Methodological paradigm: Single-system research design involving intervention

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INTRODUCTION TO THE STUDY

Much has been written by theorists and psychologists in South Africa and throughout the world on the need to contextualize and indigenize psychology (Naidoo, 1996), to preserve indigenous knowledge systems (Ngulube & Lwoga, 2007), to pursue culturally relevant research (Allwood & Berry, 2006; Allan & Dana, 2004; Adair, 1999; Adair & Diaz-Loving, 1999; Kim, Park & Park in Adair & Diaz-Loving, 1999; Misra & Gergen, 1993), and to use culturally appropriate and locally normed methods of assessment (Kekae-Moletsane, 2008; Singh, Sunpath, John, Eastham & Goundan, 2008; Foxcroft, 2002; Lu & Bigler, 2002). Traditional healing methods for people from African cultures in general have been covered in South African literature (Maiello, 2008; Sandlana & Mtetwa, 2008; Mufamadi, 2001; Holland, 2001; Tyrrell, 1971; Mutwa, 1998; Buhrmann, 1984; Krige, 1950).

BACKGROUND AND RATIONALE OF THE STUDY

I work in the psychology department of McCord Hospital, which is attached to the Sinikithemba (‘We Give Hope’) HIV clinic of McCord Hospital, a hospital not for profit (HNP) serving a predominantly urban population from the greater Durban area of KwaZulu-Natal 2 McCord Hospital has historically been a mission-based hospital, and was originally called McCord Zulu Hospital. It was the first hospital in KwaZulu-Natal to train Zulu nurses. As a result of this history, its ethos, embedded in its mission statement, was originally to serve the underprivileged population of Durban.

STATEMENT OF THE PROBLEM

The intern psychologists of the psychology department of McCord Hospital work on a daily basis with troubled and traumatized children within the hospital wards, the Sinikithemba HIV clinic and in outreach programmes in communities.

PURPOSE OF THE RESEARCH

The purpose of this research was to investigate whether the narrative and projective technique, Masekitlana, could be of use in therapy with children living with and affected by HIV/AIDS. In particular, four children between the ages of eight and twelve years and who lived in Children’s Homes were selected as participants. Working in the Sinikithemba HIV clinic, the intern psychologists and I had counselled many children living in Children’s Homes in and around Durban.

CHAPTER 1 IDENTIFYING THE STUDY
1.1 INTRODUCTION TO THE STUDY
1.2 BACKGROUND OF THE STUDY
1.3 STATEMENT OF THE PROBLEM
1.4 PURPOSE OF THE RESEARCH
1.5 RESEARCH QUESTIONS
1.6 RESEARCH METHODOLOGY AND DESIGN
1.6.1 PARADIGM
1.6.1.1 Metatheoretical paradigm: Interpretive
1.6.1.2 Methodological paradigm: Single-system research design involving intervention
1.6.1.3 Qualitative approach 1
1.6.1.4 Quantitative approach
1.6.2 SELECTION OF PARTICIPANTS
1.6.3 DATA COLLECTION
1.6.3.1 Research team
1.6.3.2 Therapeutic and assessment methods
1.6.3.3 Language and translation
1.6.4 DATA ANALYSIS AND INTERPRETATION
1.6.4.1 Qualitative analysis and interpretation of narratives 1
1.6.4.2 Mixed qualitative and quantitative analysis and interpretation of Roberts-2 test
1.6.5 QUALITY CRITERIA
1.6.5.1 Quality criteria of qualitative research
1.6.5.2 Quality criteria of quantitative research
1.6.6 ASSUMPTIONS OF THE STUDY
1.6.7 ETHICAL CONSIDERATIONS
1.7 THEORETICAL AND CONCEPTUAL FRAMEWORK
1.7.1 EMPIRICAL WORK IN INDIGENOUS CONTEXTS
1.7.2 HEGEMONY OF WESTERN PSYCHOLOGY
1.7.3 CROSS-CULTURAL RESEARCH AND PAN-HUMAN PSYCHOLOGY
1.7.4 SYMBOLISM AND METAPHOR IN INDIGENOUS THERAPY
1.7.5 NARRATIVE AND ORALITY IN THE AFRICAN CONTEXT
1.7.6 INDIGENOUS THINKING, INDIGENOUS KNOWLEDGE SYSTEMS AND THE PHILOSOPHY OF UBUNTU
1.7.7 AFRICAN CHILDREN IN TRANSFORMATION
1.7.8 ASSESSMENT IN INDIGENOUS CONTEXTS
1.7.9 INTERFACE BETWEEN RESEARCHER AND PARTICIPANT, AND RESEARC SELF-REFLEXIVITY
1.8 KEY CONSTRUCTS
1.8.1 VULNERABLE CHILDREN, INCLUDING ORPHANS AND CHILDREN LIVIN WITH HIV OR AFFECTED BY HIV/AIDS
1.8.2 INDIGENOUS KNOWLEDGE
1.8.3 MASEKITLANA
1.8.4 THERAPY AND PSYCHOTHERAPY
1.8.5 TRAUMA
1.9 LIMITATIONS AND STRENGTHS OF THE STUDY
1.10 OUTLINE OF CHAPTERS
1.11 CONCLUSION
CHAPTER TWO EXPLORING THE LITERATURE
2.1 INTRODUCTION
2.2 CULTURAL PSYCHOLOGY
2.2.1 ISSUES OF UNIVERSALISM VERSUS STUDYING UNIQUE ASPECTS OF CULTURES: ‘ETIC’ VERSUS ‘EMIC’ FOCI
2.2.2 DIFFERENCES BETWEEN WESTERN AND AFRICAN/NON-WESTERN CULTURAL FUNCTIONING
2.2.3 BUILDING FORMS OF CULTURAL PSYCHOLOGY: RESEARCH IN CULTURAL SETTINGS
2.2.4 CULTURAL IN-BETWEENITY: AN INTEGRATIVE APPROACH
2.3 INDIGENOUS KNOWLEDGE
2.3.1 CONTEXTUALITY AND UNIVERSALISM OF INDIGENOUS KNOWLEDGE SYSTEMS
2.3.2 PROTECTION AND DISSEMINATION OF INDIGENOUS KNOWLEDGE SYSTEMS
2.4 INDIGENOUS PSYCHOLOGY
2.4.1 POSITION OF THE PSYCHOLOGIST IN INDIGENOUS PSYCHOLOGY PRACTICE
2.4.2 CONCEPTUALIZING TRAUMA, TRAUMA THERAPY AND INTERVENTION IN INDIGENOUS CONTEXTS
2.4.2.1 Literature from non-African countries 51
2.4.2.2 Literature in the South African context
2.4.2.3 HIV/AIDS and trauma in South Africa
2.4.3 METHODS OF PSYCHOLOGICAL ASSESSMENT AND THERAPY FOR SOUTH AFRICAN INDIGENOUS POPULATIONS
2.4.3.1 Story-telling and Dynamic Assessment (DA)
2.4.3.2 Masekitlana, an indigenous form of narrative therapy
2.5 CONCLUSION
CHAPTER 3 THE RESEARCH PROCESS: DESIGN AND METHODOLOGY
3.1 INTRODUCTION
3.2 METHODOLOGICAL RESEARCH PARADIGM: SINGLE-SYSTEM RESEARCH DESIGN WITH INTERVENTION
3.3 METATHEORETICAL PARADIGM: INTERPRETIVE
3.4 RESEARCH APPROACH: MIXED-METHODS DESIGN
3.4.1 PUTTING MIXED METHODS INTO PRACTICE IN THE PRESENT STUDY
3.5 RESEARCH SITES
3.5.1 ST. THERESA’S CHILDREN’S HOME
3.5.2 ST. MARTIN’S CHILDREN’S HOME
3.6 STUDY POPULATION AND SELECTION OF PARTICIPANTS
3.6.1 PARTICIPANTS’ DETAILS
3.6.1.1 Participant 1: Hlonipho
3.6.1.2 Participant 2: Senzo
3.6.1.3 Participant 3: Mandla
3.6.1.4 Participant 4: Nana
3.7 PRE-PROCEDURAL MEETINGS
3.8 DATA COLLECTION METHODS
3.8.1 INTERVIEWS
3.8.2 OBSERVATION
3.8.3 FIELD NOTES
3.8.4 TECHNOLOGY
3.8.5 SYMBOLIC PLAY AND MASEKITLANA
3.8.6 STORY-TELLING AND MASEKITLANA
3.8.7 TRANSLATION AND TRANSCRIPTION
3.9 DATA ANALYSIS
3.9.1 QUALITATIVE ANALYSIS
3.9.2 QUANTITATIVE ANALYSIS
3.9.2.1 Assessment measure: Roberts-2 test
3.10 DATA INTERPRETATION
3.11 ETHICAL CONSIDERATIONS
3.11.1 AVOIDANCE OF HARM
3.11.2 INFORMED CONSENT
3.11.3 VIOLATION OF PRIVACY/ANONYMITY/CONFIDENTIALITY
3.11.4 COMPETENCY OF RESEARCHER AND THERAPIST
3.11.5 TERMINATION OF THERAPY AND RESEARCH
3.11.6 DISSEMINATION OF FINDINGS
3.12 CONCLUSION
CHAPTER 4 QUALITATIVE DATA ANALYSIS
4.1 INTRODUCTION
4.2 INTERPRETIVE PARADIGM
4.3 DATA ANALYSIS PROCESS
4.3.1 GENERATING THEMES: PARTICULARITIES, GENERALIZATIONS AND CONDENSATION
4.3.2 CODING OF THEMES
4.3.2.1 Open coding
4.3.2.2 Axial coding
4.3.2.3 Selective coding
4.4 THEMES
4.4.1 THEME 1: BELIEFS
4.4.1.1 Sub-theme 1: Cosmological, spiritual and ancestral beliefs, 1 and symbolism
4.4.1.2 Sub-theme 2: Biblical beliefs
4.4.2 THEME 2: RELATIONSHIPS WITH OTHERS
4.4.2.1 Sub-theme 1: Need for family
4.4.2.2 Sub-theme 2: Influence of non-family members on participants 113 in Children’s Homes and home environments
4.4.3 THEME 3: EVERYDAY SITUATIONS
4.4.3.1 Sub-theme 1: The ‘mundane’
4.4.3.2Sub-theme 2: Schooling problems
4.4.4 THEME 4: PARTICIPANT EMOTIONS AS EXPRESSED INTERNALLY AND REFLECTED EXTERNALLY
4.4.4.1 Sub-theme 1: Emotions 121
4.4.4.2 Sub-theme 2: External reflections of emotions
4.5 OVERLAPPING OF THEMES
4.6 OBSERVATIONS
4.7 CONCLUSION
CHAPTER 5 QUANTITATIVE DATA ANALYSIS AND INTERPRETAITON
5.1 INTRODUCTION
5.2 QUANTITATIVE MEASUREMENT
5.2.1 SINGLE-SYSTEM DESIGN AND REPETITIVE QUANTITATIVE MEASUREMENT
5.2.2 RELIABILITY AND VALIDITY OF ROBERTS-2 MEASUREMENT
5.2.3 CODING, SCORING AND INTERPRETATION OF PARTICIPANTS’ RESPONSES USING THE SCORING PROCEDURE OF ROBERTS-2
5.3 GRAPHIC ANALYSIS OF PARTICIPANTS’ RESPONSES AND INTERPRETATION OF THE GRAPHS
5.3.1 GRAPHIC ANALYSIS OF HLONIPHO’S RESPONSES TO THE ROBERTS-2 TEST USING THE SCALES OF ROBERTS-2 MANUAL (2005)
5.3.1.1 Hlonipho: Popular Pull 139
5.3.1.2 Hlonipho: Complete Meaning
5.3.1.3 Hlonipho: Available Resources Scales
5.3.1.4 Hlonipho: Problem Identification Scale
5.3.1.5 Hlonipho: Resolution Scales
5.3.1.6 Hlonipho: Emotion Scales
5.3.1.7 Hlonipho: Outcome Scales
5.3.1.8 Hlonipho: Unusual or Atypical Responses
5.3.1.9 Hlonipho: Atypical Categories
5.3.2 GRAPHIC ANALYSIS OF SENZO’S RESPONSES TO ROBERTS-2 USING THE SCALES OF ROBERTS-2 MANUAL (2009)
5.3.2.1 Senzo: Popular Pull and Complete Meaning
5.3.2.2 Senzo: Available Resources Scales
5.3.2.3 Senzo: Problem Identification Scales
5.3.2.4 Senzo: Resolution Scales
5.3.2.5Senzo: Emotion Scales
5.3.2.6 Senzo: Outcome Scales
5.3.2.7 Senzo: Unusual or Atypical Responses
5.3.2.8 Senzo: Atypical Categories
5.3.3 GRAPHIC ANALYSIS OF NANA’S RESPONSES TO THE ROBERTS-2 TEST USING THE SCALES OF ROBERTS-2 MANUAL
5.3.3.1 Nana: Theme Overview Scales 15
5.3.3.2Nana: Available Resources Scales
5.3.3.3 Nana: Outcome Scales
5.3.3.4Nana: Problem Identification Scales
5.3.3.5 Nana: Resolution Scales
5.3.3.6 Nana: Emotion Scales
5.3.3.7 Nana: Unusual or Atypical Responses
5.3.3.8 Nana: Atypical Categories
5.4 INTERPRETING GRAPHIC RESULTS: COMBINING AND COMPARING PARTICIPANT RESULTS
5.4.1 COMPARING PROGRESS AS A RESULT OF STANDARD OF CARE THERAPY WITH THAT OF MASEKITLANA THERAPY
5.4.2 CHANGES IN EMOTION LEVELS OF PARTICIPANTS
5.4.3 LIMIT SETTING SCORES OF PARTICIPANTS AS THERAPY PROGRESSED
5.5 CONCLUSION
CHAPTER 6 QUANTITATIVE DATA ANALYSIS AND INTERPRETAITON
6.1 INTRODUCTION
6.2 INDIGENOUS KNOWLEDGE SYSTEMS AND THE NEED FOR INDIGENOUS PSYCHOLOGY: REFLECTIONS ON PARTICIPANTS’ RESPONSES TO MASEKITLANA AND THE ROBERTS-2 TEST
6.2.1 ZULU ANCESTRAL SPIRITS, BEWITCHMENT, COSMOLOGY AND RITUALS
6.2.2 ILLNESS AND PSYCHOTHERAPY IN THE AFRICAN INDIGENOUS CONTEXT
6.2.2.1 African animism and illness
6.2.2.2 Traditional African healers
6.2.3 CHRISTIANITY
6.2.4 COMMUNITY CONNECTIVITY, FAMILY NEED AND ATTACHMENT
6.2.5 DISEMPOWERMENT AND LANGUAGE
6.2.6 MORAL AUTHORITY AND CONFLICT WITHIN CHILDREN’S HOMES
6.2.7 SCHOOLING CONCERNS
6.2.8 EVERYDAY CONCERNS
6.2.9 EXPRESSED EMOTION
6.2.10 CONTRADICTORY VOICES
6.2.11 MASEKITLANA AND AFRICAN SYMBOLISM AS IT INFORMS PSYCHOLOGICAL THERAPY IN AFRICAN SETTINGS
6.2.12REFLECTING ON THE RESEARCHER’S ROLE
6.3 CONCLUSION
CHAPTER 7 CONCLUSIONS AND RECOMMENDATIONS
7.1 INTRODUCTION
7.2 SUMMARY OF FINDINGS
7.3 BUILDING A CONCLUSION: ADDRESSING THE RESEARCH SUB-QUESTIONS
7.3.1 SUB-QUESTION 1: HOW DO CHILDREN INFECTED WITH AND AFFECTED BY HIV/AIDS RESPOND TO MASEKITLANA IN THERAPY?
7.3.1.1 Masekitlana stimulates a full body response 212
7.3.1.2 Masekitlana as a form of narrative therapy resonates with Zulu story-telling
7.3.1.3 Masekitlana is symbolically significant for children of Zulu origin and culture
7.3.1.4 Masekitlana satisfies children’s need to play
7.3.2 SUB-QUESTION 2: WHAT MEANING DO CHILDREN LIVING WITH AND AFFECTED BY HIV/AIDS CONSTRUCT FROM THEIR EXPERIENCES WHEN PLAYING MASEKITLANA?
7.3.2.1 The expression of African belief systems 216
7.3.2.2 Participants’ expressions of belief in Christianity 2
7.3.2.3 Community connectivity, family need and attachment
7.3.2.4 Disempowerment and language
7.3.2.5 Conflict in Children’s Homes, moral authority and creation 2 of order within society
7.3.2.6 Everyday concerns
7.3.2.7 Internal processes
7.3.3 SUB-QUESTION 3: HOW MIGHT NEW KNOWLEDGE ON THE USE OF MASEKITLANA IN THERAPY INFORM LITERATURE AND RESEARCH ON THE RELEVANCE, IRRELEVANCE OR PARTIAL RELEVANCE OF INDIGENOUS KNOWLEDGE IN THERAPY?
7.4 PRIMARY RESEARCH QUESTION:HOW CAN INSIGHT INTO THE USE OF MASEKITLANA IN THERAPY WITH CHILDREN AFFECTED BY AND INFECTED WITH HIV/AIDS, INFORM NEW KNOWLEDGE ON THERAPEUTIC TECHNIQUES?
7.5 TRUSTWORTHINESS OF THE STUDY
7.5.1 QUALITY CRITERIA OF QUALITATIVE RESEARCH
7.5.1.1 Plausibility
7.5.1.2 Credibility
7.5.1.3 Transferability
7.5.1.4 Dependability
7.5.1.5 Confirmability
7.5.2 QUALITY CRITERIA OF QUANTITATIVE RESEARCH
7.5.2.1 Validity
7.5.2.2 Reliability
7.6 RECOMMENDATIONS
7.6.1 RECOMMENDATIONS FOR PROFESSIONAL PRACTICE
7.6.1.1 Looking at indigenous psychology in the HIV therapeutic 238 environment
7.6.1.2 Children’s knowledge of and expression of factors influencing 240their lives
7.6.1.3 Living in Children’s Homes and Ubuntu
7.6.1.4 Time and rapport in therapy
7.6.1.5 Client self-reflection
7.6.2 RECOMMENDATIONS FOR TRAINING
7.6.3 RECOMMENDATIONS FOR RESEARCH
7.7 CONFIRMATION OF ASSUMPTIONS
7.8 LIMITATIONS OF THE STUDY
7.8.1 ROLE OF THE RESEARCHER
7.8.2 LOSS OF CULTURAL AUTHENTICITY
7.8.3 TRANSLATION CONCERNS
7.8.4 LOSS OF TRAUMATIC CONTENT
7.8.5 SMALL SAMPLE SIZE
7.8.6 SOURCES OF BIAS
7.8.7 CHALLENGES OF RESEARCH WHERE THE RESEARCH TEAM IS AFFECTED BY HIV/AIDS
7.9 STRENGTHS OF THE STUDY
7.9.1 THE USE OF MIXED-METHODS DESIGN AND CRYSTALLIZATION IN
SINGLE-SYSTEM RESEARCH
7.9.2 SINGLE-SYSTEM DESIGN PROVIDES ITS OWN CONTROL
7.9.3 REVELATION OF AFRICAN BELIEFS AND AN EMIC APPROACH TO
PSYCHOLOGICAL THEORY
7.9.4 MASEKITLANA IS A SIMPLE FORM OF INTERVENTION
7.10 POSSIBLE CONTRIBUTIONS OF THE STUDY
7.10.1 ADDITION TO INDIGENOUS KNOWLEDGE
7.10.2 ENCOURAGEMENT TO OTHER PSYCHOLOGISTS AND ALLIED PROFESSION
7.10.3 RESILIENCE OF CHILDREN
7.10.4 HIGHLIGHTING CONCERNS IN SOUTH AFRICA
7.10.5 GUIDELINES FOR CHILDREN’S HOMES
7.11 CLOSING REFLECTIONS