Counseling Research Methods & Processes

Dr Lim is soft-spoken, very humble and warm. We were asked to write a paragraph about self in 2 minutes, draw a line, write another paragraph about self in 2 minutes, and then draw another line and another paragraph about self in 2 minutes….

The 3 paragraphs of mine are ‘I am God’s child, seeking to understand how to impact people’s way of life through therapeutic intervention. One way is to sharpen my intuitive and interpretative skills.’ ‘I think I care enough to want to listen to another’s views or perspectives. I care enough to offer alternatives/options. I learn to leave the decision to change to the client (and to God if client is powerless to do so). I am only an agent for change.’ ‘I’m capable of change myself. I am changed by my interactions with people around me. I need to consciously be aware of not allowing my professional self to interfere with my personal interaction with loved ones. I need to consciously step back and look at the bigger picture.’

Counseling is more than having a good heart. It is about professionalizing the profession. Dr Lim talked about using the 3rd ear to listen for hidden fear, hurt and be less literal. My assessment of the client has to be continual, systematic and not rigid. Clients may come to me as a ‘customer’ (or visitor to shop for a doctor) or (complainer who appears committed but with motive to change others and not himself). Functionally, who is the identified patient? He is the one who cares most to change the situation because he is suffering the most ‘pain’ and is motivated to change.

As client goes through different levels of honesty with the therapist, the latter has to repeatedly gather information, forming hypothesis, test it and conduct therapy. In presenting a problem to the therapist, client uses his own language to describe his problems. Although the therapist has the professional vocabulary to collapse problems into meaningful category (efficient but not personal), it will appear more personal for the client if the therapist uses client’s words. The idea is for the client to verbalize his goals. The way to collect past data will be to ask, ‘why now?’ ‘What was helpful? What was not? What’s made it intolerable now? What kind of resources were there previously?’

I find the encapsulated assessment guide a very organized way to do a Focused History which is self-explanatory (sample on next page) of presenting problems. It serves as a guide which means while collecting data, I will do ‘trial therapy’ based on guesswork and clinical judgment.

Personal Life experience (intuition) Clinical experience

Factual Treatment
CONCEPTUALIZATION
Data Plan

Empirical Research (eg DSM IV) Theoretical
Biological (Behavioral) models

While conceptualizing or formulating symptoms, I may use Psychodynamic psychotherapy (PP) to hypothesize , CBT to understand (a compounded issue) as well as PP to make sense of and Existentialism Theory to examine .

Conceptualization Explanatory Concepts

1. Psychodynamic Conflicts (Internal)
(Internal forces) Developmental arrest (stuck at a certain age)
(TA – Reparenting)

2. Behavioral Contigency (sequence of events)
Keep repeating/reinforce
(e.g. What was the last quarrel like?)
A > B > C

3. Cognitive Cognitive distortions (specific incident)

-competency (not good enough)
-affiliation (nobody loves me)
-safety (people are out to get me)

4. Systemic Interpersonal functions of symptoms. [Problem is
serving a function.]


Treatment Plan:

Goal (Client’s) Intervention (Therapist’s) Review date

1. Client will be sleeping an ave of at least
six hrs each night (Frequency)

Instruct him on sleep
Hygience and
Diaphragmatic breathing
30/12/07

2. Client will report a general depressed mood of no more than 6 (1-10 scale). (Intensity)
Motivate him to identity and exercise his strength
(eg meditation) 30/10/07

Before we were dismissed, Dr Lim went through with us a long list of defense mechanism definitions. He explained each one of the following painstakingly and we benefited from it a great deal. 

DENIAL - No, I am not having cancer (after having diagnosed positively.)
RATIONALIZATION (Prove one’s action.)
INTELLECTUALIZATION (logic-tight comparisons)
DISPLACEMENT (scolded by boss, go home and kick the dog.)
PROJECTION (Husband wishes to have girl friend, blame wife for having EMA.)

REACTION FORMATION (act out opposite to how one feels)
UNDOING (husband comes home with a bunch of flowers to reduce guilt after seeing gf)

WITHDRAWAL (numbing self emotionally)
INTROJECTION (‘I think I should at least pass.) – don’t really believe.
FANTASY (too painful, boring.) - daydreaming, imaginary solutions

REPRESSION (unconsciously block out painful thoughts)
IDENTIFICATION (Feel more important by associating with someone with higher value)
ACTING OUT (Repeatedly doing actions to keep from being uptight without weighing the possible results of those actions)

COMPENSATION (hiding weakness, stress on strength)
REGRESSION (In face of PSLE, wet the bed.)
RETROFRACTION (‘I really want to do it to somebody else, but I can’t, so I do it to myself.)
SUBLIMATION RETROFRACTION (I want to beat you but I choose to change it to humor and direct it to myself.)

The defense mechanism in bold are the ones I associate with from time to time. 