The following is a case study of Ingrid Nagaya, a clinical psychologist based in Fourways, Johannesburg
It’s really nice to have you on board just to talk about private practice and being an clinical psychologist and everything around that.
What is a clinical psychologist?
A clinical psychologist is somebody that has a master’s degree, and has been trained in a psychiatric hospital for at least six months. So inside South Africa, we have to have at least a master’s degree and then it’s more about where you do your internship. The other thing about clinical psychologists that distinguishes us from the rest of the psychologists is the fact that we have to do community service. So over and above, internship, we do community service. Which is where we get placed at a medical hospital and have to do another year on top of all of the other training.
What clinical psychologists actually concentrate on is assessing, diagnosing, and managing or treating disorders in particular. Clinical conditions such as schizophrenia, depression, anxiety, for example. obsessive compulsive disorder, learning difficulties, those kinds of things.
Did you always know you wanted to be a clinical psychologist?
Ingrid :: I guess I’ve always wanted to be in the helping professions. So if I were not going to be a psychologist, I would have probably been a teacher. I’ve always wanted to make a difference and help. Clinical Psychology wasn’t really my choice I just wanted to be a psychologist. The university that I attended, selected me for the clinical programme. And that’s kind of like how it happened.
Shaz :: The university that you attended, selected you for the masters programme. From that I am assuming that clinical psychology is then a lot more specialized than the other branches of psychology. Am I right?
Ingrid :: Well anytime you go get into a psychology programme at masters level you have to be selected for masters. So educational psychologists, counseling psychologists, all have to be selected in because it’s quite a stringent programme. The difficulty with clinical psychology in particular, is because you have to do a minimum of six months to a year in a psychiatric facility. It’s very much tied to the academic hospitals, because you have to go there in order to be able to fulfill that part of the requirements. And so it’s quite difficult to be able to get placements, not because there isn’t enough of a need for clinical psychologists but rather because the placements are so scarce.
Did you have any role models growing up that shaped your decision to go into psychology?
I’ve had lots of role models over the years. I’ve always been involved in volunteer work, whether it’s been with St. JOHN Ambulance Service, all the way up to a youth program in the area that I grew up in, and then also working with ChildLine.
So over the years, I’ve been exposed to many people that really just wanted to help. And I suppose they were all my role models, different types of people. I guess the other thing would be that I grew up in quite a religious family. And so, you know, being part of a religious community means that there’s always, outreach work and helping others. So, lots of role models, no one in particular, that would have inspired me to be a clinical psychologist, except when I get to university level and then that I had a particular supervisor who was just absolutely amazing. And I wanted to be just like her when I grew up.
How long have you been in private practice?
Goodness me? So 2004? That would be 17 years in private practice?
So, before going into private practice, I was actually employed by Tara hospital. So I worked in a multidisciplinary team, I had, you know, lots of support around me from the psychiatric nurses to a medical doctor, and an occupational therapist, and a psychiatrist. You know, there was just absolutely an amazing team of people.
So going into private practice initially was very, very scary to go from such supportive environments to out on your own in the cold. So yes, it took a lot of courage in order to be able to step out of that. The wonderful thing in terms of working in a psychiatric facility like Tara hospital is that because it’s an academic hospital, there’s always a great deal of teaching and mentoring through the process in terms of actually becoming, more confident in that.
I think the thing that made me want to go into private practice is most certainly wanting to pick the type of people that I wanted to work with. At Tara hospital I worked predominantly with adolescents and eating disordered patients. I decided a long time ago that I wanted to focus on young adults all the way up to older adults. And I felt that that was where I could make the most amount of difference and the people that I was incredibly passionate about.
So it was almost as if the experience at Tara hospital and community service definitely edged me forward in terms of wanting autonomy and independence. I do believe that it was also a phase of life where I was looking at getting married and having my own family. And that kind of stuff where it it required a little bit more of my time to belong to me.
Did you have any challenges when it came to setting up your private practice?
Working in psychiatric hospital means that you don’t work as a private practitioner at all. You don’t have to bill, you don’t have to have a practice number. You don’t need to know anything about medical aids because, there’s a whole department that does that kind of stuff. All you have to do is show up, do your clinical work to the best that you can, and you move on to the next patient.
Private Practice was something else Oh, my goodness. I’m not quite sure I would have survived if I didn’t have an amazing supervisor at the time, who helped me through quite a lot of that stuff. I would say the first challenge was, you know, once you make the decision to move into private practice, where do you practice from. Which area do you want to be in geographically, I mean, What do you want to focus on? What are your areas of interest? There are just so many questions you have to ask yourself, and it was a lot, it was overwhelming to begin with, yes.
What does a clinical psychologist do?
So predominantly, psychologists offer the talking method. What we provide for people is a safe space that they can talk through their issues and talk through their difficulties. We offer a little bit of guidance. But more importantly, what we offer is objectivity. So that’s the difference between a clinical psychologist and let’s say, for example, a good friend. Yes, your good friend is going to listen to you. Objectivity may be questionable, because your friend has an emotional relationship with you. So being on the outside with the your client, or your patient’s best interests at heart is what we offer is a safe space to explore what the difficulties are, and provide support during that time.
When would someone reach out to a clinical psychologist?
I think, most often than not, when people get to me, they have exhausted all other opportunities and options. I’m talking about, okay, they’ve tried the self help books, and then they can’t understand why the self help books are actually not helping. So yes, they grasp the concepts, but how do you then apply it to your life? And why is it just not working in terms of a cut and paste.
The other reason that people would reach out is, for example, they just feel completely overwhelmed. And they really don’t know where to begin. They know they’re unhappy about something, or they feeling very uncomfortable, but they’re not quite sure where to begin.
And then on the other hand, you get people that come in specifically for a reason. So then they’re very clear about why they come into the space initially, it may be because they are dealing with a specific difficulty that requires objectivity. And they feel like they don’t want to burden other people in their lives by offloading all of this, this stuff onto them.
What kind of advice would I give? I think that it’s so important for you to be able to develop a relationship with your therapist or with your psychologist. So the most important thing for me anyway, is the fact that you feel comfortable with this person. And you feel as though this person is going to have your best interests at heart. Everything that they do going forward then would be with the intention of making sure that you know, they have your best interests at heart.
So being comfortable is 100% one of the first things that you’re looking for. It should actually be somebody who’s close by not somebody who is, a mission to get to so it makes it difficult to get to therapy. If you have to, drive a huge distance or it is inconvenient from the point of view, it’s outside of your, realm of control. In terms of it can’t fit into or outside of your working hours. So the person needs to be accessible to you, from a distance point of view. And from a time perspective, it needs to be somebody that you can build a strong secure relationship with, that’s based on trust and respect.
What advise would you give someone who is thinking of becoming a psychologist?
So I think each practitioner is going to tell you about what’s amazing about their field, right? But what’s amazing about clinical psychology is that you get a vast amount of experience in different areas. So working in a psychiatric facility for me was second to none in terms of how much I learned.
So if that is your passion. And you want to help people that have specifically severe mental illness, absolutely go for it. I do think that you have to work on resilience. Because it does require you to, make sure that you are well, and that you are able to take care of yourself. So that you can take care of your, patients, and, keep that balance. But the most important thing about clinical psychology is that you have to be passionate about this work.
What advise would you give someone who wants to go into private practice?
The first thing that I would suggest is that you need to find you a supervisor. That’s going to help you for the next three years, while you are a junior psychologist. The second thing that I would say is, it’s really important to be able to set up an ethical practice. And a lot of the time when you’re a new practitioner, you learn about the ethical guidelines of how to run, a practice the right way. But, it takes a while to be able to, filter back back into experience, and being able to live that space. That’s where your supervisor helps so much. Because they’ve got an overview on the way that you’re setting up your private practice.
For me, personally, the administration aspect of running the business, that part of the practice was just a drag. Okay, so I outsourced it as quickly as I could. In order to be able to free me up to do the clinical work. So finding the support structure around yourself, not just from a supervisory perspective. But also a network of colleagues that are working in a similar field to you, is always a good idea.
And, just being able to, to find what you need in order to sustain your practice in the way that you would like it to be. So self care is quite important. Looking after yourself, making sure that you’re not working too hard, you’re not applying too much of energy. That’s not giving you the performance that you need.
If you do work in a facility, as well as run private practice, making sure that you have time to rest because clinical work is draining. And you do need to be able to sustain yourself. And, and just having colleagues that you can refer out to makes a huge difference. Unfortunately, private practice is quite insular, it makes you feel like you’re all on your own. Being able to have colleagues that you can bounce ideas like that off is amazing, because otherwise you feel like you’re working in isolation.
Contact Details for Ingrid Nagaya
Ingrid also did an interview with the Moulding Health Team about couples counselling you can listen to that episode here