Journeying thru ECTA 2006

My objectives in pursuing the Grad Dip

As a mediator volunteer with the Family Court I am confronted with raw nerves of a human person on a weekly basis. In spite of successful resolution of most cases that passed through my hands, there is a sense of dissatisfaction that lie within me. I wish I can offer more to the parties in terms of time to listen out to their inner cries, to sort out their belief system and to work on options available to them. And before I can effectively do so I need to be able to understand why people behave the way they do.

Counseling was never seen as a forte I must admit. I prefer swift resolution between parties to time-consuming lengthy `intra-walk’ with a person. However, I have been told time and again I make a good counselor. As far as I can remember I have even once dozed off while a friend was airing her woes. Despite my unbecoming behavior, she kept coming to me year after year whenever suicide was foremost on her mind. I did not know how to help her and I was feeling like a failure.

I took up the Diploma in Psychology with emphasis on counseling at Lee Community College to help me understand myself, the people I live with and the clients I see at the court. I have not been disappointed as the knowledge and skills I have acquired are life-applicational. I see improvement in my relationship with my significant others and people around me. Even my perception and expectation of people have changed as a result.

I wish to pursue the Graduate Diploma offered to further enhance and strengthen my knowledge and skills to be recognized by the SAC as a registered counselor in due course. I hope too further training will increase my confidence in helping to start a counseling ministry in church in God’s time.


Grad Dip Course Orientation

I arrived early to get a copy of the Skilled Helper & settle part of fee. Without fail & feeling blessed, I was treated (on the Academy) to a yummy portion of chicken rice dinner.

The Grad Dip Course Orientation hit home the fact I have committed to another 6 months of learning pursuit. It was unexpected a move but on hindsight I reckoned the impulsive decision had served a good purpose. Dad’s sudden demise would have been much less easy to cope if not for the insertion classes I had to attend.

Dr Tan C T gave a brief welcome speech. He led us in group/classroom supervision previously and I found him to be very wise and skilful in his approaches. He is also warm, approachable & considerate. He made me feel safe & accepted.

Jessica went through the content in Student Handbook with us. She was candid & at times entertaining. I felt much compassion & consideration coming from her. She shows forth her genuineness, sincerity & commitment whenever she addresses the class. Personally I find her an excellent example to emulate!

There are 22 other students in my group A. I believed both groups were fired up after Jessica’s motivational facilitation. There were much bubbly mingling and gelling. Smaller peer groups were formed swiftly. I was glad our small group germinated from LEE Community College will continue to grow together in the coming months.

I am really looking forward to the first module of Grad Dip – Transactional Analysis Therapy to be taught by Jessica.


Mediation

I have been helping out as a Mediator Volunteer at the Family Court for some years now. Today I went in for the afternoon session for the first time. I met up with the Master Mediator for lunch. At age 60 she walks with a limp due to operations done to both her knee- caps a few years back. Her affliction started even before she turned 30. It was no ordinary arthritis ailment she was suffering from and to-date the doctor could not pinpoint the causes. Painfully, she had to give up her teaching career; a profession she was & still is passionate about. But she is undaunted and despite the physical pains she had to put up, she went on to help out as a community mediator volunteer and currently attached to SMC & Subordinate Court. Many years later her contribution was recognized and she was conferred the Justice of Peace title. When we interacted I caught no hint of regret whatsoever. To her it was a natural thing to do – helping people who are entangled in relational conflicts to get out of the mess and move on.

After lunch the courtroom waiting area was filled with grievous parties. I put on my mediator `hat’ and called in the 1st couple. It was another emotional case of default in maintenance payment. The female client was shedding tears most of the time. She had to excuse herself for fear of being ridiculed by her ex-spouse. When she returned to the room, I decided to call for a caucus. When we were alone, she came near me and showed me the scars on her body. She is a cancer patient in remission. She was also a victim of physical abuse before her divorce. She suffered great anguish when she found the man she loved since age 18, in bed with their maid. And she was devastated when her ex-spouse turned around and blamed her for being old and not able to gratify his sexual needs. Even today she is living in fear as her ex-spouse is fighting for greater access to their children, one of whom is a teenage girl. To her, he is capable of doing anything. I felt rather uncomfortable when she disclosed that he is the leader of a secret society here.

For a while I was overwhelmed with the many issues involved in this case. The main issue of default in payment was resolved ultimately. I felt led to follow up with her after she talked about her suicidal tendency. So for the first time since ECTA & FC jointly approved my practicum at FC, I short-listed a case for counseling follow-up. I made it clear to the client that my counseling offer is not mandatory but optional. She sounded grateful and appreciative when I called her in the evening to enquire about her. I hope to meet up with her early next week.




I am glad the Clinical Director of ECTA has endorsed my involvement at the Family Court. With new knowledge acquired, I began to fine-tune my micro-skills so as to anchor a more amicable therapeutic alliance with the clients. Maintenance issue gets to be resolved in a shorter time because defaulter is more open-minded and co-operative when he feels empathy coming from the mediator. Despite the constraints in time, I have been able to move from maintenance issue to address briefly the underlying issues that cause the frictions in the inter-personal relationships. At some points I will have to terminate the mediation session and seek the clients’ consent to adjourn for counseling sessions outside of the court. One of the main concerns with meeting clients at the free clinic at Siglap Centre is cost. Generally the clients are from lower income group & can ill-afford the additional expenses.

Lecture on TA in Psychotherapy (Part 1)

Our Graduate Diploma course kicked off today and we had a short address by the Deputy GM of Mt Medical Centre. His learning spirit is contagious and I believe by year end, if all goes well, I may be in the mood for more.

Jessica is an expert in TA Theory & Practice. She gave an Introduction to TA in Psychotherapy which I found not too difficult to follow. But because of the Affective, Cognitive & Behavioral components illustrated in the integrative model, I could not help but compare it to REBT of Dr Ellis. The bottom-line is, both approaches work towards achieving improved personal functioning and human relations.

TA emphasizes the internal dynamics & one’s capacity for thinking & feeling. The helped is empowered to solve his/her issue based on a therapeutic contract. He/she can elect to change decisions in the process of achieving therapeutic goal.

For a therapist with personality like me, TA is, unlike REBT, more appealing because it is eclectic, integrating a variety of modes such as client-centered, even solution-focused which addresses the here and now.

Being a mediator I am inclined to probing the past, the root cause and the going-on. So I feel rather at ease to know I don’t have to `dwell on’ the `pain & suffering’ all the time in order to achieve therapeutic goals. Then again Jessica reiterated the fact that TA may not work for some clients because it is directive and confrontational.

We were asked to reflect and checked for traumas we encountered in our growing up years. I recalled instantly an incident that took place when I was in primary school. One day I was out with my younger brother checking out on our neighbor’s home which was under renovation. We found a few young workers in there. While walking from room to room, suddenly I realized I was alone with one of the workers in an unlit room and the door was shut. I froze for a moment and all I could recall was the door suddenly opened and I saw my brother looking in. I felt a great relief as I ran home with my brother. I figured I must have told myself after that incident never to allow myself to be alone in the same room with a stranger. And this early decision has stayed on. I avoid taking lift with male stranger in it. Even riding in a taxi alone with the driver makes me very anxious, especially in the evening.

Lecture on TA in Psychotherapy (Part 2)

It’s interesting to see Counselling as a `C’ undertaking! The C’s Jessica offered us:

- Connection with the Counselee is the key factor determining if the therapy is going to go on or not. The micro-skills successfully employed and rapport that gradually formed will take the therapy to a greater height. Jessica talked about trusting our intuition and observation of the here-and-now phenomena.

- Contract-development by the Counselee will empower the latter to work towards achieving new goals and behaviours. And contract can be re-negotiated. Counsellors can also explore variety of procedures in carrying out the therapeutic work.

- Changes in the behaviour, affects & thinking of the Counselee can be expected because Client comes to realize that he has the power to re-decide and change what is not working.

- Circular & not linear. As a counsellor I know I need not follow the steps in the approach like a robot.

- Confronting the Counselee in case of non-compliance of contract is possible because the outcome of TA intervention is measurable & observable.

- Conversation with Counselee will be more effective than talking to him/her.

- Concluding the session ensuring the Counselee understands the terms used during therapy will illicit better outcome.

Today I learnt about Life Positions, The Structural & Functional Ego States, Early Scripts (Racket feelings), Drivers, Injunctions, TA contracts, Basic Therapeutic goals & Intervention approaches. Also about Therapist’s games and getting the strokes he or she needs.

TA approach helps me to understand why a person behaves the way he does based on early script and how he can change through re-decision to improve on personal and interpersonal behaviours.

Visits to the Nightingale Nursing Home

27 March, 2006 (3rd visit)

I was appalled to find my client, a dementia patient, fuming with fury when i arrived at her bedside. The caregiver in charge (a new face) was marching around in even greater fury. She was shouting at the Malay lady next to my client in Bahasa Malay, of course. Before i could figure out what was happening, she charged to my client and forcefully pushed her hanging leg onto the bed and told her to stay within the bed.

Well, what followed suit needed to be censored actually. My client turned to me and aired all her grievances, doubly punctuated with not very decent words (err.. vulgarities) she used on the caregiver. I was too stunned for words and tried in vain to calm her down. The caregiver complained that my client tried to climb out of bed to switch on the fan. My client tried to explain her side of the story but she could not remember what exactly took place and kept asking how come i didn't know what happened. Aiyo...

My whole 1 hour and a little more was spent trying to get her to focus on what i was saying. It was sheer failure coz her eyes were following the caregiver, and scolding her into my face. I wanted to leave earlier but caregiver talked me into completing the one whole hour. Guess she thought i might just be able to counsel my client out of her mischief.

I was glad my loaf of Gardenia Raisin bread managed to pacify the raging hearts (the other senior citizens got a slice each of the bread.)

Thank God too for the heavy downpour. By the time i was leaving, my client had eased up. And she waved frantically. I have grown to like her more.

P/s No, she still could not register my name in her head.


30 May, 2006 (Voluntary visit)

Who needs counselling, i wonder, the patient at the Nightingale's or one of its staffs?

I decided to make a detour to NNH after mediation session at court this morning. I was glad the journey took me about 10 minutes only via CTE.

Patient Tan was happy to see me, as usual. I saw her bandaged hand and asked what happened. She could not elaborate.

My seat was barely warmed up when i caught sight of the caregiver (no longer a new face) whom Tan had a quarrel with previously. The former looked unhappy. Before
Tan could talk about her i was summoned by a visitor whom i met in the lift
earlier to go to the next room.

And there i was caught in the middle of a tussle between the visitor
(Chinese-speaking) and the unhappy caregiver (non-Chinese speaking).
The visitor was so upset she was in tears. I had no choice but to put on
back my mediator’s hat and employ newly acquired counselling skills as well as translation & interpretation skills.

I was glad they made up eventually. Both shook hands & apologised to each other.
Even the patient got a `kiss' from the caregiver!

As i left the Home, i tried to analyse the different ego-states that were at play throughout the drama.

This particular caregiver seems more a `critical parent' in her attempt to
be firm with the patients (who are mostly `compliant children'). The
visitor could not stand the way her patient friend was treated (being tied
to the bed) so she released her and that made caregiver mad (the latter was
earlier being kicked by the patient while trying to tie her... !) Ouch. Aiyo.

C'est la vie?...

Marital Family Therapy (I)

Ms Choo is an energetic presenter and she certainly has a lot to impart in terms of ‘family/marital work’. Throughout the evening, she gave numerous illustrations as she went through the various approaches to marital work and specifically the Bowen Systemic Family Therapy. Being exposed to the BSFT theory for the first time, I did find some terminology and concepts not easy to grasp. I was glad the cases she cited were relevant to support whatever she wanted to clarify or emphasize. Ms Choo welcomed input from the class and she answered the questions raised with full vigor.

Bowen’s approach, like TA, has a framework & specific techniques to guide the practitioner. Murray Bowen conceptualized the family as an emotional unit, a network of interlocking relationships, best understood when analyzed within a multi-generational framework. This is so because family members are intensely connected emotionally. They profoundly affect each other’s thoughts, feelings & actions. Personally I can’t agree more. Although dad has ceased to function as a parent, in my own decision-making process I still find myself factoring in his instruction/advice given to me when he was alive.

The connectedness and reactivity promoted by my doting parents make our family a closely-knitted one as there’s greater interdependence. However, the increased togetherness has also resulted in chronic anxiety. After all the children have flown the coop, my parents find themselves worrying sometimes unnecessarily for the children. And they make it known. Obviously, the children know who to turn to for immediate support in times of distress. As a result there is less individual autonomy & problem-solving.

I learnt that the only antidote is resolution through differentiation, the process by which an individual learns to chart his own direction rather than perpetually following the guidelines of family & others. Therefore the etiology of individual dysfunction is the inability of the family to separate or differentiate themselves from one another successfully. Anxiety is aroused when children struggle with individuation.

I noted that a change in one person’s functioning is predictably followed by reciprocal changes in the functioning of others. But such change has to be initiated at a good pace to avoid arousing unnecessary anxiety.

Marital Family Therapy (II & III)


During the 2nd & 3rd sessions we were taught the 8 forces that shape the family functioning, namely Self-Differentiation, Triangulation, the Nuclear Family Emotional System, Family Projection Process, Emotional Cut-Off, Multigenerational Transmission Process, Sibling Position & Societal Regression.

I learnt that when I’m differentiated, I’ll be able to strike a balance between my feelings & cognition. I will express my emotional-self spontaneously. And I won’t be seeking acceptance & approval all the time.

I learnt that if the therapist can remain unemotionally involved with both spouses & not taking side, the spouses may learn to view themselves as differentiated individuals as well as marital partners.

I can’t agree more on the view that The Nuclear Family Emotional System adopts a pattern of past generations and repeat it. In the case when there is a prolonged family tension due to stresses the family encounters, we can expect marital conflict, dysfunction in a spouse, psychological impairment of a child as well as emotional distancing.

I learnt too when a person reduces or totally cuts off emotional contact with significant others in family, he risks making new relationships too important, & pressuring them to
meet his needs.

On the whole this module further enhanced my knowledge on the individual functioning. After having learnt how people function in different ego-states, MFT provided a bigger platform to explore reasons why people behave the way they do by looking at how they fuse with their significant others. The Genogram is an interesting and useful tool to use in the therapeutic process.

What I find very helpful is to be taught that during intervention, the therapist has to stay detriangled – “neutral” & detached as in staying emotionally connected but not emotionally entangled. His focus is to be on the Process rather than Content.

In a nutshell, BSFT is about teaching a way of thinking rather than any specific behaviour.


Depression in Elderly People


As Gerontology was a course I nearly embarked on, I opted for the public talk organized by SAGE as one of my Counselling Related Activities. I am also concerned about my mother who has just lost her spouse with whom she had spent a good 50 years together. I observed that she is coping well. Her faith in God as well as the spiritual support she’s receiving from the church has helped tremendously.

Mr Wong touched on the Types of treatment for depression in the elderly. I learnt that referring the patient to see a GP is the very basic I need to do when the symptoms of depression are obvious, such as inability to eat, sleep or work.

Mr Wong provided useful information on where and who can extend help to the depressed elderly. Educating the family members of patients on how they can help will likely lead to greater extent & quality of care coming from them.

I was glad to learn that the depressed person can help himself or herself too. However, the process of `feeling better’ takes time, so my expectation of him or her doing things to help themselves has to be reasonable and given good time margin. More importantly I have to ensure the patients are not compelled to make important decisions at this depressed time.

The session was enriching as tips were given on how to add new dimensions and inject positivism so as to enhance the quality of life.

Neuro-Linguistic Programming


I met Mr Wagner at the entrance and was privileged to have him open the door for me. At that point in time I had no clue he was the speaker for NLP but I was certainly impressed by his courteous mannerism. Later, he showed both the serious & humorous sides of him in a 3-hour session on NLP. What I found fascinating about him was that he spoke with great clarity on the serious as well as humorous subjects. The end result was I laughed as much as I learnt.

Mr Wagner introduced NLP as the process of modeling excellence in human behaviour. He dealt with the internal auditory, visual & kinesthetic channels. Of the three I reckon I use the audio & visual channels more frequently and effectively. And I found the 3 Channels of Visual Accessing Cues rather interesting. I tried that on my sons and was able to figure out quite accurately their channels at work.

I learnt that PACING is about getting into the other person’s shoes. It helps to paraphrase; to check back & repeat what I have heard. Something new I learnt was about checking rapport along the way by changing my behaviour to seek a response in the other person. If there is indeed a rapport, I can then initiate a sensitive confrontation and offer an advice.

I should try to use more short responses rather than just `ah ah’, `oh I see’. I will include ‘I hear you’, `You look unhappy’, `You sound scared’, `I wouldn’t like that either.’

Mr Abe suggested that we try using both our hands (instead of relying mainly on my right hand, as in my case) to do tasks so that a bigger portion of our brains may be utilized. That is certainly `food for brains’!