Snapshots

Snapshots of Thoughts;

Canvas of Soul....

Advanced Counseling Issues & Advanced Counseling Intervention II

Mr Tan’s idea of counseling as a good piece of conversation goes hand in hand with the art of integrative therapy. The goal of the therapist is to have a purposeful relationship with the client. The BIG event is to ‘socialize the client into and through the counseling process’. More often than not, the client has no love for self, live for others and often desiring to change according to the therapist’s suggestions.

The therapist then has to exercise ‘control’ (how much and how fast) of therapeutic intervention. The key is ‘do as client’s able to.’

I learnt that anger is not a primary emotion. It masks fear, anxiety and hurt. In fact it is a defense mechanism. As a symptom, it therefore connects with other feelings. Normalizing the anger may slowly allow the other feelings to surface. The client must trust me enough to want to reveal the more vulnerable side of him. My existential approach will require me to stay in constant touch with his emotions:

What are you experiencing?
What were you feeling?
What are you feeling now?

I would help client to gain greater awareness by contacting his raw nerves:

‘If I were her, how would you talk to me?’ (I would emphasize on the psycho-presence of her in the session.)

I would point out his non-verbal behaviour and talk about it. Ultimately client must know he cannot Control, Change and Cure his significant others.

When dealing with resistance of client at some point during therapy, I will need to re-assess client’s problems and revisit goals set at start of therapy. Resistance is part of therapy and therefore client’s readiness is crucial. On the other hand, role-play can be used to identify negative feelings, to explore and challenge them if necessary.

The grounds for termination include: Goals achieved, goals not achieved (poor fit), client refused to engage, and client refused to pay fees (I would consider a reduced rate or pro-bono if client goes into financial difficulty) or client decides to stop.

Advanced Counseling Issues & Advanced Counseling Intervention I

It was touching base with self and one another when Mr Tan seated us in a circle and requested each one of us to share about the following:

1. Where am I as a counselor?
2. How did I come into this field?
3. How did I see counseling as I started out?
4. How have my views about counseling changed?
5. How do I presently work as a counselor?

My counseling journey started out with me embarking on the Counseling Psychology diploma at the LEE College. I wanted to understand why people behave the way they do and how I can impact a positive change in people’s behaviour. Over the years at LEE College and ECTA, I have come to grasp the intricacies and dynamics of interventive counseling. This is far from the view I once held of counseling. Interventive counseling requires me to be actively listening, being both humanly and professionally present, tarrying with the client when she enters the seemingly bottomless pit and waits while she bottoms out of it.

The counseling equipping has made me more psychological-minded. It increases my capacity to empathize more, especially towards my significant others. My theoretical orientation is geared towards a CP framework. When the need calls for a walk back to the family of origin, I will employ Redecision Therapy. I have also started using CBT to address distortions in thought pattern. I believe these will be the 3 primary approaches I will introduce in my counseling work.

I am happy where I am today. I think I am a good enough parent, a good enough mediator and a good enough counselor. With God’s help, I expect myself to grow, develop and mutate in terms of effectiveness and potency.

The purpose of the above exercise is to slow us down to be introspective, to reflect and to take stock. Mr Tan reminds us that ‘to advance we need to retreat’ for our souls to catch up. There is a need to look ‘at’ self and ‘within’ self in order to grow deeper.

It also makes comical and psychological sense when he shared that ‘it takes 1 counselor to change a bulb, but the bulb must want to change.’ When I look with client in empathy and look at client professionally, I need to find something lovable and good about him.

QBC's 45th Anniversary

Timo and i are in a 60-strong choir to sing a modern contemporary song, a Negro Spiritual song and 'Halleluiah from Handel's Messiah'. I am singing soprano while Timo tenor (He has been shortlisted to sing tenor in the coming Christmas acappella). It's a wonderful experience to return to a choir after more than 10 years and able to hit the high C note at this 'fragile' age. The weekly rehearsal have helped to strengthen the vocal chord and tummy muscles. :)

Hallelujah’ Chorus from Messiah


Messiah is an oratorio by George Frideric Handel based on a libretto by Charles Jennens. Composed in the summer of 1741 and premiered in Dublin on the 13 April 1742, Messiah is Handel's most famous creation and is among the most popular works in Western choral literature. The very well known chorus, Hallelujah, is part of Handel's Messiah. It concludes the second of the three parts. The text is drawn from three passages in the New Testament book of Revelation:

And I heard as it were the voice of a great multitude, and as the voice of many waters, and as the voice of mighty thunderings, saying, Alleluia: for the Lord God omnipotent reigneth. (Revelation 19:6)

And the seventh angel sounded; and there were great voices in heaven, saying, The kingdoms of this world are become the kingdoms of our Lord, and of his Christ; and he shall reign for ever and ever. (Revelation 11:15)

And he hath on his vesture and on his thigh a name written, KING OF KINGS, AND LORD OF LORDS. (Revelation 19:16)

In many parts of the world, it is the accepted practice for the audience to stand for this section of the performance. Tradition has it that King George II rose to his feet at this point. As is true today, when the King stands, so do all subjects also rise; thus engendering the tradition. It is lost to history the exact reason why the King stood at that point, but the most popular explanations include:
• He was so moved by the performance that he rose to his feet.
• He arrived late to the performance, and the crowd rose when he finally made an appearance.
• His gout acted up at that precise moment and he rose to relieve himself.
• After an hour of musical performance, he needed to stretch his legs.
Because this piece is so often heard separate from the rest of Messiah, it has become popularly known as "The Hallelujah Chorus", which, like "The Messiah", is technically incorrect usage. "(the) Hallelujah chorus" or "'Hallelujah' chorus from Messiah" is more proper usage.

Counseling the Disabled

Mr Dudley though blind did not show awkwardness common to the blind. That I mean though he walked hesitantly due to unfamiliarity of the environment, his demeanor, mannerism, composure and persona was as natural as a normal person. Hiding behind a pair of matching sun-glasses, he even looked rather charming with his smile which he generously gave from time to time. He was very involved and engaged with the class, no trace of loss-ness. The tone of his voice was calming, reassuring and inviting… It made me feel like he was giving me 100% attention when he addressed me.

Mr Dudley presented himself THE counselor one needs to be when counseling anyone, the disabled included.

‘It is the negative attitude that makes a disabled person handicapped.’ - there is just so much truth in this statement of Mr Dudley. I counseled a new client yesterday. Only 50% of her physical body is functioning due to a brain surgery that had damaged some nerves. Through out the session, she portrayed herself as one who is capable of overcoming setback and wants to move on in life. However, the negative attitude of her significant others (her beloved mother included) has made her feel truly handicapped.

According to Mr Dudley, counseling is a FEELING discipline. It calls for the counselor to be sensory aware, to remain positive and provide non-possessive warmth.

On the practical front, when counseling a disabled, we are not to touch a walking stick or wheelchair belonging to the latter. These things have become an extension of the patient. Touching their aids amounts to touching them.

Our posture when talking to the client is important too. It is ideal to sit at eye-to-eye level. Standing up and talk to the patient makes one looks imposing or intimidating.

Mr Dudley ended the session with a skit written by him and read out by some of us in class. It was about a blind man’s struggle to come to term with his sudden blindness. We understood better as we analyzed how the social worker in the story could have improved on her therapeutic approach towards the blind man. I realized too the significant roles played by the significant others in the life of a blind person. I think Mr Dudley had used a powerful tool in sharing valid and essential points in counseling the disabled.

Group Supervision/Dynamics

Dr Ng focused on Group Therapy and quoted I Yalom, the psychiatrist-turned-group-therapist. How interesting!

The main function of a group therapy is to provide support, psycho-education and intervention to about 8 to 12 members. Confidentiality is observed by the members in the group. Dr Ng expressed his own surprise that there is no existing Depression Support Group in Singapore. The group therapy process starts with a beginning (bonding/boundary setting), middle (working stage) and end (termination) stage.

The process may be short term which is energy-driven or long term for support and maintenance.

Before the group is formed, screening/selection will be conducted to determine the appropriateness of the group, the level of commitment. About 8 persons will meet privately for 1 ½ hrs per session. Rules will be laid down, such as ‘no drug/alcohol’, have to be present in all meetings, avoid sexual involvement/biases and ‘no physical violence.’ A list of rights, responsibility and expectation will be drawn up before the contract is developed.

The characteristics of a Group Therapy include an initial stage which looks into the likes and dislikes of the members, the worry about risk level and anxiety. The group dynamics allow modeling of leader, attending to fear/anxiety, creating trust, addressing issues outside of group. The group is seated in a round circle.

During the transition stage, the resistance, conflict, difficult behaviour as well as defensive behaviour will be examined.

The working stage provides members to work on the themes. There is self-awareness and intense emotions present at this stage and the focus is on issues. It is also here the progress is being traced.

The ending stage sees the therapist preparing the group for termination about 3 sessions before last session. The rituals include ‘good-bye note’. The future plan and new roles of each member will be addressed.

Advanced Counseling Issues & Advanced Counseling Intervention II

Therapy is made up of 20% content and 80% the process. The 1st two sessions are spent listening to the client’s stories which form the content of the therapy. Effectiveness in therapy comes with true understanding of the context – how client interpret key developmental events in fixed patterns & precipitating factors at the onset of maladaptive behaviors, etc.

For Adjustment Disorder, 12 to 15 sessions will be deemed sufficient. Intensive and frequent sessions will be structured in the early days of therapy, perhaps twice weekly and subsequently to reduce to monthly session for maintenance.

At some point, the therapist is to lead and control the session. If client is unstructured, such as becoming tardy in his attendance, such behavior will be viewed as treatment issue if it happens regularly. There is a place for therapist to define and control (stay on top) of how the therapy is to take shape. If the client fails to show up, it is ok to call him/her but not to pursue.

Homework is a necessary part of treatment and following-up with it is mandatory unless the client has more urgent issue to attend to.

Case Management –

Dr Ng recommended note-taking in the following manner:

Subjective (Client’s expression of himself or herself)

1. Client’s anxious.
2.
3.
4.

Objective (Therapist’s assessement)

1. C’s stuck in his/her …
2.
3.
4.

Action (Therapist’s intervention)

1. Referred client to IMH
2.
3.
4.

Plan (Homework for next session)

1.
2.
3.
4.

The therapy should provide a structure that is stable yet flexible. The 1st thing to find out will be how, why, how frequent the problem occurs. The CBT (12-step and solution-focused) comes into play after that. Therapist must seek to know the larger system (the support group).

Dr Ng touched on 6 constructive innovations in counseling:

1. Negotiating meanings – redefining and redirecting – the client’s unique view of meaning
2. Inquiring to conceptualize from a ‘not knowing’ stance by questioning.
3. Focusing on competence and resourcefulness of client. What works?
4. Eliciting & inviting – ‘How can I help in this regard?’
5. Client’s preference – Client’s theory of change. Unwavering focus.
6. Co-signifying audience – ‘intended audience’

The class watched 2 video clips on addiction and eating disorder. We were divided into 4 groups to approach the cases using our preferred modality. I joined the Redecision group and had a good time conceptualizing the case and detailing treatment plan.

The representatives shared the work of groups and I revisited the concepts and techniques of CP & PP. 

Dr Ng was impressed by the depth and breath we have on our preferred modality.

Advanced Counseling Issues & Advanced Counseling Intervention I

Dr Ng kicked off the session emphasizing the contextual reasons for clients to seek help. They range from conflicting values, poor financial management, seemingly irreconcilable relationships, etc. The first session with client calls for increased energy on the part of the counselor to engage and connect with the client. There is even a necessity at some point to take a 1-down position when addressing the client.

With all the information provided by the client, it is advisable to deal with them in segments or progressively. Therapist and client collaboratively find meaning and operationally defined relationships. Dr Ng’s dealings with alcoholics are progressive abstinence on the part of client and he ‘prescribes’ sex addicts with down-graded control for sex, e.g. instead of going to the brothel to stay home and watch a pornography on the puter. Patrick Cairns’s ‘Out of the Shadow’ will provide an understanding of what sex addiction is about and ‘Did you call it Love?’ details the treatment for such addiction.

The verbal and non-verbal behaviours of the clients will be observed reflectively (from therapist’s own experiential perspective). Open-ended questions are posed and summarization of content shared is given from time to time. Feelings expressed by client during the process is supported by statement, such as, ‘Certainly you are going through a difficult period.’

The emotional intercourse, or sharing, commonly referred to by therapist as intimacy between the client and therapist reveals the inner processes of the former. It is the job of the therapist to develop an interventive mindset.

Instead of advising, the therapist redirects. The focus is on the client’s context and using client’s language to fix the problem. In Solution-focused there is a huge distancing between therapist and client. The other extreme is observed in psychodynamic psychotherapy where therapist and client can be affected by transference. The trick is to compartmentalize the professional and personal life.

Psychodynamics of Romance

Romance is a partnership of love-story. It is how love is maintained. It is the exchange or language of love. Romantic love is the falling in love. It is ‘I love you because…’ It is vital to keeping the relationship alive. But real love is rising to love. It is saying ‘I love you despite ….’ When we get to know each other better, our brains start to settle down and romantic love transits to real love.

Mr Lim posed the question, ‘Why romance fades?’

Some answers captured: Familiarity breeds contempt – couples stop thinking about romance or work at it. Inherent need in people for colors in life therefore results in pursuit of different partners. Mutual needs not met. Specific needs not met. Some couple’s threshold for conflicts are low. No time for each other – couple connect only to complain.

A heterosexual couple are made up of two different personalities observing own specific boundaries but crave for each other’s attention, validation and to be doted on. There lies within each of us the need for security/stability on one hand and adventure/mystery on the other. This relationship is supposed to be sustained by affectionate love and fueled by passionate desire but the ‘ship’ sometimes is smooth-sailing, other times sink.

We discussed on why affectionate love is such a chore for the men. It is, as it means staying in touch with each other, expressing love in words and actions. And this takes time. The men are more attentive to their career once they have settled into the marriage. Ideally, the couple should attend to each other in love, shows their appreciation in love languages, acknowledge gratefulness by feeling it, showing it & saying it..

It is mandatory to maintain intimate contact with spouse. People thrive well when given praises. ‘I can live for 2 months on a good compliment.’ – Mark Twain

The most common obstacle that keeps couples from being intimate is the fear of being upset. And fear is the opposite of love.

Passion and intimacy needs to be injected into the conventional family for the couple to meet each other needs fully.

Visit to IMH

I was a little apprehensive at the thought of visiting IMH. I didn’t have the time to visit its website prior to the visit and was pleasantly surprised by what unfolded before my eyes upon arrival. It was nothing near what I imagined it to be. In fact the place has a resort feel to it after a recent revamp. 


We were given an introduction of IMH as a group at the auditorium by a young gentleman who is a medical social worker. Many things were shared but what I found to be noteworthy is IMH’s vision is to be the leading mental health centre in ASIA by 2012! The challenge to eradicate the stigma associated with mental illness is daunting. The strife to put the patients on equal stand with the people in the community is a commendable one, though. Public awareness and education will go a long way to reduce unemployment and discrimination at work place. The outcome is not a favorable one yet.


Barista Express is a social enterprise set up by IMH and run by recovered patients. IMH has also funded 50% of patient’s 1st two months salary as incentive for employers to recruit their patients. Patients go through vocational rehabilitation (e.g. FSRP – Food Service Skills Rehabilitation Programme) to equip themselves for employment. The snack bar, Juiceworks, in IMH is run by recovered patients.


Personally I was impressed by the Voluntary Rehabilitation Programme at the Stepping Stones. In-patients may be referred there before discharge. It is a 8-week programme designed to educate and train the patients. Making them understand why they need to learn is more challenging than teaching them how to do it. The patients are tracked on their social adjustment as well as adjustment to medication. The attrition rate is very low as majority of the patients benefited from the programme.


I left IMH feeling unfulfilled. I wished I had the opportunity to witness how the patients are being counseled by the resident counselors. We did not get to see the whole place as some areas are not accessible by outsider.

Pathological Grief

Dr Tan defined Grief as a highly personal and subjective response to a real, perceived or anticipated loss, whereas Mourning is an intrapsychic process whereby the person adapts to the loss. And Bereavement refers to the fact of loss. When a person experiences complicated grief, health suffers. The psychological outcomes present themselves in depression and anxiety, and worse, suicide ideation. The family relationships suffer too.

Dr Tan used the Bowlby’s Attachment Theory to explain the purpose of grief. It is an instinctive and universal response to separation. Complicated grief may arise as a result of peculiar relationship with the lost person, which may in turn be determined by the nature of attachment with the primary care givers i.e. insecure attachment patterns emanating from parental rejection in childhood. Dr Tan also took us through the Worden (Grief Tasks), Stroebe & Schut (Dual Process Model) as well as Neimeyer’s Meaning/Narrative Reconstruction.

In normal grieving process, the griever may manifest grief in feelings (sadness), physical sensations (breathlessness), cognitions (disbelief), behaviors (sleep disturbance) and spiritual distress (‘Why me?’) Pathological grief may be chronic (excessive in duration), delayed (insufficient emotional reaction at the time of loss), exaggerated (person resorts to maladaptive behavior), masked (symptoms not recognized as related to the loss) & disenfranchised (e.g. EMA)

Dr Tan provided a practical approach to complicated grief. I will have to identify how the grief presents itself. Especially in late bereavement, to assess progress of mourning, identify depression and consider pharmacology. During assessment, I engage the client to talk about the loss – the deceased, the death, social support, chronic stressors (current losses), earlier losses, coping styles as well as any strained interpersonal relationship resulted.

The client needs to be prepared for grief tasks (Worden). After one has accepted the reality of the loss, he/she has to work through the pain of the grief (revive memories of the deceased). The client needs to learn to adjust to an environment in which the deceased is missing and to emotionally relocate the deceased and move on with life.
Client needs to be assured he/she will recover, will be able to continue with life and will find meaning to live on. The deceased will still be remembered even when grieving has stopped. (Permission). Dr Tan provided a list of encouraging narrative reconstruction which I find extremely helpful. The goal is for the client to reconstruct or we collaborate to co-author a coherent and consistent life-script that includes the bereavement, and that will impart resilience as they remake their lives.

Grief & Bereavement

It was a privilege to be under the pupilage of Counseling Guru Yeo. I recalled how my older sister received his potent intervention 20 years ago and went on in life with a changed mindset to give birth to 2 lovely daughters – an unthinkable task due to fear of pain and sight of blood.

Mr Yeo in his wit and wisdom made us see grief and bereavement through his lenses. I valued his free-flow sharing of insights. To him, grief impacts us in an individualistic as well as systemic way. Grief is not time-limited. It mutates from more intense to less intense and sometimes it may never end. It can also trigger previous trauma to cause re-traumatization therefore from less intense to more intense.

Grief is effectively an experiential expression of how one copes with an attachment loss. Such experience essentially signifies one’s capacity to experience (feeling & being) and one’s choice to express such experience or not.

We can be attached to Property, Project or People. Property can be replaced, such as material worth which need not have $ value, or body parts which are tangible. Project is not tangible, such as talent/capability, hope/dream/vision/feeling (in relation to). People is irreplaceable, and it is about the hope and dream we harbour for our family.

Why are some people finding it hard to acknowledge their grief? The scripts they hold determine outcome of grief. ‘Men don’t cry.’ ‘Do not disturb the spirit.’ ‘Move on.’ Delayed grief could be due to dorminant discourse. As a therapist, I need to learn to help client understand and appreciate grief and wait with the client for a time and place when tears will flow. Loss takes on a different meaning at different stages in our life continuum. One thing is certain, as with any kind of loss, there is anger. If I am not sure what to say to a person who is depressed, the golden rule is to NOT say anything. Let him/her talk. I should not be too quick to console. I need to permit EXPRESSION of grief for ‘whatever stays inside stays in.’ Agree with the client that ‘life goes on but it will no longer be the same.’ Say things like, ‘I suppose it’s hard not to feel guilty.’ Or ‘it does seem like you are responsible for the death and that’s why you are feeling guilty.’

Client may not accept the loss but he/she has to live with it by adapting to the reality. The reality is ‘People die, relationships never.’ < To my late father: In life YOU lived for us, in death YOU live in us.> The gist is it is OK to adapt to a life of NO CLOSURE (especially in ambiguous loss). It is permissible to continue to grieve even when it’s perceived as abnormal in the eyes of the normal. My goal will be to help client draw out the strength within them and to look for the resources available to them.

Abuses in Relationships

I signed up for this talk because of my pro-bono work at the Family Transformation & Protection Unit at the Family Court. The clients who walk in to apply for the Personal Protection Order battle with violent significant others. Some just put up with it meekly week after week, year after year and one fine day, they decided enough is enough and came in to exercise their legal right to put a stop the torment.

A very knowledgeable Dr Kong enlightened us on the patterns of abuse. That of two types - Type I is one-off abusive behavior and Type II, persistent.

Usually, violent behaviors are associated with psychiatric illnesses such as depression and grief. There is also the likelihood of Type II leading to Borderline Personality Disorder. Sadistic abuses are hurled by either Borderline or Narcissistic Personality Disorder.

Dr Kong explained abusive behaviors by exploring the Oedipus Complex in Freudian psychoanalysis. It refers to the stage of psychosexual development in childhood where children of both sexes regard their father as an adversary and competitor for the exclusive love of their mother. In psychodynamics, Object Relations theory is the idea that the ego-self exists only in relation to other objects (foundational relatedness with mother specifically), which may be external or internal. The internal objects (e.g. past events or experiences) are internalized versions of external objects (significant others), primarily formed from early interactions with the parents. There are three fundamental "affects" that can exist between the self and the other - attachment, frustration, and rejection. These affects are universal emotional states that are major building blocks of the personality.

It is essential that children experience connectedness with their parents. A secured and constant attachment will give rise to a healthy internal representation. The experience of deprivation during childhood can lead to stress in life. Insecured attachment results in Pre-occupied Anxiety (‘Where are you going, mum?’), Dismissive-Avoidant (‘In order to avoid being hurt, I will dismiss you first.’) & Fearful-Avoidant (Want to avoid yet fearful you will leave.) Ultimately, a good-enough parent will provide a secured base.

Object Constancy is the goal in promoting ideal psychosexual development. When good object is being internalized, there is no place for asking, ‘Where were you?’ nor ‘It’s my fault, you left because I didn’t behave right.’ During intervention, allow appropriate verbalizations – ‘I am angry.’ ‘I deserved to be loved.’