice ........................................................................................... 31
2.3.1. Clinical psychologists‟ relationship with psychiatrists in private practice over the
last century (1900s to present-day). ................................................................................. 31
2.3.2. Contemporary perspectives of the relationship between clinical psychologists and
psychiatrists...................................................................................................................... 36
2.4. A Summary of the Literature Review ........................................................................... 49
Chapter 3: Research Design and Methodology ....................................................................... 51
3.1. Introduction ................................................................................................................... 51
3.2. The Purpose of the Research ........................................................................................ 51
3.3. The Elements of the Qualitative Research – Hiles‟ Model of Disciplined Enquiry ..... 52
3.4. The Qualitative Model of Enquiry ................................................................................ 53
3.5. The Properties of the Qualitative Paradigm – Ontology and Epistemology ................ 56
3.6. The Strategy of Interpretative Phenomenology ............................................................ 57
3.6.1. Husserlian (descriptive) phenomenology. ............................................................. 58
3.6.2. Heideggerian (interpretative) phenomenology. ..................................................... 59
3.7. Methodology of Research ............................................................................................. 61
3.7.1. Participant sampling............................................................................................... 61
3.7.2. Data collection. ...................................................................................................... 64
3.8. Data Analysis ................................................................................................................ 73
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3.9. Trustworthiness Criteria for Qualitative Inquiry .......................................................... 76
3.9.1. Credibility as opposed to internal validity. ............................................................ 77
3.9.2. Transferability as opposed to external validity. ..................................................... 77
3.9.3. Dependability as opposed to reliability.................................................................. 78
3.9.4. Confirmability as opposed to objectivity. .............................................................. 78
3.9.5. Summary of the trustworthiness criteria in qualitative research. ........................... 78
Chapter 4: Data Analysis and Discussion ................................................................................ 80
4.1. Introduction ................................................................................................................... 80
4.2. Total Immersion in the Verbatim Transcripts .............................................................. 82
4.3. Free Commentary and Annotations .............................................................................. 83
4.3.1. Preamble by the researcher. ................................................................................... 83
4.3.2. Participant A: Free commentary and annotations. ................................................. 83
4.3.3. Participant B: Free commentary and annotations. ................................................. 89
4.3.4. Participant C: Free commentary and annotations. ................................................. 94
4.3.5. Synopsis of free commentary and annotations of Participant A, B, and C. ......... 100
4.4. Transformation of Initial Notes to Succinct Phrases Capturing the Essence of the Text
........................................................................................................................................... 101
4.4.1. Participant A: Succinct phrases. .......................................................................... 102
4.4.2. Participant B: Succinct phrases. ........................................................................... 103
4.4.3. Participant C: Succinct phrases. ........................................................................... 104
4.5. Connection of the Succinct Phrases into Simple Themes .......................................... 105
4.6. Amalgamation of Simple Themes into Superordinate and Idiographic Themes ........ 113
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4.7. Analysis and Discussion of Superordinate Themes .................................................... 117
4.7.1. A professed good relationship with psychiatrists. ............................................... 117
4.7.2. Clinical psychologists and psychiatrists have more congruent relationships in
institutions as opposed to private practice. .................................................................... 117
4.7.3. Mental health professionals‟ differing epistemologies influence incongruence in
the relationship. .............................................................................................................. 118
4.7.4. Time and money contribute to incongruence in the clinical psychologist-
psychiatrist relationship. ................................................................................................ 119
4.8. Analysis and Discussion of Idiographic Themes ........................................................ 120
4.8.1. Clinical psychologists fear engaging with psychiatrists. ..................................... 120
4.8.2. Some clinical psychologists do not choose to identify with the conventions of the
medical paradigm. .......................................................................................................... 121
4.8. Summary of data analysis-discussion ......................................................................... 122
Chapter 5: Interpretation of the Results and Integration of the Literature Review ............... 124
5.1. Introduction ................................................................................................................. 124
5.2. Analysis and Discussion of Superordinate and Idiographic Themes and Integration of
the Literature Review ........................................................................................................ 124
5.2.1. A professed good relationship with psychiatrists. ............................................... 125
5.2.2. Clinical psychologists and psychiatrists have more congruent relationships in
institutions as opposed to private practice. .................................................................... 127
5.2.3. Mental health professionals‟ differing epistemologies influence incongruence in
the relationship. .............................................................................................................. 128
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5.2.4. Time and money contribute to incongruence in the clinical psychologist-
psychiatrist relationship. ................................................................................................ 130
5.3. Analysis and Discussion of Idiographic Themes and Integration of the Literature
Review ............................................................................................................................... 133
5.3.1. Clinical psychologists fear engaging with psychiatrists. ..................................... 133
5.3.2. Some clinical psychologists do not choose to identify with the conventions of the
medical paradigm. .......................................................................................................... 135
5.4. The Researcher‟s Integrative Interpretation of the Lived Experience of Clinical
Psychologists in their Relationship with Psychiatrists in Private Practice ........................ 136
5.5. Conclusion of the Interpretation of the Results and Integration of the Literature
Review ............................................................................................................................... 144
Chapter 6: Conclusion, Limitations, Implications, and Recommendations of the Research . 145
6.1. Introduction of the Chapter ......................................................................................... 145
6.2. Conclusion of the Dissertation .................................................................................... 145
6.2.1. Summary of educed themes. ................................................................................ 146
6.3. Potential Researcher Bias and Assumptions, Including a Reflection of the Study‟s
Limitations. ........................................................................................................................ 149
6.4. Implications of the Research ...................................................................................... 154
6.5. Recommendations for Future Research ...................................................................... 155
REFERENCES ...................................................................................................................... 158
APPENDICES ....................................................................................................................... 178
Appendix A: Verbatim Interview Transcript – Participant A. ..................... (Appendix A) 178
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Appendix B: Verbatim Interview Transcript – Participant B .......................... (Appendix B) 1
Appendix C: Verbatim Interview Transcript – Participant C .......................... (Appendix C) 1
Appendix D: Letter of Participatory Consent between Student and Research Participant ......
(Appendix D) 1
