How to make being a RC a viable career: Is private practice the answer?

Findings of the research highlight how participants were employed in a range of employment settings, listed below:

• 38.91% (n=128/329) were working in private practice;

• 24.92% (n=82/329) were working in education;

• 10.94% (n=36/329) were employed in NGO/NPO/Faith Based Organisations;

• 4.86% (n=16/329) were employed in a Counselling Centre;

• 5.47% (n=18/329) were employed in Corporate working in employee wellness;

• 7.29% (n=17/329) were employed in National/Local government agencies/departments.

• Government agencies mentioned including also South African Police Services (n=4/329), the military (n=2/329) and mining (n=1/329);

• 4.86% (n=16/329) were employed in Health at Hospitals/Medical Centres or in Community Health Clinics; and

• One participant was working at the Medical Research Council.

• Nine participants indicated they were employed provided no employment details.

These employment settings were explored further and findings of the research show that 38.91% (n=128/329) of participants felt private practice was their only option for survival.

Participants described how after their search for full time employment they decided they “had to start” their own “private practice” and be self-employed. Findings of the qualitative analysis

155 also reveal that many participants felt that the limited job opportunities for RCs had “forced them into private practice where we cannot really do what we are supposed to do” (p#518).

Participant #463 explained “After I had searched for full time employment as a RC and discovered that there were few to no positions on offer. I had to start my own private practice and I am now self-employed.” Participant #159 has a similar trajectory:

I am not employed as a RC and it has been more than three years without finding employment. I feel like I have wasted my time because our government does not cater for us RCs. I could not find any work as a RC in any of the places I expected to be employed and so I had no choice but to go into private practice.

The comments of several other interview participants reinforced this pattern. RC#11 avers:

There is a great need in our country and our career is often disregarded and undervalued by our government to permanently employ counsellors. We have to make a living off an NGO salary or need to seek opportunities to go into private practice when the need is greatly with those who struggle to afford private practice rates.

Findings also highlight an internal conflict between what RCs felt they wanted to be doing and what they were actually doing in private practice. RC#11 recounted:

I wanted to work in a community setting. This is what the category is geared towards, but I was faced with having to think about going out into private practice and this was a nebulous and grey area for me as I felt like it did not fit my envisaged role as a RC.

An observation that came through in the findings was the reality that starting a private practice was not easy because “you basically get paid poorly anyway and have to do extra work on the side just to survive” (p#463). RC#1 described:

There are no jobs as counsellors out there, or too few, which is a pity as I do feel there is a lot of work to be done so I started my own private practice. The problem with private practice in a poor area is that mental health is a luxury in many people’s opinion, it’s an extra cost, so what happens is that when money becomes tight, they stop coming for the sessions because people will

156 never prioritise their mental health above their basic needs, they simply

cannot afford an intervention.

It should also be noted that there was some nuanced experience that emerged in the qualitative analysis that represent a diversity of experience. Findings from the qualitative interview analysis reveal variables that seemed to activate whether a participant would experience a thriving practice or a struggling practice. These are as follows:

• Personality - Giving it your all and making it work no matter what: Participant RC#13 explained:

I'm making a very good living and I can't say it's because I'm a counsellor but I can say it's because I’m energetic and goal orientated and when I want something I get it. Yes, I have added to my qualification with short courses and specialisation so as to broaden what I offer but it comes down to the question, are you innovative? Are you creative? I asked myself the question are you prepared to settle for less? The answer for me is no. I have a thriving practice seeing about 50 – 60 people at any time. I have a really bombastic personality and I just decided I was going to make this work for me.

• Joining an existing practice with psychologists: Participant RC#2 had joined a practice, with a psychologist and they worked well together depending on the type of client that came through their practice. “As the years have gone by” he explained, “people have become more familiar with what I do as a RC and the purpose of my role” (p#2).

• Socioeconomic context: Participant RC#21 attributed the success of her private practice to working in a wealthy area. She was:

…working in private practice in quite a wealthy area but I cannot even imagine how hard it would be if you were working in an informal settlement, I mean how do you make that work? That person almost needs a different kind of training.

• Specialisation and becoming an expert: Participant RC#18 had “become a trauma expert and I am working in a wealthy suburb.” Participant RC#12 described how specialisation opened a lot of doors for her and allowed her to have a private practice that really supports her.

157 Focus of a work week

Zooming back out from the findings around private practice, the results of the research highlights the professional activities that RCs reported being involved in. They described the focus of a work week saying that most of the time they were involved in one-on-one counselling, less often psychoeducation and mental health promotion, sometime psychometric screening and assessment and seldom group work. RCs reported spending even less time designing community mental health intervention to address mental health challenges, research and training or presenting workshops for Continuing Professional Development (CPD).

Scope of RCs mental health care and psychological services.

Results of the research revealed the scope of RCs mental health care and psychological services. 86.6% (n=451/521) of participants provided general one-on-one counselling; 67.9%

(n=35/521) provided trauma/crisis counselling; 56% (n=292/521) were involved in bereavement counselling; 55.9% (n=291/521) counselled youth; 51.2% (n=267/521) of participants counselled women; 48% (n=253/521) counselled children; 45.3% (n=236/521) provided counselling in groups; 44.3% (n=231/521) counselled men; 23.8% (n=124/521) provided HIV focused counselling; 16.1% (n=84/521) provided community based counselling with FAMSA, life line or other community based counselling services; 15.2% (n=79/521) provided gender/sexuality focused counselling; 12.7% (n=66/521) provided remote counselling services; and 4.8% (n=25/521) were involved in counselling in correctional facilities. This data is illustrated in Figure 5-12.

158 Note: The number of different combinations of counselling services by each participant varied the frequency therefore exceeds 100%.

Figure 5-12 Types of counselling participants provide