My Journey as a Clinical Psychologist

leneMy journey started in 1983 when I was privileged to be selected for the Psychology Clinical Training at the University of South Africa (UNISA).

Our training in Systems Theory was fairly unusual at the time, as we were introduced to Constructivism and Post Constructivism, which had a major impact on Psychological and Social Theories during the previous 20 years. The two most important concepts I have taken from this training and applied throughout in my Clinical Practice is that everything on earth is interconnected and that we humans do not have the capacity to know the truth, we can only construct a truth based on our own ideas and understandings.

We also had thorough training in Neuro-psychology which later in practice proved to be extremely valuable. My one year Clinical Internship at the Military Hospital near Pretoria comprised ofa  rotation system of 3 months per division, which offered my initial exposure to mental health problems such as Mood disorders, Psychosis, Dissociative Identity Disorder,Trauma following amputations, head injuries, Post Traumatic Stress disorder etc.

During my first 6 years after completing the Clinical Training I worked in Educational settings with children with Developmental and Neurological Disorders. This has provided me with an opportunity to develop an in-depth understanding of the variety of factors influencing the development and well-being of children during those early years. Knowledge of Neuro-psychology, Neuro-developmental factors, Attachment theories and Family Dynamics was essential. Little did I know that in later years, working with adults, this knowledge would prove invaluable to understand and trace the development of the difficulties experienced in Adulthood.

 I moved to Cape Town in 1996 and started a Private Practice in Malmesbury and Cape Town. During the next five years I was struck by the devastation caused by Child Sexual Abuse. Another serious condition I often encountered in my practice was the aftermath for young men who were conscripted to the ‘Border-war’ in South Africa and Angola. Many of these young men who suffered from Post-Traumatic-Stress (PTSD) resorted to unhelpful coping strategies such as alcohol, drugs and sex, which have a devastating impact on the quality of their lives and those of their families.

During this time I had further training in Narrative Therapy and Hypnotherapy.I have found Narrative Therapy particularly helpful with clients presenting with fragmented and traumatic ‘stories’, that didn’t make sense and had no meaning. The joint co-construction of a different, but ‘coherent story’ with ‘meaning’ has proven extremely valuable to many clients. Some of the principles of Hypnotherapy assisted clients at times to uncover ‘forgotten’ experiences contributing to their difficulties.

After five years in Private Practice I felt the need to broaden my therapeutic skills and knowledge. I decided to qualify for the ‘Statement of Equivalence’ in the United Kingdom, to allow me to work there as a Clinical Psychologist. This required really hard work and a lot of patience! After two years I was awarded the Statement. I am still registered with the British Psychological society and hold the Chartered Status with the Society. I’m also registered with the Board for Health Professionals in the UK.

I started my journey in the UK in 1999 with a locum post on the’ Isle of Guernsey’ in a Child and Adolescent Service. This was such an amazing experience on that most beautiful island that it felt unreal at times. During the six months locum I did some further training in Brief Solution focused work with Children, in London.

My next position was in Oxford in a Youth Offending Service. As part of a new government initiative to address the level of youth offending in the UK, I was tasked to develop this service with a multi-disciplinary team. We had intensive training in different aspects relating to violence, sexual offending, managing anger and mental health problems.  As before, my previous experience and theoretical background proved to be valuable in terms of understanding the complexity of problems we were dealing with. An understanding of the impact of micro and macro systems on individuals, the narrative constructs of power issues in relationships and in society, developmental factors and traumatic experiences, contributed to an understanding of these very troubled young people and assisted us in developing an appropriate and successful service.

During this period I was also attached to the Park Hospital Children’s services in Oxford as well as a community clinic in Banbury. I had the opportunity at the hospital to do intensive in-house training in Cognitive Behaviour Therapy.

After completion of this contract I was offered a position in Edinburgh in the ‘Young People’s Unit’ ‘YPU’ at the Royal Edinburgh Hospital. Mental health Services in the UK are offered on a Tiered system: Tier 1 being for ‘everyday problems’ dealt by GP’s and trained nurses or Mental Health workers. Tier 11 addresses more serious problems which are referred to a Psychology Service. Tier 111 deals with complex problems and aims to prevent clients from being admitted to hospital. Tier 1V provides services for clients who needs hospitalisation specialised treatment and often for their own safety and those of others. The Young People’s Unit provided services to Tiers 111 and 1V for young people aged 14 to 21. Working with major Depression, Severe Anxiety,Psychosis, suicide, family violence and emerging Personality Disorders provided me with further specialised learning opportunities.

 I was part of the ‘Child Sexual Abuse’(CSA) team, providing services to survivors of sexual abuse and support to colleagues.  During this time I also started Post Graduate Studies at Bristol University in ‘Narrative and Life Story Research’. As part of these studies I did a research project, looking at the impact on clinicians working with CSA. Together with the findings of another similar study, Supervision Guidelines were developed for clinicians working with CSA to prevent and address the prevalence of ‘Secondary or Vicarious Traumatisation’.

 I also presented a 10 week training course to staff in ‘Systemic Practice and Family Therapy’at the YPU. As part of my job Description I provided Narrative Therapy training sessions to Clinical Trainees.

Towards the end of 2005 I returned to South Africa to complete my dissertation on the impact social and political changes had on the First People of SA, The Khoi-Khoi. My interest was in inter-generational trauma and the transfer of coping skills from one generation to the next. This research did not find its way to a dissertation, but in a Publication, with the purpose of providing for these people a space where their voices could be heard. (See publications).

During my last 5 years in England I worked in the field of Forensic Psychology in low and medium secure Hospitals for Mentally disordered offenders. The prevalence of Traumatic experiences during childhood and PTSD was unusually high. I had ample opportunities for training in this field, as well as working with Psychosis, Schizophrenia, Personality Disorders and Bi-polar disorder. With colleagues I developed a Family Service for Families with a member diagnosed with Psychosis or Schizophrenia. We also developed a Group process to support clients dealing with Voices, Hallucinations, and Paranoia.

During this period I also started training in Schema Therapy which help identify , clarify and change early childhood beliefs that continue to impact on our thinking feelings and behaviour into adulthood, most often at a subconscious level.

After having been diagnosed with serious illness I returned to South Africa in 2012. This period in my life gave me ample time to reflect on my career, my knowledge and my skills. During and after my recovery I became particularly aware of the impact of the high levels of stress we experience in our modern society, where the norm often is ’More is Better’.  I became particularly interested in two ‘fairly’ new developments in Psychology namely Compassion-focused Therapy and Psycho-neuro-immunology. The theories underlying these approaches offers an extremely helpful way to understand the role of stress, the suppression of emotions and guidelines regarding overcoming or escaping from the viscous circle we so easily find ourselves in.

I’ve continued my Schema Therapy training back in South Africa and has begun to integrate the concepts from Schema Therapy with the latest developments and knowledge from quantum physics as applied and researched in Epigenetics – challenging the Gene-myth, Neuro-Plasticity – proof that the brain and its functioning can change and grow new pathways and Neuro- Psychology explaining how our thoughts determine our feelings and actions.

I feel privileged to share with my clients my knowledge and skills and to work together towards a  healthy, contented and compassionate life.

PUBLICATIONS

2014, Lené Malan. Wanneer die Maan vol is , in Nederlands als Poort na Afrika, Bart de Graaf & Riet Jong-Goosens

2011, Lené Malan & Aneta Shaw,Daai ding loop in jou Bloed.  Protea Uitgewers. Pretoria.

 2011, Lené Malan& Aneta Shaw.  Das Hat Man im Blut,2011, Solitaire Press, Windhoek.

2007, Lené Malan,’ A Nama Story’, in ‘The Face of the Spirit, illuminating a century of essays by South African Women’, Department of Arts and Culture, RSA.

1988, L Malan, Z Ennis, & L Fourie. Now you see it, now you don’t: A case study of a disintegrating family and a dissenting team In Ed’s Jean Mason & J Rubenstein, Family Therapy: South Africa Today. SA Institute of Marital and Family Therapy.

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