April is Autism awareness month, and the 2nd of April is World Autism Awareness Day, so what better time to learn more about the disorder? – Sable Leicher

Autism is officially classified as Autism Spectrum Disorder (ASD), and includes what was previously known as Asperger’s Disorder. The use of the word “spectrum” indicates that people with ASD can have a range of symptoms and behaviours, and some may need more support than others. Often, the labels “high functioning” and “low functioning” are used to describe the way people with ASD present, and to explain the kinds of support they require. “High functioning” individuals have fewer support needs, and may be more independent than those who are classified as “low functioning.” Some individuals with ASD have cognitive delays and learning difficulties, while others may function at a normal or even heightened cognitive level (previously known as Asperger’s Disorder).

ASD is a developmental disorder, which means that it begins in childhood and occurs across all stages of development into adulthood. Approximately 1-2 in every 100 people have ASD, with varying support needs. This makes ASD one of the most common developmental disorders in the world. However, despite the fact that 2% of the world’s population is on the spectrum, scientists and doctors still know very little about what causes ASD. It seems to be that there is a genetic component to the disorder, and ASD does seem to run in families. However more research is needed to understand exactly what the genetic link is. Furthermore, risk factors for autism include older parental age and parental substance abuse. Many people may have heard the claim that vaccines cause autism, however there is no scientific evidence to support this idea.

Although we don’t know exactly what causes ASD, we do know what signs to look out for, and spreading awareness of these signs can assist in earlier identification and intervention for children with ASD:

  • Difficulty in forming and maintaining social relationships: individuals with ASD often struggle to understand the social norms that others live by. This makes it difficult to maintain friendships and communicate with peer groups.
  • Difficulty in understanding nonverbal communication: maintaining eye contact, reading facial expressions and gestures, and subtle changes in voice (such as sarcasm) are difficult for individuals with ASD.
  • Repetitive behaviours: this is also known as “self-stimming” (self-stimulation). This includes repeated motor movements, repeated use of an object or toy, or repeated speech sounds.
  • Insistence on sameness: individuals with ASD often adhere to a strict routine, and have important rituals that they must follow.
  • Sensitivity to sensory inputs: sounds, lights and textures may feel overwhelming, or the individual may be less sensitive to sensory inputs and need heightened stimulation to get a response.
  • Concrete thinking which causes difficulty in engaging with symbolic or imaginative play.
  • Fixated interests: individuals often have interests which seem unusual to others. These “obsessions” may help the individual in soothing their own anxieties.
  • Difficulty with language
  • Anxiety and depression.

The symptoms of ASD are seen across developmental stages, but may present differently for adults and children. Adults may have learned coping strategies to assist them with social communication and sensory overload. These social and sensory difficulties may also cause children difficulties in a mainstream school environment, and may cause adults difficulty at work. Additionally, due to a lack of understanding of what ASD is, often families are treated with stigma, and individuals with ASD are isolated.

Additionally, considering the high rates of HIV/AIDS in South Africa, health practitioners as well as teachers and childcare workers should be aware of the effects of HIV/AIDS and ARV’s on children’s development. Developmental delays may result from HIV/AIDS and related treatment, or may be a result of a developmental disorder such as ASD. This means that it can be difficult to diagnose ASD, and highlights the importance of being aware of a child’s context. However, early identification and intervention of ASD is crucial in assisting a child to develop to their full potential, and practitioners should not overlook the possibility of ASD even when other factors are present.

Finally, it is important to remember that each person with ASD is unique: each individual has their own place on a complex spectrum. This means that what is difficult for one individual with ASD may be easy for another. Dr. Stephen Shore, who is on the autism spectrum himself, has said: “If you’ve met one individual with autism, you’ve met one individual with autism.” We should be sensitive to each individual’s unique strengths and weaknesses, and approach individuals with ASD with empathy and kindness.

Helpful Resources:

  • Autism South Africa:


011 484 9909



TALKING ABOUT PREGNANCY “You can hear now. Your inner ear is formed. I shout “I love you!” into the bedroom. Then I feel stupid. Then I don’t.” – Suzanne Finnamore, ‘The Zygote Chronicles’ -Amy Shirley

Pregnancy is often spoken about as a time of excitement, joy, worry and dreaming for the future. Whilst this is often true, pregnancy is also a time of immense physical, hormonal, emotional, and psychological upheaval. This is not just for the prospective mother, but the father, siblings and (yes!) the developing embryo as well.

As is often said, it is with good reason that the gestation period is as long as it is. Time is needed for the woman, and her family, to prepare for the arrival of a newborn. This is not just in terms of being able to buy baby clothes and to perhaps paint a room, but rather to prepare for the impending changes in mind, body and lifestyle.

During the months of pregnancy, prospective parents may spend time dreaming about what their child may be like. Who will this baby look like? Will they take after their mom or dad? And the less easy, will my baby be okay? Will I love this baby like I do my firstborn? What kind of mother or father will I be? Am I ready? Will I make the same mistakes that my own parents made with me? A new parent moves away from being just a daughter, sister, a son or brother themselves, to embracing the new identity of ‘mother’ or ‘father’. This can be a daunting transition for some.

It is normal for pregnancy and birth to be a period of ambivalence. It is common to have fears, anxieties, questions, and uncertainties alongside feelings of excitement, happiness and expectation. In truth, it has been understood that if someone is unable to allow themselves to be aware of their feelings of ambivalence about an impending newborn, that it may be more difficult for them to adjust to the reality of life with an infant.  During the pregnancy, a father often has to negotiate and find a space for himself, where he is able to feel a part of what is happening to the mother’s body.

There are of course circumstances that may make pregnancy a more difficult time. Challenges such as an unwanted pregnancy, the amount of support a pregnant mother has, her relationship with her own mother, the impact of her own unprocessed trauma, what this foetus may represent to their mother, physical health of mom and baby, poverty and the like. Pregnancy is naturally an emotional and vulnerable time. It is important that a pregnant mother acknowledges these difficulties, and seeks assistance where needed.

For the developing infant, the time in their mother’s uterus is constant and stable. Nutrients, oxygen and warmth are all constant, and no pleas have to be made to obtain anything that is needed. Following the process of birth, a newborn will have to quite quickly learn how to communicate their needs to a caregiver who is just starting to begin to understand the uniqueness of this baby. By the fourth month in utero, a foetus has developed the capacity to hear. The sounds of their mother’s heartbeat and breathing, her voice, all penetrate the cocoon of the womb. This can provide a sense of comfort for the infant, and newborns can often be soothed by their mother or father’s voice.

Pregnancy is indeed a time of transition. This time can be negotiated if prospective parents are able to think about what feelings they are experiencing throughout the process, acknowledge their ambivalence, embrace the joy and the difficulties, include each other and any older siblings, and access assistance if it’s needed.

Pregnancy Facts:*

  • The longest pregnancy recorded was over a year long
  • Progesterone is a hormone that creates a natural lethargy, leading pregnant woman to be less active, and protecting the developing foetus
  • The amount of blood pumped by a pregnant woman’s heart increases by 40 – 50%
  • The walls of the ventricles of your heart get thicker, in order to pump this increased amount of blood
  • Pregnant woman’s sense of smell becomes clearer
  • A foetus’ capacity to hear is fully formed halfway through pregnancy
  • In-utero, the foetus develops the ability to yawn, cry, and some have been observed putting their thumb in their mouth

*Pregnancy Facts from Parents24 https://m.parents24.com

*Eastwood, L & Hamburger, T (2004). Thinking about the early childhood Training Manual

Parenting through Encouragement and Praise

Parenting is a universal experience and yet can seem so different for every family, culture, country and context. The nuances that make this experience of raising a child so unique include what the parents or caregivers bring of themselves to the relationship, as well as the unique circumstances that the caregiver-child dyad find themselves in. However, there is a common denominator to the experience of parenting: it is hard, and often a thankless or judgmental space to be in.

At Ububele we understand the difficulties of parenting. We offer an 8-week parenting program called The Incredible Years, tailored for parents of children between the ages of 7 and 14 years.
Being a parent requires a fair amount of honesty (at least to yourself), so let’s begin by admitting that we felt as humbled to run a parenting course as we did to write a blog about it. There are a range of judgements and stereotypes that can make being open and honest about the struggles of parenting so difficult.

The 7 to 14 year-old period is a challenging time in a child’s development and requires adjustment from the entire family if it is to maintain a healthy balance. Apart from starting ‘big’ school and the homework that comes with it, children in this age group are undergoing cognitive, emotional, and biological changes that could leave parents feeling under-equipped. Cognitively, this concrete operational phase sees children developing an understanding for concepts such as time, space, and quantity. They are able to start thinking theoretically, hypothetically, and counterfactually. From the age of 11 years and older, strategy and planning become possible.
These changes sound marvellous but some parents come to Ububele asking for assistance with children who may be experiencing behavioural difficulties. These parents can feel overwhelmed when their children’s capacity to strategize and execute actions far exceed their reflective and planning capabilities.
Apart from learning to read and write, do sums, and gain independence, children’s peers gain greater significance and act as major moderators of children’s self-esteem. This sounds healthy but if your child is experiencing academic difficulties, bullying, or conflict in the home, they may be vulnerable to relying on negative peer influence and other risky behaviours to regulate their suffering self-esteem. Add stressed parents, generational trauma, poverty, unemployment, and poor access to health services to the mix, and the relationship between parents and children becomes strained, sometimes even destructive.
The Incredible Years Parenting Program, facilitates a positive bond between parents and children by advancing the social and emotional behaviour of children through caring and positive parenting. This program aims to promote social and emotional learning, emotion regulation and problem solving with parents. The program ultimately strives to prevent the onset of delinquency, drug abuse, and violence among an at-risk, vulnerable population and grow children into competent, secure, and responsible adults.

One of the topics is on praise and encouragement. Through this, amongst several other topics, the Incredible Years Programme aims to aid parents in fostering a positive relationship with their children.
Now these words (praise and encouragement), may seem quite removed and some parents might think this is being too soft on their children or spoiling them. Such myths around praise and encouragement can form barriers to really motivating and encouraging children to not only persist with difficult tasks but to make them independent beings who can initiate tasks, and be responsible. Most importantly, praise and encouragement can provide nourishment for the child’s self-esteem and confidence, something pivotal to this age and later as they enter adulthood.
Erik Erikson would argue that if children’s initiative is not encouraged, supported, and praised they may begin to feel inferior and doubt their own abilities. Moreover, if a child’s actions, efforts and initiatives are met with negativity, criticism and punishment, they may never develop intrinsic motivation. What they may develop, however, is poor self-esteem and a poor self-image which carry far-reaching negative consequences.

Praise and encouragement are drip-feeds of positivity, which can be welcomed by parents who may feel overworked, underappreciated and as if their days are made up of fatigue, and the stresses that come with being a parent. A chance to step back and appreciate the child’s efforts, and their ability to perform a task or persist with something difficult such as homework or a class project provides an opportunity to really get to know one’s child. As each family is unique, so is each child and this form of parenting may look different for each parent and child.
What may work for one child may not work for another. One child may take more to verbal praise such as “I appreciate you helping me set the table for dinner” or “Well done, it seems like you put a lot of effort into your homework today”. Others may require a more hands-on approach, or the introduction of tangible rewards to reinforce a certain behaviour. For example, a teenager comes home late. The parent wants the teenager to come home at a reasonable hour because of safety concerns and so that they can help with supper preparation. The conversation could go something like this, “I can see that you are coming home late, and I hope that we can agree that you come home by 4pm so that you can help with supper. If you do that I can give you extra money for the weekend so that you can buy something you like.” If a child is trying to fulfil such an agreement, praise can be used to encourage the behaviour you want to see “Thank you for coming earlier today, I can see that you are trying hard to keep to our agreement”. Sometimes effort needs to be praised, to continue to foster and grow the child’s responsibility.
Parents can use a single word to provide praise and feel that this might cover all that is needed. What is important is not particularly the words that are used, but rather that the statement highlights and acknowledges the desired behaviour, e.g. making one’s bed or getting up early without being asked, and shows appreciation for it, e.g. “thank you for…” or “I appreciate that you…”
It is important to avoid pitfalls such as being sarcastic or undermining the praise with something negative. These are examples of this kind of undermining: “Thank you for coming to the table for supper on time, but it would have been nice if you washed before coming to the table – you are so dirty” or “Wow! You actually made your bed! I wish you could do this everyday!”. Always try to be authentic and sincere when praising and encouraging your child.
A helpful way to really ensure one’s effectiveness in praising or encouraging, is to imagine how a child might feel or think from the interaction, and ultimately what the child may take away from it. Will it make them feel good? Will it communicate that their efforts are valued? Will they come away from it knowing that their parent or caregiver sees them and the efforts they make?
Praise and encouragement can often make a child feel seen and heard, which is a powerful and meaningful way to build on the relationship. If one is seen and heard this has significant implications later, such as healthier self-esteem and self-image which encourages one to persevere even when things get tough.

The external world presents many varying challenges for young children, so it is important to really strengthen the connection between caregiver and child. This connectedness truly grounds a family throughout many crises, and builds resilience in individuals and robustness in the family to keep relationships healthy and intact despite the circumstances. In a world of negativity and hardships, praise and encouragement can be a beaming light and positive energy that truly makes an impact.
Some parents might be reading this and thinking that this seems almost impossible to achieve. There is no time between work, getting the children to and from school, feeding them, and ensuring they have clean clothes. We know how busy and tiring it can be to be a parent especially if you are managing a household on your own or have more than one child. However, you need only take small bites of the ‘elephant’ before tackling it entirely.

This topic of praise and encouragement proved to be quite difficult for parents to receive on our most recent parenting course. Have you ever noticed how we (parents and non-parents alike) tend to notice and commit to memory negative experiences more easily than positive ones? One of the most challenging tasks in my (limited) experience with working with parents is to get them to shift their focus from their children’s problem behaviours, to reframing positively those behaviours which they would like to see more of. In this case, the moral of the story is ‘less is not more’. Here is an example with parents focusing on behaviours they want to see less of:
“We don’t want to see our daughter listening to music on her earphones all the time”.
Granted, this may be annoying for several reasons, but after challenging this perspective in a parenting course, parents’ focus will hopefully shift to the behaviour they want to see more of:
“We want to have more conversation with our daughter, so we can feel connected to her. Having her earphones in her ears all the time feels like it gets in the way of that”.
As you read the example above, you may have felt some sort of emotional contrast between the two sentences? Maybe, maybe not. Perhaps the two sentences are open to cultural scrutiny, perhaps not. This is a thought that each parent can explore for themselves and decide what is best for their family. The choice however, may affect how you react to the outcome of each of the above. The second sentence is constructive and invites an attitude of encouragement and praise when the child refrains from using earphones all the time at home. The daughter’s refraining from this behaviour, aligns with the parents’ goals for a closer relationship with their daughter and may be met with remarks of appreciation which reinforces the positive behaviour change. This in turn, leads the child to being intrinsically motivated not to isolate herself from her family through the constant use of her earphones. This is one small example, but the principle can be extended to all areas of the home and school.
Finally, do not forget self-care. Self-care is pivotal in parenting. If you are completely depleted and exhausted, you can feel as if you do not have much to give. But taking time out for an activity you enjoy or to rest can make all the difference. There is no need to be apologetic for this. Allow for boundaries and communicate them to your children. “I have had a rough day and am feeling very tired, so I am going to make some tea and relax for a bit. I will come and help you with your home work after that”. Allowing yourself to take this time to re-centre and connect with your “self” before jumping into the next big chunk of your day is so important.

Jacqui Morgan and Vickashnee Nair – Ububele Intern Counselling Psychologists

Love, Time and Attention

Growing up in the impoverished dormitory township of Chitungwiza, some 30 km south of Harare in Zimbabwe, I understood from the tender age of 7 years, that in the midst of all the daily financial struggles we faced, I was one of the richest kids on earth through the simple gestures of support that my parents showed me. My father, now 83, was a shop floor factory worker on a minimum wage and my mother, 15 years younger, never saw the inside of a classroom, as she was an orphan. With nine children to feed, my parents compensated for their financial lack with extraordinary emotional and psychological support.

My mom fought hard for me to get the best possible education available. I remember one day, when I was in grade one, she went to the headmaster to ask for a month’s grace period on my behalf, while my dad looked for school fee funds. Mr Goto maintained a hard-line stance.,. In that moment I was touched my mom’s tears and the pain she felt for me. It was as if my feelings were transferred to her and she knew exactly what I was going through. She held my emotions and processed them as if they were hers, which brought healing to my soul. After a lengthy conversation, Mr Goto finally agreed, but by then I had already made my first major decision in life: I was never ever going to fail at school (her desire for better education for me would not let me). A promise I have kept to this day.

As with most children, I longed for my dad’s approval of the things I did. One such thing was playing football. I had a deep passion for the game and was good enough to be a key player of a local football club for primary school kids. Even though results differed from game to game, one thing was always constant: the presence of my dad, Philemon, in the stands. The sight of him in the crowd was the most inspiring thing to me, and it still is to this day. His mere presence in those moments, taking time away from his tiring factory shifts, meant the world to me. He would sometimes come wearing his dirty greased overall, a sign that he clearly prioritised watching me play, coming straight from work not wanting to miss a moment’s action. Well, I am neither a psychologist nor a professional footballer, but I can tell that those simple moments are what made my character as a man. They instilled in me resilience and a sense of self-worth that money could not buy. Within those treasured memories is an enormous, deep-seated, and powerful force from which I draw energy whenever I am faced with difficult circumstances. Without saying a word, my dad taught me a critical lesson in fatherhood: have time for your children, be present and be in the moment of what they are doing. A feat I am trying to replicate with my two kids.

It is only when I joined Ububele that I got to conceptualize and understand the theoretical framework behind what I experienced from my parents. Though ordinary people, my parents had an innate and intuitive understanding of cultivating our psychological and emotional faculties as kids while somehow shielding us from the harsh economic realities we were confronted with. It is no surprise that I recently called them, just to say thank you for being there. If all of us parents, especially men, can do the same and give both time and attention, it will surely be a better world.

Ububele’s parenting programmes equip you with the necessary tools required to enable you to not only understand your past, but also to build better emotional and psychological infrastructure for your children.

By: Costan Rungano
Finance and Operations Manager

Our friend Rica Hodgson (1920 – 2018). Freedom fighter and devoted friend of Ububele by Hillary Hamburger

Rica was born in South Africa on the 1st of July 1920. Her adult life was devoted to the struggle for democracy. She was banned, detained, house arrested and exiled by the apartheid government, only returning after 27 years. In her book “Foot Soldier for Freedom”, published when she was ninety, she recounts her remarkable story. At her moving memorial, a true celebration of her life, everyone agreed that she was not a mere foot soldier.

Our paths had crossed in the early days but it was only when she came home that we became close friends and she became a significant person in my life.

By the dawn of the new century our freedom euphoria was diluted by our anxiety over the signs of severe social dislocation. While we had emerged from an oppressive history it was clear that we remained a traumatized nation.
What we didn’t read in the newspapers we heard more directly from the victims. As psychologists we focused on minds that had been warped by 300 years of colonialism and the harsh vicissitudes of everyday life. We set about converting a two story building into a mental health center which we called Ububele, an isiXhosa word which means kindness but which extends to include the idea of compassion and concern for others.

When Tony and I began to think about Ububele our friend Rica endorsed our idea. After a lifetime of service to struggle she had retired from her job as Walter Sisulu’s secretary. When we opened the pre-school in 2000 she was there to help. I cooked for the children then and Rica helped by going to the market to buy a weekly store of vegetables. As we grew and acquired a full-time cook, Rica continued to help wherever she could. She delighted in the children and never missed a graduation and Xmas concert.

Our principal, Mrs.Thembi Motsoane, gave a talk on Alex FM about Ububele in January 2000. She talked about early education and the kind of pre-school we would set up. Within two hours a young mother, Zanele Ndlovu arrived, tugging two little boys, Tshepo and Sizwe, after her.

She told us that she wanted her children to learn and be happy but she didn’t have money to pay us. Both she and the father of the boys were out of work. We told her that she didn’t have to pay but suggested that she help out at Ububele for one morning a week instead.

Zenele brought her two happy little boys to school every morning. We soon became aware of the fact that she stayed on doing all kinds of chores and helping out where ever she was needed. We spoke to her, concerned that she had not understood that we had suggested she work one morning a week. “I want to come everyday”, she answered, “you don’t understand that Ububele has changed my life. I am so happy to be in this beautiful place watching my children”. We understood – Ububele softened the hardship of her life in the township.

Well into the second year when Sizwe was about to graduate we noticed that Zanele was losing weight. Soon Sizwe reported that his mother couldn’t come to school because she was sick. Zanele wasn’t at the end of the year concert when Siswe graduated and when school started the following year Tshepo didn’t return. We were shocked to hear that Zanele had died over Xmas and that both the children had gone to live with Zanele’s mother. How could they possibly deal with this? In the light of this tragedy they needed a safe place to contain and help them to deal with this tragic loss of a loving mother. Added to this was the loss of a familiar and safe haven in Ububele.

We tracked their gogo down and asked her to make an appointment to discuss Tshepo and Sizwe with us.
It was difficult to make a definite appointment as she worked in Pretoria . She would get in touch with us when she had some time off.

A week later we were having lunch in the boardroom. Rica had joined us. While we were chatting and munching away, there was a buzz from the receptionist at the front desk to tell us that the grandmother of Tshepo and Sizwe wanted to see us. We expected a worn-out old gogo to appear. Instead a nifty, youngish woman in the uniform of the S.A. Defense Force appeared.

She introduced herself as Rosie, the gogo of Tshepo and Sizwe . as we shook hands. Then she saw Rica and exclaimed, “Oh my God! Rica! Am I dreaming?” Rica looked slightly bemused as she asked “do I know you?” Rosie responded with excitement. “Yes you do. I’m Rosie from Tanzania. Remember the Solomon Mahlangu Freedom College.” She walked over to Rica and threw her arms around her. Rosie joined us for lunch and told us the following story.

She was 16 years old back in 1976 when the children rose up in Soweto. She had gone back to school after having given birth to Zanele when she was 15. After the uprising she left S.A. to join Umkhonto we Sizwe. Her mother had brought up her daughter Zanele. When she came home again her daughter had grown up. They were strangers to each other. She felt bad that she had left her child. But she had a good job with the Defense Force and was able to help Zenele until she died. Now she would try to be a good mother to her children.

We were all moved by her story and her wish to make reparation. She was warm and engaging as we talked. Rica took all this in her stride as they exchanged stories. We, on the other hand, were left with a sense of wonder and a renewed conviction in the value of Ububele, Rica’s favourite

Rica’s death is surely a time to celebrate a remarkable woman. When she turned 90 she told me lightheartedly that she thought no one should be allowed to live beyond 90. I think that Rica lived much longer than she wanted to, but since we humans don’t have a say in such matters. She faced her old age with grace. The devotion of her loved and loving Spencer, Claudia, granddaughter Tanya and husband Victor, cushioned her frailty and helped her fade away gently.

Reflections of a former intern counselling psychologist

New Beginnings

Every year, unknowing educational, counselling and clinical psychology students depart from the path of student psychologists into the realm of intern psychologists. I ventured onto this journey at the Ububele Therapy and Assessment Centre. I was privileged to have commenced on this trek with three fellow psychology interns. Looking back at the year, I cannot fathom the possibility of embarking on this journey on my own – as many interns at times have to do. The internship year is filled with so many personal, contextual and situational dynamics and challenges. To me it felt important to engage with individuals who were experiencing a similar journey.

Choosing an internship site was in itself a daunting task. I personally applied to sites that were linked to my interests. My reason for applying to Ububele was based on their focus on the importance of attachment, and with it their recognition of the importance of early caregiver-child relationships. The primary focus area of Ububele is thus on infants and young children, whilst I was particularly interested in how the experiences of early childhood impacts and manifests in adult behaviour.
The internship programme at Ububele provided exposure to different forms of interventions. These included the Baby Mat programme, Parent or Caregiver-Infant Psychotherapy, Child Psychotherapy, Adult Psychotherapy, Parenting work, Assessment, and the Bus Play group. I believe that the diversity of programmes provided me with an opportunity to explore my possible passions and interests. I found myself surprisingly pulled into the world of Parent and Caregiver-Infant-Psychotherapy, as well as the potential this intervention has for an individual’s life course.

The reality of the South African context
One of the most challenging, and equally rewarding parts of my internship year, was working within a context faced with many structural inequalities, as well as the implications of those disparities. When I initially decided to pursue a vocation in psychology, I carefully examined the different programmes available. I applied to Wits, because they offered a Masters in Community-based Counselling Psychology programme. Although I was passionate about the potential of individual counselling, I believed more strongly in the criticality and the need for broader interventions that could drive and sustain systemic change on societal and community levels.

My internship at Ububele provided me with the opportunity to work closely in, and at times with the Alexandra community. Our baby mat sessions were held at various clinics in Alexandra, we offered therapy at the Brownhouse at Alexandra Clinic and some of us had the opportunity to do home visits. An intervention that was however particularly close to my heart was the Bus Play Group. It involved us driving to a particular site in Alexandra with the Ububele bus, which was filled with reading material, toys and mats, and engage with the children residing at the site.

I initially felt very excited about the play group, but soon became quite ambivalent about going every week. It was immensely difficult, and I knew I would return to the office feeling both emotionally and physically exhausted, but I also felt devastated when something prevented me from going. The playgroup reminded me of all the different reasons I applied for a programme that was community-based and, yet it was also difficult to work within the reality that many of the children I had come to care for, had to manage daily. I had to remind myself continuously that community interventions require intense work and at times refocus. Of the different play groups, there was one play group that had community input and parental involvement. Though I felt so inspired by this group, it reminded me that different sites could not be viewed through one lens. As such, the team for our playgroup continuously strived to find ways of connecting with the families and role-players and searched for interventions that worked for our children at our site. The experience taught me that there was no ideal scenario, though I found the process to be a deeply enriching experience.

Final thoughts
Though I realise that every intern’s journey will be unique, I’ve taken the liberty to include a few notes that future interns may find useful on this sometimes-turbulent expedition…

Grasp every opportunity
Recognise that every moment during your internship is an opportunity to learn – either about yourself, the workings of the human mind or the dynamics of relationships. You won’t know where you may find yourself in the future, so grasp onto every source of knowledge that those brilliant minds around you are willing to share.

You are the instrument
A central learning during your internship is how to sit with your own emotions and how to work with it in therapeutic relationships. So, remember that you are a human being with emotions! Sometimes you need to honestly ask yourself, whose feelings you are really dealing with in the therapy room, on the baby mat or in the play group and how is it impacting the work that needs to be done.
Writing the transcript

It is not only for supervision… When you are still new to world of psychotherapy, and exploring the potential of your own knowledge and skills, there is nothing more valuable than an honest transcript. Noting the cringeworthy elements of your transcript is most likely one of the most powerful ways to learn. You may not be able to go back in time, but you can do better in your next session.

Appreciate supervision!
It may not always feel nice hearing what other people may have to say about what you do in the therapy room, but being defensive about it won’t encourage learning. During your internship year, any form of critique is a good thing!!! You have the opportunity to think about the critique received, and if you choose to, use it to improve.

Accept the limits of any intervention
Any intervention is likely to have its unique set of limitations. Be willing the accept the limitations of even your most valued intervention, and think about how it could be further improved upon.

Recognise your own limitations
None of us are perfect and that’s okay. You are in your own personal therapy, right?

Support Systems
If you don’t have an amazing support system inside the site, ensure that you have an amazing support system outside of it. Even if you do have an amazing support system inside the site, still ensure that you have an amazing support system outside of the site. Whether your support system comprises of friends or family, make every effort to spend quality time with them.

You, You and You
Know yourself beyond the therapy rooms, corridors and corners of your internship site.
Your internship year requires incredible dedication and work ethic, but ensure that you maintain a balance and can recognise when you are starting to run on empty.
Always remember… Your internship year has the potential to be tough, but so do you!

Lynne Goldschmidt
Counselling Psychologist

Rough and Tumble Play

By Mary-Anne Tandy, Child and Adolescent Psychotherapist

Much research has taken place on the importance of parent-child interactions, including parent-child play. Play offers children the opportunity to develop social competence, learn, explore and build secure attachments across cultures and social groups. Although mothers have been the primary parent, increasingly more emphasis and research is focusing on the relationship between fathers and their children. This includes the differences in play, as men tend to take on play that is more physical while mothers offer a more caring role.

What is rough and tumble play? It is a specific form of physical play, characterized by aggressive behaviours such as wrestling, grappling, jumping, tumbling, and chasing, in a play context [Pellegrini and Smith, 1998]. Physically active play is emerging as a key component of fathers’ influence on children’s wellbeing. Children’s relations with their peers, for example, are rated more positively by their teachers when fathers physically engage with their children (especially boys.) (Macdonald & Parke 1984)

Play is often seen as a waste of time. Many parents and educators hold the belief that the child is not learning anything useful through play. However, children who have little opportunity to play are more likely to become anti-social and disaffected. Furthermore, it seems that children are being given increasingly fewer opportunities to play both at home and school. Hours are often spent in front of a screen of some sort. There are fewer environments in which joyful and exuberant play can happen. The way in which the curriculum is structured with the focus on sitting down, sitting still, being restricted, places enormous demands on a young child at the expense of more “rough and tumble” or physical play.

Rough and Tumble play with a parent may enable children to learn how to decode emotional cues, regulate their heightened emotions, and express their emotions in appropriate ways. Sadly, playing in natural outdoor spaces has been removed from the lives of too many children. They have too few outdoor rough and tumble opportunities. Instead there are play dates and structured sports for more affluent children and a lot of hanging around unsupervised for children who are not.

In a world where children’s mental health problems are on the rise, in particular anxiety and the inability to regulate, fathers’ can take up the role of opening the child to the outside world. Encouraging children to explore or take initiative in unfamiliar situations, be braver, more courageous and stand up for themselves. This play moderates aggression; it enables children to be competitive without being aggressive.

Rough and Tumble play costs nothing, it only takes time and even then 15 minutes will do.



By: Amy Shirley, Counselling Psychologist

There are many people who believe that newborn babies only begin to really become aware of their surroundings and able to interact with those around them after a few months in the world, or when they start walking or talking. In fact, much research has shown that this could not be further from the truth.

“…Newborns come into the world with a wide array of mental skills and predispositions and a set of abilities that are uniquely suited to the critical needs of early life”. (Nugent et al. 2007)

Newborn babies are able to:


Newborns are sensitive to eye gaze from the very start of life.

Newborn babies are able to track / follow objects and faces.

They have a preference for faces over other stimuli, showing how social they are and how geared for bonding.

They also have a preference for their mother’s face, and can tell the difference between their mom’s face and that of a stranger.

They are also, amazingly, able to search the features of the face and use this to find clues about another person’s emotions. And they are capable of copying or imitating facial expressions!


Newborns are able to hear and orientate themselves to sounds.

They are able to tell the difference between their own home language and foreign languages.

They prefer high pitched voices, and can differentiate between the voice of their mother and strangers.

Babies are able to shut out certain environmental noises.


Newborn babies have a highly developed sense of smell.

Babies can tell the difference between the smell of their mother and other people.

They are also able to distinguish the smell of their mother’s breast milk from another’s.


Babies are highly sensitive to touch.

Touch is a primary way that infants are able to connect to their caregivers.

Much research has been done on the positive effects that stroking an infant gently has on the infant’s behaviour, and the relationship between them and their caregivers.


Infants show a preference for sweeter tastes over bitter and salty ones.

They have also been demonstrated to show preferences for some sweet tastes over others.

These incredible capacities of newborns are all geared towards the advancement of the caregiver-infant relationship, which serves one of the primary functions of this early period.  A caregiver’s sensitivity and responsiveness to the needs of their child plays a major role in the development of a secure attachment. Relationships that make children feel safe create a sense of security and confidence impacts on their physical, emotional and cognitive development.

This information is based on: Understanding Newborn Behavior and Early Relationships: The Newborn Behavioral Observations (NBO) System Handbook (2007)  J. Kevin Nugent ,  Constance H. Keefer , Susan Minear , Lise Johnson , Yvette Blanchard.  

Bridging the Gap – The experiences of an Ububele Home Visitor

By:  Khosi Sithole

I was born and raised in Alexandra. I am a mother and I am a home visitor at Ububele, amongst other things. I have been part of the home visiting project for over two years.
One of my neighbours had seen the application form at Ububele and persuaded me to apply. She appealed to my love of babies in order for me to apply. I was not sure exactly what home visiting entailed when I applied for the job. According to the form, they were looking for mothers around Alexandra, women that are warm, understanding, and able to walk long distances, amongst other things. I thought I fitted the bill perfectly as I possessed all the listed requirements.
We were short listed to take part in the training process that lasted for two months. These were one of the most emotional and taxing weeks of my life. The training required participants to be honest and open about their experiences about motherhood, childhood, relationships and feelings. I remember thinking: “What are they trying to do to us? Why are we asked to think about our feelings and thoughts? Why do we begin everyday sitting silently in a circle”? Note that sitting still was one of my biggest struggles, as I was always fidgeting and uncomfortable in the silence.
As the weeks went by, a few people dropped out of the training for various reasons. For most of the training, it felt like being led to a destination using an unknown path. The methods used were completely different to any other training that I have ever found myself in. In the beginning, I felt uncomfortable and unsure because of the manner in which the training unfolded.
None of the participants knew exactly what the panel was looking for at this point in the process. “Please be yourselves and do your very best” that was mostly the answer we got. Wheels in my head would spin as I wondered what if “myself” is not what they are looking for? It became clear to me that the only thing I could do was to be me and in that way I would not regret pretending to be someone that I am not if they did not choose me. I was chosen!
I was part of the second group of home visitors ever to be trained at Ububele. The first group was trained in 2012. Currently there are six home visitors.
It was not easy coming into the field of mental health. The nature of the work requires one to be constantly aware of one’s own feelings, thoughts, and the impact that these have on one’s relationships. I did not know much about infant mental health and its impact on the development of babies. I was one of those people that believed that babies do not understand and that the most important thing was to be physically healthy and being able to provide financial support. I never considered how my own mental state influenced my baby until I came at Ububele. It is common knowledge in my community that you must not breastfeed your baby if you are experiencing negative feelings, as these will affect the baby. I never really took that to heart, as I thought that it was old wives tales. The training helped me to realise that actually it is fact that both negative and positive feelings have an impact on baby’s development and how important it is to be aware of one’s own personal feelings.

Umdlezane is an Nguni word used to describe a woman who has recently given birth. It also refers to the period where the woman who has just given birth is in the care of the females in her family. They would rally around the mother and the baby. It is in this time that they would help the mother with her daily tasks. For example cooking and cleaning the new mother’s house. The women also look after and support the new mother. The need for the mother to be totally with her new baby is of the utmost importance. This facilitates the process of bonding and attachment between mother and baby.
In a place like Alexandra, where many women have their families in the rural areas, the Umdlezane period can be lonely and unpleasant. The support of family in this fragile time is very crucial. This is where the Home Visiting Project comes in. We are not there to take care of the household chores but we are there to support the relationship between mother and baby. We are there to acknowledge, witness, think and reflect on the experiences of mothers in Alexandra in a non-judgemental manner.

The Invitation
It is an honour for me to work in my own community. Alexandra Clinic is where I am stationed, the very clinic in which I was born. Expectant mothers and mothers with infants are invited to the project at the various clinics in and around Alexandra. I stand in front, greet the mothers and have a “talk” with them. Each home visitor has their own style of inviting mothers to the project. I strive to speak about some of the changes that are occurring in their lives as new mothers or as pregnant women. I try to highlight a need for a space to share all the good, the bad, the high and lows and everything in between about being pregnant, being a mother for the first time or being a mother again. It is entirely up to the women to decide if they are interested in being part of the project. The women write down their details and we follow up with them as soon as possible. It is not easy to stand in front of strangers, and speak to them about the value of having a stranger come into your home and allowing them access into your and your baby’s life. There is still an understandable resistance and scepticism from the women. We see this in the number of women who will give out their details but, in the end, they do not take up the visits. We make follow-ups by telephone and set up appointments with interested women. At times, mothers would sign up but change their minds in the early stages of the visits. This is what we call “duck ‘n diving”. It is in the supervision spaces that we get to share our experiences and feelings around the nature of recruitments and think about how best to proceed. These weekly sessions help me to think with my supervisors and colleagues about aspects of a case that I feel has a need for more minds. These two spaces contain me as a container in my supporting of mothers and babies.

The case of Thandi and Thoko
It was in 2015 that I met Thandi and unborn baby Thoko
Thandi lives in a shack with her partner in Alexandra. It was difficult to find Thandi’s home as she stays in the part of Alexandra where the signal is not very good. On other visits, I would phone the mothers to ask them to fetch me from the gate, but in this instance I had to find my own way to Thandi’s home through a maze of shacks. Eventually, with the help of one of the neighbours, I found Thandi.
At the time of our meeting, she was seven months pregnant and a mother to a twelve-year-old boy. The boy stays in the Eastern Cape with his paternal family. She was thirty and the pregnancy was unplanned. This was her third pregnancy. The second had resulted in a miscarriage two years previously. In the pre-visits she communicated her anxiety about the amount of movement that the baby was making. She was concerned that this particular baby seemed to be not very active. Thandi had consulted her doctors and they had told her that the baby was fine and developing well. She would compare this to her prior pregnancies and this would raise concerns for her. This allowed us to talk about the uniqueness of each pregnancy and how this might be an opportunity to see how different baby is. I thought about how movement in the womb is a sign of life and how lack of movement may be interpreted as a sign of death. Given Thandi’s history, it was easy to see why she would be so anxious about the amount of movement in her womb.
From the onset, one of the themes that were carried was of life and death. She revealed her HIV positive status and how she had contracted multi-drug resistant TB. She shared her experience of being in isolation and alone in a TB hospital. Each day she would watch other patients dying around her. It was terrifying and she wondered whether she would be next. The absolute terror, feelings of hopelessness and despair were not shared with any of her family or her partner. She felt her environment was not conducive enough to share those terrifying moments. They were only able to manage the woman who came out of the hospital and not the woman who lived in hospital for a year.
The miscarriage had hurt Thandi very much. There was no logical explanation as to why it happened. She felt she did not want to have other children after it. The pain she felt and the fact that she felt she was too old to be having other children motivated her decision. Her partner was the one who informed her that she was pregnant. Thandi was in denial about the pregnancy. She thought the TB treatment had hindered her ability to have children and she had no desire to be pregnant again. She was shocked, disappointed and scared when the test confirmed her partner’s suspicions. It was hard to watch her excited partner, as she did not share that excitement. She questioned her body’s ability to carry to term, the impact the treatment might have on the baby’s development, and what would happen after she gave birth.
My role as home visitor allowed Thandi to shine a light and share the feelings and thoughts she holds about her experience in the hospital and the miscarriage. I faced my own mortality and my fears as to what would happen if I died. I found myself questioning my capacity to contain Thandi, who seemed to have gone through a lot in the past. She had been in a dark pit with no one. As a home visitor, I went down with her and stayed with her. There were initial thoughts of fleeing and escaping the pit. Will I be able to get out? How will this experience shape our relationship going forward? Will we make it to the other side? It got to a point that I started exhibiting symptoms of TB. It was in the supervision that I realised that my body was responding to the overwhelming feelings that Thandi had placed in me. I realised that maybe this is what she might have felt herself. This we refer to as transference and counter-transference: the exchange of feelings between us. I brought this back to Thandi who admitted that she does feel unsure, anxious and overwhelmed by the prospect of being a mother again.
Another theme that was present was separation and loss. Thandi had a son who she only visited occasionally over the holidays. She expressed how she feels like she is a first time mother even though she had given birth before. He was initially raised by her family, and later moved to live with his paternal family. It seemed a good idea at the time not to raise her son. She felt he had everything he needed because they were well off. In the course of the visits, she expressed her regrets and pain of separation from her son. “At the time it was a good idea”, she would say more than once.
This reminded me of many South African children are raised by grandparents and other family members for various reasons. One of the main drivers of this is a need for economic stability. There are many parents in South Africa living in the urban areas without their children. This was an opportunity to engage the other side of separation from the view of the parent and not only of the child. The sacrifices that parents make in order to provide for their children are painful and difficult. The time lost can never be regained in the growing up of the children.
When Thoko was born, she was surprised by how she coped. Things were not the way that she had imagined them to be. The actual delivery was very painful compared to her first one. She did not have any complications.
When we met three months later, the happy woman in front of me pleasantly surprised me. We spoke about her journey and experiences. She was alive and well. Her baby was also doing fine, without any disabilities, as she had feared. We looked back and realised how brave she was. The anxieties are still there, but they are not as crippling as they were before the visits.
The mind is a powerful tool and without proper guidance, nurturing and control it can conjure up monsters. As the saying goes “Monsters grow in the dark”. I believe that through the Home Visiting project, we are able to shine a light on the “monsters”.
I was left feeling in awe at the amount of struggle that Thandi had overcome. I felt that what she needed more than anything that I could offer, was someone to hear and listen to the other side of mothering; that is not all cuddly and fluffy. I was honoured to have been the bridge that carried her over her fears, anxiety, pain and insecurities, to a better connection with Thoko. My task was not to bury the pit, but to facilitate a pathway to the other side. My role was to reassure her and remind her that she had come out of the pit. I was not there to take away her troubles but I was there to think with her about those troubles and support her on her journey. It can be frustrating knowing that there is a pit in your path to happiness, having a bridge does not make the pit disappear but it allows for the crossing over to the other side.

Acknowledging, witnessing, thinking, reflecting, supporting and encountering monsters along the way; it is all in the day’s work of a Home Visitor.


By: Shelley Nortje (Clinical Psychologist)

Ububele has recently begun offering their services at a local hospital’s Neonatal Intensive Care Unit (NICU). The intervention offered involves offering support to mothers whose babies are admitted in this NICU ward. This usually happens if the baby is born preterm, has a very low birthweight or if there are other medical complications. This is a difficult space to be in as an infant mental health professional, for medical staff, for mothers and their families, as well as for these small babies.

The experience of mothers in this situation is one of trauma and uncertainty. These mothers may become depressed and may feel helpless as they rely on medical staff with specialized knowledge, that isn’t always shared or explained, to assist their babies. One mother for example expressed how confusing and scary the different machines attached to her baby, and the sounds they made, were for her. Mothers are also separated from their babies for certain times during the day. The small babies appear quite vulnerable and alone in their incubators. Mothers are encouraged to feed their babies and touch them however, the contact seems limited and hesitant as mothers appear scared to touch their tiny babies in case they should cause them more harm. One mother apologised to her baby when the baby’s leg tremored when mom touched her sensitive skin. These preterm babies are more sensitive and easily dysregulated, and mothers may feel guilty about their ways of interacting with their baby without sufficient knowledge about their babies’ experience. When the baby reaches a certain weight babies are eligible for discharge. Mothers may at this time begin to panic. Their insecurity and lack of confidence in their ability to care for a preterm baby may be evident.

Preterm babies, unlike full term babies, may behave in slightly different ways. On average, preterm babies are less responsive to sight and sound, their communications may be more difficult to read or understand, they have a limited ability to self-regulate, their sensory thresholds are reached more easily (ie: are easily over stimulated) and it usually takes them more effort and energy to respond. These characteristics of the preterm infant can make it harder for a mother to always understand what the baby needs and how to soothe and support their development.

A mental health professional, with a solid understanding of infant development and infant mental health can offer helpful support at this time for babies and their families. They can help parents understand their baby’s behaviours and share their observations about their baby’s bodily communications and capacities. For these babies that have a more difficult start to life, having this extra support and guidance may be valuable.

Should you or someone you know be struggling to understand babies’ communications please contact Ububele for assistance in strengthening and building these important relationships.