1a) In Singapore, counselling has been developed to address a broad and expanded range of

issues including mental health, violence, suicide prevention, addition, workplace issues, and

more. Counselling is available in various sectors and environment in the community, such as

voluntary welfare organisations, private practices, religious bodies, health care and schools.

Counselling has been developed to be easy and convenient for people who need the services

to access them. In many locations that cover all parts of Singapore, one can find government

and private counselling agencies, counsellors in educational institutions, such as Family

service centre, to cater to a wide ride of needs, issues and background of problems, such as

issues in marriage, mental disorders, families.

1b) (i) In public’s perception, counselling is more readily accessible, with free and affordable

options, and caters to working class. Psychotherapy, in public perception, is more costly and

inaccessible, and caters to the middle to upper working class.

(ii) In counselling, the helping process typically encompasses the collaboration of the client

and counsellor, using methods that extend beyond one single manual or therapy model. In

psychotherapy, treatment process typically involves the employment of interventions defined

by a manual or a specific therapy model.

2) a) It is important to maintain confidentiality as it fosters the of loyalty and reliability in the

therapeutic relationship between the client and counsellor. The ethical principle that

underlines the needs to maintain confidentiality is fidelity. Being committed to maintain

confidentiality is the basis of building trust and maintaining fidelity, so as to maintain a safe

climate for counselling.

b) If the client expresses the intention to self-harm, or is suicidal, and if client has the means

and plans to carry it out, then confidentiality will have to be breached and the family member,

next of kin, or authorities have to informed to protect his or her life.

When there is evidence (e.g. bruises or other injuries) to strongly suggest that client has been

abused. Authorities will have to be informed especially if the client is a child and has no

means to escape from the situation and from the abuser.

When the client is involved in legal proceedings, and is being sent for mandatory counselling,

and a court order has been issued to disclose content of sessions.

3) First condition is genuineness or authenticity or congruence. It refers to the counsellor

being sincere and authentic. Counsellor exhibits appropriate outward responses to the client

that is congruent to the true feelings that one has in relation to the client. It fosters the

building of therapeutic relationship when client feels counsellor is genuine. When the client

experiences the counsellor showing and owning feelings of vulnerability, the client is likely

to gain an easier acceptance of their own feelings, and of themselves.

For instance, when the counsellor experiences their own feelings of uncertainty during the

session, they express it. “When I listened to the dilemma your experience, I can sense

uncertainty and apprehensiveness in me.”

The second condition states the counsellor needs to have empathy which comprises of a state

of being and a skill. As for state of being it is having the ability to put themselves in client’s

shoes. The skill is the ability to portray the counsellor’s understanding of the client’s situation

to the client through reflection of feelings. When clients feel heard and understood, they are

more likely to open up further. When feel connection with the counsellor, the bond between
them is fostered. For example, counsellor can say, “You feel disappointed because your

efforts are not recognised by your parents.”

Third condition states the acceptance and unconditional positive regard, where the counsellor

in non-judgmental and accepting of the client. The counsellor holds unconditional positive

regard for the client and is respectful. Counsellor does not impose own stance, and provides

support to client for client’s choice. When clients feel accepted for who they are, it may

strengthen the trust in the counsellor. It may aid them in the process of self-acceptance, and

also increase their faith in their ability to direct their own progress.

4. The structure of CBT process consists of 6 tasks.

Firstly, the building of therapeutic relationship. It is my first job to foster a safe environment

for client to explore the issues with the counsellor. When client trusts the counsellor and feels

safe to share, they can proceed to collaborate to work towards change.

Second task is the assessment using 4 domains- Cognitions, emotions, behaviours and

physical or physiological symptoms. CPT practitioner will assess the intensity, frequency and

duration of symptoms where applicable. An accurate assessment lays the foundation for a

thorough case conceptualisation and helps to select appropriate intervention.

Thirdly, case conceptualisation is used by me to examine the reasons and causes behind the

issues the client is facing. It includes presenting issues, predisposing factors, precipitating

factors, perpetuating factors and protective factors.

Forth task is the intervention. I will be employing the suitable cognitive and behavioural

techniques to help the clients towards desired change. They include Socratic dialogue, skills

training, homework tasks, relaxation/ mindfulness techniques.

Fifth task is monitoring. It refers assessment of severity, continuous tracking of improvement,

and evaluating the effectiveness of the techniques being implemented.

Sixth task the relapse prevention. I will facilitate appropriate termination of counselling

sessions, to ensure client continues to grow and progress after termination, and plan follow-

up sessions if required.

5.I am motivated by my hope to be able to make a difference in people’s lives. One good

impact is that I may be able to inspire the clients and use my positive values such as

determination to help the young client to motivate himself to improve. This works to benefit

the client and help him/or be positive and hopeful about changes and future.

A positive negative impact is I may feel demoralised, disappointed or frustrated when the

client’s progress is not up to my own expectation. If the client can detect this negative

feelings, it would impede the progress further by harming the therapeutic relationship. He or

she may also lose confidence and doubt his or her own ability.

I must be careful not to bring my personal agenda into counselling sessions, such as to

‘change’ my client to meet my expectations of what is right or best for him or her. To do that,

I will seek ongoing supervision to remind myself the ethics and aim of the counselling, which

is to respect and follow client’s choices, and go with the pace that client is comfortable with.
I will also keep in mind the importance to remain professional and support the client in his or

her growth journey.

My other motivation stems from my hope to be able to provide advice and solutions.

It can work to help aid counselling practise, by benefiting the client through giving my

insights, sharing my experiences in life, and providing positive and appropriate suggestions.

Client may use that to aid in their goal setting create positive changes in their lives. However,

I may end up subconsciously or unintentionally influencing my ideas onto the client, or judge

the client, or show disapproval when I personally do not agree with client’s choice. This

interferes with the client’s right to choose their own direction and create their own goals to fit

their idea of a meaningful life.

To address this negative impact, I have to seek clinical supervision. I have to be honest and

self-aware when I think that I will make a different decision if I were in client’s position. I

have to be mindful not to display any verbal or non-verbal cues that will show the client my

disapproval. I need to keep in mind the ethical principle of counselling, which is to adopt an

objective stance or attitude towards the client. My aim is to help the client to choose their

own direction, rather than modifying their choices and imposing my values onto them.

6a) Outcome and evaluation research will be used. Its key aim is to evaluate the efficacy and

benefits of particular counselling approach, usually of a specific client group. It is important

to find in depth information and evidence to aid in your selection of an appropriate approach.

By selecting the most suitable approach and therapy, it increases the likelihood of success of

the counselling to benefit client.

A hypothetical paper will be Research evaluating the efficacy of using Cognitive-Behavioural

Therapy for elderly clients who experience loneliness and isolation.

6b) She exhibited projection. Projection is an outward projection of own’s negative feelings.

It is the attribution of one’s negative emotions and thoughts onto someone else. When Casey

spoke to me about nobody would care for her, she asked me why I am feeling sad. Casey is

likely feeling sadness about her situation, and instead of expressing as her own feelings, she

projected it on me.

Denial is the removal of external events and information from one’s consciousness and

awareness. She is also exhibiting denial. She did not admit that she has done anything wrong

to upset her friends and refuses to apologize. It suggests that she is unaware of how she hurt

her friends and that she has caused the strain in their friendship.

6c) One possible perpetuating factor that maintains Casey’s issues is her inability to maintain

friendships, possible stemmed from her lack of relationship management skills. She hurt her

friends’ feelings and refused to apologized when they pointed it out to her. Hence she feels

lonely and they are not visiting her.

I will use Skills training, which is teaching of appropriate skills that would address the

client’s current areas of deficit. It may aid her in accepting that it is normal to lack the skills

to manage her relationship. Skills training will be used to help Casey improve her skills to

maintain her friendships, through improving her ability to communicate. Through role-plays

and role-reversals, client practise the skills learnt with the counsellor first, in a safe space.

Then, we will work collaboratively to plan how to apply the skills in her life to strengthen her

relationship with her friends.

 Another perpetuating factor is her action of keeping to herself and not leaving the house.

Hence she does not have interaction with the external world and other people. Isolating

herself have caused her to feel more lonely and sad.

Homework task will be designed to be specific and relevant to client’s goals. It will guide

client to exercise of newly learnt, adaptive behaviours in everyday situations. It aims to

change her mindset that she does not need to leave the house. She will be facilitated to

recognise the consequences of her keeping herself at home all the time. For example, she may

say she feels lonely, sad and that she has little things to look forward in life. She will be

encouraged to try going out for a walk one day, or to a place of her choice. She will also

record down her reflection, such as to observe for changes when she goes out. She may

discover that she enjoys going for walks, meeting her neighbour, or anything that brings

about positive changes in her mood and life.

One more factor is having the irrational belief that nobody cares about an old lady like her,

and that she is better off living alone. Having unhelpful thoughts like this makes her feel

more sorry for herself, and less motivated to bring any change to her situation, hence

maintaining her issues.

Socratic dialogue is a questioning technique used to help clients identify and acknowledge

the assumptions and beliefs which are untrue and irrational. These thoughts are challenged to

help clients form healthier, more rational ways of perception. It aims to help Casey

understand that her cognitions have the power to shape her emotions and behaviours.

Her irrational belief and thought state that she is “better off living alone” and “nobody would

care about an old woman like me”.

I would challenge this statement by saying, “What evidence is there to validate this statement

that nobody would care for an old woman like you?”

I would also say, “How has being alone been for you?”

By challenging her beliefs it may help her to realise they are untrue, irrational and unhelpful

and helps her to change to rational statements. For example she might change her statements

to rational ones such as:

“There is no evidence that proves nobody cares for me. My friends have said they care about

me when they visited me. I would not know if others care for me I do not even go out and

interact with them.”

“I have not been better off living alone. I feel lonely and I miss the company of my friends.”