ashweek

Motto for 2011

2010-12-27T22:42:00.000-08:00

Prayer is the lisping of the believing infant, the shout of the fighting believer, the requiem of the dying saint falling asleep in Jesus.

It is the breath, the watchword, the comfort, the strength, the honour of a Christian.

- CHS

Let the motto for 2011 be, "Continue in prayer."

Year 2011

2010-12-27T22:41:00.000-08:00

We, the called & faithful & chosen, will be glad & rejoice in Thee. Thou art the present portion of Thy people, favor us in the New Year with such a sense of Thy preciousness, that from its first to its last day, we may be glad & rejoice in Thee. Let Jan open with joy in the Lord, & Dec close with gladness in Jesus.

- C H Spurgeon

Rejoice!

2010-12-27T22:40:00.000-08:00

For God so loved the world, that he gave his only begotten Son, that whosoever believeth in him should not perish, but have everlasting life.

For God sent not his Son into the world to condemn the world; but that the world through him might be saved. - John 3:16-17

A very blessed Christmas to all ye who are faithful. Rejoice! Have a Merry Christmas! ;)

Keeping Christmas

2010-12-27T22:38:00.001-08:00

The better thing than observing Christmas day is in keeping it. Are you willing to believe that love is stronger than hate, stronger than evil, stronger than death & that the blessed life which began in Bethlehem 1900 yrs ago is the image & brightness of Eternal Love?

Then you can keep Christmas. And if you can keep it for a day, why not always? ...

- Henry van Dyke

Christmas...

2010-12-27T22:37:00.000-08:00

Christmas is about the arrival of an impossible Baby - Jesus Christ - who would be characterized by doing the impossible.

Why do you think God delights in doing the impossible? Is God asking you to believe something that seems impossible this Christmas? ...

***

马利亚对天使说：我没冇出嫁，怎么冇这事呢？

天使回答说：圣灵要临到你身上，至高者的能力要荫庇你，因此所要生的圣者必称为神的儿子 .

- 路加福音1:34-35

***

Through Christ we have been adopted as children of God. What does this language communicate about God's commitment to loving us? What does it mean to live as a child of God and loving others with the same commitment?

Re-discovering Christmas ...

2010-12-27T22:35:00.000-08:00

Wise men still seek Jesus. - Rick Warren

***

How have you experienced Jesus as a Wonderful Counselor, Mighty God, Everlasting Father and Prince of Peace? How is He a King of Kings and Lord of Lords in your life?

***

Immanuel means "God with us." How is Jesus still "God with us" even now that He's not walking on the earth? How is God "for" us different from God "with" us? How important is it to seek to experience that closeness all the time? ..

***

How is God like a conductor or director? How can we apply the discipline of rehearsal to improve our relationship with God?

How was it like when we were completely in tune with what God wanted for our life? What are some spiritual disciplines that we need to rehearse more regularly to get back in sync with God?

Matthew 25

2010-12-27T22:31:00.000-08:00

‎'Master, when did we ever see you hungry and feed you, thirsty and give you a drink? And when did we ever see you sick or in prison and come to you?’

Then the King will say, ‘I’m telling the solemn truth: Whenever you did one of these things to someone overlooked or ignored, that was me—you did it to me.’

Isaiah's prophecy concerning Jesus (Isaiah 9)

2010-12-27T22:29:00.000-08:00

A Child Has Been Born—for Us!....

The people who walked in darkness have seen a great light.

For those who lived in a land of deep shadows—light! sunbursts of light!...

You repopulated the nation, ...you expanded its joy.

Oh, they’re so glad in your presence!

Festival joy! The joy of a great celebration,

sharing rich gifts and warm greetings.

7 mighty men i should know...

2010-12-27T22:27:00.000-08:00

Athanasius (296-373)

Augustine of Hippo (Libya) (354-430)

John Wycliffe (1325-84)

Martin Luther (1483-1546)

John Calvin (1509-1564)

Jonathan Edwards (1703-58)

William Carey (1761-1834)...

C S Lewis

2010-12-27T22:25:00.001-08:00

If you want to get warm you must stand near the fire: if you want to be wet you must get into the water. If you want joy, power, peace, eternal life, you must get close to, or even into, the thing that has them... Once a man is united to God, how could he not live forever?

Matthew 5:3-5

2010-12-27T22:24:00.000-08:00

You’re blessed when you’re at the end of your rope. With less of you there is more of God and his rule.
You’re blessed when you feel you’ve lost what is most dear to you. Only then can you be embraced by the One most dear to you.

You’re blessed when you’re content with just who you are—no more, no less. That’s the moment you find yourselves proud owners of everything that can’t be bought.

约翰福音3：5~7a

2010-12-27T22:21:00.000-08:00

耶稣说：「我实实在在的告诉你，人若不是从水和圣灵生的，就不能进神的国。从肉身生的就是肉身；从灵生的就是灵。我说：『你们必须重生』 .... 约翰福音3：5~7a

Annie Counsels & Mediates

2010-06-22T20:53:00.000-07:00

CT/RT Certified [May 2010] ;)

2010-06-04T00:41:00.000-07:00

Blogger Buzz: Blogger integrates with Amazon Associates

2010-06-04T00:23:00.000-07:00

Blogger Buzz: Blogger integrates with Amazon Associates

Morning Glorious Lord

2009-11-16T02:58:00.000-08:00

Morning Glorious Lord
[Lyrics by Annie Seah]

1. My heart is quickened
my feet ordered
to meet My Lord in the morning.

What is it, Lord, you see in me?
'Tis undeserving soul
your forgiveness endures.

Chorus:

The Lord keeps - as we can’t -
us upholding The Covenant
in this frenzy world.

The Lord sees - what we don’t -
us reflecting HIS glory
in our human frailty.

2. Your Spirit beckons,
'tis glorious morn;
in sweet commune, You & us, Lord.

That in our yielding,
anchoring our soul;
glorious eternal Lord with us abide.

[Repeat Chorus.]

16 Nov 09

Blessed are the Peacemakers

2009-07-22T08:06:00.001-07:00

I am blessed.

My Significant Other

2009-07-22T07:47:00.000-07:00

Freddy Oh is a leading expert in the areas of testing and problem-solving for Petroleum products. He has over 27 years of experience in the Oil and Petrochemical industry. During these years he has accumulated a wealth of knowledge and hands on experience in dealing with the quality and problem-solving aspects for products like Jet Fuels, Gasoline, Diesel and Fuel Oil.

Freddy graduated with Honors from London University College in Chemical and Polymer Technology and holds a Post Graduate Diploma in Education. He is a Chartered Chemist from the Royal Society of Chemistry, UK, since 1987. In 2004, Freddy was one of the first batch of Chartered Chemists to be awarded the prestigious title of Chartered Scientist by the United Kingdom Science Council in recognition of his decades of experience and vast contribution to Petroleum Technology.

Freddy is at present the Laboratory Technical Director of CCIC, where he is constantly in touch with the latest developments in the Petroleum and Petrochemical industry. He provides valuable knowledge to the laboratory and customers in various technical areas. He conducts a number of training programs, both internal and external and specializes in courses like gasoline and fuel oil blending, diesel specifications, Jet Fuel specifications and bunker fuel program.

Freddy is also a technical assessor for Singapore Lab Accreditation Scheme (SINGLAS) under the Singapore Accreditation Council (SAC). He contributed significantly in the field of Chemical and Biological Testing when he was a Technical Committee Member for SAC-SINGLAS from 1994 to 2000.

Freddy and Annie have 2 sons aged 21 & 19.

A WAY TO GROW

2009-07-04T07:16:00.000-07:00

4 JULY 09

2009-07-04T07:12:00.000-07:00

BY ARIFFIN

2009-07-04T07:05:00.000-07:00

It's all worth it....

2009-05-03T21:43:00.001-07:00

POEM: On Learning Choice Theory

2009-03-16T08:39:00.000-07:00

I’m on a one-way ticket to perdition
There’s nothing else to blame but my own confusion
Obliviousness is synonymous to my way of thinking
Only God knows when this nightmare will be ending

I feel this way though life has its meaning
I’ve lost all hope to carry on this struggling
By a twist of fate which happened one morning
I was obligated by friendship to attend a so-called counseling

Being skeptical to change or to finding any more hope
A team of Choice Theory angels came to teach me the ropes
At the present moment there is no beginning, no end
It’s just a transition to greater fulfillment

Choice Theory guided me without answers, but only questions
Which if practiced would train me to better handle situations
I’m not saying that my future will be absolutely bright
It will be just more worthwhile to take on this fight

I’ve always looked for a reason to take on this challenge
But then again I myself am my own greatest reason
Things and relationships come and they go
That’s why I have to be selfish and start saying no

This isn’t flattery or outright ball-carrying
It’s sincere from four days of genuine soul-searching
The reason for writing this poem and story
Is to show my gratitude, thanks and a whole lot of appreciation

by Y bin D (Prison number XXXXX)
Changi Prison, Singapore
4 March 2009

A Worthwhile Pilgrimage

2008-12-29T21:02:00.000-08:00

All the 33 of us returned safely on 11 Dec. The Lord had helped me 'endured' the pilgrimage physically. My body was in 'discomfort mode' throughout the journey from Doha/Cairo/Sinai/Israel/Jordan back to Spore - jet lag, dehydration, constipation, pain on skull n neck even under umbrella n cap (my body seems to absorb heat quickly), diarrhea, heat rashes on the body in spite Cold Cream(i have atopic skin - humidity is good for me), by the time i 'found' Jerusalem, i was 'dumbfounded' (lost my voice that day).

I experienced 3 spiritual encounters during the journey. The first encounter was when my hand touched the Western Wall in Jerusalem. I felt as if my heart met with God's. I brought no petition to Him except to tell Him i love Him and thank Him for extending His love to me. The second encounter was a very heavy heart as i walked up and down the flight of stone steps Jesus took during His last days on earth. I could as if experienced His mixed emotions as He was confronted with life & death issues unique to His calling. The most intimate encounter i shared with Christ was when He ministered to my inner being on the Sea of Galilee. His words of comfort in Aramic moved me to tears.

It's a worthwhile trip on the whole altho' i didn't venture to climb Mt Sinai. The Bible now comes alive and has a familiar feel to it after having seen the places. Yes, Jesus is alive and real to those who are spiritually alive to Him. Praise God for sustaining the 33 of us. My walking shoes decided to stay back in Israel... I crossed the border from Israel to Jordan (& on to Mt Nebo) on slippers bought on impulse/divine directive at Jericho! God saw to it that i didn't return bare-footed! I am glad to be back in Oasis Spore and the humidity that i need. :)

Shalom to you n loved ones this Christmas and in the new year!

A Spiritual Pilgrimage

2008-12-29T20:48:00.000-08:00

A Spiritual Pilgrimage to the Holy Land plus Cairo, Mt Sinai & Mt Nebo
29 Nov – 11 Dec 2008

QUEENSTOWN BAPTIST CHURCH
Tour Leader: Rev. Richard Loh

DAY 01: 29 Nov 2008, SATURDAY
Singapore-Cairo (via Doha) on Qatar Airlines
Flight Details:
QR 639 Singapore/Doha Dep 0205hrs Arr 0530hrs
QR 514 Doha/Cairo 1320hrs 1605hrs
Arrive at CAIRO AIRPORT. Meet & assist. Transfer to GRAND PYRAMIDS HOTEL or similar in CAIRO for check in, dinner and overnight stay.

DAY 02: 30 Nov 2008, SUNDAY
Full Day Cairo Tour
Breakfast at hotel. Will have FULL DAY TOUR in CAIRO for sites like the PYRAMIDS / SPHINX then to PERFUMERY. In the afternoon, visit OLD CAIRO for HANGING CHURCH & CITADEL. Thereafter, visit the EGYPTIAN MUSEUM and the KHAN EL KHALILI BAZAAR. Dinner and overnight stay.

DAY 03: 01 Dec 2008, MONDAY
Depart Cairo for Sinai
Leave CAIRO CITY early morning and drive to SINAI, passing by SUEZ CANAL and MOSES SPRING. Visit the ST. CATHERINE MONASTERY and see the burning bush before going for lunch. Thereafter, climb MT. SINAI, and check in at SINO PLAZA HOTEL or similar for dinner and overnight stay.

DAY 04: 02 Dec 2008, TUESDAY
Depart Sinai for Taba Border Crossing- Dead Sea
Breakfast at hotel prior to check out. Drive to TABA BORDER for crossing into ISRAEL. Meet & assist by Israel guide. Lunch in a nice Asian Fusion restaurant in Eilat before driving to the DEAD SEA. Check in at MORIAH CLASSIC (previously known as the NOVOTEL THALASSA HOTEL) or similar at the DEAD SEA. Leisure time at the Dead Sea: enjoy “floating” in the Dead Sea and try different Spa programs available. Dinner & overnight.

DAY 05: 03 Dec 2008 WEDNESDAY
Dead Sea-Qumran-Masada – Jericho - Jerusalem
Breakfast and check out at the hotel. Start with MASSADA (take a cable car). Then to QUMRAN CAVES. Continue on to JERICHO. Continue to BEIN SHEAN. Then proceed to Jerusalem. Check in at GRAND COURT HOTEL in Jerusalem or similar for dinner and overnight stay.

DAY 06: 04 Dec 2008, THURSDAY
Jerusalem-Old City
Breakfast at the hotel. Start the day with a visit to MT. SCOPUS for a panoramic view of the city. Drive to BETHANY (Lazarus Tomb). Continue to MT. OF OLIVES: DOMINUS FLAVIT, ASCENSION CHAPEL, PATERNOSTER CHURCH, GETHSEMANE GARDENS, BASILICA OF AGONY. Then continue with the walking tour in the OLD CITY: POOLS OF BETHESDA, VIA DOLOROSA, HOLY SEPULCHER CHURCH. WESTERN WALL (entry to Western Wall Tunnel), TEMPLE MOUNT with Dome of the Rock. Return to hotel for dinner & overnight.

DAY 07: 05 Dec 2008 FRIDAY
Jerusalem-Bethlehem
Breakfast at the hotel. Drive to BETHLEHEM for NATIVITY CHURCH & SHEPHERD’S FIELDS. Continue to the MT. ZION, visiting ST. PETER IN GALICANTU CHURCH, LAST SUPPER ROOM, KING DAVID’s TOMB, DORMITION ABBEY. Drive via Knesset & Menorah to ISRAEL MUSEUM to see Shrine of the Book with Dead Sea Scrolls and Holyland Model. Dinner at “Genesis” – a night out re-enacting the time of Abraham (plus camel ride). Return to hotel for overnight.

DAY 08: 06 Dec 2008 SATURDAY
Jerusalem (New City)
Breakfast at the hotel. Visit YAD VASHEM HOLOCAUST MUSEUM. Visit Yad Hashmona Biblical Gardens. After lunch visit GOLGOTHA and the GARDEN TOMB for Communion service. Return to hotel for dinner & overnight.

DAY 09: 07 Dec 2008 SUNDAY
Jerusalem – Jaffa – Caesarea – Mt Carmel – Megiddo – Mt Tabor - Nazareth
Very early breakfast and check out at hotel. Drive along the scenic coastal road via Jaffa, and Caesarea (Visit the ancient city, amphitheater and the Aqueduct) to MT. CARMEL, MUHRAKA. Lunch and continue to MEGIDDO (Armageddon) and Mt Tabor. Thereafter, we make our way to Nazareth and check in at GOLDEN CROWN HOTEL or similar for dinner & overnight.

DAY 10: 08 Dec 2008 MONDAY
Nazareth-Cana-Upper Galilee-Tiberius
Breakfast and check out at hotel. Tour NAZARETH visiting Annunciation Church & Mary’s Well. Continue to CANA. Continue on to UPPER GALILEE: BANIAS and DAN SPRINGS, Nimrod Castle, MT. BENTAL. Proceed to TIBERIUS. Check in at GAI BEACH Hotel. Dinner & overnight at the hotel.

DAY 11: 09 Dec 2008 TUESDAY
Tiberius-Ginosar-Capernaum-Tabgha-Mt. of Beatitudes
Breakfast at hotel. Take a BOAT RIDE at the Sea of Galilee. Visit YIGAL ALLON CENTER (BOAT AT GINOSAUR), CAPERNAUM, TABGHA, MT. OF BEATITUDES. Visit YARDENIT Baptismal Site at Jordan River. Dinner & overnight at the hotel.

DAY 12: 10 Dec 2008 WEDNESDAY
Tiberias - Mt Nebo - Amman Airport
Breakfast, Then cross the SHEIKH HUSSEIN Bridge to Jordan. Visit Mt Nebo (time permitting) before going to Amman Airport to catch flight home
Flight Details:
QR401 Amman/Doha Dep 1700hrs Arr 2030hrs
QR638 Doha/Singapore 0150hrs 1435hrs

DAY 13: 11 Dec 2008 THURSDAY
Home sweet home…

Naughty By Nature

2008-03-12T10:00:00.001-07:00

She ain't heavy... She's their mum..

2008-03-12T09:58:00.000-07:00

Self-therapy using CBT

2008-01-08T09:33:00.001-08:00

'What lies at the bottom of the ocean and shakes all over?’ A nervous wreck! Yes, that was me confronted with fear of public speaking. This is a common phobia among my contacts and reportedly the no.1 fear in the American society. Whenever we are thrown into the situation to speak up, very few of us are brave enough to do so. Although my work does not require me to address a large group but I am expected to lead in a small group from time to time.

When I was younger, I used to tremble whenever I spoke in a large setting. I am more composed now but I am still plagued by internal discord just before I open my mouth to speak. My thoughts would also become jumbled somewhat. The CBT specialization has helped me address the fear. I think I am worried about making mistakes. I want to give a perfect speech or deliver a perfect performance. I may have even harbored a mistaken thought that I have to get everyone in the audience to approve of me.

But I think I am wrong. I realize now as I type, my audience doesn’t expect perfection. I think they want something of value. If they walk away feeling better about themselves or feeling happy or entertained, they will consider their time worthwhile. The operative word is GIVE not GET. (Not to get respect, approval, fame, client… but to give of myself.) The truth is also someone in the audience is going to disapprove of either me or my argument. I need to recognize that in a large group, there will always be a diversity of opinions, judgments, and reactions. I have learnt that the best way to succeed is to give myself permission to be myself in front of other people. And that includes being silly or do anything else that feels natural in the moment. The key is to be humble and if possible, humorous too.

Growing Families International (GFI)

2008-01-08T09:31:00.000-08:00

330 delegates congregated at the Queenstown Baptist Church for the GFI conference.
GFI runs the GKGW (Growing Kids God’s Way) and Reaching the Hearts of Teens in some churches in Singapore. I attended the Teens course earlier this year to learn of the spiritual dimension that parents turn to when all else fail to work. I was encouraged when reminded that I am HOPE for within me dwell HIM who is HOPE.

As a parent of the post-modern age, what I say and how I say it matters. The impact of post modernism is chaos and confusion somewhat. It is like playing different types of games on a common field. There are many rules and different realities. Nothing is absolute. How do I communicate the absolute truth when the young person before me ‘sees everything at once’? The diverse choices available to him/her make decision-making a more complex process. How do I adapt to social/technological changes in order to tune into the senses of the children of the new age.

How do I manage the WHY and the problem of HOW?

(B + g) = W + H = S to satisfy N.

B – Beliefs g - goals W – Why H - How S – Solution N – Need

‘g’ must have reasons to exist. Without beliefs there will be no goals. ‘W’ is why we do what we do. It represents the constant beliefs in our hierarchy of values forming our beliefs and goals.

The next symbol of the equation is where the rubber meets the road in parenting. It is taking the WHY behind what we are doing based on our BELIEFS and GOALS and translating it into HOW we accomplish our WHYS. HOW represents the many options and variables of application.

HOW and WHY compete when HOW tries to take over WHY. One of the most unrecognized causes of frustration in the management of the home appears when HOW takes over WHY. We mistakenly and unintentionally assign value to how something is done that supersede the VALUE of WHY (Primary). Sometimes the HOWS of life stop us cold. In our frustration, we begin to examine why our METHOD (HOW) does not work and we miss moving forward in life because we are stuck trying to fix a broken HOW.

The secondary HOW then begins to dominate our thinking and time. We end up worried and more focused on fixing the broken HOW than returning to the original WHY to consider other means to satisfy it. In fact, we often become spellbound by FEAR that if our HOW does not get fixed, our goals will never be achieved. In parenting, the greatest values are not on HOW you accomplish our goals, but the WHYS that govern our goals.

The Ezzos touched on the childhood transitions based on Structured Function Principles.
Transitions take on a progression. Expectations on the 1st born are higher and tend to frustrate the child as he/she may find it difficult to keep up. The parents can’t wait to move on to the next stage of transition and may impose certain training prematurely.
Wrong assumptions too may lead to fixing of the wrong things.

1. Nature Vs Will

Before age 3, the NATURE of a child is all ‘me, myself and I’. 3 different theories describe a child below age 3.

a. The child is morally good and has no desire to do wrong.
b. The child is morally neutral.
c. The child has the propensity for self-serving acts that may hurt others.
(i.e. The child sins with no knowledge of it.)

The WILL is a cognitive choice – sinning with knowledge.

2. Training Vs Education

Training takes place before a child is ready to be educated.
Training is the substitute for understanding as the child is not old enough.

When a child does something with the RIGHT motive but WRONG action, EDUCATION is necessary.

When a child does something with the WRONG motive and WRONG action, then CORRECTION is necessary.

Training progresses to education and the process should be positive, speaking ‘LIFE’ and not ‘DEATH’ into the child.

3. Boundaries Vs Freedom

No structure is more stressful as the fear for the unknown is real. Ideal parenting should be restriction leading to freedom and not the other way round. Children may not be able to make moral decisions. They are confronted with too many choices too. First 3 years of the child’s life, parents are the ‘bosses’ as the child is not capable of obeying.

4. Compliance Vs Obedience

When the parents believe that OBEDIENCE is important, the goal will be to train the child to obey. A child may comply outwardly without genuinely want to obey in his/her heart. Compliance is a mind over heart issue that shows outwardly. When a child remains compliant way beyond 3 years of age, problems may arise.

5. External Vs Internal

Children are externally influenced by what they see in their parents (self-control, wisdom.. etc) There are also internal (intrinsic) values which the children possess.

6. Authority Vs Influence

Authority is God-given where parents exercise to achieve goals. A child is ready to make his own choices WHEN he is ready to accept NO option. Parents only exercise relational influence for relational goals.

Attitudes that are not Beatitudes:

Positive attitude starts with the virtue of GRATITUDE. Negative attitudes start with a single vice of ungodly judgments. Attitudes are expressed in facial expressions (rolling of the eyes), body language (shrugging the shoulders) or through speech (yelling). Attitudes do not truly develop until after the child’s conscience begins to interact with moral understanding. Bad attitudes can not be out-grown. Parents correct both the wrong actions and bad attitudes.

Children 6 years and above can be made to reflect on bad attitudes and make it right.

CBT Specialization II (Schema Therapy)

2008-01-08T09:29:00.001-08:00

Dr Theiler placed strong emphasis on therapist-client relationship. Concepts in CBT are good for Axis 1 e.g. anxiety, phobias but long-standing issues such as Personality Disorders (Axis 2), CBT alone are not helpful. People with PDs are more rigid in relation to cognitions and emotions. Relationships are often more critical to PDs.
Some people are not able to express and that result in inaccessibility of some cognitions.
Cognitive theories often neglect early childhood.

Schema Therapy (Jeffery Young) is a wholistic and integrative theory (combines CBT with other psychotherapies) with treatment designed to help many long-term (originating from childhood and adolescence) emotional difficulties. Early maladaptive Schemas develop when specific; core childhood needs are not met. Such as safety, a stable and predictable home life – loving, nurturing and attention-giving. There is a lack of acceptance, praise, empathy, guidance and protection. Feelings and needs are not validated.

The broad goal of Schema Therapy is to help clients adapt through changing maladaptive schemas and dysfunctional coping responses by getting their core needs met. The Early Maladaptive Schema (EMS) is defined as a pervasive theme comprised of memories, bodily sensations, emotions and cognitions regarding oneself and one’s relationships with others that are developed from birth throughout one’s lifetime (Client’s perception of reality). And they are dysfunctional to a significant degree. (Young, 1999)

The EMS is more than a belief; it is a theme in life. E.g. Abandonment, Mistrust & Abuse, Emotional Deprivation (due to Cold Parents), Enmeshment, Vulnerability, Defectiveness (due to Critical Parental Style), Social Isolation, Approval-seeking, Failure, Entitlement (Indulgent Parents), Dependence (Overprotective Parents), Subjugation (Controlling Parents) etc.

Schemas originated from negative childhood & adolescent experiences, innate temperament and cultural influences (religion, social economic status, etc). Schemas formed as a result of severe frustration of needs, traumatization, ‘too much of a good thing’, over-identification with significant other, etc.

Coping Styles in relation to Schemas – The ways in which a child copes with a dysfunctional childhood environment:
Schema surrender - --- (freeze)
Schema avoidance ------ (flight)
Schema overcompensation ---- (fight)
As such, we can go into any of the following schema modes through-out our life –

* Vulnerable Child
* Angry Child
* Detached Protector (avoidance & no emotion)
* Punitive, Critical Parent
* Overcompensator
* Spontaneous Child (may be irresponsible)
* Healthy Adult (to strengthen)

Applications of Schema Therapy

Initial Evaluation:
Suitability of Client – psychotic, drug-abuse, or when problem is situational.
What are the main presenting problems and therapy goals?

Pattern Identification:
Presenting problem
Cognitions
Symptoms
Relationships
Life & Family history
Genogram

σ Young’s Schema Questionnaire YSQ
σ Four early memories (client’s memories from childhood)
σ Parenting Inventory YPI

 Link presenting problems to life pattern
 Find emotional links

Schema psycho-education:

 Assign reading of ‘Reinventing Your Life’ by Jeff Young, Ph.D. and Janet Klosko, Ph.D. on chapters for schemas that client scored high on.
 Discuss YSQ and YPI. Look for discrepancies between the two.

Experiential Techniques for Assessment:

 For triggers, get upsetting childhood images of mother or father
 Set up imagery or dialogues with significant people for empowerment
 Ask clients what they need in the image
 Link emotions from childhood images with current life circumstances – Client vents anger and asserts rights when appropriate; client grieves for losses

Case Conceptualisation

• Background information
• Relevant Schemas
• Current Problems
• Schema triggers
• Temperament or biological factors
• Developmental origins
• Early Memories
• Core cognitive distortions
• Surrender behaviours
• Avoidance Behaviours
• Over compensatory behaviours
• Relavant schema modes
• Therapy relationship

Summary of Conceptualization presented to client for feedback and conceptualization is fine-tuned. Client and therapist agree on important problem to work on first in the Change Phase.

 Test the validity of each schema, using evidence from all periods of life
 Try to discredit evidence
 Set up dialogues between Schema Side and Healthy Adult (note positive aspects and feedback to client)

Cognitive Techniques: Self-help Assignments

 Therapist dictates flashcards (to write positive statements) using template
 Write separate flashcards for all recurring life situations/schemas
 Assign Schema Diary in later therapy

Therapy Relationship for Schema Change:

Point out when client’s schemas seem to be activated in a session
Ask client for trigger event, emotions and cognitions
Test validity of client’s reaction: distinguish accurate perceptions from schema-driven overreactions.
Therapist is aware when own schemas are being activated and obtains supervision when necessary.
Concept of Limited Re-parenting – Client internalizes therapist’s Healthy Adult mode
Therapist fulfills needs that were never adequately met, within appropriate boundaries of therapy relationship

Assign and rehearse behavioral and interpersonal changes related to presenting problem to break dysfunctional behavioural pattern.

CBT Specialization IIb

2008-01-08T09:27:00.001-08:00

Underlying Schemas

Schemas are clusters of knowledge in a given area that are associated with emotions and behavioural scripts. This tacit knowledge occurs first in the course of development and relates to attachment experiences. It is a non-verbal, implicit view of the self. Tacit knowledge is the source of automatic and unconscious reactions to emotionally meaningful stimuli.

Cognitive Restructuring (from Dr Theiler’s perspective)

Stage 1 – Developing self-awareness

During this stage, the therapist attempts to help the client to identify their evaluative negative ATs, the associated processes of cognitive distortion and their underlying schemas.

Strategies for developing self-awareness:

- Revisit the specific episodes (the ABC model) using Form 2.1 to assess client’s cognition – the distorted automatic thoughts, the underlying maladaptive assumptions, the underlying negative schema; the behavior as well as interpersonal relationship of client with others.

- Explore shifts in affect (inside and outside the session)

- Free association (ask what AT comes to mind?)

- Using imagery/Role-plays

- Symptom induction using Hot Seat technique to bring in the emotions

- Discussion of the worst case scenario (how likely?)

- Look for thoughts that might explain feelings

- Dysfunctional Thought Records (DTR)

- Homework
Stage 2 - Identifying Contrasts in Thinking

The client needs to know thoughts can be different. The variations in the thoughts are determined by the schema one holds. Thoughts can be replaced and that can change feelings/mood.

Stage 3 - Evaluating and Challenging Thoughts

Terms are being defined using Semantic Technique, such as, ‘success’ in the client’s understanding and belief. (How would you define ‘success’? What is 100%, 50%, 0% success?) Therapist will conduct Cost Benefit Analysis, ie., the cost to having such assumption as well as the benefit. Examining the evidence will further help evaluate the value of holding such thought. Both therapist and client will also explore alternative explanations or other way of looking at things. Subsequently actual consequences are evaluated – So what if it happens?

Another technique is Distinguishing Behaviors from People, for e.g., if you do some things that are worthwhile, then how can you be worthless?

Double-Standard Technique is used to highlight client’s tendency to apply a different standard to self from another.

Examining evidence For and Against the assumption – What is the quality of the evidence?

Logical Analysis – E.g., How does someone’s not liking you make you worthless? If one person likes you and another doesn’t, are you worthless or worthwhile?

Challenging the ‘should’ statement and identifying the conditional rules will help client to progress in life although the therapeutic outcome may not be perfect.

Below is an example of a vertical arrow for identifying schemas:-

What if I sing the wrong key? (NAT)

People will notice

They might laugh at me

They’ll think I’m not good enough

I think I’m not good enough
Assumption: If I sing off key, people will think I’m not good enough (it means I’m not good enough)

Belief: I’m not good enough

A General Model of Cognitive Theory

Learning experience

Dysfunctional Schema formed

Critical incident

Schema activated

Negative automatic thoughts and cognitive biases

Anxiety and other affective responses
Behavioural responses

The Standard CBT approach to Depression

Assessment & formulation: Involves behavioural (e.g. withdrawal from others, rumination and social skill deficits), cognitive and interpersonal factors; suicidal risk and medical review

Socialization to treatment

Establishment of goals

Behavioural activation & other behavioural interventions (crucial first step in depression)

Cognitive interventions

Inoculation against future depressive episodes

Phasing out therapy

Developing a Cognitive-Behavioural Formulation

1. Create an all-inclusive problem list that includes major symptoms and problems in functioning

2. Propose an underlying theme that might underlie all the problems
(Client’s belief) What are the antecedents and consequences of the behaviour?

3. Hypothesize how the underlying theme might cause the problems

4. Explore the precipitants for the current problem

5. Look for the origin of the problem in the client’s early life

6. Predict obstacles in treatment based on the formulation

CBT Specialization IIa

2008-01-08T09:25:00.001-08:00

Depression affects the whole being of a person – negative (thoughts) about self, (emotional) pains and loss of pleasure (behaviours) with most things.
The fact is people inherit a vulnerability to depression but they do not inherit depression itself and that explains why depression is episodic. All depressions are biochemical events. Medication and the label attached to this illness may help combat shame. Stressful life events (e.g. breakup) are strongly related to onset. They are psychosocial causes of depression.

Anger has a role to play in depression but it is not the sole cause. Depression almost always has more than one cause. Low self-esteem and fear of expressing anger are risk factors for depression. Each painful depressive episode has the potential for personal growth. The depressed person may need to ‘think about what they are thinking about’ – psychological-minded or aware of self. He needs to instill change in himself. The goal is to progress or move forward while retaining the good. The best approach to battling depression is to use multiple approaches to change such as behavioural, cognitive, and interpersonal.

The key symptoms of Major Depressive Episode (MDE) can be clustered into 5 areas:

Behaviour - Inactivity due to loss of interests, poor self-care, self-defeating behaviour, restlessness (do lots but achieve little), light and noise avoidance, alcohol and drug use, crying & inability to cry (in itself does not worsen depression), self-harming behaviours.

Emotional - Depressed mood, loss of interest or pleasure, guilt and shame, anxiety, anger and despair. (Emotional bankruptcy).

Thoughts – Poor concentration, poor memory, difficulty making decisions, negative beliefs about self, the world and the future. Biased memory of the past, ruminations, being easily overwhelmed, racing thoughts, acute sensitivity to rejection, a belief of being punished, paranoia, delusions and hallucinations and thoughts of death.

Physiological - Weight loss, weight gain, insomnia, hypersomnia, agitation, psychomotor slowing, fatigue, reduced sex drive, pre-occupation with bodily symptoms.

Social - Isolation, decreased assertiveness, irritability, disconnection, difficulty tracking conversations, friends asking what’s wrong and friends drift away.

Dr Theiler presented two Personality Subtypes of Depression – The Socially Autonomous style (Type A) and the Socially Dependent type.

I was reminded of my client Grace who fell into the latter type. She has a strong desire for help and always comes to session with a plethora of material. The trouble is she often saves the most important problem to the end and thereby extends the length of the session. She wants the therapist to solve problems and I expect her to return even when she can handle the problems. From her sharing of presenting issues, it was clear she has been over-dependent on her spouse. She expects her spouse to make nearly all decisions by giving up control to spouse. Her spouse finds her too intimidating as she overreacts to crises and wants to share all her feelings with him.

It was interesting to note too some spouses or family members who were called to the session upon requests of clients fell into the Autonomous Type. They were indifferent to therapy and believed they should solve own problems. They too showed lack of trust for the clients’ ability to control and tend to make decisions on their own by covering up their reactions to crises. Some of my teenage clients fall into this category too.

Treatment of Depression

Pharmacology (AntiDepressants Medications – work for approx 50%)
ECT (ElectroConvulsive Therapy) – benefit 50% of those not responding to ADM
Both ADM and ECT may be required for severe MDD

Psychological treatment for mood disorders –

Psychodynamic Long-term and Brief
Cognitive-Behavioural Therapy (Beck et al.) which is evidence-based.

In CBT, the automatic thoughts are being examined. Such thoughts are short, specific and idiosyncratic. They seem to occur reflexively and involuntarily. People’s thoughts are negative most of the time. They involve evaluative distortions of reality. (Even highly intellectual people are not spared.)

Some patterns of distorted cognitive processes (it is refreshing to go through them again):

Filtering (out of positive) by magnifying the negative details.

Polarised thinking – Things are either good or bad. There is no middle ground.

Overgeneralisation - Come to a general conclusion based on a single piece of evidence.

Mind-reading – Without others saying so, I know what people are feeling and why they behave the way they do.

Catastrophising - ‘What if it happens to me?’
Personalisation - Thinking that everything people do or say is some kind of reaction to me.
Control fallacies - If I feel externally controlled, I see myself as helpless, a victim of fate. The fallacy of internal control makes me feel responsible for the pain and happiness of everyone around me.

Blaming - I hold other people responsible for my pain or blame myself for every problem.

Shoulds - I hold a list of ironclad rules about how I and other people should act. People who break the rules anger me and I feel guilty if I violate the rules.

Emotional reasoning - I believe that what I feel must be true – automatically. Eg. If I feel stupid and boring, then I must be stupid and boring.

Fallacy of change - I expect other people will change to suit me if I just pressure or cajole them enough. I need to change people because my hopes for happiness seem to depend entirely on them.

Global labeling - I generalize one or two qualities into a negative global judgment.

Being right - I am continually on trial to prove that my opinions and actions are correct. Being wrong is unthinkable and I will go to any lengths to demonstrate my rightness.

Heaven’s reward - I expect all my sacrifice and self-denial to pay off, as if there were someone keeping score. I feel bitter when the reward does not come.

BasPsychopathology & Classification of Mental Disorders

2008-01-08T09:23:00.000-08:00

Classification of Mental Disorders
Wherever we try to mark out the frontier between mental health and disease, we find a neutral territory, in which the imperceptible change from the realm of normal life to that of obvious derangement takes place.’ – Kraepelin (1917)

There is no consensus definition of Abnormal Behaviour. The elements (changes as society changes) of abnormality include:

Distress (suffering)
Dysfunction (maladaptiveness)
Deviancy (statistical deviance)
Deviancy (social deviance – violation of the standards of society)
Discomfort (social)
Dangerousness (irrationality and unpredictability)

Mental disorders are classified so as to provide:

A nomenclature (to structure information helpfully)
An effective ‘language’
Social and political implication (legal etc)
Natural history of disorder defined (prognosis)
Effective specific treatments
Aetiology and pathophysiology
Genetgics (phenotype vs genotype )

Stigmas, Labelling and the Downside to Classfication:

Loss of information
Absence of context
Stereotyping -
Labeling - What happens if fail to label correctly? Diagnoses can be self-fulfilling prophecy for patient. How long does the label apply?
Sigma – Is it ever removed?

DSM classification of mental disorders:

- Patient’s subjective description of a physical or mental disorder
- Objective observation of a patient’s physical or mental disorder by a diagnostician.
Basic Psychopathology - The study of abnormal states of mind

Disorders of Perceptions:

Perception is a process of becoming aware of what is presented to the sensory organs. An illusion is a misinterpretation of a normal perception (normal phenomenon). E.g. saw a shadow and perceived the tenant had come home. Hallucination is a sensory perception without an external stimulus. Hallucinations may occur in any sensory modality—visual, auditory, olfactory, gustatory, tactile, proprioceptive, equilibrioceptive, nociceptive, thermoceptive.

Hypnagogic hallucinations and hypnopompic hallucinations are considered normal phenomena. Hypnagogic hallucinations can occur as one is falling asleep and hypnopompic hallucinations occur when one is waking up. Hallucinations may also be associated with drug use (particularly hallucinogenic drugs), sleep deprivation, psychosis or neurological illness.

Disorders of Thinking:

In psychiatry, thought disorder is a term used to describe a pattern of disordered language use that is presumed to reflect disordered thinking. It describes a persistent underlying disturbance to conscious thought and is classified largely by its effects on speech and writing. Disorders of thinking may affect the stream of thought. Affected persons may show pressure of speech (speaking incessantly and quickly), derailment or flight of ideas (switching topic mid-sentence or inappropriately), thought blocking, rhyming, punning, or 'word salad' when individual words may be intact but speech is incoherent.

Eugen Bleuler, who named schizophrenia, held that its defining characteristic was a disorder of the thinking process. It is important to note however that the delusions and hallucinations of psychosis could also be considered as disorders of thoughts in its content. Delusion is a belief that is unshakeable, untrue and unshared. It can be persecutory (paranoid), grandiose (expansive), jealous, love, hypochondriacal (the belief and fear of serious illness which lasts for six months, beyond and despite medical reassurance), nihilistic (severe depression) and guilt.

Disorders of form of thought is persistent and inappropriate repetition of a response, eg dementia - Perseveration. Rapid shifting on one topic to another, eg mania - Flight of ideas. Clang Association is based on similarity of sound without regard for differences, eg. Schizophrenia.

Disorders of Emotion:

Affect is a subjective feeling at a point in time while mood is a prolonged emotional state. Changes in the nature of emotion come in the form of anxiety, depression, elation, anger, fear and panic. Abnormal fluctuations of affect refer to blunted, flattened, labile and incongruity of affect.
Disorders of Consciousness:

This is a state of drowsiness resulting in incomplete reactivity to external stimuli. Stupor is a state in which patient is mute, immobile and unresponsive yet fully conscious.

Disorders of Memory:

Memory processing involves registration, retention, recognition and recall of datas.
Left brain is for verbal memory. Right brain is for visor-spatial memory. Amnesia is failure of memory.

Disorders of Motor:

There are many types of Motor Disorders. Tics refer to irregular repeated movements of a group of muscles. Echopraxia attempts to imitate movements of others.

Other disorders:

Depersonalization - change of self-awareness, a feeling of unreal, of being detached and unable to feel emotion.

Derealization – objects and environment seem unreal and lifeless.

Déjà vu – recognition of events that are in fact novel/new

Jamais vu – failure to recognize events encountered before

Confabulation – fabrication of stories in response to questions about situations or events that are not recalled

CBT Specialization Ic

2008-01-08T09:21:00.001-08:00

CBT is a collaborative empirical approach looking for evidence. It is to be presented as one useful perspective and non-cognitive determinants of distress are not to be ignored. The focus is on trialling the new perspective in order to decrease the emotional commitment to the old. It is about asking ‘what’s useful?’ ‘what’s not useful?’

In order to develop a Cognitive Behavior Formulation, I have to assess client’s suitability for CBT in terms of accessibility of ATs, awareness of differentiation of emotions, acceptance of personal responsibility for change and compatible cognitive rationale of ‘beliefs may be given up if found to be invalid and self-defeating.’ Client must have the potential for alliance. Chronic issues may be harder to treat as compared with an acute issue.

Having considered the above, I will first create an all-inclusive problem list that includes major symptoms and problems in functioning. Then I will look for the underlying (or overaching) theme that might underlie all the problems (e.g. low self-esteem) and then hypothesize how the underlying theme might cause the problems. Explore the precipitants for the current problem. Look for the origin of the problem in the client’s early life. Predict obstacles in treatment based on the formulation.

The 3 stages of Cognitive Restructuring:

Stage 1 - Developing self-awareness

Help the client to identify their evaluative negative ATs, the associated processes of cognitive distortion and their underlying schemas. When client ‘floods’ the therapist with his story, one way to slow him down will be to write down key words to slow down the process. Client may do so in an attempt to reduce anxiety by not going in-depth.

Recounting specific episodes (the ABC model) by asking client to relate the most recent or most important event through free association, imagery or role-plays. Explore and interpret shifts in affect when discuss about the worst case scenario. Look for thoughts that might explain feelings. Distinguish thoughts from facts. Categorize the distorted thinking. Encourage the client to keep a Dysfunctional Thought Records as homework.

Using the Vertical Arrow technique to identify schemas:

What if I babble? (NAT)…. that will be distressing because..
People will notice…………… that will be distressing because..
They might laugh at me……. that will be distressing because..
They won’t take me seriously… that will be distressing because..
They will think I’m stupid.. that will be distressing because..
I’ll think I’m stupid and… that will be most devastating!
(Auto-pilot thinking)

Assumption: If I babble, or am incoherent, people will think I’m stupid (or it means I’m stupid).

Belief: I’m stupid.

Some ways to deal with problems of arousal (Symptom Induction):

1. Use of controlled breathing to reduce anxiety (client feels threatened and can’t cope)

2. Self-soothing (mindfulness)

> Appreciate positive things:

visually (nature; be in the pleasurable moment)
hearing (music)
smell (perfume)
taste (yummy food)
touch (spa; massage)
kinestic (rocking chair)

3. Distraction techniques: [Marshall Linehan – Alternative Process]

ACCEPTS

A – Activities (child throws tantrum at home, take child outdoor)
C - Contributing (talk to someone)
C - Comparisons (others are anxious too)
E - Emotions (alternative)
P - Push away (leave)
T - Thoughts (distracting thoughts)
S - Sensations (alternative eg when having thoughts of self-mutilation, put cold water on chest)

Stage 2 – Identifying CONTRASTS in thinking

Bring to client’s awareness that thoughts or evaluations CAN be different. Rate client’s emotions and beliefs. Help client to identify CONTRASTS in other people that people can behave differently in same situation. Ask client, ‘if you were to think this other way, what might you feel or behave?’ (Thought Insertion). Client experiences personal contrasts in thinking too as in they hold meaningful perspectives at different times/events.

Stage 3 – Evaluating and Challenging Thoughts

- Define terms such as ‘I am a failure.’ Objectively (useless good for nothing) and subjectively. (What does that mean to you? – ‘I didn’t get a HD for this paper.’)

- Cost-benefit analysis (Advantages and disadvantages)

‘I’ll get rejected if I go to the party.’

Costs: I won’t enjoy even if I go. I will the chance for being accepted.

Benefits: I avoid some anxieties of going. I don’t have to make any effort. (Avoidance)

- What is the evidence?

- Is there any other way of looking at this? (alternative explanations)

- So what if it happens? (evaluating actual consequences)

- Using behaviour to resolve the negative thought (eg using ‘shame attack’)

- Double standard technique (Others can do anyhow but I must give a flawless presentation.)

- Challenging the ‘should’ statement (absolute).

- Identify conditional rules (‘If I perform 100% at work, I’ll be ok.’

- Help client to distinguish PROGRESS from PERFECTION.
(Do not need the BEST outcome. Do not have to be perfect.)

CBT Specialization Ib

2008-01-08T09:18:00.000-08:00

When client comes in with his problem (e.g. ‘feeling anxious when looking up newspapers for job opportunity’), CBT framework will be used to conduct an initial assessment of the presenting issues. The client will describe problems with regards to:

1. Situations where problem occurs

- Have people noticed or commented on your anxiety? What have they said?

2. Duration

- How long have you experienced this problem?
- When did you first notice that you were feeling anxious?
- Did something happen before you start to feel anxious?
- Have you experienced any major traumatic events in the last 6 months?

3. Frequency

- Do you notice that the problem happens every time you check out on job opportunities?
- Does it happen more on some days compared to others? Why/Why not?

4. Intensity

- On a scale from 1 to 10 where 10 is really bad and 1 is not bad at all, where would you rate your level of anxiety? (i.e. SUDS scale)

- Is it always that bad? Can you think of other situations where the rating would change?

5. Course of problem

- Has there been a time in the last 1 month you have not felt anxious?
- Does it come and go?
- What has brought you to see me now?

6. Predisposing factors

- Are you aware of anyone else in your family who experiences anxiety? If yes, has he sought help for the problem? - Hospitalization, medication, etc.
- Do you have any medical health problem?

- Have you noticed frequent changes in your mood state?

Behavioral Analysis of the Problem:

Situational triggers - ‘Have you noticed that you feel more anxious when you are checking out the job advertisement with people around you?’

Behaviour triggers – ‘Have you noticed that you feel more anxious when you need to call the prospective employer for appointment?’

Cognitions – ‘Can you tell me exactly what was going through your mind when that happened?’

Affect/emotional factors – ‘Can you tell me whether there are any other moods that influence the anxiety?’

Social factors –
‘Does it make any difference whether you are interviewed by just one interviewer or a few?’
‘How would you normally respond to no reply from job application?’
‘What does your husband think about the problem?’

Physiological triggers – ‘What do you notice about your body before you experience the anxiety?’

Maintaining factors –

‘You said that you are tired of working, is this something that you would try to avoid?’
‘What would need to happen for you to let go of this problem?’
‘What have you stopped doing because of this problem?’
‘How has your life changed since having this problem?’

Coping (Environmental) Resources/Personal Strengths

‘I wonder what you do to help manage this problem.’
‘What about other times in your life when you have felt anxious – how did you get through these times – do you remember what you did?’

Client’s views of the problem & expectations of change

‘How hopeful are you that the problem will go away?’
‘What are you expecting from the treatment process?’

CBT Specialization Ia

2008-01-08T09:14:00.000-08:00

AP Glen Bates arrived with flu but there was no sign of jetlag. I recalled how I benefited from him when he was here in June. I had a PTSD client then and the equipping was timely enough for me to ‘unload’ whatever that was relevant from AP G Bates on to my client. Lo and behold, the client recovered after two sessions. 

As the final Assessment Tasks were designed (and to be marked) by AP G Bates, the whole cohort seemed unusually motivated to engage and elicit whatever tips and ‘extra’ information necessary to churn out a satisfactory piece of work.

One of the major assumptions of the CB approach is that people have a natural tendency to negate the cognitive processes which results in psychological distress. Cognitive processes are the key proximal (‘at the time’) determinant of stress and behavioral dysfunction.

Primitive Thinking Mature Thinking
Non-dimensional and global
‘I am rotten.’ ‘I’m rotten in everything
I do.’ Multidimensional
- multiple selves (roles/styles)
Absolutistic and moralistic
- Fear of making mistakes, must have approval
all the time Relativistic and non-judgmental

Invariant Variable
Character diagnosis (Who we are) Behavioural diagnosis
(What we do)
Irreversible Reversible

AP Glen Bates touched on Ellis’ REBT on sources of well-being namely, approval from others (ego/sense of self), successful performance/achievements (ego/sense of self) and comfort (absence of distress).

In REBT, the Core Irrational Beliefs are:

- Demands (Unless that happens….)
- Awfulising (A distress state of internal rumination.)
- Low Frustration Tolerance (LFT)
- Global evaluations of self-worth (ingrained view of self)

Whereas Beck’s Cognitive theory consists of:

- Automatic thoughts :

Short, specific and idiosyncratic (personally relevant)
Occur extremely involuntarily and rapidly, immediately after the event
Do not occur in sentences or logical order
Often ATs have the same themes (e.g. approval)
ATs involve evaluative distortions of sense of self. (e.g. I am stupid.)
Seem plausible at the time

- Distorted cognitive processes (unconscious) :

• Filtering – ‘Anyone can do it.’ ‘Most times I can’t do it well.’
• Polarised thinking – ‘I must pass with HD, otherwise I can’t face my family.’
• Overgeneralization - ‘He is out to get me all the time.’
• Mind reading - ‘He thinks I’m unattractive.’
• Catastrophising – ‘I will faint if I go on stage.’
• Personalization – ‘They are looking at my direction. They must be talking about me.’
• Control fallacies - Externally controlled: ‘He always says I am useless and bad. I must be bad.’ Internally controlled: ‘My company goes into bankruptcy because of my poor performance.’
• Fallacy of fairness – ‘They always think I am biased in my judgment.’
• Blaming – ‘He always makes me feel awful.’
• Shoulds – ‘He should address me properly instead of calling me by my first name.’
• Emotional reasoning – ‘I must be stupid and boring coz I feel stupid and boring.’
• Fallacy of change – ‘My husband must start buying me flowers on Valentine’s Day.’
• Global labeling – ‘The whole school will shun him for being tardy.’
• Being right – ‘I know the only right way to go about doing it.’
• Heaven’s reward – ‘I have sacrificed so much for the family but no one is grateful.’

- Underlying schemas (how people interpret events)

σ They are clusters of knowledge occurs largely out of awareness (associated with emotions and behavioral scripts)
σ Tacit knowledge occurs first in the course of development and relates to attachment experiences
σ It is non-verbal, creates an implicit view of the self.
σ It is the source of automatic and unconscious reactions to emotionally meaningful stimuli

A General Model of Cognitive Theory:

Attachment Theory:

Attachment theory asserts that there is a vital initial stage early in life that lays the foundation for the development of healthy relationships. An attachment bond is a specific form of relationship that is characterized by feelings of comfort when near the other person and a desire to remain close when distressed or when this person is inaccessible. The need for attachment bonds is believed to be inborn and is satisfied initially by the presence of responsive, dependable, and available caregivers who provide sustenance and comfort and actively intervene when problems are beyond the child's capacities. Attachment figures provide a secure base from which the child can explore the world and return for comfort, safety, or help when necessary due to distress, fatigue, or other problems.

In order to establish healthy adult attachment patterns, the child must have experienced with caregivers some level of safety, consistency, responsiveness, and comfort that creates a "secure base." If established, this secure base allows the child to actively explore his or her external and internal worlds and successfully develop new relationships. Through these early interactions, each person develops "working models" or internalized views of self and others that influence how each person anticipates and perceives later interpersonal relationships as well as the methods for and ability to elicit appropriate caretaking behaviors from others. As such, the attachment process and attachment styles of people are mediated by the quality of early caregiving, which ultimately influences future relationships.

Securely attached individuals are better able to explore and experience their internal and external worlds relatively effectively and confidently. Anxiously or insecurely attached (avoidant, detached, enmeshed, or ambivalent) individuals have more difficulty exploring and experiencing their worlds and have particular difficulty getting their interpersonal needs met appropriately. A pattern of insecure attachments is believed to be related to a variety of psychological difficulties.

Bartholomew, K. (1990). Avoidance of intimacy: An attachment perspective. Journal of Social and Personal Relationships, 7, 147-178.

SOS Suicide Prevention II

2008-01-08T09:11:00.000-08:00

Being the Executive Director, Mrs Tan is very well-versed with the SOS Suicide Model.
As it was right after lunch, I noticed a couple of sleeping eyes. I was glad I did not take a full lunch and got interested in how to ‘ask suicide questions’. Posing the question will not make the situation worse if the ideation is already there. I was relieved to learn it may even be a relief for the client to know someone cares enough to want to know about it. Asking the question outright at the right timing with the right amount of empathy instead of skirting around it nervously will be perceived more professional and confident, I reckon. Open-ended questions invite the client to open up slowly as most times the latter is in a state of ambivalence.

Who do we pose the question to? Clients from any age group and the mentally ill included. Elderly persons fall under the high risk bracket of suicide cases. Even those aged 10 and below know what suicide is about basically although the depth of their knowledge varies. The young persons are impulsive and they fall under suicide copy-cats. Those who are mentally ill form 1/3 of completed suicide cases. I must not miss the opportunity to pose the question. It is safer to err on the side of caution.

In my risk assessment for suicide ideation, I examine client’s feelings, motives and expressions. Some empathetic statements I can use before popping the suicide question are:

1. I hear you say ‘life is not worth living’, I wonder if you have ever thought of ending it?

2. I sense you feel intense hopelessness, I wonder if you ever consider ending it all?

3. You seem devastated and overwhelmed by the challenges you are facing presently. You talked about ‘no way out’, I wonder if you have thought of ending it all?

The Los Angeles Suicide Prevention Centre identified 7 basic factors which can be used for judging a person-at-risk’s potential for completing suicide.

1. Age - Risk of suicide increases with age.
2. Sex - Men die by suicide more often than women. (Apparently the methods they used are more fatalistic.) Women attempt suicide more often than men.
3. Stress - A loss/change (current or anticipated) that is perceived as substantially diminishing the value of life.
4. Symptoms - Changes in behaviour, physical condition, thoughts or feelings (hopelessness/helplessness).
5. Current Suicide Plan - A specific, detailed plan consisting of method, venue and date and time of how to kill oneself and the means to carry it out.
6. Prior suicidal behaviour - Prior attempt or history of suicide in the family. Is it active and intense? (Happened recently? Frequency? Method?)
7. Resources - Supportive, preserving factors - Family, friends, career (external) and faith (internal).

In my assessment of risk, my focus will be on item 5, 6 and 7.

If there is no concrete suicide plan (+), no prior suicidal attempt record (+) and there is resource for client to fall back on (+), the risk is LOW.

If there is suicide plan (-), no prior suicidal attempt record (+) and there is resource for client to fall back on (+), the risk is LOW – MEDIUM

If there is suicide plan (-), there is prior suicidal attempt record (-) and there is resource for client to fall back on (+), the risk is MEDIUM

If there is suicide plan (-), there is prior suicidal attempt record (-) and there is no resource for client to fall back on (-), the risk is HIGH.

The protocol for SOS counsellor to do will then be:

1. Identify risks (using empathetic statements and suicide question)
2. Inquire plans
3. Assess risks (CPR)

Personally, I find clients’ ambivalence usually lies between wanting to die for someone and at the same time to live for another. By helping client to focus on the one(s) he would live for seems to help to a great extent.

Response to Child Psychotherapy

2008-01-08T09:06:00.000-08:00

Ms Leong: “I see that working with Children and working with Adolescents as being
vastly different, and I certainly believe that it requires very different
skills, as well as specific knowledge to working with adult clients. I think
in any statements on this position we need to draw a clear distinction
between the two, and recognize them as linked, but slightly different
specialisms.

I feel that therapists working with these 2 groups must constantly use a
'mental check list' to see if we have sufficient skills and knowledge to do
the job competently. If in doubt we should seek supervision and get into
working support groups.

We should also encourage ourselves if we are working with children to invest
in books, conferences and workshops to strengthen ourselves with an
underpinning theoretical framework and that our therapy is also supported by
professional literature.”

A belated reflection after reading Toh Hwee Boon’s input :

In my practicum experience, I had only come across 3 children (aged 9 to 15). From the outset, I chose to abide by the formal training received from ECTA with regards to confidentiality and boundary. For both groups of children (in primary and secondary), I would assure that whatever they shared would be kept in confidence unless they had intent to self-harm or hurt others. (Informed Consent form applies.) As for the parents, I would make it clear that permission would be sought from their children before I divulge any info. As such, I didn't have an issue with enmeshing the two parties. I agree with Jessica’s subsequent comment in a later email that very often the parents themselves are overwhelmed by their own personal and interpersonal issues to be able to handle their kids. I believed the relational tensions experienced by the kids at home had caused the kids to play out their frustrations in school. In the cases above, therapy was extended to the parents concurrently so that with improved relationships they could role-model their kids better.

I agree with H Boon that children can be very 'lonely' in spite of intense care of their well-being by parents and school. Their 'facade' (fueled by their rackety feelings) seems to work for them for some time but you and I know we need to help them to address the repressed feelings when they find it difficult to cope any longer. In therapy, often than not children react well to 'friendly chats' which leads to deep sharing if the therapeutic alliance is well-established. For children who enjoy drawing, I used their drawings to find 'openings' to enter their inner worlds. Some stories are great materials to inculcate good values indirectly. In this IT age, an IT-enhanced therapy may be more appealing and meaningful (?) to the computer savvy ones who are more attuned with the technology. For older children, I find topics on hobbies, games, friendship etc good avenues to explore and venture into the young minds.

I have yet to meet any parent who is resistant to therapy. The parents in my contact are mostly concerned & overly concerned ones with a couple of spouses who prefer to pursue their own happiness than addressing the needs of a kid. By and large, they want to co-operate with the therapist to reach out to their children (away from the limelight in school). This may take on a different meaning and implication in a school setting as the school authoritative figures are also involved in the helping (open) process. Some times the parents who are called in to meet the school counselor have different sets of expectations to comply - the school’s expectation of the child, the counselor’s expectation of the parents and child, and the parents’ own expectation of the child. Whose value systems should prevail in this case?

I will be seeing a Primary 6 child next month. She is ‘misbehaving’ according to her mother. The negative behavior came about after being locked up in the house together with her mother and siblings by their father on two occasions. She became hysterical during one of the lock-ups and threatened to jump out of the window. Knowing her unique background information, I cannot think of a straightforward approach to addressing her as she may be 12 years of age, but having witnessed and experienced family violence growing up has developed in her the fighter’s spirit.

Every child and adolescent has their own unique encounter in life. I agree with Jessica in that our approaches towards children and adolescents may have to be creatively varied to meet the special needs of the young person willingly or unwillingly enter our therapeutic zone. 

SOS Suicide Prevention

2008-01-08T09:02:00.000-08:00

Mrs Tan briefed us on the types of services provided by SOS at the outset of workshop:

- Email befriending (targeting the young people mainly)
- Face to face counselling sessions
- Hospital and police referrals
- Emergency squads (2 volunteers on standby)
- Local outreach to suicide survivors/bereaved (LOSS)
- Healing bridge
- Community education (suicide prevention)

Trained counsellors man the 24 hr hot line – 1800 2214444 and types of crises intervened include accidental (sudden and unexpected ) or situational (retrenchment) crises, developmental or maturational crises (unwanted pregnancy, loss of health), disasters (mass destruction). When a person’s coping mechanism is overpowered by disequilibrium, it is not a pathological state; it may occur to anyone at any stage in a life span. (Golan 1978) It is possible to overcome the crisis if the problems are clearly defined and the significant persons re involved in the resolution.

The six stages of a crisis:

1. Hazardous build-up (stress/pressure/tension evaluated from Client’s point of view.)
2. Precipitating event (coping mechanism stretched as a result of direct/indirect events; experience loss of some sorts.)
3. Disorganization (can’t think properly; turn to secondary resources – eg social worker)
4. Breaking Point (pinnacle/unbearable. Reach out to anyone/anything even to an active suicide attempt.)
5. Re-organization (exhausted emotions, rediscovery of strength and options.)
6. Restoration (renewed confidence in self. able to make choice and take action.)

While handling a crisis situation:

1. Remain calm and attend to the feelings by putting judgement aside. Reflect client’s feelings (say ‘I sense you feel…’ ‘I hear you say….’)

2. Explore the problem NOW, not the root cause. Examine triggers/meaning/impact.

3. Periodically paraphrase/recap to the client to ensure common understanding of key terms.
4. Define the focus - WHAT is causing the client great pain? Allow focused area to change.

5. Explore available resources - What has Client tried so far? What would the client wish to do about the situation? What is client afraid to do? Who would he like to talk to if he could?

6. Establish open line of communication for client to re-contact if client’s choice of action plan fails.

On the continuum of suicidal behaviour, the following take place:

1. Client harbours and exhibits risk-taking thoughts and behaviours respectively.
2. Suicidal ideation – (at thinking level) either fleeting or intense
3. Suicide threat (e.g. sitting on the window ledge)
4. Suicide attempt (any form) – High intent to die but survive attempt
5. Suicide (death is the outcome) - High intent to die.

6. Low intent to die and end in death – classified as accidental suicide if no foul play (misadventure, accident)
7. Low intent to die and survive – para-suicide

Facts:

- Suicidal people don’t want to die.
- A suicidal crisis is generally of short duration.

Myths:

- People who talk about suicide won’t do it.
- Suicide occurs without warning.
- Asking someone if he is feeling suicidal will put the idea into his head.
- Suicidal people do not seek medical help.
- Terminally ill people often die by suicide.

A suicidal person is more likely to be thinking about ending their pain, rather than ending their lives.

Acknowledge and reflect their strong feelings of suicide AMBIVALANCE.

Counseling Research Methods & Processes

2008-01-08T08:53:00.000-08:00

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. 

Nothing Stands in Son's Way

2007-11-26T00:39:00.000-08:00

The Combat Diver Course is a 31-week course specifically designed to train military divers of the Navy. The course is divided into four phases as follows: Phase 1 is the Physical Phase, where trainees go through strenuous training to train up their physical and mental strength. This phase ends with the Team-Building Week, more famously known as "Hell Week". Phase 2 is the Diving Phase, where trainees are taught techniques in basic diving, as well as land and underwater demolition. Phase 3 is the Land Combat Training Phase, where trainees go through land-based training. Phase 4 trains shipboard competency. (http://www.mindef.gov.sg/imindef/mindef_websites/atozlistings/navy/microsites/ndu/index.html)

It was with great jubilance as the family witnessed the Passing Out Parade of Clem from the Diving Phase of Combat Diver Course on 10 Nov 07. He is now in Phase 3 which is the Land Combat Training Phase.

NDU is the only unit in the SAF that specialises in diving. The bulk of NDU’s responsibilities lie in search and rescue (SAR), explosives ordnance disposal (EOD) and general salvage work. Readily responsive to calls for assistance, our naval divers are also involved in less critical situations, such as “evidence recovery.” MSG Norris Charles, a veteran instructor, said: “There was once in 1994 when we spent five hours below Anderson Bridge recovering a gun which was accidentally dropped by a robber!”

One of the most challenging tasks for the EOD divers took place in 1990 when a team of 60 divers worked around the clock for three days to clear 21 World War Two bombs in the waters off Pulau Brani. MSG Charles who specialises in EOD said, “Mine clearance is a very long process, as it can take days, weeks or months. All EOD divers have to attend a specialised course before they qualify as mine clearance divers.”

He emphasised: “Of course, safety is top priority. We inspect every single diver before diving to ensure that his equipment is fully demagnetised to prevent any explosions when approaching underwater mines.

“On top of that, every mine clearance diver goes through currency drills under close supervision every quarter so that he is thoroughly familiar with all the standard operating procedures.”

Although naval divers operate primarily underwater, they are certainly not “fishes out of water” and will surface in times of need. NDU’s combat capabilities include shipboarding, force swimming (groups of divers swimming in formation) and close quarter combat. Such capabilities are necessary when hostages have to be rescued from hijacked ships or when ships suspected of carrying contraband cargo have to be boarded and searched. SSG Eric Tay, a combat-trained NDU diver said, “Compared to normal salvage jobs, combat diving is a different ball game altogether. There are special tactics that you need to learn. In order to be a good combat diver, you must also possess situational awareness and survival instincts.”
He added: “Fitness also plays a part, because you are not just diving. You also have equipment and weapons, and you will have to swim fast. The diver’s mental state is also very important, as in how much you can motivate yourself to achieve your objectives.”

PUSHING TO THE LIMITS

A firm grounding in physical fitness and mental agility is provided to all trainee divers during the training process at NDU. As in all cases, training builds the competence required to perform the job. However, it is a little different in the NDU, where every trainee diver knows that the training will either “make or break” him, depending on his determination to persevere through the rigorous training.

It takes about six months for a trainee diver coming straight from Basic Military Training to complete his Class 2 Diving Course, where theoretical and practical knowledge on diving is imparted. To build up the trainees’ water confidence level and their knowledge of how their equipment would perform underwater, a pool competency course is conducted in the first half of the course. Under the watchful eyes of the safety officer, trainee divers are subjected to simulated stress akin to actual underwater conditions.

Each diver’s performance is closely monitored to ensure that he is competent in managing potential underwater problems. During these drills, all trainees must maintain a cool composure and alert mind to be able to extricate themselves from the problems that they face underwater.

After he clears this stage, a week of sweat and toil awaits him. Popularly known as ‘hell week’, the old adage - the survival of the fittest - certainly applies here. Hell week means a gruelling 120 hours of non-stop physical exertion both on land and in water, with trainees allowed three hours of sleep only on the third day. Only the best will make it.

SSG Tay said: “The aim of hell week is to let each individual know that he can be pushed beyond his limits. There is a saying that the human brain is about 10 times stronger than the body. There’s no way you can test a person’s psychological strength until you break his physical strength first.

“So the first three days of hell week are very physical. However, you must keep on going if you want to succeed. Those who quit will be deemed unsuitable to be naval divers. You have to be a team player to survive. There’s no ‘Rambo’ in the Navy.” If you thought that hell week would be the culmination of training, guess again. Naval divers have to brace themselves for another three months of basic combat training before they can graduate from the course. In this last phase, trainees are taught the rudiments of combat tactics. In an exercise called drown-proofing, trainee divers are dumped unceremoniously into the pool with their hands and legs tied. They are then required to bob up and down in the pool, swim for about 100 metres and perform manoeuvres like somersaults underwater.

Without a doubt, our naval divers are all set to create a deep impact in the new millennium. “Nothing stands in our way” was the motto adopted by NDU in 1995 to reflect the daring and “can-do” attitude of the divers. You can be sure that with the tenacity, grit and determination of our naval divers, nothing will stand in their way.

(http://www.specialoperations.com/Foreign/Singapore/NDU/Default.htm)

Snapshots

2007-10-29T07:50:00.000-07:00

Snapshots of Thoughts;

Canvas of Soul....

Advanced Counseling Issues & Advanced Counseling Intervention II

2007-10-21T21:22:00.000-07:00

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

2007-10-21T21:15:00.000-07:00

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

2007-10-21T09:19:00.000-07:00

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

2007-10-11T08:14:00.001-07:00

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

2007-10-11T08:12:00.001-07:00

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

2007-10-11T08:10:00.001-07:00

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

2007-10-11T08:08:00.001-07:00

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

2007-10-11T08:05:00.000-07:00

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

2007-10-11T08:01:00.000-07:00

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

2007-10-11T07:58:00.000-07:00

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

2007-10-11T07:49:00.000-07:00

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

2007-10-11T07:44:00.000-07:00

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.’

Counselling at the FSC

2007-08-20T00:31:00.000-07:00

Mr Ho worked for the FSC previously and with input from Colin and Nancy who are currently attached to the FSC, we were enlightened on counseling at FSC.

FSC is a neighbourhood-based centre runs by a voluntary welfare organization. It is accessible by the community for family resources. As the FSC is limited by boundary, the residence of the needy person has to be established upon contact to avoid waste of time. An Information and referral (I&R) form is to be filled and the person in need will then be linked to appropriate services.

Apart from Case Work and Counseling, FSC’s other core programmes are Preventive & Developmental Programme (PDP) as well as Outreach to Elderly, Adult, Children & Youth.

Counseling in FSC setting is handled by a Case Worker generally, however, in some FSC, counselors are appointed to handle counseling issues exclusively. In the case of Case Worker who is assigned cases, the first contact will determine if it is a one-off case for consultation purpose. Otherwise, it will be referred as an Open Case and it is normally contract for a 5-session follow-up. Case Worker functions more like a Social Worker. Counseling at FSC involves administrative assistance, home visitation, etc. Monthly or quarterly reports are compiled for evaluation purposes. In a FSC setting, case conference limits confidentiality as the latter is extended to agency staff. It is short of saying NO confidentiality.

Counseling in FSC is challenging. Colin reported 60 active cases in hand. I wonder if actual counseling intervention is short-changed or effectively addressed when the workload is heavy. On the other hand, such diverse setting provides perks as the Case Worker/Counselor is exposed to varied issues and options available to resolve them.

Mr Ho conducted a Live Demo of interviewing a client with a Reflecting Team of counselors which can be conducted in a FSC setting. I learnt the Relaxation Technique used and how he helped the client processed her thoughts, even the significance of her tears: ‘If the tear has a voice, what would the tears be saying to you?’

Counselling in Addiction Disorders

2007-08-20T00:28:00.000-07:00

Dr Yeo has such sense of humor one cannot help but overlook the facts he is trying to present. That was precisely what took place on a few occasions during lecture because some coursemates got him to repeat some facts a couple of times.

There are two broad concepts of addiction according to Dr Yeo. Addicts are viewed as bad criminals and must be punished under the Social model while the Medical model deem addicts sick and therefore need to be treated.

I benefited from Dr Yeo’s painstaking description of the different types of substance abuse. For the first time, I heard of Shyabu, Adam, Yaba, FRY and Ketamine. During assessment of drug addiction, check for poly-drug abuse, look for coexisting diagnosis, depression, anxiety disorder, psychosis and underlying personality disorder.

Medical detoxification is the first stage of addiction treatment. It safely manages the physical symptoms of withdrawal but does little to change the long-term drug use.

Motivation is the strongest factor in facilitating change in an addict. Counselor has to adopt Rogerian concepts of empathy, warmth and genuineness. Roll with the resistance and refrain from imposing and labeling. Patient is offered different perceptions and self-efficacy – You CAN do it. Each slip or relapse is viewed as one step closer to recovery. (An addict may relapse 4 times before permanent change.)

Dr Yeo advocated Confrontational Models in Group Psychotherapy dopted in Alcoholic Anonymous & Narcotic Anonymous and ‘Hot Seat’ (Minnesotta Model). Such models may not be suitable for patients who are depressed, anxious or have low self esteem.

The patient goes through stages of change and the therapist’s tasks will be:

- Precontemplation stage (To raise doubt, perception of risk)
- Contemplation (Tip the balance, evoke reason tochange)
- Determination (Help choose best course of action)
- Action (Help take steps to change)
- Maintenance ( Identify and use strategies to prevent relapse)
- Relapse (Help renew process of contemplation, determination & action without demoralization of being stuck)

Non-drug interventions for addiction - counseling and other behavioral therapies - that help will be Replacing Drug Using Activities, Drug Resistance Skills, Motivation, Problem Solving Skills and Interpersonal Relationships.

I am to identify trigger points, cue avoidance, offer alternate forms of stress relief – exercise, pilates and meditation. Time freed up when trying to quit addiction has to be filled up with alternate interests and a healthier lifestyle. I will also facilitate family intervention by helping patient set goal and earn trust of family members. There must be financial accountability. The issue of co-dependency will be looked into to ensure the patient is not being empowered to carry on with addiction.

Counselling at Student Care Service

2007-08-20T00:26:00.000-07:00

Mrs Tan looked more like a teacher than a counselor but she was also a very creative facilitator and I was impressed.

The ice-breaker game she got us to engage in was rather intense in that within ten minutes or so we were to interact and exchange worldviews to half of our peers. Some information we disclosed were rather personal but our group has over the months become more familiar with one another. It did not mean a greater knowledge of one another. So this game actually got us to talk heart-to-heart briefly. A nice way to melt the ice!

Mrs Tan briefed us on Student Care Service (SCC) & School-based Counseling (SBC). The SCC was actually set up by VWO since 1978 to help maximize the students’ potential. It has evolved from providing just School Social Work (operating within school’s premises). A list of other services such as Educational Psychological Services, Casework & Family Counseling, Guidance Programme etc are also available. The main focus will be on the students in all aspects: educational, financial, emotional, relational, behavioral & developmental.

School-based Counseling takes place when a social worker meets up with students referred by the school, parents, other students or selves to work on presenting problems in individual or family counseling sessions. The general goal will be to enhance the functioning of these students through enabling the students and their family to cope with or resolve problems experienced by students. The psychological components that of perception of counseling, expectations of school and parents as well as accountability will determine the successfully running of a SBC set up.

Mrs Tan shared some useful skills and techniques in SBC. De-triangulation will ensure that the counselor’s focus is on the student only. And during counseling session, exception questions will be ideal when addressing students (age factor). Clarification and summarization of statements will also go a long way in bridging the relationship. The students’ faith and hope will be raised according to the expertise of the counselor. The relationship between the counselor and student plays an equally important role as the support system the student has (family etc and his or her own internal resources included).

Alas, we were not able to go in-depth into how to deal with critical presenting issues such as Rape/Molest, Under-aged sex/pregnancy, Beyond Parental Control, gang involvement and runway teens. It will be ideal to have a legally-trained facilitator to walk us through the legal processes and procedures.

Counselling the Children

2007-08-20T00:25:00.000-07:00

To Dr Fung, children’s mental health is more than just absence of mental illness. The children must feel good about themselves, relate well with their significant others and caregivers and peers. They are also protected.

There are difficulties in detecting mental health problem because children may not complain or they may have difficulties talking about feelings. Their acting out are seen as naughty and sometimes withdrawn behaviour is missed. And most times parents are having problems.

About 10% of children have some form of mental health disorders. Children may suffer from different types of mental health problems in the form of disturbances in development, feelings, behaviour or relationships. Behavioural disorders are more common than emotional disorders. Depression is rare in children. Mental health problems in children are associated with multiple risk factors, the most significant being lower intellectual ability and parents being single, divorced, separated, widowed or deceased.

When counseling a child, talk about culturally appropriate topics. Explain to the child the purpose of counseling while building rapport with him/her. With some understanding of the developmental phase of the child, the needs are being assessed. I will learn the likes and dislikes, strength and weaknesses of the child. By being observant I engage with the child and establish the therapeutic alliance.

When talking to the children, my sentences have to be short, clear and simple. My tone has to be calm and reassuring. My words should ideally be positive. It will help to use open questions and rephrase if necessary. One good technique to ensure comprehension will be to ask the child to repeat rather than ask ‘Do you understand?’ I need to give time for the child to speak before starting new ideas or feelings.

When the children don’t want to talk, play and art therapy should then be used. Let the child do his own activities in my presence. Listen to what he says verbally and non-verbally. Acknowledge with statements of understanding before giving advice. Validate the child’s feeling. Let the child know how I feel and then provide supportive therapy. Medical treatment should flow from diagnostic formulation of psychopathology from a developmental perspective.

Mindfulness-Based Cognitive Therapy & ACT

2007-08-20T00:23:00.000-07:00

Dr Tan is a Professor of Psychology at the Fuller Theological Seminary. He shared an article written by him that covers the appropriate and ethical use of prayer including inner healing prayer, and Scripture in a Christian approach to cognitive-behavioral (CBT). Expanded CBT now includes Mindfulness-Based Cognitive Therapy (MBCT), Acceptance and Commitment Therapy (ACT), and Dialectical Behavior Therapy.

Unlike CBT, there is little emphasis in MBCT on changing the content of thoughts; rather, the emphasis is on changing awareness of and relationship to thoughts, feelings, and bodily sensations. Aspects of CBT included in MBCT are primarily those designed to facilitate ‘decentered’ views such as ‘Thoughts are not facts’ and ‘I am not my thoughts.’ Clients are taught to disengage from habitual (‘automatic’) dysfunctional cognitive routines, in particular depression-related ruminative thought patterns, as a way to reduce future risk of relapse and recurrence of depression. MBCT was specifically designed for remitted patients.

ACT is a functional contextual intervention approach based on Relational Frame Theory, which views human suffering as originating in psychological inflexibility fostered by cognitive fusion and experiential avoidance. In the context of a therapeutic relationship, ACT brings direct contingencies and indirect verbal processes to bear on the experiential establishment of greater psychological flexibility through 6 core processes: -

1. Acceptance
2. Cognitive Defusion
3. Being Present
4. Self as Context: A transcendent sense of Self
5. Values
6. Committed Action

ACT is unusual in that it is linked to a comprehensive active basic research program on the nature of human language and cognition.

Reaching the Hearts of Teens

2007-08-20T00:20:00.000-07:00

I embarked on a 8-weekly workshops on Reaching the Hearts of Teens purely to look at teens’ issues from the spiritual perspective. Personally, I believe no family reaches a healthy status by its own power. There is a spiritual dimension that cannot be minimized.

It was a good turn-out of parents with only one teenager among us. During the first workshop I observed a strong sense of desperation in most parents. There was fear and tension when it comes to relating to our teens. The objective of the workshops was to replace the parents’ fear with confidence and tension with trust.

Teen rebellion was referred to as relational tension by the Ezzos. Such tension is a result of our fallen humanity – it’s the absence of wisdom ruling the moment. (Proverbs 1:7, 26:12) Teenagers tend to flee from relationships, which comes out in the form of rebellion. Hormones are unquestionably at work during the teen years. They may affect the human body, but not the human heart. The ultimate source of the tension is a deficiency in the parent/teen relationship. In struggling families, teens seek independence from childhood structures of growth and development as well as unhealthy relationships (e.g. divorce) existing in the families. Defiance is fundamentally a heart issue. The bottom line is that it’s a moral choice. There is within every human a natural selfishness that makes us want to defy anyone or anything that’s going to take away our self-governance.

Some of the tests we did:

1. The health of individual family profile between parents and individual teenager. As my teens have matured to a good extent, I shared a rather healthy parent-teen relationship with them, with minor problems.

2. The Primary Love Languages of parents and teens. I found out that I treasure quality time among Encouraging Words, Acts of Service, Gift-giving & Physical Touch. My sons thrive well when they receive Encouraging Words from their parents.

I learnt much from attending the workshops which I applied rather immediately on the clients I was seeing. Personally I like the Ten-Talk Rule on seeking full attention when our teens ask for it. When they absolutely and immediately need my attention, they can say, ‘Mum, I need to talk with you, and this is a ten-talk.’ (On a scale of one to ten, ten being most urgent.)

Counselling the Mentally Ill

2007-08-20T00:17:00.000-07:00

As always, Dr Tan came across as a compassionate person. He acknowledged the late-comers by saying things that made them feel comfortable and self-accepting. I felt blessed to be associated with the top psychiatrist in Singapore and to be a student of his.

Psychotherapy is the systematic use of a human relationship for therapeutic purposes of alleviating emotional distress by effecting enduring changes in a client’s feeling, thinking and behaviours.’ - Strupp 1986

Time Limited Psychotherapy is not suitable for long-standing personality disorders, chronic and persistent mental illnesses (such as schizophrenia and bipolar disorder. CBT has been demonstrated to be effective for Depression, Anxiety Spectrum Disorders, Eating Disorders, Sexual Disorders and Substance Abuse.

I learnt different techniques to solicit information from the mentally ill clients who may be vague or give monosyllabic replies and some resistance to boot. I need to find a balance between letting the patient tell his story in his own words and in obtaining information from him using Opening Techniques. Clarification Techniques (Patient-Centered) are used for Specification, Checking Symptoms, Probing (for delusion), Interrelation (for disordered thinking) and Summarizing (for psychotic clients).

I can also choose the Interviewer Directed Steering Techniques at some points – Continuation, Echoing, Curbing (irrelevance) & Transition (smooth or abrupt )

In dealing with Resistance, we use the techniques of Acceptance, Confrontation, Looping, Exaggeration and Induced Bragging.

It was helpful that the techniques were illustrated with transcripts of dialogues between therapist and client.

Boundary & Legal Issues in Counselling Practice

2007-08-20T00:15:00.000-07:00

Dr Tan commented that therapist and client relationship should be asymmetrical, i.e. one way focus on client and his/her needs. It should not be 2-way or dual as in social relationship where there is no boundary. A therapist should maintain objectivity, neutrality and abstinence.

Dr Tan touched on the non-sexual boundary crossings. Although self-disclosure used to be an absolute prohibition, it becomes essential when disclosure of therapist’s health condition, for e.g., may determine the duration of sessions.

Confidentiality may be breached if client’s suicidal, homicidal or when the court demands for it. And confidentiality of clinical information about clients remains ethically in force after the death of client and therapist. (This is new to me!)

Tarasoff Principle - When a psychotherapist determines that his patient represents a serious danger of violence to another, he incurs an obligation to use reasonable care to protect the intended victim against such danger. The discharge of such duty may call for the therapist to warn the intended victim or others likely to apprise the victim of the danger, to notify the police, or to take whatever other steps are reasonably necessary under the circumstances. - Judge Tabrinen 1976

(Protective Privilege ends when public peril begins – Tarasoff vs Regents 1976)

To Give Up or Not to Give Up

2007-07-27T09:10:00.000-07:00

Artwork (c)2006, www.psychotherapy.net

Introduction

In Redecision Therapy (RT) the client experiences the child part of self and creates fantasy scenes. By integrating the cognitive framework of Transactional Analysis (TA) Theory (Berne, 1958) and affective principles and processes of Gestalt Theory (Perls, 1951), client can be helped to safely give up the constricting decisions he made in childhood. (Mary & Robert Goulding, 1979)

< To Give Up or Not To Give Up >

Marie, 37, had filed for divorce but was troubled by her own decision. Prior to her legal action, Marie noticed her husband, Judd (49), a sales executive, behaving strangely, such as bringing his handphone with him into the shower and returning home in the wee hours. She had a nasty feeling that her husband had snapped back to his former adulterous living again.
Marie was incensed when Judd confessed that he was madly in love with a married Chinese colleague. When confronted, Judd rebutted coldly, “you are no longer sexually appealing to me, I have no choice but to find someone else.” [Judd played the PROSECUTOR role in Mind Game– ‘Look what you have done to me.’ – You are not OK.] (Berne, 1964) Marie was devastated and in her words, “it felt like a thunderbolt.”

Marie had been losing sleep over Judd’s increasing absence from home. Most nights she would cry herself to sleep. Her demands for his attention were reciprocated with more hostility. Marie became forgetful and experienced mood-swings. Ironically, in the quiet of the nights, beneath the torments brought about by her husband (the first and only man in her life), she still yearned for his love and touch. She felt desperate, not knowing how to continue in a love-less marriage.
Even after she had filed for divorce, Marie would still pine for affectionate messages from Judd. He had indicated in one of his messages, ‘perhaps it’s good for us to go separate way now. But who knows, I may come back for you someday and we can re-marry. Just don’t let any man touch you until then.’ [Playing the role of RESCUER – ‘What would you do without me?’ - You are not OK.] Ironically, Marie was both infuriated by his selfish thoughts and gladden by his show of jealousy.

Case history - Past problems

In the first eleven years of their marriage, to the external world, theirs was the ideal picture of a perfect family— loving and contented parents with a happy child. Marie, being 12 years younger than Judd, looked up to him as a decent and loving partner. On the other hand as Marie is more resourceful and stable in her income, Judd deferred every financial decision to her. She was seen as a confident and decisive person, adored by her late mother and well-respected by her students and friends.
The year after Marie’s parents passed away, i.e., 2002, Judd began a series of extra-marital affairs. The latter was remorseful after the 1st affair and promised to stay faithful. The delighted Marie bought him a car. In December 2005, Marie found out Judd was seeing 4 women (2 Philippinas & 2 Malay ladies). Marie was indignant and perplexed by the drastic change in Judd. Their relationship deteriorated to cold wars.
Heart-broken and depressed, Marie popped in 30 panadols in an attempt to end her life. Judd stopped their only son (16), Jayden, from seeking help and threatened to punch the latter.

On another occasion Jayden saw his father accessing pornography websites and confronted him. Judd was upset and both ended up in a heated argument. Marie was disgusted by the faulty role-modelling of Judd especially when the latter would approach the son and licked his face. Jayden’s school grades had dived. The class teacher had commented that Jayden looked downcast in school.

Therapeutic Contracts

Eric Berne (1966) defined a TA contract as ‘an explicit bilateral commitment to a well-defined course of action.’ TA assumes that people have the capacity to think and make decisions. As the Redecision Therapist, I helped Marie identify what she wanted (Therapeutic Contract transcript - Appendix 3) and how she could use her resources to achieve her goals. It is a contract for change Marie made with herself after she had closed her escape hatches such as taking her own life or harming others. Her escape hatches were closed by Adult decisions: ‘to live and take care of myself’ ‘and let others live and take care of themselves.’

Appendix 3

THERAPEUTIC CONTRACT TRANSCRIPT

Redecision Therapist: What do you want to change?
Marie: I am unable to stay focus in my work.
RT: What specifically do you want to change now?
M: I want to get out of the sadness that plagues me daily.
(M is seeking Symptomatic Relief.)
RT: What needs to happen for you to make this change?
M: I need to give up clinging on to the rotten marriage and move on.
(M is seeking Script Cure – to move permanently and substantially out of SCRIPT patterns.)
RT: What are you willing to do in order to make this change?
M: I will talk about my problems, experiences and memories to gain an understanding of my thoughts, feelings and behaviours in this meaningless relationship that is heading for a divorce. (Soft Contract)
RT: How might you sabotage yourself?
M: By telling myself that `I am not good enough’ or `I can’t survive without Judd.’
RT: How will you and I know when you have made the change?
M: When I report to you that I am no longer feeling sad.
(James, 1976)

Treatment Plan for Redecision Therapy

Transactional Analysis

In RT, the primary question is: What early childhood decisions are causing problems today. As Eric Berne first noted, a client’s current problem is often the result of injunctions and decisions stemming from childhood.
A useful way of diagnosing Marie was to assess her ego-states. Ego-states, in Berne’s definition of the term, were the building blocks of the Structure of Personality (Berne, 1961). Parent and Child were both echoes of the past. Adult was a response to the here-and-now, using the person’s grown-up resources. All three states entailed thinking, feeling and behaviours. (Stewart & Joines, 2003) RT seeks to re-programme the Parent, de-contaminate the Adult and de-confuse the Child. What ego-state strengths can Marie muster to make contractual changes and how well can Marie sustain these changes once they are made?

When Judd criticized Marie for not being sexually appealing enough, the latter went on a slimming programme to look shapely. But when Judd commented she looked too thin, she regained her weight right away. [Playing the role of VICTIM - ‘Poor me.’ – I am not OK.] - Marie paid more attention to her own faults and flaws (coming from her Critical Parent ego) than to her assets and successes. Marie needed to learn to nurture herself (Nurturing Parent ego) rather than self-criticized. One of her contracts was to learn to love herself wisely by doing things that would promote personal growth. To model positive nurturing, I must give Marie positive strokes for growth or change, as well as for ‘just being’.
Marie’s Adult, or thinking part, had been contaminated. A Parental contamination stood in the way of achieving a contract, it needed to be resolved. Marie was very close to her mother and was well-compensated by her mother’s love so much so she did not feel the need for fatherly love. For years, her father was aggressive and violent towards her mother and her. He broadcasted his affairs with other women without blinking his eyes. Marie’s mother was deeply upset but did not protest, instead accepted it as ‘fate’.

However, the young Marie had often heard her mother sobbing uncontrollably in the middle of the night. In the day her mother would escape to the gambling den with Marie in tow. That suited Marie fine as she resented her father and would not stay a minute longer in his presence. On the other hand, she felt sorry for her mother and vowed in her heart to do anything to please her, even at the expense of her own happiness and convenience.

There seemed a Structural Pathology of double contamination from the Parent (P) and the Child (C) ego-states. Marie re-played a Parental Slogan, agreed to it with an Adapted (Compliant) Child belief, and mistook both for reality:

Mother (P): ‘Resign to your fate. Hang in there. Be pleasing and you will be ok.’ Paired with
Marie (C): ‘Like mum, I’ll keep my anger and resentment to myself. I will make Mum happy by not giving up.’

(2nd Order Structural Analysis – Appendix not available)

Script Analysis

Berne defined a Script as a personal life plan decided upon by each individual at an early age; in respect of the interpretation of external events. (Steiner, 1974) Two-chair technique was used to conduct the Script Questionnaire (Appendix 5) to elicit drivers and injunctions from her parents.

Appendix 5

Script Questionnaire (Jeff & Margaret White)

(A)

Set up 2 chairs, one for Marie and one for her parent (mother) figure:

Mother: `I am most happy with you when you stay close to me. (Driver)

* * *

Marie: When I was little, my mother was most upset when I give up trying. (Injunction)

Marie: When I saw mother upset, I felt guilty, sad and remorseful.

Marie: When I felt this way, I kept quiet and sulked.

Marie: (The theme of my mother’s life) - She suffered in silence.

(B)

Set up 2 chairs, one for Marie and one for her parent (father) figure:

Father: `I am most happy with you when you obey. (Driver)

* * *

Marie: When I was little, my father was most upset when I made mistakes. (Injunction)

Marie: When I saw father upset, I felt frightened and resentful.

Marie: When I felt this way, I stayed away from my father.

Marie: (The theme of my father’s life) - He was chauvinistic and selfish.

Marie’s script matrix - Appendix 6)

Drivers –
From father: Be perfect/Try Hard From mother: Be close/Be pleasing
Drivers come from the Parent ego-states of our parents. Marie’s father flared up each time Marie made a mistake. She would take cover by following her mother to the gambling den. She knew by staying close to mother made the latter happy.

Injunctions –
From father: Don’t express/Don’t be close/Don’t be important

From mother: Don’t give up/Don’t be you/Don’t think

Whenever her father went into a rage, Marie would be reduced to tears (The Adapted Child). She would be prohibited from explaining herself. Marie found herself also being restricted by her mother’s injunctions of ‘Don’t think, Don’t be you and Don’t give up’ which came from a threatened position. Such injunctions stifled and confused Marie in her sense of judgment and decision-making. In order for Marie to be free from the injunctions, she must be able to make a new Decision.

Rackets Analysis

Rackets are repetitions of which were stroked in the past. They are expressed each time a real feeling is about to emerge. (English, 1972) Rackets usually come from early child decisions. (Racket System - Appendix 7)

Appendix 7

Marie’s Racket System

Script Belief / Feelings:

Self - I am unlovable. (Core)

Husband goes for other women. (Supporting)

Others - Men in general sexually `objectified’ women. But they
would return to their spouses. (Core)

Men visit the prostitutes to gratify their sexual need
only. (Supporting)

Quality of life - Life is harsh and miserable. (Core)
I am not good enough. I will keep trying. (Supporting)

Rackety Displays:

Observable Behaviours - Unable to focus at work. Sulk. Insomnia.

Reported Internal Experiences - Heart palpitations/loss of appetite/feeling miserable/loss of zeal

Fantasies - Son would remain single to take care of her / Husband would return to re-marry her / Husband would pass on STD to her

Reinforcing Memories: - Marie sleeps with her son and cries herself to sleep/Re-reads Judd’s sms-es

Permitted Feeling: Sadness and Grief

Repressed Feelings: Resentment and Anger

Marie’s racket feeling was scared (SCARED) and sadness (SAD) and prohibited feeling was resentment and anger (MAD).
The racket and prohibited feelings were displayed during a session. Marie recalled one of the many selfish requests Judd made. It was also at this juncture she gave out a Gallows Laughter to reinforce her pathology (overwhelming sense of sadness).

RT: What was the laughter about?
Marie: He pleaded with me to go through the vaginoplasty surgery to gratify his sexual desire.
RT: You were tickled by his proposal?
Marie (in exasperation): “I kept quiet but wondered what next?!”

Marie began to realize even if she were to go ahead with the surgery, she might not be able to stop Judd from seeing other women. After I had gone over the Racket Analysis with her, she became acutely aware of feeling and behaviour patterns.

Marie (relented in tears): “I resented him for treating me as a sexual object.” (She was made to repeat thrice in an emphatic tone.)

Marie’s Impasse
“I want to get out of my unhappy marriage.” “But I don’t really want to give him up.”

Gouldings emphasized Perls’ belief that when a client is ‘STUCK’ with a problem, this indicates that two parts of his personality is pushing in opposite directions with equal force. The net result of the above led Marie to nowhere in spite using a great deal of energy. The resolution to treat the above IMPASSE was to help Marie make a REDECISION.

Marie had a second degree Impasse with Impasse present within her Child (C2). There was subconscious conflict exists between P1 and C1. She was modeled ‘not to give up’ by her mother despite having miserable marital relationship. She complied with the injunctions of her parents from her Child as her Early Decision was “I am not worthy. I will do whatever you say. I will never give up trying to please you.”

Two-Chair technique (Early Scene Work)

Redecision had to be made within the Free Child Ego State of Marie’s C2
by A1 between the young Marie’s Child (C1) and the fantasized Child of Marie’s mother that gave the injunction. Using the two-chair technique, Marie was facilitated to go back to the early scene (to the scene when the young Marie was lying in bed next to her sobbing mother) so that she could contact her unexpressed feelings and sought permission to break her impasse - ‘to give up trying and move on’.

Marie (the child): “Mum, it hurts to see you cry.”
RT: “Be your mother and give permission.”
(Mother): “You may give up when it hurts too much, dear.”
Marie: “I am hurt too much. I want to give up the rotten marriage.” “I can give up. I can move on.”
(At this juncture, Marie remained silent for a full minute. There was no shedding of tears and in her words, ‘I felt a brick lifted off my chest.’) (Symptomatic Relief)

During Adult Debriefing, Marie was helped to anchor the scene of resolution and make adult plan for herself to feel, think and do differently about her future. (Moving towards the Script Cure)

Conclusion

Redecision is a beginning rather than an ending. Marie’s contracts to change were achieved in the brief therapy. Her new found sense of control was obvious when she moved out of her matrimonial home with her son even before her divorce was made absolute. The therapy had empowered her to begin a new and happy Script without Judd.

It is OK to Give Up when it Hurts too much.

(1798 words)

References

Berne, E. (1958). Transactional Analysis: A new and effective method of group therapy. American Journal of Psychotherapy, 12, 735-43.

Berne, E. (1961). Transactional Analysis in Psychotherapy. New York : Grove Press

Berne, E. (1964). Games People Play. New York : Random House Ballantine Book

James, M., & Jongeward, D. (1978). Born to win. Boston : Signet

Goulding M.M. & Goulding R.L. (1997). Changing Lives through
Redecision Therapy. New York : Grove Press

Perls, F. (1951). Gestalt Therapy: Excitement and Growth in the Human Personality ISBN 0-939266-24-5

Steiner, C. (1974). Scripts People Live: Transactional Analysis of Life Scripts. New york : Grove Press

Stewart, I., & Joines, V. (2003). TA Today. England : Russell Press

Counseling Patients with Cancer

2007-06-26T06:58:00.000-07:00

Artwork (c)2006, www.psychotherapy.net

Dr Koh gave a run-down of statistical and informational update on curable and incurable cancers. The graphic presentation was a little difficult to stomach. Although it was brief, the impression it created has since stayed on in the mind. His ultimate message to us all was, ‘Early detection saves lives!’ The tumor size, symptom control and quality of life will determine the outcome of treatment. Some common screenings that normal and healthy people can go for are mammogram, Hepatitis B Screening, Pap Smear, Fecal Occult blood test.

It is well documented that counseling and psychotherapy can improve quality of life for cancer patients. Cancer and cancer treatments can affect a person’s:
 body image and appearance
 energy levels
 physical, social, and mental functioning
 intimate relationships and sexuality.
The goal of counseling and psychotherapy is to help patients make the functional, emotional, and spiritual adjustments necessary to maintain their quality of life.

A wide variety of psychological interventions are available to the cancer patient, including:
σ educational cancer-related counseling
σ individual supportive psychotherapy
σ cognitive behavioral therapy
σ group therapy and/or cancer support groups.
In my counseling with cancer or terminally ill patients, good communication skill is very important. Patients often have filtered information. It is important that I identify and acknowledge their emotions, find out what they already know and what they want to know. When giving information, I will need to check that the language used is right, i.e., word used must have the same meaning to both.
I wished Dr Koh would elaborate on how Cognitive behavioral therapy (CBT) could help the cancer patient. But I guess as a medical doctor he focused on how the counselors could attend to the patients in an all-rounded manner. I went on line to search for related article to understand how CBT can be used on cancer patients. (http://www.cancerline.com/cancerlinehcp/9898_21550_0_0_0.aspx? Extracted on 25 June, 2007)

CBT was initially developed by Aaron T. Beck, MD to treat depression and has been validated as an effective psychotherapy for patients with cancer. CBT is based on the assumption that depression and anxiety arise from negative internal dialogue, or “self-talk.” By replacing negative dialogue with positive self-talk, patients feel and act more positively, even in the face of life-threatening illness.

Central to CBT is the theory that the individual has control over his or her thoughts and has the power to modify feelings and behavior. The cognitive behavioral therapist helps the patient to take specific steps to do this.

1. Actively identify negative thoughts as they occur.
2. Document the negative thought.
3. Correlate it with related events.
4. Identify the type of faulty thinking.
5. Replace the negative thought with more a realistic—and positive—interpretation of events.

Studies have shown that CBT helps to quickly alleviate stress, depression and anxiety in patients with cancer. CBT reduced the prevalence of moderate depression in women diagnosed with stage 0–II breast cancer. Women with early stage breast cancer who underwent CBT experienced less anxiety and disruption of family relationships.

From the same website, I learnt Relaxation Techniques that have been proven helpful in bringing down the anxiety level of patients. Relaxation has been defined as a “state of consciousness characterized by feelings of peace, and release from tension, anxiety and fear.”

In the 1970’s Herbert Benson, MD began recommending a simple form of meditation to his patients to elicit the “relaxation response.” This response moderates sympathetic arousal and produces marked health benefits, resulting in:

 decreased heart rate and blood pressure
 lowered lipid levels
 decreased levels of circulating stress hormones
 improved immune functioning

There are a number of techniques that patients can use to induce relaxation, but they possess underlying common factors. Some of the most common methods are:

guided imagery or visualization
progressive muscle relaxation
meditation

Studies do not show benefits of one relaxation technique over another.

Research does show that relaxation is an effective adjunctive therapy to help cancer patients:

 self-regulate feelings of distress
 reduce cancer-related and neuropathic pain
 improve mood disorders
 lessen fatigue

There is also evidence that relaxation improves post-surgical outcomes, such as length of stay and recovery time.

"To talk sometimes, to listen often, to understand always.
To cure sometimes, to relieve often, to comfort always.” - Pierre Ambrose

Post Traumatic Stress Disorder (PTSD)

2007-06-26T06:57:00.000-07:00

Artwork (c)2006, www.psychotherapy.net

It was a warm Sunday at Thong Sia. I had a hearty meal with family at Sushi Tei, Paragon before class. One of the air-cons was down but I was strategically seated where the working air-con faithfully blew at me. How blessed! Soon papers and hands were swaying to keep one awake… The ‘traumatized’ ones kept nodding as Prof Bates continued.

Wow, Swinburne University was rated top Victorian university for The Educational Experience (Source: The Good Universities Guide, 2007.) We have been informed previously that the university was ranked 4th out of 39 universities in Australia for Learning and Teaching Quality (Source: Department of Science, Education and Training (DEST), 2005) I have made the right choice and now proud indeed to be associated with the University! < LET’S GET ON WITH IT. >

I was all ears throughout Prof Bates’ lecture because I am currently seeing a client diagnosed and medicated for PTSD. I have seen her once todate and have provided her (Applied) education about trauma and PTSD. It was indeed timely to be further equipped by Prof Bates!

My client (K) suffered sleepless nights for 3 weeks before she sought psychiatrist help. A new colleague (M) she was closed to for 3 months had jumped to her death after sms-ing her the night before. K is an only child. She became very agitated to loud noises and fearful in darkness. She wept whenever she thought of M.

There seemed to be a psychological trauma K is suffering. It is an injury to her mind and inherent processes and functions (including identity and sense of self). Her assumptions about the world have been shattered and must be rebuilt.

In DSM-IV-TR the range of event that became a stressor for K was neither Directly Exposured to the tragedy nor Witnessed the Event. It was an Event Learnt About of the sudden loss of a close colleague. As a stress syndrome PTSD is defined as a psycho-biologically driven organismic function of adaptation to abnormal excessive or extreme stressor events that tax individual coping resources.

K consistently re-experienced ruminations of the tragic news. She kept thinking of the days before the fatal plunge. Whenever she read of news pertaining to suicide, she would bring it up to the parents. Her parents were upset by her ruminations. K had recurrent and distressing dreams aligned with death. Her symptoms of hyper-arousal include: Difficulty falling or staying asleep, irritability with noise, hyper-vigilance (have to sleep with the lights on).

K’s sense of self, others and the world have undergone a drastic shift. She needs strategies for developing self-awareness to restore herself to the previous functioning:

1. Recounting the specific episodes (the ABC model)
2. Exploring shifts in affect 3. Free association 4. Using Imagery
5. Role-plays 6. Symptom induction 7. Discussion of the worst case scenario
8. Look for thoughts that might explain feelings 9. Dysfunctional Thought Records 10. Homework

K is now being medicated (I am a believer in pharmacotherapies) and she will be offered Phased Treatment of PTSD. There will be symptom management of low tolerance level of noise using relaxation techniques. Trauma focused work (imaginal exposure in K’s case) as well as cognitive restructuring (grief and guilt, etc) will be followed up. We will also collaborate and work on Relapse prevention and maintenance of treatment.

A snapshot of treatment strategies for K as proposed by Prof Bates

1. Writing Therapy (Pennebacker) to develop a trauma narrative.

K will be asked to describe the traumatic event in an open ended manner. I will enquire about the details of the event to ensure inclusion of:

- physiological and emotional reactions at the time.
- choice points and actions taken before, during and after
- meanings attached to the event, own reactions or behaviours
- responses of others during and after
- cues that trigger memories
- specific symptoms of re-experiencing, avoidance, arousal
- difficulties in relationships, academic or work since the event

Confronting the traumatic memories has to be done gradually and safely. Research shows too few practitioners offer effective interventions esp exposure.

2. Imaginal Exposure (IE)

IE is graded, prolonged, repeated, pace, collaborative and functional. K needs to know emotional processing helps to organize the memory and process the trauma and that thinking about it is not dangerous. She needs to be repeatedly exposed to the trauma and in the long run it will lower her anxiety and disconfirm beliefs. Exposure enhances her sense of self-control and personal competence.

Before I conduct IE on K, I need to be aware if she has a history of impulsivity or psychosis. There are 3 primary targets for exposure:

1. The memory of the trauma
2. Other internal and external cues that trigger anxiety and re-experiencing
3. Situations that are avoided (The workplace)

Conducting IE:

1st step:

1. Client initially relaxes and `book ends’ are established.
2. Client then tells the story of the trauma (which is tape recorded)
3. The therapist acts as guide asking questions to a) focus on details (e.g. sights, sounds, smells and other sensory experiences) b) ensure all significant details of the story are included and nothing is avoided.
4. Periodically rate client’s distress (0 to 10)

2nd step:

1. Client listens to tape recording of the story again and again closing eyes and attempting to relive it
2. Exposure should continue until anxiety ratings drop at least 50%
3. If trauma is complex, story needs to be broken into segments and tell across several sessions.
4. Exposure must proceed until anxiety drops because a) terminating when distressed strengthens the distress b) decreasing anxiety for the first time is a powerful experience that contradicts fears of being overwhelmed by anxiety and provides motivation for future work.

3rd step:

1. Once client has habituated to the tape of the trauma story at the clinic, client listens to the tape as homework.
2. At least 45 mins per day is recommended to supplement writing the trauma narrative.
3. Anxiety specific cues can be included (loud noises, car horns)

3. Cognitive Restructuring

K was feeling guilty about not being able to detect depression in M. She wished she had spent more time with her. In PTSD, cognitive restructuring targets the client’s distorted thoughts, assumptions and beliefs associated with the trauma.

K said, ‘What happened was my fault.’

Techniques:
• Examine knowledge and choices available to K at the time.
• Double standard technique – would she blame a friend in a similar situation?
• Construct pie chart assigning responsibility to all relevant parties
• Practice self-forgiveness

K thinks ‘The world is unpredictable.’

Techniques:
 List advantages/disadvantages of the belief.
 List areas of K’s life where she has some control and rate degree of control
 Cost/benefits of specific attempts at control
 Record behaviours producing predicted outcomes
 Engage in behaviours with predictable outcomes
 Accept that some events are unpredictable

K feels that she is incompetent and that’s why M did not trust her enough to share her problems before she jumped to her death.

Techniques:
 Examine evidence of competence in K’s daily life
 Examine unreasonable expectations of competence in extreme and unusual circumstances
 Keep a log of competent coping
 Graded task assignment

K is also experiencing defensiveness when she is relating to people. ‘Other people cannot be trusted. M said one thing but did another.’

Techniques:
σ List known people who are trustworthy
σ Rate people on a continuum of trustworthiness
σ Carry out behavioural experiments that involve trusting people
σ Keep a daily log of people who honour commitment

K’s sense of life, ‘Life is meaningless.’

Techniques:
List activities that formerly were rewarding
Schedule pleasurable/rewarding activities
Recognize that feelings of loss confirm meaning
Examine which goals or activities no longer seem meaningful and which now appear more important
Work toward an acceptance of death
Find meaning in each day

Group Supervision/Dynamics/Live Demo by Jess L

2007-06-26T06:55:00.000-07:00

There was some confusion before the Live Demo of Redecision Therapy. Many turned up at East Coast Road after taking lunch as we were told only fruits would be served. To our surprise lunch was provided so some of us had double meals. Jessica seated us in a semi-circle and provided a bowl of candies as well as a box of tissues in the middle. She gave a brief introduction of her co-therapist after which she encouraged us to take part in the Live Demo as counselees.

A few of us volunteered ourselves after Jessica went over the TA Treatment Contract.

- Confidentiality
- No seagulling
- I am OK You are OK
- Mutual respect
- The right to pass
- No walking out
- Non violence

The two therapists then proceeded to demonstrate the four stages of intervention in Redecision Therapy.

1st Intervention:

Therapist invites client to ‘the scene’.

Therapist: “Go back to that ‘scene’.”

(The racket and repressed feelings were elicited.)

2nd Intervention:

If this continues for next 10 years, is this what you want to see happen? Is that what you want? (It’s possible to leave client with an impasse – as homework.)

3rd Intervention:

Amplify the script. Address the ‘CON’ contract. – ‘I came to see you because I heard you are a potent counselor.’ Tell client she/he must want to change for their own sake.

4th Intervention:

Therapist to provide PERMISSION, PROTECTION & show POTENCY. Redecision by client is made with A2. During the Adult debriefing, client is to come out with an Adult plan/resolution.

There was no apparent Script Cure after the Live Demo as it was rather brief. Perhaps mini-script cure was achieved. Or just social cure.

As therapist, I am to expect incremental progress in therapy as mini decisions over time will bring about changes in calibration and anchoring of new decisions.

Replace script
Educate
Deconfuse (adult ego decontaminate)
AwarE
Creative (2-Chair)
Intuitive
Spontaneous
Intimate
AutOnomous
Now

The Live Demo created an impact in my learning process. It has indeed displayed the dynamics of the therapy in all its subtleties. The flow of creativity, intuition and spontaneity was intensely present and a dire necessity to bring forth a desired decision.

I have fantasized being a potent Redecision therapist in the coming days. 

Spirituality & Addiction

2007-06-26T06:54:00.001-07:00

Artwork (c)2006,www.psychotherapy.net

According to Rev Sam Kuna, Spirituality is a common characteristic of human race.
Webster’s Dictionary defines spirit as strong alcoholic liquor produced by distillation. This suggests the highly intoxicated ones are actually highly spiritual at the same time!! 

Webster also defines spirit as the Divine presence resident in humanity. Inside each of us is a Divine presence waiting to be awakened.

Addiction as a Primary Disease is not caused by anything else. And the addiction causes depression, anti-social behaviour, anxiety and psychotic symptoms.

Addiction as a Secondary Disease is a manifestation of a psychodynamic disturbance. It could be an attempt at self medicating depression, anxiety, personality problems or psychosis or a manifestation of a family pathology.

Proposed formulation: Addiction as both sinfulness and sickness. The word `sin’ was used to denote the act of hurting self (addict) and others (significant others). The disease can make spiritual growth more difficult – yet it makes the need for discipline and discipleship more evident. Treating the disease without treating sin is possible, but sin will manifest itself in another way. It is interesting that those who advocate the concept of addiction as an illness most vigorously advocate spirituality, reliance on God and spiritual growth with the same vigor! All the therapeutic communities in Singapore are faith-based half-way houses. 12 steps programmes have great success related to the spirituality/faith element. Existential approaches deal with emptiness and despair to break the extreme social and human isolation. Cognitive approaches speak about lifestyle change, and commend `religious beliefs’ as helpful to change.

The Spiritual Model of Recovery –

1. Filling the Existential Vacuum

The longing for pleasures of the moment or meaning of life can lead to crime, drugs, alcohol to fill the void.

2. Revitalizing Movements

This is an outpouring of energy, ideology and redirection to fill the void. This new identity offers hope, restores self-worth and meaning in life. History has shown that Religious and Spiritual experiences encourage well being and have proven to be therapeutic.

3. Three elements of Social Movement

a. Ideology

* Admission & confession of past mistakes
* Processing of guilt (it’s a poor motivator)
* Reframing the future based on the present
* Hope for future, freedom from addiction

b. Total Commitment

For any radical change, there must be a dedication to a new standard/pattern.

c. Enthusiasm

Breaks with former associates and befriends with others who become positive peers.
Life is transformed.

4. Finding a Worthwhile Mission

One finds life by losing it in the interests of others! A new sense of relief enables the individual to demonstrate love and concern for others.

The next day after I attended Sam Kuna’s talk, I met a client who has been battling with drug addiction. I have offered him my counseling support and hope I will remember my role as a spiritual counselor: To be patient and show respect for humanity. And to understand my own limitations as well.

Sexual Addiction

2007-06-26T06:53:00.000-07:00

Artwork (c)2006, www.psychotherapy.net

I was updated from the outset on some latest (and insightful) statistics on the sex industry: That it is the 3rd largest economic sector on the internet. There are more than 100,000 pornography Web sites and 200 new ones introduced daily! Most pornography is downloaded between 9 and 5 pm which makes this a corporate problem!

38% of sex addicts struggle with an eating disorder and 40% of sex addicts are women. 42% of sex addicts have a problem with chemical dependency. Many ‘sex addicts’ or ‘sex anorexics’ get treated under bi-polar disorder, or OCD. 17% of sex addicts have attempted suicide; 72% have thought of it.

Some new inputs I gathered during the symposium included the following:

- Addiction is chronic: The disease can be arrested, but not cured. Recovery requires both abstinence from the mood-altering substance and involvement in a lifelong process of growth and healing.

- Extreme Control of one’s life can be an addiction: Dieting, Sex Avoidance, Alcohol Avoidance, Saving, Hoarding, Risk Aversion, Compulsive Athleticism are some examples.

Within the addictive system, sexual experience becomes the reason for being – the primary relationship for the addict. The sexual experience is the source of nurturing, focus of energy, and the origin of excitement.. the remedy for pain and anxiety, the reward for success, and means for maintaining emotional balance.

The Addiction Cycle involves Preoccupation (Mental obsession), Ritualization (Triggers), Compulsive Sexual Behaviour and Despair (Guilt).

The Core Beliefs of a Sexual Addict (Carnes, 2001) is:

- I am basically a bad, unworthy person.
- No one would love me as I am.
- My needs are never going to be met if I have to depend upon others.
- Sex is my most important need.

There are 3 levels of sexual addiction:

Level 1 - Behaviours that are regarded as normal, acceptable or tolerable e.g. masturbation, pornography, prostitution
Level 2 - Behaviours which are clearly victimizing and for which legal sanctions are enforced e.g. voyeurism.

Level 3 – Behaviours which have grave consequences for the victims and legal consequences e.g. incest, rape.

(All levels of sexual addiction are painful.)

Cybersex – The triple engine (Cooper, 1998) - Accessibility, Affordability & Anonymity

Impaired thinking - ‘The Internet helps to broaden my sexual horizons.’ ‘Cybersex is just electrons; it’s not real.’

There are recreational users, at-risk users and sexual compulsive users.

Sexual Anorexia –

There is a tremendous fear of intimacy. Many sexual anorexics come from rigid homes, judgmental and non-affectionate parents.

Treatment –

In working the Steps and going through a treatment process addicts first tend to deny, then comply, then gain intellectual acceptance, and finally arrive at emotional acceptance.

The S-Anon Family Groups are a fellowship of the relatives and friends of sexually addicted people who share their experience, strength and hope in order to solve their common problems. The program of recovery is adapted from Alcoholics Anonymous and is based on the Twelve Steps and the Twelve Traditions.

Sexaholism is an addiction just like any other addiction – with the same elements of loss of control, tendency to continue the damaging behaviour despite negative consequences, and the need to do more of the behaviour to get the same result.

(Extracted from S-Anon Int’l Family Groups.)

Parenting in theDigital Age

2007-06-26T06:51:00.000-07:00

Artwork (c)2006, www.psychotherapy.net

This workshop provided me with timely information and help as I am currently following up with a school refusal Sec 3 boy who is deeply addicted to computer games.

AP A Khoo is presently doing a research on computer addiction and her talk was entitled: The world of videogames – What’s so good and so bad about it. She talked about the different types of digital games - action and shooter games (e.g. tomb raider)/role-playing games (RPGs) (e.g. Everquest)/adventure games (e.g. Syberia)/real-time strategy (e.g. WarCraft)/simulators (e.g. Flight simulator)/sports (e.g. Tiger Woods Golf)/platform & puzzle games (e.g. Super Mario Bros).

Some benefits of game-playing:

1. develop strategic thinking & planning skills
2. generate creative solutions to problems
3. improve processing visual information and eye-hand coordination
4. provides esp males, with an outlet for pent-up emotions

Importance of digital games:

1. promote positive feelings
2. provide outlet for aggression, has cathartic effect
3. as learning tools
4. meet psychological needs
* entertainment and leisure
* emotional coping – fr loneliness, stress, low self-esteem (may increase self-esteem temporarily)
* escape from reality
* satisfying social needs, making new friends, strengthening friendships, generating sense of belonging and recognition
* need for challenge and achievement
* need for excitement
* need for power

Research shows positive effects:

* helping children with ADD
* use as a method of pain management
* improve laparoscopic skills
* process certain visual info as well as for combat
* games are part of well-adjusted lifestyle

Downside of exposure to violent games – increased acceptance of physical aggression. (short-term effects – aggressive thoughts; long-term effects – development of aggressive attitudes)

What parents can do:

Be aware of games that are available on the market and choose appropriate games for their children. (Use game ratings as a guide: ESRB – Entertainment Software Rating Board)

Have a deeper understanding of the nature (type and content) of games. (Set targets to be achieved in the game rather than limit the time they spend on the games.)

Supervise and monitor amount of time children/teenagers spend on games.

Play games with their children and advise them on appropriateness of emotions e.g. venting of anger.

Discuss issues such as gender and race stereotyping and the inappropriateness of violent solutions to real-life problems.

Encourage children and teenagers to have exciting and enjoyable offline real-life activities such as sports.

Research findings - Teenagers are LESS likely to meet someone face to face
when they have been given SPECIFIC-safety rules
* not allowed to arrange for face-to-face meetings
* not allowed to talk to strangers in chatrooms
* not allowed to give out personal information

when there is someone at home when they return from school

when there is close communication with parents at home

Games provide social interaction and friendships, empathy & help, achievement & challenge, leadership & teamwork.

The bottomline:

Is there a balance between online activities and that of the real world?

What activities are being compromised?

Redecision Therapy

2007-06-26T06:47:00.000-07:00

Artwork (c)2006, www.psychotherapy.net

Jessica started off the session with BRAGGING ! She got the rest to brag and several of us responded in a childlike manner. (I supposed BRAGGING came from the FREE CHILD EGO.) I told Magdalene who was sitting next to me that I bragged all the time I had run out of things to brag. As I typed this journal, an urge came upon me to brag. I felt a great sense of admiration as I observed how my Chartered Scientist husband help a China company set up a rather well-equipped laboratory here in Singapore within 2 months, early this year. At age 60, he is steadfast and committed in his endeavors. And that’s impressive!

I was exposed to TA and Gelstalt during the Grad Dip and I did fairly well for my essay. With some basic understanding of TA and Gelstalt, my level of apprehension towards Redecision Therapy was manageable. In fact, I was looking forward to be equipped by the new tool. Jessica was a creative and intuitive facilitator in that she knew how much the students could chew per time. I was glad she went slowly with the more confusing aspect such as the different level of orders in Structural Analysis.

Going through the TA second time round reinforced my previous understanding of it. We were asked to partner with another to do our own Script Matrix. I was delighted to partner with Mag as I found her to be very intuitive too. The outcome of the process revealed our racket and repressed feelings as well as our early decisions. I cried a lot growing up (RACKET FEELING - SAD). It was my way of adapting to the harsh words thrown at me. Inside me I was scared, hurt and angry. (REPRESSED FEELINGS) My life position was I am not OK and you are not OK. And that explained my suicidal ideation. Mag helped free me from the injunctions by giving me the permission to Speak Up, to be Assertive and to be Real.

I learnt what it meant to confront the “CON” or ways in which the client discount the self, the therapist or the reality of the situation. (For e.g., help my son to realize he is in the wrong.) When client contracts to change but 2 parts of his personality are pushing in opposite directions with equal force, he is said to be `stuck’ with a problem (Impasse). Impasse clarification helps prepare the client for Redecision work. The 1st , 2nd and 3rd degree Impasses were not difficult to understand. However, the Redecision Work can be a challenge. Clients may find it awkward to go back to the early scene to re-connect with and settle unfinished business with their late parents especially if the clients had been taught to respect the elders at all times.

Redecision Therapy will be adopted in my counseling work when my clients are willing to track back to an early trauma to re-experience it and change the early decision.

Multicultural Counselling and Therapy (MCT): A Model of Integrating

2007-06-26T06:43:00.000-07:00

Artwork (c)2006, www.psychotherapy.net

MCT is the fourth-force in counseling, after Psychodynamic Psychotherapy (1st), Behaviorism Therapy (2nd) and Humanistic Approach (3rd). Benny talked about the ‘FIT’ between Client and Therapist in the area of congruency, sensitivity and therapeutic alignment. MCT brings together two elements: The Person of the therapist and the Cultural context of therapy. Culture influences individuals and the therapeutic process.

I like this definition of culture (Castillo ’97 p 20) - A culture is the sum total of knowledge passed from generation to generation within any given society. This body of language includes language, forms of art and expression, religion, social and political structure, economic systems and legal systems, norms of behavior, ideas about illness and healing, and so on.

We were asked to name 5 personal descriptors each. I noticed that all of us except for a couple of negative ones gave complete positive descriptions of ourselves. I wonder if it was culturally expected of us Counselors to present ourselves positively.

My main clientele are similar to me in that they are parents and unemployed but dissimilar in more aspects, such as they are either separated/divorced or single parents. They are also from a low income family therefore not highly educated, and may have been convicted previously. They may also embrace a different religion. For a start, I will have to ensure the counseling venue has to be a neutral place (that is, not a church setting if they are Muslims). I will also have to figure out if they are able to pay for the use of counseling clinic.

The goal of MCT is to be intentionally cultural. 3 areas of competencies of culturally intentional counselors are:

The ability to create options to clients, implementing process of therapy that is congruent to the clients as well as the ability to formulate plans, act on many possibilities existing in a culture and reflect on these actions.

MCT is more of a meta-therapeutic approach. I have to identify frameworks and concrete helping skills and strategies that are culturally sensitive. MCT is best described as a method than a theory. It begins with an awareness of self and the pervasiveness of culture throughout the therapeutic process. It is practiced with a set of guidelines rather than applied with techniques.

Constructive Psychotherapy

2007-06-10T07:07:00.000-07:00

Artwork (c)2006, www.psychotherapy.net

Constructive Psychotherapeutic framework was adopted in my counseling work with Barbara (Case history in Appendix A). Constructivism is essentially a range of perspectives on human experiencing. `To construct’ is to create order as order is essential to perception and fundamental to meaning. (Mahoney, 2003) The implicit goal of psychotherapy is to help disordered individual return to order. It addresses both the PRACTICAL (i.e., what can one do to help) and the PERSONAL side of psychotherapy (i.e., what it feels like to change).

Constructive assessment and intervention are interwoven into the fabric of a developing human relationship. Each meeting with Barbara allowed me and her to examine and creatively experiment with our experience of each other. There are three interwoven Levels of Focus in Constructive Psychotherapy. They are: PROBLEMS, PATTERNS AND PROCESSES.

PROBLEMs & THEMEs of Constructivism

At this level of focus, problem is defined as a felt discrepancy between the way things are and the way they are expected to be. (Mahoney, 2003) Barbara was brought into therapy because she could barely cope with her problems. As a constructive psychotherapist in face of the complexities of human change, I asked myself what I could do to help her regain the courage and hope she needs to face the days ahead.

Constructive Theme/Assessment - ACTIVITY

In constructivism, the individual is deemed an active agent in the process of experiencing. We are each engaged in acts of selection at every moment (Bateson, 2000). Daily, Barbara is actively participating in shaping her own experiences by making choices that influence who she is. As Barbara tends to anticipate what she remembers, she expects her future to resemble her past. And this is making her downcast and miserable each day.

During our interaction I noticed she was trembling a little and I attended to it by telling her my observation. She revealed that her body often shook whenever she recalled her past. In this instance, how her parents went round borrowing money from relatives on the pretext of settling her school fees. She resented them for using her to solicit money. She wished she had not been born and could stop worrying about her future.

Constructive Theme/Assessment – ORDER

From the outset, I had to view Barbara as a constructivist herself, i.e. she has the capacity to construct meanings in her life. (Mahoney, 2003) At age 18 Barbara found her life unsettling and too challenging. She could not understand or accept all the bad things happening to and around her. Her world used to be chaotic and life-threatening especially when the `loan-sharks’ came banging on the door late in the night and she was left with the maid to fend for themselves. I sensed anguish and disgust when she revisited the past. She wished she could rid herself of such negative emotions, yet there is a powerful momentum to the ways she has come to feel. Knowing her parents’ low tolerance for the slightest rebuttal from her, Barbara has learnt to suppress her displeasure. She harbored silent protests and shed quiet tears.

Constructive Theme/Assessment – SELF

Piaget (1987) developed a model of cognitive development in which he described knowing as a quest for a dynamic balance between what is familiar and what is novel. He noted that we organize our worlds by organizing ourselves. And self is a process; a fluid coherence of (unique) perspective from which we experience and this sense of self emerges and changes in relationship to others.

To help Barbara optimally, I must know how she experiences herself – how she relates to herself, how she views her past and what seems possible and impossible for her future. After knowing her strengths and weaknesses, I will find out what she sees as options. Barbara felt like a passive pawn in the game of life because no one in the family took her seriously. She did not think she was capable of making sound decisions on her own. Barbara saw herself negatively with not much agency/freedom. She seemed to have limited resources and personal capacity. She harbored irrational/unrealistic idea of her not being able to do anything to change the way things were.

Constructive Theme/Assessment - RELATIONSHIPS

Active organization of self takes place `with’ and `through’ social bonds & systems of symbols. (Harding, Keller, Knorr-Cetina). The quest for order and meaning is often expressed in narrative form.

As Barbara’s story unfolded during the session, I sensed her struggles to break herself free from the past. Living primarily in the present is often a challenge when she is constantly reminded of the poverty state she was in and is still in. Barbara could not understand why her parents did not love and care for her enough to provide for all her needs. She particularly missed her deceased grandmother whom she believed would do all she could to bail her out of her misery. I noted an aura of ease and comfort on her face when she talked about her grandmother. More importantly, Barbara needed to be encouraged to develop the balanced skill of being in the present as well as planning ahead.

Constructive Theme/Assessment - DEVELOPMENT

The disorder experienced by Barbara is a natural expression of life trying to reorganize itself. The developmental process is often a zigzag course. As the human change processes can be complex, I need to be creative, affirming and respectful of Barbara’s capacities for development. I must meet her on her own grounds. I need to find out whom she confides in and how she has been hurt and helped in her cycles and spirals of experiencing. (Mahoney, 2003)

PATTERNs (Core Ordering Principles)

The presenting problem may have been the proverbial straw that made Barbara’s life burden too much. I acknowledged her agreeing to receive help as healthy and self-caring response to feeling overwhelmed. Barbara asked, `Why do I always find myself feeling frustrated, resentful and insecure? What have I done to deserve all these?’ Barbara’s adaptation to her worlds has required that she develops structures that allow her to anticipate and respond in systematic ways. She finds herself stuck in a pattern of experiencing; it seemed useful to trace the pattern backward in time. (Mahoney, 2003)

Mahoney explained that the developmental essence of constructivism is the reason why the constructive psychotherapy embraces a balance between past experiences and present action. Life-Review Exercises was undertaken to give meaning to present pattern of experiencing in Barbara’s life and to create new possibilities for future experiencing. The Personal Experience Report (Appendix D – sample) provides many questions aimed at evoking capsule summaries of Barbara’s early experiences.

There are 4 themes (Reality, Self, Value and Power) in the tacit dimension (Michael Polanyi, 1966) of Core Ordering Processes. These are deeply abstract processes. They are not easy to change.

Where was Barbara’s reality grounded? She had developed a distorted cognition that she deserved the unfair treatment her family members imposed on her. Her self-belief was a negative one as she blamed herself for bringing the bad luck to the family. She did not have a sense of agency/control in her life because her parents would make sure she report to them regularly. What kind of value guides her emotional judgment? She considered it bad to go against them despite being exploited.

It was here I explored where she wanted to invest her current energy. I had to ensure foreclosure do not take place to avoid a felt sense of isolation or unworthiness. I allowed ample time and space for her to bottom out of the negative experiencing.
By doing so, Barbara worked at pattern levels while trying to solve the school fee problem. She was led to examine the bigger picture or the underlying issues. When changes take place, what changes in significant and enduring ways will be her core processes of experiencing herself and her world.

PROCESSes - Basic Principles of Constructive Practice

I embarked on process work on the inner (intra-personal) level of Barbara. According to Mahoney, constructivism is focused on possibilities, strengths, personal resources, and human resilience. (Mahoney, 2003)

Relationship

In Constructive Psychotherapy there is an attempt to engage client in a consensually authentic process of human presence. (Martin, 1958) In view of the cycles of experiencing, I need to modulate my provision of comfort and challenge according to Barbara’s changing needs. The therapeutic relationship is one of respectful collaboration, trust, safety, and activity. Barbara who is the primary agent of change (as opposed to object of change) is to be told of the nonlinear, tacit and continuing aspects of her development. The meaning making achieved through this joint responsibility helps Barbara make sense of the past and promote a more hopeful vision of the future.
Rationale

My primary responsibilities as a therapist are to honor the felt experience of Barbara. I am to offer compassion, hope and trust, also practical suggestions for coping and incorporate techniques that have been tried and tested. As Barbara’s old ways of being fail to satisfy the demands of new challenges in life, she will need to try something different, explore alternatives, and turn challenges into opportunities.

Barbara’s primary responsibilities are to remain as engaged as possible in her own development. Her patience and persistence will help her regain a sense of order in life.

Rituals

Barbara needs to be equipped with problem-solving skills so as to increase her capacities to generate ideas for potential solutions to specific problems in life. Barbara needs to learn therapeutic techniques that involve creative reconstructions of her life stories (narratives). Engaging her in therapeutic writing such as Unsent Letter or Personal Journaling may help to modify the meaning(s) of her past and changes her sense of agency, alternative possibilities and hope. Her careful self-observation of the experience and effects of a ritual can help to strengthen her new patterns of adjustment.

Barbara also expressed her intention to change to a more self-comforting and self-caring person by actively pursuing some structured experiments in experiencing such as Self-Comforting Exercise (Appendix B).

Conclusion

The Constructive Psychotherapy framework basically provided me with the structure to work on Barbara with her problems. It is expected of Barbara to experience changes in baby steps (gradual) or large leap (abrupt). (Thelen, 1992). I must not expect Barbara to embrace changes with open arms as she needs to protect herself against changing too much, too quickly. I need to anticipate cycles of opening and closing in her developmental experiences as she seeks to achieve a balance. (Mahoney, 2003)

The problem-solving process Barbara and I went through enabled her to generate a list of options for help to solve her presenting problem. We experimented with many options and were surprised when one of the options yielded a positive outcome. Barbara’s outstanding school fees have since been fully paid for. Although Barbara is still worried about her future, especially how her Polytechnic education will be funded, she seemed more resilient than when I first met her. During the later sessions, Barbara displayed greater openness to experience. With increased capacities to self-comfort, she experienced greater sense of empowerment. I observed a more hopeful Barbara with improved self-esteem and increased self-awareness.

Appendix A

Case history of Barbara (not her real name)

Bio-data of Barbara:

Barbara, 18, was a foreign student in a local school here. She is the youngest of three in her family. She has just graduated from XXX secondary school after having sat for her N and O levels examinations. She will be embarking on a nursing course in a local polytechnic here.

Barbara was referred to me by her secondary school’s Vice-Principal, Mrs Koong.

Barbara’s Family (non-Singaporeans):
3-Generational Genogram of Barbara

Father and Mother:

They were highly successful business partners in the early years of their marriage. As they were busy building their business empire, their children were left in the care of their paternal grandmother and maids. Soon after Barbara was born, their business relationship with their suppliers turned sour. The couple suffered mental and financial setback when they chose to take their suppliers to court. Soon they ran into huge debts, chalking up on legal costs and had to surrender their home to the banks. The loan sharks were after them and they had to go into hiding.

Barbara’s parents are now living and working in City A of Country M. From time to time they would talk about their past glorious days when the family gets together. Without fail they would point their fingers at Barbara and blame her for bringing bad luck to the family. Today, Barbara seemed to believe she has been the jinx in her family.

Older Siblings:

After the grandmother’s health dived due to poor diet and distress, she soon passed away. The grand-children were left behind with the maid to fend for themselves when the parents went into hiding. For days they would feed themselves on Maggie mee until the parents came by to drop off more palatable & wholesome food. Barbara and her siblings commuted to Singapore school from the tender age of 7. They had to wake up at 4 am and would not be home till 7 pm or later if there was congestion on the causeway. Both her siblings’ education was disrupted after O levels due to the financial difficulty faced by the family. They are now staying and working in City B of Country M. Barbara stays with them whenever she is back there but Barbara does not share her problems with them.

Presenting problem:

Barbara was in tears when Mrs Koong the Vice Principal told her her O level result slip could not be released to her as her school fees for the last two years have not been paid for. Barbara’s mother promised to settle the arrears in January but she did not show up. Neither was she contactable, according to Mrs Koong. Barbara was devastated because she needed to submit the result slip to the Polytechnic in a couple of weeks’ time. Barbara was a picture of gloom when I met up with her. She looked pale and way too thin for her height. Her mouth drooped at the sides and her gaze was either on the floor or on the wall.

Appendix B

Part 1: Background and current concerns

Name: Barbara Age: 18

Occupation: Student

With whom do you now live? Siblings & Maid

Describe the primary problem or life concern that you would like help with.

I need to find the money to pay for the outstanding school fees or else
I will not be able to enroll myself for a Poly education.

I can’t stand my parents. They use me and don’t care about me.

In a few words, how would you describe yourself as a person?

I think I give in too much to my parents.

What are you now doing to cope with or resolve the problem?

I fret and fret but end up being scolded by my mother.

Have you tried any other solutions in the past?

My parents should provide the solutions.

Do you face any immediate challenges that we should deal with as soon as possible?

My parents don’t give me any pocket money. I go without food some days.

I am now feeling or I have recently been feeling…. Despair & hopeless

I have been having experiences of sleeplessness

What are your sources of strength? My VP in Sec school cares for me.

How do you cope when under stress? I called my VP and share with her my problems.

How can I help you? I need to know how to solve the money problem.

Part 2: Emotional Life

Over the course of the last 90 days, to what extent have you experienced each of the following?

Anger & other negative feelings

Never 0 1 2 3 4 Often

When you were a child, which feelings or emotions were you taught to think of as 'good’ or 'bad’?

'good’: If I obeyed my parents
'bad’: If I disobeyed my parents

Which of the following expressions of emotions were discouraged when you were a child? (circle all that apply)

Crying whining laughing pouting arguing

How would you describe your childhood in general?
(circle one)

Very unhappy 1 2 3 4 5 6 7 8 9 10 Very happy

Each of the following statements describes experiences you may have had as a child. Cross all that apply to you and your childhood.

_____ Our family life was happy. ___X__ I enjoyed school.

____ I felt loved and respected.

For the following, underline which words would make the statement true.

_X___ My mother/father was often or entirely absent.

My mother…. _X__ was sometimes violent.

My father….. ___ was abused or abandoned as a child.

In their order of appearance in your life (from first to last), who were the people by whom you felt loved?

Name Relation to you

1. XXX My paternal grandmother

What was your happiest experience as a child?

My paternal grandmother gave me pocket money everyday.

What was your most emotionally painful experience as a child?

When my paternal grandmother passed away.

Part 3: Spirituality

What were your parent’s religions? How important was religion to them?

They prayed to all kinds of gods. Now they are Christians. But I am not sure how important is religion to them.

What is your current religion or spiritual orientation?
Christianity.

Part 4: Recreation

What are your favourite things to do for fun?

SMS-ing.

Are you now involved in any form of regular physical exercise or stretching?

No. No mood.

Appendix E

Self-Comforting Exercise

Purpose: To explore and develop Barbara’s capacities to ask for and receive comfort from herself.

Duration: 20 minutes with no distraction.

Instruction to Barbara:

Assume a comfortable position, and be as relaxed as possible.
Imagine one part of you wants to be held or comforted for reassurance, forgiveness, strength or understanding.
Imagine another part of you that is deeply caring, compassionate, and generous – the part of you that is called upon when your friends need your help.
Pretend that you can give a different voice to these two parts.
Begin with the voice of the part of you that is asking for comfort. Say things like, `I feel neglected.’ Then pause.
Allow the comforting part of you to respond soothingly and reassuringly.
Say things like, `Yes, dear, I know you feel neglected. I am here with
you.’ Pause again and allow the hurting side to respond.

Allow a conversation to emerge between the two parts. It may feel appropriate for you to stroke the area of your body that is tense and hurting. This will ease up at the end of session.

When Barbara feels ready to finish the exercise, she invites each part of her to say something to the other that expresses affection and appreciation.

References

Mahoney, M. J. (2003). Constructive Psychotherapy: A practical guide. New York:
Guilford.

Bateson, P., & Martin, P. (2000). Design for a life. New York: Touchstone.

Piaget, J. (1987). Possibility and necessity: Vol.1. The role of possibility in cognitive development (H.Feider, Trans.). Minneapolis: University of Minnesota Press.

Harding, D.E. (1961). On having no head: Zen and the rediscovery of the obvious.
London: Penguin.

Keller, E. F. (1985). Reflections on gender and science. New Haven, CT: Yale
University Press.

Knorr-Cetina, K. (1999) Epistemic cultures: How the sciences make knowledge.
Cambridge, MA: Harvard University Press

Polanyi, M. (1966). The tacit dimension. New York: Doubleday.

Buber, M. (1958). I and thou. New York: Scribner’s.

Thelen, E. (1992). Development as a dynamic system. Current Directions in Psychological Science, 1, 189-193

My birth-place - MUAR !

2007-05-30T10:29:00.000-07:00

Muar (also referred to as Bandar Maharani) is a town in northwestern Johor, Malaysia. The name "Muar" is also used for the name of its district, which is further sub-divided between the Town of Muar and the sub-district of Tangkak. Muar district borders Malacca on the west coast of Peninsular Malaysia. However, both administrative regions are still collectively called Muar by their residents.
Muar district is 2346.12 km², with a population of 328,695 (2000). The name originated from the word Muara or estuary in Malay. The other possible origin is Indian influence which comes from two words; ‘Muna’ and ‘Ar’. ‘Muna’ means three and ‘Ar’ means river, denoting the Muar River, which flows through Muar.

Geography

The town of Muar is located at 2°3′N, 102°34′E, at the mouth of the Muar River. The town is about 150 km (93 miles) southeast of Malaysia's capital Kuala Lumpur, and about the same distance(179 km) northwest of Singapore . It is 45km south of Malacca Town and 50 km north of Batu Pahat.

Climate

2006-2007 floods

On 19 December 2006, unusually heavy rainfall in the states of Johor and Melaka resulted in the worst flooding in southern Peninsular Malaysia. Muar was not spared from this dreadful disaster which lasted almost a month. Many areas of Muar such as Pagoh, Lenga, Kundang Ulu, Bukit Gambir and Sawah Ring were seriously flooded with some areas up to 10 feet. About 22,933 people were evacuated to relief centres (reported by The Star, 25 Dec 2006). Flood waters also damaged freshwater pumps and electric generators. Consequently, in an ironic twist, water supply was cut off in Muar for almost one week. During that period which coincided with the Christmas and the Aidil Adha celebrations, most of the residents in Muar could not obtain clean fresh water supply and people had to resort to collecting rain water. Overall, the flood resulted in huge losses in Muar where many possessions and infrastructure were destroyed.

History

Muar is rich in history but due to the absence of proper historical record and archeological evidence, Muar's history mostly remains in oblivion. It is believed that the history of Muar started much earlier than the Sultanate of Malacca. In 1361, there was an account that claimed Muar as part of the Majapahit empire. Another account had also stated that Parameswara, founder of the Malacca empire, had established a settlement at Pagoh, Ulu Muar upon his exile from Temasik before proceeding to Melaka. Muar is also the home for the one and only tomb of the Malacca Sultanate, Sultan Alauddin Riayat Shah (1477 - 1488). Other tombs were brutally destroyed by the Portuguese during their occupation of Malacca. Muar played a role in resisting the Portuguese occupation of Malacca in 1511. In response to attacks from the Portuguese fleet, the Bentayan fort was built by the Sultan of Malacca to repel seaborne invasions.
Muar, during the Portuguese era, had been a site for a Portuguese fort named Fortaleza de Muar to defend the colony against the Dutch and Acheh attack.
Muar was the royal town of northern Johor. It had in fact been an independent kingdom ruled by Sultan Ali for a short period, when control of the state of Johor (except Muar) was formally ceded to Dato' Temenggong Daing Ibrahim under the terms of a treaty between the British in Singapore and Sultan Ali. He was in fact the real heir of the Johor Sultanate but due to his weakness, the Temenggong was the de facto ruler, instead.
Upon his death in 1877, his 11-year-old son, Tengku Mahmood, was named his successor, fueling anger and dissatisfaction of Tengku Alam. Colonel Archibald Anson's action of returning Muar to Sultan Abu Bakar made him even more dissatisfied. Therefore, Tengku Alam launched Jementah Civil War to force the government of Johor to return Muar to him but the government refused. After Johor government's victory in Jementah Civil War on 30 December 1879, Muar was finally annexed as part of the Johor state. Muar was also known as 'Bandar Maharani' (Empress'Town), a name given by Sultan Abu Bakar in 1884. Muar for many years has been the second largest town (in terms of population) in Johor but that spot has now been taken over by the neighbouring town of Batu Pahat. Nonetheless, Muar still remains the second most important town administratively after the state capital, Johor Bahru.
Muar Town was founded by Lim Tong Lian[1] who was leader of Muar Straits, called Kangchu, during the 19th century. During that period, most Chinese were involved in the plantation of gambier, a type of spice. Subsequently, Muar town developed into a commercial center.

Muar State Railway

Muar is the only town in Malaysia that had been served by its own railway network, known as Muar State Railways (MSR), operating just 4 years after the first railway line of the country from Taiping to Port Weld was inaugurated in 1885. The railway operated from 1889 to 1925 linking Jalan Sulaiman in Bandar Maharani and Sungai Pulai for a distance of 22.5 km. Being the local light railway, MSR was isolated from the national railway network but there was a plan in 1916 to extend the line to Batu Pahat. However, the project has never taken off due to financial and geographical constraints. The railway was profitable and had facilitated the mobility of people and goods besides promoting the economic development through opening of new coconut plantations along the railway corridor. However, its prominence had dwindled upon the opening of Jalan Abdul Rahman in 1918 that linked Bandar Maharani and Parit Jawa. In addition, maintenance of the dilapidated infrastructure was very limited. The track was often neglected to the extent that poor drainage had damaged the track substructure. Moreover, the absence of ballast stone in the track construction had also contributed to the fast deterioration of the track that ground settlements were common and had caused several derailments. Huge fund was required to rehabilitate the railway. Being saddled with financial constraints and declining popularity, MSR's glorious existence of 36 years finally came to an end in 1925. Remnants of the track has disappeared since the track had been replaced by Jalan Temenggung Ahmad. The display of MSR locomotive at Taman Tanjung Emas is the only relic that proves the presence of MSR in the past. It is believed that the locomotive is the oldest in the country that can be seen intact since the steam locomotive on display at the National Museum in Kuala Lumpur is of a later model. Considering that Muar has never been a state capital nor largest town of the state, it was a remarkable feat for Muar to have its own and exclusive railway network comparable to the present day LRT system, a facility that even Kuala Lumpur, the nation's capital, did not have at that time.

Administration

Muar District is currently divided into two entities, administratively, Muar town and Tangkak. Muar town is administered by Muar Municipal Council, while Tangkak is administered by Tangkak District Council.
A new administration centre, called Muar Two, is being planned for Muar town. The new administration centre which will house all the federal and state administrative buildings will be situated on the inner ring road of Muar town.

Future development

The sub-districts of Muar and Tangkak will be separated and each upgraded to full-fledged districts in 2007. Tangkak will not be called Tangkak district but Ledang district.
Mentri Besar Datuk Abdul Ghani Othman said the new Ledang district would cover Tangkak town, Tanjung Agas, Kesang, Sungai Mati, Serom, Sagil and Bukit Gambir.
“We are looking for a suitable site to build the administrative centre. When Ledang is a district, those from here can say they are from Ledang, not Muar,” he told reporters at the Ledang Umno Hari Raya gathering on November 18, 2006.

Commerce & Industry

Muar is known as the furniture capital of Malaysia. It has more furniture factories than any other towns or cities in Malaysia. In addition, Muar is also the home of two factories belonging to multinational companies, i.e., SGS-Thomson (ST) Microelectronic and Pioneer. Industrial estates within Muar district are located at Tanjung Agas, Pagoh and Tangkak, Parit Bakar.

There are many supermarkets in Muar, such as The Store, One-Stop, Astaka and K-Mart. Wetex Parade (housing The Store) is the only shopping mall available in Muar at present, located at Jalan Ali, in the heart of the business and shopping district. In the past five years, a new business centre has sprung up along Jalan Bakri at the junction of Jalan Haji Jaib, Jalan Bakri and Kampung Kenangan Tun Dr. Ismail, where the Econsave Hypermarket has just opened for business (03/10/2006).
Besides, new commercial development which is expected to house a private hospital and shopping centre, including Giant Hypermarket is ongoing on the northern bank of Muar River, on a site reclaimed from a mangrove forest.

Towns in Muar

The following are some of the small towns in Muar:
• Parit Bakar
• Parit Jawa
• Bukit Bakri
• Bukit Pasir
• Pagoh
• Bukit Gambir
• Sungai Mati

Infrastructure

The 14 km Muar Bypass highway (2 lane dual carriageway) inclusive of a picturesque Muar Second Bridge that was completed in 2005 is the latest landmark of the town.

The highway that traverses through the outskirts of the town would ease the journey by diverting the traffic from Muar town, and thus, alleviating the congestion at the older Sultan Ismail Bridge. Such highway (or ring road) is normally a feature for Kuala Lumpur, Johor Bahru, Penang, Malacca and Seremban which are all state capitals. Although Muar does not enjoy the status of a major city, its provision in Muar has illustrated the economic importance of Muar and would enable Muar to regain its former spot as the second largest town in Johor.
Besides federal roads, Muar is also accessible via the North-South Expressway through the Tangkak and Pagoh interchanges which are located 20 km and 30 km from the town, respectively.
Ferry services to Dumai, Sumatra, Indonesia is also available on regular basis, departing from the Custom Jetty.

Tourism

Gunung Ledang National Park

One of the main tourist attractions in Muar is the Gunung Ledang National Park. The park is situated 170 km from Johor Bahru and has an area of 107 km². The park has two entry points, one in Sagil, Johor and the other in Asahan, Melaka. Gunung Ledang's peak, which is 1276 m above sea level is the highest point in the park and Johor. Gunung Ledang is also the 64th highest mountain in Malaysia and arguably the most climbed mountain in the country. Sagil waterfall, which is also in the park is a famous picnic site.

Food

Otak-otak at Jalan Haji Abu
Muar is also famous for its food. The most well-known local food are "Otak-otak" and "Mee Bandung Muar". Muar is also known for being one of the few places where satay (a Malaysian delicacy of skewered grilled chicken or beef) is served for breakfast.
Visiting some restaurants and coffee shops in Muar would give nostalgic experience since the environment and food/beverage being served have not changed since the 60s and 70s. Coffee served by these restaurants has its unique taste which is believed to be comparable to the famed Kluang coffee.
Muar has a famous street, "Jalan Haji Abu", known as "Dham Chia Kuey" in Hokkien, which is well known for it variety of food. Many local Chinese food are available here, including wanton mee, otak-otak, "Õ jian" (Fried Oyster Omelette), and etc.
Besides that, Muar has two well-known Hainanese Chicken Rice Ball shops located at Jalan Meriam. The chicken rice is made into sphere shapes, which look like tennis balls.

Accommodation

There are also a few hotels which cater to tourists who wish to stay overnight in Muar town. These include:
• Apartel Maharani
• Classic Hotel
• Riverview Hotel
• Embassy Hotel
• Hotel Sri Pelangi
• Kingdom Hotel
• Leewa Hotel
• Nam Yang Hotel
• Muar Trader's Hotel (opened in 2007, located at the building formerly owned by Muar/Pagoh UMNO division).

Local Attractions

Rows of well preserved pre-war buildings still dominate the town’s architecture. These buildings still house various shops along Jalan Abdullah, dubbed as Muar’s central business district. Prominent heritage buildings, among others, are the Abu Bakar Building (completed in 1929) that houses the town’s administrative offices and the Custom building (completed in 1909). The age of most buildings can be easily identified since the date of completion (ranging from 1930s to 1950s) were cast on the buildings’ exterior. These buildings are the priceless heritage that portrays Muar’s prosperous past and appreciating this splendour would bring one’s memory back to the nostalgic yesteryears.
Another attraction of Muar town is Taman Tanjung Emas, the town’s park, which is located at the estuary of Muar river. It is outlined by a picturesque esplanade overlooking the scenic river. The park, which is much visited during the weekends, also houses a 9-hole golf course. A 45 minute to one hour river cruise departing from this park is also available to offer tourists views of Muar town from the river.

The Sultan Ibrahim Jamek Mosque is one of the major landmarks of Muar town. Completed in 1927, its architectural design has British influence. The mosque is noted for its four-storey minaret in its backyard. The latest icon of the town is the Sultan Ismail Mosque, located at the northern bank of Muar River in Tanjung Agas. Its design is similar to the first mosque. Completed in 2002, it is the biggest mosque in town. Both mosques offer a breathtaking scenery when viewed from the Muar River mouth, while on a river cruise.

Education

Education of Muar's younger generation is adequately provided by the schools in Muar. This is an incomplete list of schools in Muar.

Secondary Schools
• SMK St. Andrew (SAS)
• SMK(A) Ma'ahad Muar
• Muar High School
• SMK Convent
• SMK Bandar Maharani (SMKBM)
• SMK Dato' Sri Amar Diraja (SEDAR)
• SMK(P) Sultan Abu Bakar (SAB)
• SMK Tengku Mahkota (SMTM)
• SMK Jalan Junid
• SMK Sri Muar (The Secondary School I attended 1970 - 1975)
• MRSM Muar (full boarding school)
• Sekolah Menengah Sains Muar (full boarding school)
• SMK Tun Mamat (half boarding school)
• SMK Bukit Pasir
• Chung Hwa High School
• SM Teknik Muar ( formerly known as Sekolah Menengah Vokasional Muar)
Muar High School (Bob was the Head Prefect)

Muar High School (麻坡高级中学) was established in 1904 and the majestic building built in 1915 is still standing. During the Second World War, the school was used as a Japanese concentration camp. Its alumni include national and state leaders, high-ranking government officials and industrialists, such as Tan Sri Osman Saat, Tan Sri Muhyiddin Yassin, Dato Seri Abdul Ghani Othman and human rights activist Rahul Doraisamy.

National Primary Schools

• SK Ismail 1
• SK Ismail 2
• SK Convent Infant Jesus
• SK Sawah ring
• SK Bukit Gambir
• SK Simpang Lima
• SK Serom 3[1]
•
Chinese Primary Schools

• SRJK Chung Hwa 1A (中化一小) (The Primary School I attended)
• SRJK Chung Hwa 1B
• SRJK Chung Hwa 2A (中化二小)
• SRJK Chung Hwa 2B
• SRJK Chung Hwa 3 (中化三小)
• SRJK Chung Hwa Presbyterian (中化基小)
• SRJK Sing Hwa (醒华小学)
• SRJK Chian Kuo
• SRJK Hwa Ming (华明小学)
• SRJK Pu Nan
• SRJK Pei Yang

Hospitals

• Muar and Tangkak are served by two government hospitals as well as numerous primary health centres. The two hospitals are:
• Muar General Hospital, which has recently been upgraded to specialist hospital status and renamed Hospital Pakar Sultanah Fatimah.
• Tangkak District Hospital
• Currently, both hospitals also serve as teaching hospitals for Melaka Manipal Medical College.

Culture

• Muar is the birthplace of ‘Ghazal', Johor’s traditional musical heritage, which has a Persian origin.
• It is generally acknowledged that the local dialect of Malay spoken here (and throughout the state of Johor) is the standard version of the language adopted by the country.
• Other than the above, the Muar Chinese community is well known for their lion dance. Muar "Guan Sheng Temple" had been world champion for 10 times consecutively in the International Championship for Lion Dance.

Notable people from Muar

• This is an incomplete list of famous current and former residents of Muar.
• Johor Menteri Besar, Datuk Abdul Ghani Othman.
• Former Johor Menteri Besar, Tan Sri Osman Saat.
• Minister of Agriculture and Agro Based Industry who was also a former Johor Menteri Besar, Tan Sri Muhyiddin Yassin.
• Former Health Minister of Malaysia, Chua Jui Meng. (He is my uncle! )
• Famous singer/celebrity, Ramlah Ram, Nash, Zainal Abidin,TRO Group and Jaafar Onn.
• Malaysia top badminton player, Yap Kim Hock.
• Former Minister of Law and the Judiciary, Lord President of the Supreme Court and Attorney General of Malaysia, Tan Sri Abdul Kadir Yusuf was born in Parit Sakai.
• The former Minister of Home Affairs and first Speaker of the Dewan Rakyat, Tan Sri Mohammad Noah.
• Former UMNO meeting chairman Tun Sulaiman Ninam Shah.
• Former Acting President of Malaysian Chinese Association (MCA), Datuk Dr. Neo Yee Pan.
• Former Managing Director of NEC Infrontia Asia Pacific, Dave Chong Min Kuin.

(http://en.wikipedia.org/wiki/Muar extracted on 30 May, 2007.)
Visit http://www.geocities.com/jazlany/history.htm for more information on Muar.

Purpose Driven Life

2007-05-30T10:04:00.000-07:00

What on earth am I here for? Today I completed 8 weeks of studies on Rick Warren’s book consisting of 40 chapters of daily reading and 8 weekly small group discussions. It has been an exciting journey of discovering the purposes of my life here on earth.

THE TRUTH IS … IT’S NOT ABOUT ME! The purpose of my life is far greater than my own personal fulfillment, my peace of mind or even my happiness.

How do I see my life? I used to view life as a journey to nowhere. After having known God the Creator and Sustainer of life, the journey I am on now has a destination. The Bible says, `Do not conform yourselves to the standards of this world, but let God transform you inwardly by a complete change of your mind. Then you will be able to know the will of God.’

The Bible offers three metaphors that teach us God’s view of life: Life is a test, life is a trust, and life is a temporary assignment.

Life on earth is a Test and I will always be tested. This understanding made me realize that nothing is insignificant in my life. Even the smallest incident has significance for my character building. The good news is that God wants me to pass the tests of life. The Bible says, `God keeps his promise, and he will not allow you to be tested beyond your power to remain firm, at the time you are put to the test, he will give you the strength to endure it, and so provide you with a way out.’

Life on earth is a Trust. My time, energy, intelligence, opportunities, relationships, and resources are all gifts that God has entrusted to my care and management. I am a steward of whatever God gives me. The Bible says, `Those who are trusted with something valuable must show they are worthy of that trust.’

Life is a Temporary Assignment. The Bible says, `For we were born but yesterday… Our days on earth are as transient as a shadow.’ St. Peter said, `Friends, this world is not your home, so don’t make yourselves cozy in it. Don’t indulge your ego at the expense of your soul.’

The fact that the earth is not our ultimate home explains why we experience difficulty, sorrow, and rejection in this world. It also explains why some of God’s promises seem unfulfilled, some prayers seem unanswered, and some circumstances seem unfair. C. S. Lewis observed, `All that is not eternal is eternally useless.’ This is not the end of the story.

The problem with kids (parents)! @ Wesley Methodist church

2007-05-30T10:02:00.000-07:00

I signed up for this workshop in an attempt to understand the PIU – Pathological Internet User. The definitions for PIU are Technological Addiction (Griffiths, 1996), Non chemical (behavioural) addiction, which involve human-machine interaction passive (TV) and active (puter games). Unlike substance dependence, computer addiction is basically impulse control problem (Young, 1999). Possible reasons for attraction of the Internet will be dissociation (low commitment), sensation seeking, anonymity and disinhibition (fantasies). The effects of PIU are pleasure, excitement & relief (e.g. accelerate the passage of time).

Some samples of diagnosis of PIU were given and symptoms explored. The psychological ones include having a sense of well-being or euphoric while at the computer and feeling empty, depressed, irritable when not at the computer. Physical symptoms include carpal tunnel syndrome, dry eyes, migraine, backaches, eating and sleeping irregularities, failure to attend to proper hygiene.

Treatment for PIU –

1. Behavioural – to develop a time-table for internet usage; use reward and reinforcement approach to keeping internet discipline; change patterns of routines; CBT; weaning, if necessary and accountability.

2. Physiological - Neuro-transmitters/chemical changes.

3. Spiritual - renewing of the mind (Romans 12:1 & 2); sensitization to the Spirit (John 16:8-11) & fleeing from temptation (2 Tim 2:22)

Danny shared that the PIU is of major concern because todate there is still no concrete treatment available to help this growing population. I am looking forward to equip myself with CBT as this is probably an approach that may help to a good extent.

Come end of May, I will be attending another workshop on the thrills and ills of gaming the digital way. I hope more ways can be learnt to help the desperate parents who battle with their young PIU at home.

Child Guidance Clinic @ Health Promotion Board

2007-05-30T10:00:00.000-07:00

I arrived at the SGH early enough to have a quick bite at the Café. I was disappointed with the quality of food. The clinic was quite deserted when I arrived. The ECTA students were all looking excited to take on the day at the Clinic. By 8 am, we, together with some medical interns, were crammed into a small room. It was a special room in that there was a one-way mirror that allowed us to view the life-demo going on in the next room.

The medical team took us through Reactive Attachment Disorder (RAD), a psychophysiologic condition with marked disturbed and developmentally inappropriate social relatedness in most contexts that begins before five years of age and is associated with grossly pathological care. This pathological caregiving behaviour may consist of any form of neglect, abuse, mistreatment or abandonment.

Due to maltreatment by caregivers, RAD sufferers have difficulty forming healthy relationships with their caregivers, peers and families. In the treatment modality, the concept of `goodness of fit’ applies to caregiver and child.

Following the talk on RAD, a medical intern conducted a live-demo on a fresh case of school-refusal (unlike truancy, patient’s refusal to go to school is known to his family members.) It was a complex case and the intern took more than an hour to elicit useful information. A year-long school-refusal surprised Dr Fung. Children with such behaviour should have been brought in within two weeks, he lamented. Dr Fung is an advocate of multidisciplinary treatment. He mobilized the other medical team members to look into additional findings, such as co-morbidity and possible organic cause. His personal choice of action on such behaviour would be to send the patient back to school the next day or soonest possible. (Early Return.) This is a `flooding’ process whereby the patient is compelled to face the anxiety or whatever that is making him/her shun school immediately. However, there is also a place for graded exposure, he commented, so as to address anxiety or etiology excavation (such as learning difficulty).

We watched 3 live-demo by Dr Fung, out of which 2 were follow-up cases. He demonstrated the compassionate and caring side of a medical professional. I could see the therapeutic alliance he established and maintained through out all the sessions. He was also very effective as an instructor in that he briefed us on the case and gave a tentative prognosis on it in between sessions.

It was time well-spent for me indeed as I gained insights into children cases.

Practicum Sites

2007-05-30T09:58:00.000-07:00

My practicum at Northlight Secondary School did not materialize and I could understand why. The counseling setting did not seem to match what I am trained for. The resident counselor counsels on his feet. And he provides a lot of social support too.

I felt supported when ECTA endorsed Queenstown Baptist Church as a practicum site for Helena and myself. One of our church pastors who is graduating from the Singapore Bible College in Master of Pastoral Counselling this May will be spearheading the Lay Counselling Ministry. I was encouraged to learn the counseling corner was going to be set up in one of rooms downstairs at church.

The room is easily accessible and counselees will not need to show up at the church office (2nd floor). This is ideal setting for confidentiality reason. As the church has yet to come out with a structure pertaining to counseling protocol and data record, I have been advised to use whatever format ECTA has provided me. Todate I have used the room twice and my clients have commented that the room is rather cozy. I was happy for the client too in that there is no charge for use of it.

I am currently also following up a case at Paragon clinic. The client finds the location convenient. I have seen him one on one over 5 sessions.

Mt E Charter is another site I go to provide counseling support to outpatient. Although convenient I took a while to get used to the environment.

Siglap Free clinic is the furthest from home but I find the clinic rather conducive and the environment quiet and private.

Presently my clients who need counseling follow-up have 3 sites to choose from and that is indeed a great thing. Gone were the days when I would worry over the distance and cost for clients who cannot afford to pay. 

With greater exposure to counseling and training, I noticed changes in my self-relationship. There is an increased self-awareness, greater openness to experience (e.g. speaking in group setting), greater self-acceptance, improved self-esteem, increased capacities to self-comfort and to receive and give affection. More wonderfully, a greater sense of personal agency or empowerment and a more hopeful or grateful engagement with life ! 

The Practical Issues of Psychodynamic Psychotherapy

2007-05-30T09:55:00.000-07:00

We have just completed the 22 hours of Psychodynamic Psychotherapy module by Dr Lyn Chua. I must say it was a very enriching learning experience. Dr Lyn is very knowledgeable. She is organized in her approach yet opened to intuition. The class felt drawn to her as she seemed approachable and whole-hearted in her dedication to impart knowledge and skills to us in a short time.

I learnt that, as a psychodynamic psychotherapist, I will have to convey information about patterns of client’s thinking, feeling and behaviors. Like a good teacher, I will have to exert profound effect by my impact as a person. As always, client’s cultural orientation needs to be factored in.

Not all clients are suited for psychodynamic psychotherapy. The class came up with a list of clients who are potential candidates for psychodynamic psychotherapy. And they are perfectionistic patients who are bright and suffering from panic attack, senior manager putting on an indifferent façade at work, substance abuse addicts, PTSD patients, and terminally ill patients, homosexual, angry, egoistic and narcissistic clients….

In addition to the assessment and selection, techniques and basic concepts of psychodynamic psychotherapy, I learnt the practical problems as well. Dr Lyn highlighted that gifts from clients are not to be accepted, ideally. And there’s a place to explore reason behind client’s desire to give gift. However, small gifts to establish relationship or mark important occasion can be appropriate. Secondly, telephone call from client should be kept brief and to avoid giving `interpretations’ on the phone so that client will not be kept in suspense or go into distress. 

As a psychotherapist, I need to be aware of power imbalance between client and myself. I have to ensure that there is no manipulation of transference. Instead to use the trust of the client to serve the latter’s own needs, so that fiduciary duty will not be breached.
I need to be aware of what emotions make me uncomfortable. It will really help if I begin to reflect on own strengths, weaknesses, feelings and issues. I need to be able to accept client’s critiques of me and acknowledge my own limits. Supervision too opens my mind to explore options and possibilities, and bring out awareness of my own blind spots.

I visited Freud’s home-turned-museum last December but have come to know Freud better through Dr Lyn Chua.

I Am by temperament nothing
but a Conquistador - An Adventurer…
with all the curiosity, daring, and tenacity
characteristic of a man of this sort.
~ Sigmund Freud to Wilhelm Flieβ
1 February 1900

Prayer Labyrinth @ QBC

2007-05-30T09:52:00.000-07:00

Dr R talked about the `higher self’ – the spiritual (actualized) self in some of us. To help achieve it, I believe Dr M Mahoney’s centering exercises certainly steer one to recover a sense of meaningful order and to maintain it. The feeling of being in a safe base irrespective of where we are can be derived from exercises that emphasize on breathing, bodily balance, and meditation.

The Prayer Labyrinth set up in church recently provided me the opportunity to exercise what I learnt in module one about the art of `being’.

Labyrinths are found in many cultures dating back as much as 3,500 years. The Labyrinth has appeared as a form of sacred wisdom. Its patterns are said to express an archetypal in the shape of a mandala. Although its origins are unknown, the Labyrinth was used in Europe by medieval Christians and pilgrims to replace the longer journey to Jerusalem and the Holy Land. Historically Christian pilgrims walked a symbolic spiritual journey to and through Jerusalem, following the footsteps of Jesus. By walking the Labyrinth they experienced that journey metaphorically.

Walking through the Labyrinth was simply being in deep meditative and symbolic discipline of setting one foot in front of another, paying attention to the body, the wisdom of the heart and the graces of `being’ rather than `doing’.

Walking the Prayer Labyrinth fulfilled 6 important contemporary needs:

σ Deepening spirituality
σ Inwardness and connection to the soul
σ Access to intuition and creativity
σ Simplicity
σ Integration of body and spirit
σ Intimacy and community

The prayer journey was divided into 3 rooms:

σ The Majesty Room
σ The Grace Room
σ The Faith Room

After unloaded my `physical baggage’ (handbag etc), I took a deep breath and began the journey. I did not feel rushed, set my own pace and listened to my breath. I meditated on specific word or passage, prayed, honoring the sacred sense within myself.

I was led to meditate on God’s creation of the universe, mankind and specifically me. I was reminded that God has left His fingerprints on me. I am precious and special in God’s heart.

The Labyrinth was a sacred space and I felt safe to process my emotions and be open to new insight. My emotions grew intense at one point and I found myself sobbing my heart out. I felt a surge of cleansing power running through me, as if God was addressing the very wound and hurt that was deep inside me.

I was reminded of His saving grace. He may be silent but He is still watching over me in that `silent’ space. Am I willing to let God’s silence do His work in my life? Silence does not mean nothing is happening. Like the way the seed grows, things are happening in ways that we cannot see. I may not see His hands at work but He is in control. God asked, `Child, are you wiling to move beyond trusting Me for what I can do, to just trusting in Me? Trust that I am good and my intentions are always favourable to you, even when it is not what you expect?’

As I left the Labyrinth, the lyrics of `He who began a good work in you’ strengthened me further.

“He who began a good work in you will be faithful to complete it.
If the struggle you’re facing is slowly replacing your hope with despair,
Or the process is long, and you’re losing your song in the night,
You can be sure that the Lord has his hand on you.
Safe and secure, he will never abandon you.”

Constructive Psychotherapy II

2007-05-30T09:49:00.000-07:00

Artwork (c)2006, www.psychotherapy.net

The themes and principles of CP were being digested but not fully internalized. By now I have grown used to Dr R’s `Consider this….’ I find it imperatively effective in drawing attention.

Compassionate human presence is the central emphasis of a counseling session. It is the art of being humanly present to another person. The 3 interwoven levels of focus in a session are PROBLEM, PATTERN & PROCESSES.

Problems are often attempts at solutions. The Client needs to develop skills set to bridge the difference between immediate and delayed consequences.

Problems are usually expressions of patterns. A client working at pattern levels may be trying to solve specific problems. He/she is trying to make sense of the patterns of distress/dysfunction. Ultimately self-forgiveness and more constructive ways of coping have to take place.

Problems and problematic patterns are the expressions of processes. Processes are the engines of our experiencing. Process work is work in the immediate, such as meditative practices and stream of consciousness.

Dr R took us through the Basic Centering Techniques (Breathing exercises, Body balancing exercises & Relaxation). The different techniques are Movement Therapy and we were kept awake even after a big lunch.

The mindfulness meditation is directed in a secured environment. Metaphors are being used by the Therapist to help Client finds stability in relationships, places and patterns.
Empathy coming from the Therapist enables the Client to be rightfully supported. It does not equate agreeing to Client’s reality. It is not a reality check.

Problem solving & cognitive restructuring are selected techniques in CP. The acronym SCIENCE is used to organize the essence of problem-solving skills.

Self-talk is an important domain for awareness and change. Evaluate the merits of thought - Does it make sense? If not, imagine counterarguments to thoughts.

Other techniques include Pattern Work (bibliotherapy), Basic Process Work (meditation), Fantasy (role-playing), Self-relationship (mirror time) & spiritual skills.

Constructive Psychotherapy

2007-05-30T09:47:00.000-07:00

CP module kicked off last evening. The first impression Dr R gave me during the Insertion Class last year was a very hazy one. I could not remember a single thing he lectured on. It was with much apprehension when I made my way to TS Building last evening. What if I still could not tune in to him??

The 3rd batch of Master students (March intake) is a welcoming sight, in terms of numbers and faces. I found myself sitting rather near Dr R (hoping to tune in better). It turned out to be a rewarding action. From time to time, he `confronted’ me with challenging & thought-provoking questions and therefore kept me captivated and tuned in major part of the sessions.

CP is a framework/modality using constructivist principles to assess clients and implement interventions such as centering techniques, problem solving, pattern work, meditation and self-care exercises, drama & dream work. The principles used are aimed at transforming emotional experiencing positively.

I managed to read the first 6 chapters of CP by Dr M J Mahoney before class and that helped me somewhat in my grappling with the Constructive process during the class. Dr R presented the module in his own unique style. Only towards end of the whole module, I saw the light - the big picture. But I was happy coz if it were to happen in the process, I might wander off carelessly.

Dr R reminded us that during counseling the Client must increase while the Therapist decreases in prominence. However, sharing of the dark secrets is a monumental task, therefore, the client must be given time to share his/her unique experiences. In the same light, Client must be allowed to cry/weep. Offering the tissue box too soon may result in a foreclosure prematurely.

Dr R challenged us to develop our higher (spiritual) self. The best therapist has been helped in the process of helping others, in a substantial way. The `child’ & `critic’ inside us has to be diffused. As the Therapist shifts from the adult self to the higher self, he is able to help bring the humanness of the darker side into the light.

This weekend we covered the 5 organizing themes (R.O.A.D.S.), the basic therapy principles (R.R.R.P.), constructive assessment/core ordering principles (C.O.Ps) (R.S.V.P.)

We were led into an indepth understanding of the themes R.O.A.D.S. - Relationships, Order, Activity, Development & Self. These themes suggest that a constructive view of human experiencing is one that emphasizes meaningful action by a developing self in relationship.

1. Self-organization is fundamentally shaped by social bonds (human relatedness) and symbolic processes (our form & structure of thinking is itself relational - thru stories – Bruner.) In a counseling relationship, the Therapist is also being shaped as he/she interprets the Client.

2. We actively seek order and create meanings so as to achieve a sense of balance. Ironically, challenges to our order are essential to all learning & development. As a counselor, I will remain a `technician’ if I do not evolve. And in my attempt to change or help Client regain a sense of order, meaning, or balance in life, I have to refrain from being intrusive. I have to help Client recognize the triggers that bring out the default, negative reactions. We long to change, yet there is a powerful momentum to the ways we have come to be.

3. Both Therapist & Client are active agents of choice & change. We choose, often reactive, proactive, at times unreflective, anticipate, pay attention, select, move, lean, fall…

4. Equilibration (balance) reflects our attempts to deal with the contrasts between old and new pattern. We experience opening and closing in development. We literally shut down when the challenge to our ordering capacities is overwhelming. Therapist needs to encourage patience, persistence and instill hope in the client. For the first time, I fully understand the purpose of Centering Skill (finding and regaining balance) as well as exploratory decentering (risking excursions into new possibilities for experiencing).

5. The sense of self is crucial to healthy human development. It is intimately related to the sense of reality. The self relationship will determine the quality of my life – self-concept, body image, self-esteem, self- comfort & self reflection. Counselling can provide a secure base for examining and changing self and interpersonal relationships. I have to be careful foreclosure on the complexity of the self does not set in because this will result in the Client walking away from growth.

The first basic principle of Constructive Practice (R.R.R.P.) addresses the co-created human bond between the Therapist & Client. The therapeutic (compassionate) relationship provides a secure base in which the Client can both explore and experiment with new ways of experiencing. The Therapist is a consistent & trustworthy source of affirmation, encouragement, & hope.

(Collaboration & action) Rationale - When people go through changes in life, they experience a sense of confusion coupled with strong negative emotions. These emotions are natural response & expression of people’s attempts to regain meaning and functionality in life. Clients are expert on their own experiences. Therapist is to honor the `felt experience’ of the Client. Client will attempt to rethink emotionally (revise) his or her life story.

Rituals (affirmation & hope) are an important expression of people’s intention to change and their active participation in that pursuit. Rituals are aimed at developing skills such as self-comforting & emotional regulation. Rituals involving supportive groups or significant others can be powerful in influencing developmental pace.

Processes of Change (Balancing Skills & cycles of experiencing) - The reorganization of life patterns occurs in oscillations of success and failure, and expansion and contraction. The changes in the patterns of experiencing are usually non-linear. Resistance to change is most intense when core ordering processes are involved. Such resistance is an expression of self-protection.

Psychological development is reflected in shifts of attention, changes in perceptions and personal meanings, changes in interpersonal relationships, improved capacities to rebound from setbacks, and changes in self-relationships - increased self-awareness, greater self-acceptance, etc.

Constructive assessment/Core Organizing principles (COPs) R.S.V.P.

Reality - Try to enter Client’s world, momentarily. Listen for the meaning systems by which she is living. Is she seeking more meaningful structure? Real-fake?

Self - Focus on the client’s presentation of herself. Seek to understand her general patterns of self-relationship. Is she skilled in self-comforting? Body-world?

Values - A distorted cognition will affect the values (the emotional judgments) of the Client. Positive-negative?

Power - Is Client overwhelmed by a sense of helplessness? In-out of control?

*COPs are conservative and self-perpetuating and not easy to change.

Gambling Addictions: Assessment, Brief Interventions & Community

2007-05-30T09:13:00.000-07:00

Jessica okayed the Counselling Related 15-hour Workshop organized by the Social Service Training Institute & Community Addictions Management Programme.

Very often I come across gambler clients at the Maintenance Mediation Chamber where I mediate cases. My experience with gambling addict as I grew up made me view them with a degree of disrespect. My maternal grandmother gambled all her life. Nasty words were hurled at me whenever I cried or showed up at her home. I was a jinx in her eyes. I was disgusted when I was older and learnt that she had gambled away most of money inherited from great-grandparents. To me gambling was a horrible habit a person adopted as a life-style. Well, the workshop I attended did change my perception to a large extent.

The Disease Model of Addiction came as a surprise. It views addiction as a biological illness that requires medical & psycho-social intervention. According to the model, addiction involves biochemical processes in the brain. It involves the mid-brain and parts of the pre-frontal cortex. It is a medical illness, chronic, relapsing, genetic, environmental, psychological, though no `cure’ is treatable. The addicts may not be responsible for the disease but they definitely are responsible for the recovery.

Addiction is a family disease. For every person with addiction, 5 family members are affected. And gambling addiction has the highest risk of suicide.

Ms Marjorie Nixon the trainer described the different types of gamblers, i.e., professional gambler, anti-social gambler, social gambler, serious social gambler & problem gambler. The National Prevalence Survey on Problem Gambling (2004) indicated that an estimated 2.1% of Spore’s population were probable pathological gamblers (PPGs). And 1/3 to ½ of all problem gamblers are women with 89 – 95% of WPG are escapist gamblers and most often favour EGM’s (Electronic gaming machine).

I learnt that compulsive gambling may be due to the following factors: Family history of addiction; growing up in a family with extremely critical, rejecting or emotionally unavailable parents; family that emphasizes status or overvalues of money.

We went through the DSM-IV for Pathological Gambling. Some of the behaviors include restless/irritability when attempting to cut down/stop/withdraw, return another day to get even after losing money (chasing losses), relies on others to provide money to relieve desperate financial problems….

The therapist and addict need to work on treatment goals of returning the addicted individual to his/her best level of functioning and avoid damage/dysfunction to the individual and society. Also for the addict to maintain sobriety and actively work on preventing relapse.

The paradigms of Addiction Treatment include Motivating Interviewing (Tailoring interventions to stages of change); CBT; Behavior Modification; Psychodynamic Therapy; Family Systems Therapy; Pharmacotherapy; 12 Step Recovery Programme & Other Self-Help Groups & Sponsorship.

Ms Marjorie went over the 12 Steps of Gamblers Anonymous in greater depth. There seems a lot of conscientious effort required on the part of the gamblers to admit loss of control, to believe in a Power greater than them, to submit to God, to make a moral inventory of self, to humbly ask for God’s intervention, make a list of all persons harmed in the process and make amends to them all.

Basically the 12-Step is about changing ONE thing, i.e., EVERYTHING.

It is a life-long process to change from a gambler to a NON-gambler. It is difficult and it may mean forsaking a brother who is a gambler. The path to a new way of life for the addict is paved with HOPE, responsible thinking/living, self-acceptance, trust from others, improved behaviour and insight into self…

I wish someone was there to offer my grandma the help she needed to recover.

As a therapist, my task is to release that potential for change in the addict, to facilitate the natural process already inherent in the individual. (Miller & Rollnick, 1991)

The 5 basic principles of Motivational Therapy to help elicit change include expressing empathy (identify with feelings/human yearnings), develop discrepancy (to create and amplify, in the client’s mind, a discrepancy between the present behaviour and broader goals), avoid argumentation/roll with resistance (resistance is a signal for the therapist to change strategies), support self-efficacy (acknowledge progress, no matter how small).

According to Mrs Marjorie, `in the final analysis, it is our clients who ultimately choose to maintain or change their problematic behaviour. We must not only accept this reality but when working with clients who want to change, we must also respect and protect their right to freely choose the type and intensity of treatment that they believe will best meet their need.’

Moving on to Master's (March 2007)

2007-05-30T08:59:00.000-07:00

The day finally arrived for me to head to EC Road for the Master’s Orientation. The commitment to complete the 12-month Master Program was strengthened by the upfront full payment of the total course fee so that the 2% hike in GST will not affect me. I felt a great sense of peace as well as passion as I journeyed on to the next level of academic pursuit.

Why am I pursuing? What is there for me after the Master? Come to think of it, there is really no BIG plan.

2007 started with a BIG Bang. Husband took up the Lab Tech Directorship of CCIC Group. I hope he would not need to travel to China in the next 12 months. Older son will be enlisted into NS in April. Younger son is waiting for the Poly course placement in April. Both are gainfully employed currently and I fantasize about retirement!

Dr Tan C T gave a warm welcome speech. As there was a couple of new coursemates, Jessica gave the long version of the Orientation which benefited my short-term memory bank.

The time-table for the next 12 months indicated much learning to do. I am pleased with the improvement and enhancement ECTA is doing to the Master programme to benefit the students in new intake. I am pleased to be part of a progressive and innovative training institute.

I decided to stick to previous supervisor Mr Augustine Tan as he has been a source of encouragement. I have benefited greatly from his mentoring and supervision.

I realized I need positive energy to stay on the course and that will also mean having peers that are upbeat and forthcoming. I have proposed to Helena & Timothy to form a study group as we are staying close to one another. I am looking forward to varied group dynamics and synergies.

The text books are thick and heavy. But I am all ready to read what M J Mahoney has to say about Constructive Psychotherapy. I sensed positiveness in his approach. 

Journeying thru ECTA 06

2006-10-12T00:49:00.000-07:00

Responses to CRP questionnaire

My clients of a mix of Chinese, Malay & Indian are mainly local but I do see immigrants from Malaysia, China, Taiwan, Indonesia, Philippines & India.
They are mainly from lower income group & are lowly educated. During counseling, English & mandarin are the main languages used. My clients are from different religious background. Most times I see couples and occasionally minors.

Some men I see strongly believe that wives are to be domesticated and accept whatever the former can provide. They abuse their right as master of the home in the way they order their wives around. There are some who expect & insist that their working wives contribute equally towards family expenses. Often I encounter men who think that they have every right to ‘discipline’ their spouses/sisters/daughters by inflicting pain on them. They believe that the solution lies within their `fists’.

It is also common to find Muslim men exercising their right under the Muslim law to set up new family despite a struggling financial outlook. Another issue I deal with involves pathetic Indian women who will not call it quit despite being victimized by their spouses.

The more unique issues include local men who view and treat their foreign wives strictly as domestic helpers/care providers and pay them a nominal wage to take care of the elderly/invalid parents or young nephews and nieces. They neglect their function as husbands, i.e., not meeting the sexual need of their so-called wives. On the other hand, there are foreign women who use marriage as the means to attain PR status in Spore. Also, Taiwanese women abuse their right to `direct access’ of their husband’s paycheck. And men who passively endure violence inflicted on them by their partners.

Counselling per se is not looked upon keenly in the local context as only people who are perceived as ‘dysfunctional’ need help. As clients in Singapore are very time-conscious & BUSY people, the important factor that determines the kind of models to use will be that of TIME. SFBT can be brief and solution-focused; it seems to work on most of the clients I see.

There is also the gender issue of male clients preferring not to go back in time to address the painful past - They are more passive and less in touch with their feelings. They may also be selective in sharing their personal concerns.

The use of `hot-seat’ fantasy technique to help clients express their feelings where there is unfinished business may not be favoured by the more `conservative & traditional’ clients as unleashing negative emotions towards the deceased is considered a taboo.

MFT encourages the therapist to look into the Family of Origin to examine the interlocking relationships. This can present itself negatively as in-laws or family members may not be forthcoming when it comes to talking about sensitive & conflicting issues, esp to strangers. This has to do with the `face’ issue.

For me, the difficulties I encounter counseling culturally-different client will be to stay sensitive & working on interventions that are congruent with their values. Very often, I see Indian wives who have no courage to put a stop to their spouses’ acts of violence esp after many drinks. (Drinking seems to be an issue for the Indian men.) The more traditional Indian wives who treat their husbands as if they are gods, will suffer in silence for years before they seek protection from the court to deter them. Divorce is the last thing on their mind. The act of walking out of their husband is unpardonable in the eyes of their family of origin. It will be unwise of me to advise the wives to leave the husbands knowing they are in danger of being ostracized by family & community. In such cases, remaining sensitive and working on interventions that are congruent with the values of the wives can be a challenge.

It may help to confess to the clients of my ignorance of their culture and to request for their understanding and time for me to learn from them as the counselling session goes.
By considering the social & cultural context of clients, I learn to appreciate the nature of clients’ struggles. I will be better able to give unconditional positive regard and remain non-judgmental through out. And hopefully, the clients will be more open and co-operative during the change process.

I suppose acquiring an inquisitive mind about the different culture inherent in the Spore society will help me to broaden my perspective. Reading articles & books on multicultural counselling will also provide me with greater insights. Last but not least, having the courage as well as humility to take on clients with different culture will certainly strengthen my multi-counselling competency in the long run.

Final Exam

The Clinical Director of ECTA met up with the graduate diploma students and briefed us on the Final Exam. Personally I felt that she did a fine job because I came away feeling rather re-assured. Incidentally, in my experience as a student of ECTA, I observe that all my concerns have been addressed to in the timeliest manner.

I have good words to say about the administrative staffs too, notably Audrey and Terra. They are about the coolest people I have met. They have contributed their professional, warm, sincere and unfailing support to facilitate my learning.

The week leading to the Final Exam was a tough patch in my life. Mid-way through the preparation, I received the bad news that an older sister of mine and her family have come under spiritual attack. They were getting disturbances in the night and my sister was not eating and sleeping well. The next day I received a call from another sister informing me of the medical finding of a breast lump. My mind threatened to go into disarray. I had to consciously and with great effort stay focus on the exam preparation at hand. Thankfully and by God’s grace, I managed to get some revision done.

Now that exam is over and course is coming to a closure, I am glad I can devote some time for my two sons whose O & A levels are round the corner. What I have gone through in the last 5.5 months has in effect helped equip me to cope better with the demands and unpredictability of life.

We will be told the result of the Final Exam this coming Sat during the Course Review/Closure session at the East Coast Training Centre. I do hope all of us will sail through and head for the next level of learning. By now, I am prepared to take up the Master level. I believe the 12-month program will do me much good as I go deeper into the subject. I hope to continue clocking my practicum at the Family Court and if possible, to provide counseling support at the Women’s Prison.

Journeying thru ECTA 06

2006-10-11T23:26:00.000-07:00

Individual Clinical Supervision

To my delight, A Tan agreed to my proposal to meet for 2 hours each time. That works out to 5 sessions over 5 months and hopefully all the sessions will end by Oct, 2006, as planned.

A Tan was at his office waiting for me when I arrived 5 minutes to 2 pm. I brought 3 cases with me but we had time only for one case. As this was our first meeting, we spent some time sharing about our background, current pre-occupation & future plan (in my case). I learnt that A Tan is a REBT practitioner. He was analytical and skilful as he helped me with my queries. I was impressed by his sincerity, warmth and humility.

The case we discussed during this session was on CL who is having problem coping with her husband’s drinking habit. Although this has been an issue for years, CL finds it increasingly difficult to accept it, especially after having gone through a rough patch recently when her husband had a mild heart attack. She is losing respect for her husband whom she looked up to in the past for moral support. Presently her husband has returned to his old drinking routine of 6 cans of beer nightly (Monday to Friday) and coming home near midnight, tipsy & talking incessantly.

CL has planned to draft a legal letter to demand her husband to quit drinking right away or she will leave him. She admitted that such thought arose as a result of frustration and anger. I acknowledged her emotion and led her to examine the underlying emotion, that of anxiety she is experiencing each time her husband returns home late.

I have learnt that CL’s dad was a heavy drinker. CL was devastated when her dad passed away suddenly as she was close to him. It is likely that she is afraid of losing her husband in the same manner. I have encouraged CL to articulate her anxiety to her husband rather than getting angry or having cold wars. I have also explained to her our functional ego states and how she could communicate to her spouse more effectively.

A Tan and I deliberated on CL’s value system and what she wanted to see change. At this point in time we are not certain if he has an addiction issue. To CL’s spouse, it is merely social drinking. I gave CL information on CAMP @ IMH. It is a programme to help rid addiction. CL will need to convince her spouse the need to seek help. A Tan has helped me expand the therapeutic horizon and I learnt new things each time I came away from the interactive supervision.

Cognitive Behavioral Therapy

Some basic CBT knowledge acquired while pursuing a Counselling Psychology Diploma previously prepared me to some extent what to expect from Dr Irit. I found the history & evolution part of CBT rather interesting. Surely the name Pavlov rang a bell because his Classical Conditioning kicked off my previous endeavour in Counselling Psychology studies.

Being a stay-at-home mother, I employed Operant Conditioning on my children all the time to elicit desired outcomes. Personally I believe that understanding my children’s individual functioning has helped me to approach them with the appropriate stimulus.
In the earlier years my approach was in the order of Positive punishment (Canning on the walls more than on their legs, tho’), Negative reinforcement (Nagging), Negative punishment (No ice-cream),) or Positive reinforcement (Praises). I believed this could be the pattern I was brought up with and came to accept it as the way to go.

However, as the children grew up, I perceived that a varied approach towards them have to be adopted to sustain positive and effective outcomes. It was a complete reshuffling to Positive reinforcement (monetary incentives), Negative punishment (No computer), Negative reinforcement (Nagging), or Positive punishment (reserved for capital offences).

I find the Cognitive Model helpful in helping me understand why my child behaves the way he does. The main issues we grappled with centered around their academic performance and at one point, computer game addiction of my younger son. He turned moody, teary & upset when the computer was disabled. He chose to just idle or sleep instead of studying when he had no access to computer. Physiologically he seemed lethargic & listless.

On probing further, his Negative Automatic Thoughts consisted of `I have lost my only recreational activity’, `My gaming friends may not play with me in the future’, `my parents fail to recognize my prowess in computer gaming’ etc etc.

To be able to access his `internal dialogue’ and to sort out the series of unproductive thoughts that flowed through his mind requires timely intervention in a gentle and loving manner.

Solution-Focused Brief Therapy

Mr Edwin attributed his successful approach in SFBT to 15% in the model, 15% on hope in Client, 30% on rapport with Client & 40% on the extra-therapeutic factors the Client brings into the session.

The focal point I observed from Mr Edwin’s sharing is that resilience in Client makes SFBT work. The therapist serves as the therapeutic tool - the resourceful person. In order to shrink the problems in Client’s life, the strategy is to acknowledge the problems but talk about the strengths, qualities & possibilities – essentially a therapeutic dance in communication. The process is akin to bringing him/her with what he/she has to where he/she wants to go.

As a counselor, the `play with language’ will certainly determine the level of rapport I can established with Client. Even in my dialogues with my significant others, I believe by re-framing & re-phrasing my words, I can help reinforce certain qualities in them.
For e.g., instead of using the descriptive word `stubborn’ which is negative, I can choose to use `persistent’ or `determined’.

I had the opportunity to apply what I learnt from Mr Edwin the therapist on a teenaged boy by the name of Ed recently. Although the latter’s prominent problems were obesity & online game addiction, I did not focus on his problems. (Incidentally, his obesity is being monitored by a medical doctor.) Due to a low level of confidence, he was unable to accept how his problems could be resolved in a miraculous manner. So I devoted more time looking for exceptions by asking about times when he chose not to play games.

In an attempt to elicit more positive behavior, I emphasized on what Ed is already doing to solve the problem, e.g., his ability to stay away from online gaming if his friends do not call.

I encouraged Ed to take charge of his life by keeping time when playing. For this will also stop his parents from nagging at him.

These days I find myself adopting Exception Finding Questions, Scaling Questions & Coping Questions in my mediation/counselling sessions at the court too. And when clients are made to reflect, they are more likely to continue what has worked for them in the past and to try new strategies as well.

Mental Disorders

I always count it a joy to be under the pupilage of Dr C T Tan, irrespective of how brief the session may be. He exudes a fatherly figure and is blessed with intelligence, wisdom, grace & lots of warmth. With years of experience as a psychiatrist, he has much to offer. And I was glad he did it simply and in good digestible portion, & nearly always illustrated with relevant cases.

Once again, I learnt to distinguish the differences between Neurosis (SAD), Psychosis (MAD) & Personality Disorder (BAD). The neurotic exhibits symptoms such as Anxiety, Depression, Phobias, OCD & PTSD. On the other hand, a psychotic may be deluding, hallucinating or loss of touch with reality (DHL).

I was surprised to learn that Qi-Gong practitioner who becomes overly involved may experience psychotic symptoms. Although I have never attempted such sport, I was rather regular in my yoga pursuit some years back. I decided to come out of it when I experienced much unease during meditation and disturbed by the unpleasant sound of chants.

DSM IV was heard of for the first time & I was glad Dr Tan gave the wise & timely admonition that I should refrain from being an idolater of it. Also for the first time I met a Schizophrenia sufferer who looks as normal as anyone of us in the class. He is the good-looking Harris Ng. Dr Tan demonstrated how to communicate with a mental patient such as Harris. There was a lot of gentleness & affirmation.

Harris’ books entitled `Recovered Grace: Schizophrenia’ were autographed by the writer most willingly. I found the time to read the book days later and was enlightened by his frank sharing and tickled by his sense of humor. After reading the book, I felt a burden being lifted off my chest. More aptly the fear of being in the presence of schizophrenia is now a thing of the past. Through Harris, I have learnt to recognize the human-ness in schizophrenia & have willed to stop 'dehumanizing' them in future.

Anxiety

One in every 10 Singaporeans is ANXIOUS! Wow! The pleasant news is ANXIETY is non-existent in Dr Ang’s class. Under the spell of his wit & humour, we learnt about ANXIETY with much ease.

When Dr Ang was describing about Social Phobia, I felt to some extent the relevancy of it in my life at some point. Although my parents are friendly & warm, they are not vocal but reserved by nature. Their children have, by and large, inherited their nature. We are a brood of shy and quiet people who avoid at all costs the limelight & of being the centre of attention.

I recall being informed by the court last June to anticipate an interview by the press for having won the Individual Award in The Subordinate Courts Benchmark Awards for Volunteerism 2005. My heart missed many beats as anxiety welled up within me. The thought of opening up my inner self to the public was a discomfort, to say the least. The ‘saving grace’ came when our family trip to Perth was confirmed by the airline. So relieved I was to avoid successfully the situation that would have generated some panic attacks. Being the center of attention can be very unpleasant for me, indeed.

What I encountered at court yesterday was memorable for me. For the first time I had an OCD sufferer for a client. I recalled what I learnt in class and looked out for her tell-tale signs. She was stunned and extremely anxious when I picked up a document from the floor. I offered her some money for lunch as she claimed she had spent her last dollar. But she had to turn me down because my money was full of germs and she could not bear the thought of handling it. She even refused to accept a new bottle of mineral water from me when she said she would just drink some water instead.

I felt really sorry for her homeless state. Her family admitted her to the IMF due to her medical condition. She was subsequently discharged due to default in payment. She has been sleeping on the bench at Changi Airport in the past one week, happy with the clean & air-conditioned environment, away from the mosquitoes, flies & insects.

Her husband explained that the maintenance money given to his wife was spent on soaps, detergents, etc. He & family members could not take her washing ritual anymore. He could be in a denial state when he commented that she was merely putting up an act. I was glad when he indicated the need for further counseling support.

Attachment to Mt E-Charter Behavioural Health Services

There were 60 of us showed up at the Mt E-Charter on the 10th level of Mt E hospital. After signing the Patient Rights & Confidentiality Agreement, we were divided into 2 groups led by 2 young professional staff on a ward tour. I was expecting to witness an ECT procedure. Even the patients were no where in sight.

We were briefed on the Treatment Team Core members & approaches of Mt E-Charter. The professional conduct of the Counsellors were being stressed – boundaries, confidentiality,….

I find the assessment of client @ Mt E-Charter rather comprehensive and thorough – leaving no stone un-turned:

- Observation of behaviour & presentation
- Background behaviour
- Current functioning (work, social, family)
- Self-report of problems (verbal or checklist)
- Caregiver perspective of problems
- Formal assessments (eg IQ, suicidal..)
- Evaluating whether referral to another is appropriate or indicated

The counselor is expected to acquire the knowledge of the symptoms, the natural history of a disorder and the effective treatments. The client has to be educated to help them adhere to the treatment plans. The acquisition process of such knowledge will serve as ongoing learning and skill development.

I enjoyed the art therapy session thoroughly. It was a journey-in and self-discovery adventure. I discovered the artistic side of me.

First Intake Interview

The new Training Centre was not difficult to locate as we had 77 year old Vincent with us. He is very familiar with the Katong area. The steps leading up to the classroom were many and quite a challenging climb for some of us. To my surprise, Vincent took it in good strides. He has the `material’ to take on the Masters Program, indeed! I am about 80% keen on furthering to the next level.

Jessica shared with us gems related to first intake interview. One of the goals of a counseling assessment is to give hope. I will have to be mindful that I don’t make promises that the distressful circumstances will definitely improve, although that may be what the clients want to hear. Rather, I am there as a counselor to offer support and encouragement that change is possible if the client tries.

The 6 Cs of counseling are Contact, Connect, Contract, Content, Change & Closure.
Contact & Connect form the therapeutic alliance. Client then Contracts with self to renew self, behaviorally &/or emotionally. I am reminded that Content of contract has to be clear & achievable to promote Change. And the treatment plan is fluid, constantly being reviewed. Finally a Closure – an understanding insight, an `aha’, some `hope’ of sort.

Richard Nelson-Jones (1993)’s Helping Model:

D eveloping relationship
A ssessing problem
S tate goals
I ntervene
E nd

Suicide Prevention Crisis Management

We spent two interesting Sundays with Mr Soh who is a seasoned life-saver.
It was indeed a privileged learning experience to be coached by him on this `life & death’ subject.

I have not been exposed to crisis of a massive nature therefore am not able to imagine how I can handle one. One course mate had gone on medical mission trip to treat survivors of natural disaster and returned to share about her experience. It was enriching to listen to how she was enabled to cope with the devastation and sorry sights by the resilience of the victims!

The class was asked to do a survey on suicide ideation/thoughts by Mr Soh. The Score for ‘No such thought’ was rather high. I put down ‘Sometimes’ because I do think of it whenever I miss my father too much. Ironically, when I was growing up and unable to cope with father’s constant shelling, I too had attempted suicide.

Most of the time I agree that suicide is irrational and cannot be justified. For when I commit suicide, I am telling my Creator God He has created me in vain. And that His Son Jesus has died on the cross in vain too. This belief has kept me from taking the pre-matured exit.

I learnt that suicide is a coping mechanism; one cannot take it away without replacing it with something else.

I learnt also that the 3 most important factors to look into when assessing suicide risk are:

1. Current suicide plan
2. Prior suicidal behavior
3. Resources.

It can be really dramatic & draining to try to dissuade someone from taking his own life. I salute Mr Soh for his untiring effort and great passion in the work he has been doing for many years. I am impressed by his devotion and zeal.

Ventilation & New Development

I have been thinking about my mediation & intake interview involvement at court. Undeniably, it has been enhanced by new knowledge & skills acquired at ECTA.

I have even begun to view my technique at FC as mediative-counselling. If I can resolve a financial issue at an one-off mediative-counselling session, that's to me a success. And when the need arises, the clients are offered the choice to have other issues in their lives addressed outside the court premise.

I was cautioned as I might appear to be soliciting for clients at FC. I was somewhat baffled. I am not paid by ECTA nor FC nor the clients who are mainly from low income group. (Even the $20 per hour at free clinic @ ECTA is a burden to them.) So if client is not made to pay for counseling, how can it be deemed unethical?

As a volunteer, I am not in a capacity to dictate a change in the way clients are being handled at the court, in terms of time & manner. Very often I come across clients who struggle with their daily functioning. I wish I could do more, at the very least, offer more time for them to ventilate and reflect, & hopefully derive at some positive outcomes based on the limited resources they have.

Since early August, I have been helping out at the FTPU of Family Justice Court to interview/counsel victims of family violence. I have to

a) assess the history of the case and the risk of family abuse to the Complainant and/or the children;

b) inform the Complainant of the court procedures and processes involved in the application for a protection order;

c) educate on safety measures and the effects of family violence on the Complainant and the children;

d) assess the case for suitability for counselling; and

e) refer the Complaint to other relevant services such as crisis shelters and welfare organisations.

(The above interview is supposed to take 20 minutes per case. I feel strongly the victims in crisis should be given at least 30 to 45 minutes during their first visit to court as the trauma is most intense at this point for some.)

Counselling Research Project (CRP) 1st round Meet

Our group met to discuss on the project which is due end of Sept. At the end of the first session, and having made sense of the requirements, we were a picture of relief.

We started off trying to define Culture. I liked this one:

It is said that culture is a human necessity and a way of life. It is the core of internal ways in which human beings develop their sense of self, including values, beliefs, thought patterns, perceptions, and worldview. All these qualities help determine and shape one’s external culture; in other words, the way(s) in which one establishes and maintains a relationship with the environment and others through implicit norms, language, traditions, rituals, and loyalties that influence attitudes, behaviours, and customs (Gushue, 1993).

Effectively, I am a culture on my own which makes up the sum total of a culture of a group. I am unique to the core as my worldview is shaped by my upbringing, environment, significant others..... so much so when I interact with another human being, we will need to `enter' the other person's `world' to fully understand each other. This is certainly challenging - until and unless I am `invited', I can only know a person to the level of his/her comfort. Some men may avoid revealing the vulnerable side of them, as a Counsellor, my focus will have to shift from targeting their emotions to `what can be done' to improve the bleak situation.

'Family culture' refers to rules that we abide by in our own little family unit, for e.g. mummy will be the first to discipline the child, when it doesn't work, the dad will step in... etc. I recalled the case of the Chinese couple from China seeking PPO at court. The husband was viewed as `inferior' by his wife from a different province in China. His wife was `chastised' (beaten up) for behaving uncouthly, typical of the province where she came from. As a Counsellor, I was at a lost as to know what's deemed acceptable by both. Taking on the case will mean learning from them as the session goes.

Culture in Counselling

To me, culture takes centre-stage in counselling. What both counsellor & counsellee bring into the counselling session are two sets of unique cultures. The quality outcome of the counselling session depends much on the interaction and inter-connectedness of the therapist & client. As the helping profession requires that the counsellor establishes a therapeutic alliance with the client so as to empower him to make positive changes to his life situation, the onus is on the counsellor to align himself culturally with the client. It is therefore of paramount importance & a primary task for the therapist to be able to embrace the client coming from a diverse culture unconditionally in order to win the latter’s trust & acceptance.

I am familiar with the Chinese culture but having exposed to the clients at the court, I realised that Chinese in Spore, Msia, HK, Taiwan…. even China itself are culturally diversed. During counselling, from time to time, I find myself `stepping back’ and learning about Chinese culture unique to e.g. Taiwan or a certain province in China.

I am propelled as a Christian to imitate Christ – to regard others positively & unconditionally. I believe that all men are basically good. We do falter from time to time but if God the Creator has provided the redemption for the fallen nature of men, who am I to judge and condemn? Also, I believe in the embodiment of Christ as detailed in Matt 25: 34 - 40

34 Then the King will say to those on His right hand, ‘Come, you blessed of My Father, inherit the kingdom prepared for you from the foundation of the world: 35 for I was hungry and you gave Me food; I was thirsty and you gave Me drink; I was a stranger and you took Me in; 36 I was naked and you clothed Me; I was sick and you visited Me; I was in prison and you came to Me.’

37 “Then the righteous will answer Him, saying, ‘Lord, when did we see You hungry and feed You, or thirsty and give You drink? 38 When did we see You a stranger and take You in, or naked and clothe You? 39 Or when did we see You sick, or in prison, and come to You?’ 40 And the King will answer and say to them, ‘Assuredly, I say to you, inasmuch as you did it to one of the least of these My brethren, you did it to Me.’

I `see’ Christ embodied in my client & Christ that’s embodied in me gives rise to the compassion I have for him. Helping is therefore motivated by a personal spiritual conviction.

I grew up in a small town sharing compound with Malay (the ethnic majority in Malaysia) & Indian neighbors. My experience living side by side with them was pleasant. There was racial harmony, neighbourliness, & strong bonding. My parents’ whole-hearted acceptance of them resulted in me having an Indian christian bro-in-law & a Malay muslim bro-in-law. As an ethnic majority in Spore, my worldviews towards the other ethnic groups remain unchanged. My view of them is again spiritually inclined. We are but sojourners travelling through this world together.

The Influence of Culture on the Practice of Professional Counselling

2006-09-30T06:05:00.000-07:00

Preamble

Culture is the core of internal ways in which human beings develop their sense of self, including values, beliefs, thought patterns, perceptions, and worldviews. All these qualities help determine and shape one’s external culture - the ways in which one establishes and maintains a relationship with the environment and others through implicit norms, language, traditions, rituals, and loyalties that influence attitudes, behaviors, and customs (Gushue, 1993). While it is true that Singapore is a mix of different ethnic groups, each group has retained much of its individual unique cultural character. This is because Singapore’s policy has always been geared towards multiculturalism, where every ethnic group is allowed to preserve its own culture while peacefully interacting with others. In the light of this, counselling and intervention is always presented within the cultural context and constraints inherent in our cosmopolitan society. The understanding of a client’s unique culture is necessary in order for a counsellor to effectively help the former behave and feel differently in a trusting relationship so as to achieve their goals.

This paper is a qualitative inquiry by the research group to explore the impact of culture during our training as counsellors. The following discussion includes our views on the importance of cultural influence in our counselling work, our personal values, prejudices and motives for helping people as well as our worldviews as a major ethnic group. As we identify various cultural issues encountered when applying western counselling models in the Singaporean context, our constructivist’s approach would be to unlearn our negative cultural conditioning, and re-construct and adopt more meaningful models. The benefits of a multicultural perspective would be examined and ideas on ways to acquire greater multicultural counselling competency would be presented.

Methodology

In the social sciences, qualitative research is often a broad term describing an in-depth research that focuses on how individuals and groups understand the world and construct meaning out of their experiences and the reasons that govern it. The why and how of decision-making will be investigated. It is essentially narrative-oriented and uses the methods of content analysis. The researchers are explicitly a part of the data gathering process. The need is for smaller but focused samples to make meaning of culture in their counselling practice. (Retrieved from http://en.wikipedia.org/wiki/Qualitative_research#References on 12th September, 2006.)

Our group of six members met once before the workshop to make sense of the research project handouts we received earlier. During the workshop, we formulated a questionnaire (included as Appendix A) to be responded individually by members of the group. At subsequent meetings, we presented our individual responses (data) in transcripts. The process of open coding, axial coding and selective coding (Neuman, 1997) were adopted.

In open coding, the individuals’ transcripts were scrutinized for common and salient points. They were highlighted using colored code labels for themes that emerged. For axial coding, connections between categories and sub-categories of the earlier coded themes were derived. In so doing, we expanded our knowledge of the categories and identified the axis of key concepts. Finally, in selective coding, we revisited the data and earlier codes to analyze and elicit further evidence to validate and support the major themes.

Key Dimensions of the Group

Gender M F F F F F
Age 53 53 45 37 30 48
Race Chinese Chinese Chinese Chinese Chinese Chinese
Religion F/Thinker X'tian X'tian Catholic X'tian X'tian
M/Status Married Divorced Married Married Single Married
Academic MBA BSc (Hons) Diploma BBA BSc Diploma
OccupationManagerAdministratorRealtorDirectorProgram ExecutiveCourt Volunteer
(Figure 1)

As can be seen in (Figure 1), our group is quite homogenous with similar demographic profile. All are of Chinese decent; therefore belongs to the dominant ethnic group in Singapore. Majority are Christians, professional and bilingual, i.e., English and Mandarin speaking. Age and academic qualification are the prominent diversities in the group. By and large we share similar cultural heritage in the Chinese community.

Participants’ Perspectives

There is a group consensus that culture is an important component of counselling as Magdalene puts it:
Culture moulds one’s identity which is expressed in terms of core belief, value system and thought processes. The ability of the counsellor to connect with the client at his core beliefs, value and thought processes would determine the level of bonding in this helping relationship. The counsellor’s level of sensitivity towards the client’s cultural identity has an impact on the counselling process and its success thereafter.

According to Juliet:
In diagnosis, psychological judgments are never free from the influence of therapist’s own cultural values. In intervention, counsellors need to be knowledgeable of the culture of their clients because each culture holds different ideas about what constitutes problems in living.

As we have grown up in a cosmopolitan environment, we are immersed in various orientations of different ethnic groups. Our awareness of our own culture only increases when we go to places where our culture is not the norm. Similarly in a counselling room, when we are with our client from a different culture, our awareness of our own culture tends to increase too. We are aware too of the diversity existing within the same culture as people may communicate and interact in a whole range of ways.

Our worldviews as ethnic majority are highly correlated with cultural upbringing and life experiences. There is a tendency to take for granted that the ethnic minority has full knowledge of our culture since it is pervasive in the society. On the other hand, some of us harbor tinted views of the ethnic minority that cause us to unwittingly impose upon them stereotypes and preconceived notions. Annie shared her notion: ‘It is typical of Indian men to drink and abuse their spouses.’

Jennifer shared on what being sensitive to ethnic differences entails:
My sensitivity includes respect and acceptance of who they are, the way they are and their beliefs. I choose to treat people of the minority race fairly and equally. I do not feel the need to treat them with sympathy; otherwise, it would only remind them that they are being differentiated. I learned from my Indian and Malay friends at school about their feelings as minority races in Singapore and that they prefer to be seen as equals.

To be more effective counsellors, we have to first examine ourselves or be aware of our personal values, beliefs, prejudices and motives for helping people. For instance, Peter’s own cultural beliefs that men should be stronger and be able to take on the world and solve their problems rationally and efficiently make him more sympathetic toward his female clients. While some of us in the group who are Christians may be motivated by the teaching of Christ and our spiritual conviction to help people, Peter has this to say, ‘My motives for helping people is firstly for some sort of spiritual maturation. It is my way of building a better world for the future.’

On the whole, there is a recognizable appreciation of our own culture in our group. The curiosity to explore the deeper meaning of our own cultural behavior will certainly enlighten and make us more sensitive to the differences or similarities existing in different cultural groups. ‘A wise counsellor would always try to transcend such barriers and enter into the frame of reference of his client and operate from there.’ (Yeo, 1993)

The first theme that emerged was therefore
the need to be self-aware
as we approach clients from different cultures.

Common Cultural Challenges

The clients we see include students from as young as 6 years old, elderly patients at Nursing Homes/hospital. We also have couples with marital, family and financial issues. Their age group ranges from early 20s to the 70s. They are a mix of Singaporean Chinese, Malay, Indian and some immigrants. Our clients are mainly from low to average income group with basic education. English and Mandarin are the main languages used. Dialects are used when counselling the elderly folks.

Each member in the group shared both common and unique cultural issues they face in counselling. The sexism issue Annie regularly encounters involves female victims of domestic violence in Indian family whose men predominate in positions of power. Most oppressed Indian women inevitably choose not to react for fear of being ostracized by their own family and community. According to Yeo (1989), Asian derives their identity from membership in a family and a community and focusing on the individual might well alienate the person from the family.

Peter and Juliet shared about the common gender issue where parents think they must stay with sons only, while conflicts with daughters-in-law are common issues too. Some parents choose to stay on their own to avoid humiliating their sons. Medical and emotional problems may result from loneliness, poor self care and diet.

Jennifer related her early experience:
I’ve encountered difficulties on many occasions with clients of a different race, particularly Malay clients, in dealing with issues on pregnancy crisis. My early impression was that they were either not willing to share nor receptive to explore other options and alternatives pertaining to their decision to terminate their pregnancy. The session became more fruitful only after I acquired greater understanding of the Malay culture.

For Magdalene, while she is competent in conversational skills with some dialects, attempting to apply counselling techniques or skills present a real challenge. Majority of the counselling approaches are western in origin. The concepts and explanation are all in English. It is easy to miss the deeper nuances when she attempts to apply or translate them into dialect or language which she is not fully competent in.

Both Magdalene and Ruth observed that it is culturally the norm of the older generation to attribute crisis to some external causes and to seek help from temple mediums. The words of the mediums will then be accepted as truth. It can be a real challenge to counsellors from a different faith.

Ruth, the youngest member in our group, perceives age as a stumbling block to effective counselling when her clients are much older. In the Asian context, age is a sign of maturity and wisdom. With elderly clients, we are expected to show respect and humility, not as someone to solve their problems.

Annie faced the social-economic issue when she encountered Singaporean men who resorted to increase their socio-economic status by taking wives from the poorer ASEAN countries. The wives function more as domestic helpers or care providers to the elderly/invalid parents or young nephews and nieces within the extended family. The relationship is further strained by language barrier and other cultural issues.

Western Counselling Models in Singaporean Context

The group is pragmatic in our counselling approach, integrating different therapy models to meet the client’s unique needs. With cross-cultural interaction comes the possibility that the client’s intentions and actions may be misperceived, misinterpreted, and misjudged notably, when we employ the western counselling models on culturally different clients. We are aware that some of these models may not even fit people from western cultures due to within-culture diversity and other diversity factors beyond culture. (Egan, 2005)

The second theme that emerged was the need to understand the worldview of culturally different clients in order to know how best to
integrate the western counselling models in our counselling work.

Magdalene commented that the concept of individuation in Bowen Theory is culturally not in tandem with many elderly Chinese clients, who come from an environment where the family, community, or clan takes precedent over self; hence differentiation of self can be alien to them.

A person’s identity is formed and continually influenced by his or her context. Working effectively with clients requires an understanding of how the individual is embedded in the family, which in turn requires an understanding of how the family is affected by its place in a pluralistic culture. (Sue, Ivey & Pedersen, 1996).

Bowen Theory encourages the therapist to look into the Family of Origin to examine the interlocking relationships. This can present itself negatively as in-laws or family members may not be forthcoming when it comes to talking about sensitive and conflicting issues inflicting the family. Juliet presumed Bowen Theory will be better understood and accepted by the English-educated clients, but she found out to her dismay that some concepts contradict their cultural beliefs.

Peter found Rational-Emotive Behavioral Therapy (REBT) to be too confrontational in style. Telling a client that he is “horriblising” and “catastrophising” his life issues when he is seeking understanding from a counsellor in his moments of anxiety is not going to be welcomed. Asians generally seek familial help when they have problems. The concept of going to a counsellor who is a stranger is already a major deviation from their social norms. Facing a challenging counsellor may pose as a humiliating experience for some.

Annie’s observation:
Solution-focused Brief Therapy (SFBT) focuses on what clients want to achieve through therapy rather than on the problem(s) that made them seek help. The approach does not focus on the past, but on the present and future instead. This goes down well with the clients she sees who are pragmatic and time-conscious.

However, Magdalene observed that asking the miracle question to a pragmatic elderly client may pose a challenge. Some of them have mindsets that have been deeply entrenched in their being; they do not see the need to change. Similarly, to challenge the Irrational Beliefs (Cognitive Behavioral Therapy) of the elderly whose sense of self has been conditioned to adopt a resigned disposition can be an uphill task.

The use of `hot-seat’ fantasy technique to help clients express their feelings where there is unfinished business may not be favored by the more ‘conservative and traditional’ clients as unleashing negative emotions towards the deceased is considered a taboo.

Magdalene related her encounter:
Using Gestalt approach, I encouraged him to imagine that the mother was present at the moment, and for him to tell her what was on his mind. He responded, ‘she is already dead, what is there to say?’ I realized later that while he might be bad mouthing and blaming her for his current plight, it was culturally not appropriate for him to confront her.

Ruth felt incompetent when she encountered elderly people who often interrupted her during conversation to correct her. Her age and lack of knowledge in dialects made it difficult for her to express herself aptly. But she found Carl Roger’s Person-Centered therapy useful when working with clients who question her abilities.

Multi-cultural Competencies

The challenges we face as counsellors in a multicultural environment require that we know and understand the client’s culture so as to be congruent with the frame of the world that the client is in during counselling, i.e., individuals are best understood by taking into consideration salient cultural and environmental variables. Regardless of the therapist’s orientation, it is crucial to listen to the clients and determine why they are seeking help and how best to deliver the help that is appropriate for them. (Corey, 1996) In this pluralistic and post-modern age, no one helping approach has all the answers for the clients we see due to the complexity of human beings, as expressed by Sue, Ivey and Pedersen (1996).

The third theme that emerged was the need for therapists to create therapeutic strategies that are congruent with the range of values and behaviours
that are characteristic of a pluralistic society.

Jennifer had this to say:
Without a deeper understanding of the Malay culture and religion, my counselling sessions with the Malays would certainly be unfruitful. There are family and social pressure to learn within the context of religion and culture. The Malay clients who are pregnant out of wedlock find themselves opting for abortion as the only way to avoid violating family tradition. I have to work on interventions that are congruent with the values of the clients.

It is a sign of respect that counsellor refrains from deciding what behaviour should be changed. Through skilful questioning on the counsellor’s part, ethnic minority clients can be helped.

The process of internalizing a new culture is an on-going undertaking. Generally the group is willing to be exposed to all kinds of clients so as to open up our own world views of the different cultures in our society. This includes interacting with people of different races at social events and festive celebrations. We recognized that with the culturally-constraint client we have to go slow during the first counselling session. The clients can be invited to teach the therapists about the significant parts of their cultural identity.

We all acknowledged the importance of supervision and guidance when we are unsure and need clarification. We also will be seen as more professional if we master the basic terminologies of counselling approaches in other languages/dialects.

Having an enquiring and inquisitive mind about the different cultures will help broaden our perspectives. Formal education on the multicultural aspects of counselling will help to hone our skills. We can also gain insights by reading articles and books related to multicultural counselling. There are hefty handbooks offering the theoretical background, practical knowledge, and training strategies needed to achieve multicultural competence. (Pope-Davis, Coleman, Liu, & Toporek, 2004). In addition, there are highly detailed research studies offering further insights in multicultural competence. (Darcy, Lee, & Tracey, 2004). The greater our depth and breadth of knowledge of culturally diverse groups, the more we can be effective practitioners (Corey, 2001).

Conclusion

In summary, the qualitative inquiry has promoted self-awareness of our own personal culture as we develop a sense of the world. Courage, openness and humility are some important elements we identified to secure trust and acceptance by our clients of different cultures. Our group will certainly strive to integrate appropriate counselling approaches to create therapeutic strategies that are congruent with the client’s range of values and behaviours, without abdicating our own deepest beliefs and values.
(2,991 words)

Appendix A

Questionnaire

1. What kinds of people do you see in your practice?

2. What are some common cultural issues that you face in your
counselling?

3. What kinds of issues can you identify in applying western
counselling models in the Singaporean context?

4. What are the difficulties that you find in working with clients
from a different culture? You may illustrate with a case.

5. What are some of the ways you adopt during counselling to effectively
overcome the difficulties you find working with clients mentioned in question 4.

6. How has your multi-cultural perspective benefited you in your
counselling work?

7. What would you do about your training as a counsellor to acquire greater
multicultural counselling competency?
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