Case Studies

The following is a case study of Dr Adilia Silva, a clinical psychologist based in Kensington Johannesburg.

We chat with Dr Adilia Silva about why she became a psychologist and everything private practice management related.

What made you decide to become a psychologist.

As a little girl, I said I wanted to be a psychologist, not a clinical psychologist because I didn’t know the difference. I did want to understand human behaviour, it was always a thing for me. Yes, there was the health aspect, but it was more about understanding people. That was my little girl dream.

Around standard four science started becoming important in my life. And I started thinking maybe genetics would be something I would enjoy or medicine. But psychology was always at the back of my mind. I wanted to understand people and grasp the complexity of human nature.

How long do you have to study to become a clinical psychologist

Yeah so it’s a bachelor’s degree, which takes three years. In my case, I have a degree in science and came from that route. But people can join the psychology program from different routes, some come from BA and Bcom routes. You don’t need to know in the first year that you want to be a psychologist, but as long as you take psychology that’s all you need. Once you have completed the three years bachelor’s you go into a selection process based on your academics for the Honor’s Program.

In order to practice as a psychologist, you need to complete your Masters. The application and selection process for the Masters program is based again on your academics as well as you as a person, it is rare to be accepted into the program on your first attempt, especially for the clinical counselling program. You will also need to apply to Master’s programs at several universities.

Without a Master’s degree, your job opportunities are limited. You can do another six months where you will then qualify as a registered counsellor or a psychometrist. This allows you to practice but you will not be able to practice as a psychologist. What some of my colleagues did is they started out as registered counsellors while they were applying for Masters so that they could earn an income in the meantime.

Would you say that the Master’s selection board is looking for maturity and people that can make a valuable contribution to the field?

Definitely, you need to be mature, you need to experience life. So yes, you can be young and get in, but you have to have had certain experiences. It is about maturity level it is about for me, it’s how much you can walk in the other person’s shoes with them. So it’s the empathy, how much empathy have, you actually got to be able to do this work? And if you haven’t had a lot of life experience, there’s not much empathy.

When you qualified as a clinical psychologist did you have to do a internship or community service?

I had to do my internship, and then I had to do my Com Serve. So my community service, both are government positions. You apply to the government and they position you. So my first position was at a psychiatric hospital. I worked at Sterkfontein Psychiatric hospital for my internship.

And there were quite a lot of exposures. I’ve got placed in the forensic unit, where we would observe people to see if they could stand trial, essentially. And then I worked with those that couldn’t stand trial, they would be were taken back to Sterkfontein and I would do therapy with them. Then I went through the acute and chronic male and female units. So essentially, it’s people that are in crisis, and those that have had long-standing disorders.

So I worked at Sterkfontein during my internship. And then during my Com Serve, I worked at a General Hospital, again, government, and I got to see a whole different side of things. Great experience, but also very eye-opening. In terms of what is available. So what services are available in a hospital? And then what resources should I say aren’t available.

What were some of the challenges you faced in your Com Serve year?

It was very difficult because you need to do short term therapy. It can’t be long term, you can’t be developing this huge internal dialogue and awareness and all of that kind of thing. It’s quick. These are the coping skills, boom, 123 Get out and we don’t have time. There’s a waiting list is all of this kind of thing.

And then, unfortunately, at the hospital I worked at there were a lot of attempted suicides. So over the weekend, the hospital would get filled, with attempted suicides. On Monday morning, we would almost like triage the psychological ward. Who’s has to stay and be admitted who is fine to go home, who needs just quick therapy or all those kind of things? With limited resources, and that was difficult. There was also a lot of stigma. People saying I don’t want to see a psychologist. I’m not crazy. Kept coming up. And I would think of, no, that’s not the point. You just tried to kill yourself. You are not, crazy. It’s just life is hard right now.

At what point did you decide you want to go into private practice.

Well, I went from Com Serve straight into private practice. At that point, it was either being an academic again, which was not going to happen, or there’s no job for me, then I was like, Whoa, private practice. Deepend here I go it was very scary. I did not know anything I didn’t know that I’d actually be a business person on top of being a psychologist. Or that I had to know about accounting, didn’t know about all of these things, and, registering with medical aids there are so many facets that it’s mind-boggling. Yeah. Scary.

So, did you think academia prepared you enough for private practice?

Just in terms of time management, having a lot of balls juggling at the same time. That helped me a lot. Also, I knew by then that I needed to already be networking. So academia did help me know that I need to network and how to juggle many balls at the same time.

How do you manage unpaid accounts in your practice?

Well, every year, I always have that unpaid amount. My plan for this year is actually to say to any new people that come into my practice. If they pay me via EFT they actually pay me before the session. Because that’s what I found that people don’t pay me. Because they walk off, I don’t have to pay. And I’m not going to do EFT I’m not going back so I don’t have to pay.

Because there aren’t the physical aspects, I don’t have credit card facilities. So it’s EFT or cash. And if it’s EFT, people just walk off on it and don’t have to pay. So that is something that I have almost 10 years down the line, I’ve learned now I need to put a new thing into place and become stricter. So the psychologist is going that I feel for this person. While the business person in me is going I can’t run at a loss anymore.

If there was something that you wish someone had told you or showed you before you started in private practice what would that be?

Along those lines, how do I keep, my files? Where do I keep my files? What do I do with them? So I know we have to keep them for seven years, and so forth. I mean, there are exceptions with all of these kinds of things. But generally, just someone who would sit with me and talk about those things, the practicalities of the files, the admin in terms of the patient notes of those aspects.

I thought, it’s like when you are a student when you do your Com Serve, all of that, you do your notes, as you’re talking to the person in private practice, you can’t do that. That you’re doing all that stuff in your own time. So I’m not even talking about just the billing and all that it’s the actual other aspects of the work. And I wish someone would have sat with me and said, Can you actually need a plan? Yes, you need to set up time and block out time for that. Because otherwise, you won’t get to it.

Contact info for Dr Adilia Sliva Clinical Psychologist

Mobile Number :: 060 479 9823

Email Address :: [email protected]

Practice Address ::  32 Good Hope St, Kensington, Johannesburg, 2101

Website Address :: www.asfsilva.co.za

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