An intersectional exploration of experiences of Registered Counsellors in primary health care

Abstract

This study employed an intersectional framework to examine how Registered Counsellors (RCs) in South Africa’s public primary health care sector perceive their professional identities and practices. Guided by a constructivist paradigm, and features of a collective autoethnographic approach, the study adopted a reflexive thematic analysis approach to examine the written narratives of three RCs. Two Clinical Psychologists initially analysed the data, deriving themes; thereafter, the RC participant-authors reviewed the identified themes to assess resonance and credibility. The analysis explored how intersecting domains of identity shaped RCs’ experiences within the communities they served. Four themes were identified: (1) Negotiating Authority and Otherness in Public Mental Health, (2) RC Participants Engaging with Cultural Variability, (3) RC Participants Carrying the Weight of Mental Health in South Africa and (4) RC Participants Learning to Manage the Emotional Weight of their Role. The findings demonstrate how overlapping identities such as race, gender and culture influence RCs’ perceptions of professional practice, client relationships and approaches to cultural competence. Structural and social inequities further shape how RCs manage emotional and relational labour in under-resourced contexts. RCs negotiate tensions between similarity and difference, balancing cultural awareness with professional responsibility while bearing the emotional weight of community trauma and inequality. Reflexivity emerges as a socially and politically charged process embedded within unequal systems. Intersectional reflexivity enables RCs to challenge hierarchies and provide culturally responsive care. By foregrounding RCs’ relational experiences, this article highlights the transformative potential of identity-conscious mental health care practice in post-apartheid South Africa.