By Jamie Jian and Gauri Krishna Subramanyan
Dan Ng is a Senior Counsellor and the Deputy Head of the Care and Counselling Department at St Luke’s ElderCare, a healthcare provider, focused on providing integrated services and
programmes to the elderly through nursing homes and eldercare centres. He has also had
experiences in counselling in education-related institutions such as the Ministry of Education, Nanyang Institute of Management, and SP Jain School of Global Management.
Before he transitioned into the field of counselling, Dan had been an Instructor and Trainer in the Singapore Armed Forces for over 15 years.
It started when I was working in the military. I was trying to find ways to upgrade myself. I compared my CV to my then-girlfriend (now wife!) when I realised that many of my skills were specific to the military environment, such as weapons training.
There were many more skills that I needed to pick up for the typical workforce. So, I proceeded to take a diploma in applied psychology because, at the time, the idea I had about psychology was that I would be able to read a person’s mind. That turned out to be a massive misconception that psychology is not so straightforward. In fact, during the first module, there was so much information about how our brain functions that I almost fell off my chair! But still, I managed to complete my diploma. I then found myself at a crossroads: to pursue a degree in psychology or a degree in counselling? I did some research, and I realised that I would be required to pursue a postgraduate degree to be a registered psychologist in Singapore. On the other hand, while the counselling was by no means more manageable, the education path was within my means. So that is how I decide to choose a counselling journey.
Being new in the helping profession, the transition was challenging. There were many things that I needed to learn and unlearn, and I had to remind myself of my new identity as a counsellor constantly. Thankfully, I had many good mentors and supervisors who have been helpful and patient in guiding me throughout my professional journey.
This year marks my fifth year with St Luke’s ElderCare. It has been an incredible journey with this organisation. From 2017 till now, I would describe the work culture here as a big family. Even though we function differently in the organisation, we will come together to support one another whenever there is a need. We always welcome our new colleagues and provide a supportive network such that if anyone needs any help, they can come to any one of us. I’m delighted to work in this environment where I have many like-minded colleagues, and I believe that is the reason why I have stayed with my organisation till now.
I guess it is similar to the many people out there. The first thing I do is always check my email! After that, I plan the activities that I need to attend that day, such as meetings, cases, and providing other support to colleagues. As the Deputy Head, I facilitate department meetings and run case discussions with multi-disciplinary teams. Due to the COVID-19 pandemic, having meetings seems to be “easier” leveraging the Zoom, and we can meet everyone more frequently.
As a Senior Counsellor, I manage the cases referred to us and evaluate any requirement for crisis intervention. Whenever my colleagues at the centre notice a potential case, such as abuse or suicidal ideation, usually cases will be identified through the assessment tool known as the Even Briefer Assessment Scale (EBAS). If there is a high EBAS score, my colleagues at the centres will alert me, and I will arrange my schedule to work directly with the senior. Most of the time, I would liaise closely with my colleague to establish a safety plan with the client. As a part of the SOP, we would also check in with the client’s family members to understand the situation, especially for cases where elders are found with a bruise on their bodies. There may be a possibility of injuries that the senior sustained from a fall on their own. This step is crucial because we want to update the family on our concerns of the elder’s safety and well-being. Also, this will reduce any misunderstandings and avoid any situation whereby the family only notices the bruises after returning from our daycare.
Every few days, I would also constantly follow up on how the senior is coping — their attendance, eating habits, sleeping cycle and the constancy of the behaviour patterns. I typically handle around 25-30 cases per month. Having a more senior position, I’m also given more responsibility for a wider scope, including supervision, training, and orientation for new colleagues. I conduct training on communication skills, and I supervise students through partnerships with the academic settings— bachelors and postgraduates in counselling programmes from SUSS, JCU, and other universities. I’m essentially the point of contact for these programmes, and I liaise with our Centre Managers to identify and allocate suitable seniors (clients) for the students to ensure that they have a fruitful learning journey with us.
One of the challenges I face is the need to be conscious of the choice of my words. If I have to contact the family members regarding a case, I have to be mindful not to cause unnecessary alarm to the family members. Sometimes, I need to paraphrase to convey my message sensitively. The choice of words is also crucial when dealing with complex cases. Some clients can be susceptible to specific terms, and if I’m not careful, it might jeopardise the therapeutic relationship that I have established with them. For example, instead of using the word ‘stubborn’, I would say: “Mr/Mdm so-and-so, today I happened to have a conversation with your son. Your son shared with me that you did not take your medication regularly. I was just wondering why...”
As counsellors, we are equipped with different counselling modalities and skill sets. We’re able to establish good therapeutic relationships and alliances with our clients; motivate them, empower them, and reaffirm their positive coping strategies. Our role is to explore the challenges and develop the intervention plan for our clients. Nonetheless, there is always a limitation that we cannot overcome: the ageing process. That is the biggest challenge that I face as a counsellor. For example, some elderly refuse to take medication because they believe that it would not help them to regain their health or physical functioning. It is a fact that we can’t reverse the ageing process, but I guess we need to help them to understand how they can continue to have a quality of life despite their current conditions. Being part of the holistic team, we can empower our clients to give them a safe platform to share about their struggles and emotions.
In this case, I would say something like: “Mr/Mdm so-and-so, what you have shared sounds logical, that taking this medication may not help you regain your health condition or physical functioning (immediately). But I’m just wondering, why would your son still insist for you to take this medication?” Being a counsellor, I cannot tell them what is right or wrong, but I believe I can redirect the clients to reflect on the matter. Hopefully, elders will change their perspective to be more positive after reflection.
Most elderly are grandparents or parents – their role has always been to give and provide for their family members. At the last stage of human development, they are going through a struggle, significantly when their health is deteriorating. The least they want to be is a burden to their family, having their loved ones worry about them. Sometimes, that could be one possibility that they are stubborn or resistant to medication or health checks. When I work with my elderly clients, I will try to normalise it, encourage them, and remind them to know that it is a process that everyone has to go through.
Prioritising cases is another challenge that I have. For an instant, “life is being meaningless” is quite common amongst the elderly, but sometimes the cases that are highlighted simply as complaints that do not really mean it, or that the senior didn’t sleep well the day before. People often misuse the word ‘depression’; for the elderly, many possibilities can affect their mood and state of happiness, both internal and external. Sometimes it’s due to a loss of mobility or independence. Personality needs to be considered too. Such cases need sufficient evidence to indicate that it is an abnormality — information such as the senior isolating themselves at the centre, not participating in activities, etc., which relies a lot on observing their usual behaviour patterns. I also need to verify with the senior’s family members if there is a constancy on the negative thinking from the senior. Before classifying the case that was reported, there is a need to understand the senior’s situation psychologically.
I believe that all of us would have this struggle every day. We may be passionate about our work, at the end of the day, we are all human beings. There will be ups and downs in our work, and even with our family. So, we will need to remind ourselves to be professional in our respective roles. I believe this applies to every profession. We might have a bad start to the day because of family issues. However, when we step into the office, we should put aside these emotions in the working environment because it would not be fair to our organisation, colleagues, and clients we are serving. This is something that I’m always mindful of, and I will set that boundary as I believe this is essential for me to build that connection and rapport with clients (even with my colleagues) so that I’m able to engage them better. Especially with the elderly, it’s challenging to get them to think positively because there’s such a high resistance level. Hence, it’s important that we set aside our emotions so that we can give our clients our full attention.
Whenever our clients appreciate the safe platform to express their struggles and emotions, it warms my heart. Many seniors often do not communicate this with their family members because they don’t want to “burden” them. Since I’m sort of a “neutral” party where they can openly share their worries with me, I find it incredibly fulfilling when they tell me their life journey on how they travelled to Singapore from China; how they met their spouse, and even the life experiences of them during World War II. But really, I believe that giving them this non-judgemental platform helps them share some of the things that they are unable to share with their family, and this is where I get my fulfilment from their trust. And, of course, the smile of the elderly!
I think one big misconception is that many people confuse professional counselling with social
work, befriender, mentor, or volunteer. I think there’s a need to understand each profession’s role and know that professional counselling goes beyond volunteering and active listening. Counsellor’s job may be perceived as very “easy” as shown in the movies where the counsellor goes “mhm”, “uh huh”, “I guess it must be very tough for you”, and so on. But it’s important to realise that professional counselling is not as straightforward as some people think. There are stages of building the therapeutic relationship, identifying the underlying issues blind spots and not forgetting to align the intervention with the different counselling theories and modalities.
Be it in counselling or other professions, the things we learn in school will always be the foundation of the knowledge we need to have. In relating to the counselling setting, there will be limited resources, for example, the lack of a cosy environment for counselling sessions. That’s the reality — sometimes, these limitations allow counsellors to “work harder” to reach out to the clientele.
It would be good to take up a degree in counselling to better understand what counselling all is about. The experiential learning that you gain from the internship placement gives exposure to working directly with clients putting on the “counselling hat”. During the learning journey, it is essential to reflect on the reason for taking up the counselling programme before taking the faith in entering the counselling profession.
As you progress through the modules, you will naturally pick up relevant skills such as active listening, paraphrasing, reflecting on emotions, and various counselling theories. That’s why it’s crucial to go through these modules and get your degree because it equips you with all the fundamental knowledge required for the job.
Beyond that, I would say that coming to this profession itself allows you to rediscover who you are. Simply taking the module might not give you the whole picture. That’s why I think you’ll only be able to determine whether this is the line of work you want to be in when you enter the profession itself.
The Covid-19 pandemic has affected all of us and many other countries. It has significantly hindered our ability to have physical meetings, pushing us to leverage technology. I think there’s a greater need for us to be more equipped with digital skills and familiarity with digital tools. For example, when we use video calling platforms such as Zoom to provide counselling sessions, which can be a struggle to engage and connect with the client. It calls for out-of-the-box thinking from counsellors on how to get our clients’ attention and establish that connection, even if it is over Zoom.
Although having face-to-face sessions would be ideal, we are unable to do so right now, and we can only move forward. That’s why I think we need to adapt to this new situation using technology. But of course, as with everything, this is not devoid of limitations either. In the clinical setting, when we provide counselling to our clients, emotions may be trigged, and the digital medium keeps us from being physically present to intervene or help. That’s why it’s essential to understand the constraints of technology and establish a particular protocol or safety network for our clients if such a thing happens.