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Help clients understand and break the
lethal [wounds + unawareness] cycle! |
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Key
Definitions and Terms Let's Talk the Same Language!
p.
3 of 5 By
Peter K. Gerlach, MSW
Member NSRC Experts Council |
 The Web address of this page is
https://sfhelp.org/pro/basics/terms.htm
This
research-based, nonprofit Web site (https://sfhelp.org) exists to improve the
of typical divorcing families and stepfamilies and
reduce epidemic American re/divorce.
This page is one of a subseries on
effective professional (clinical / legal / pastoral / educational / medical /
media) work with these families.
In these articles, "co-parent" means
any part-time or full-time caregiving adult in a divorcing family or
stepfamily. The "/" in re/marriage and re/divorce notes it may
be a stepparent's first union. Clicking any link in these pages will open a
popup or new window. Use your browser's "back" button with the latter to
return here. These articles for professionals are under construction.
These definitions are not offered as absolutes. They aim to
help you understand what I mean in the articles in this site, and to promote
clarity on your own definitions. Premise:
the terms you
use in your thoughts and clinical conversations can significantly aid or
impede the effectiveness of your work. See this
lay glossary for more terms. Do you routinely
pay attention to your and others' language and usage in important situations?
+ + +
Clinical
Assessment (Dx) -
In our context, assessment
is the conscious and intuitive process of using theory, client information and
behavior, and perhaps
colleagues' input to estimate what prevents the client family-members' from filling
their primary
needs well enough. Assessment conclusions and the clients' goals allow evolving clinical
goals and intervention strategies to reach them. Key factors that affect the
assessment process are
-
the assessor's
knowledge,
-
the clinician's and any
supervisor's respective
and
priorities,
-
the clinician's model of human
systems,
dynamics, development, and human change, and...
-
whether the assessing person/s are
governed by their
.
Assessing stepfamily clients is the same in
process and techniques as with other family and dyadic (e.g. marital and
parental) systems. The criteria to be assessed include a complex set of
extra (individual + dyadic + household system + multi-home
system) factors that
most
clinicians aren't aware of without appropriate training and experience.
Reality check - if you're curious or skeptical, scan this
stepfamily strengths
inventory.
Not knowing how these special factors interrelate with
each other and the presenting problems, risks assessment
errors. This usually happens from the provider using inappropriate biofamily-system
Dx criteria. That greatly hinders effective clinical
interventions.
My 36-year clinical experience is that effective stepfamily-client assessment requires
the clinician to collect and sort data in each of the four domains above over
a series of meetings. Some data can be collected via an intake
questionnaire and
interview. Other data must be assessed
by direct observation of
members.
Clinical outcomes and cost effectiveness improve when an agency or program trains
intake workers to specialize in interviewing new stepfamily clients.
An
immediate intervention can be the worker suggesting relevant education (e.g.
this Web site and related guidebooks)
before the first session.
To help you forge your own assessment model, see...
-
the
that I observe stressing typical multi-home stepfamilies,
-
this
summary of typical presenting problems and
underlying primary needs,
-
this mosaic of common stepfamily role and relationship stressors, and...
-
this framework of effective
intakes and assessments with these five complex client-family
.
<< terms
index
>>
Clinical
Intervention (Tx) -
In this site, a clinical intervention
is any professional behavior that significantly affects _ the attending
clients, and/or _ the people they live with, and/or _ any
involved mediators,
case workers, lawyers, clergy, doctors, tutors, and school staff.
Interventions are
_ intentional professional behaviors implementing a conscious and/or instinctual treatment plan, plus
_ unintended or unconscious clinician behaviors that evoke
significant reactions in attending clients and/or the people they live
with.
Effective interventions clearly fill (1) the current and long-term needs
of the client family system (i.e. the interventions raise and stabilize the
family's nurturance level, over time); and fill (2) the primary needs of the
professionals involved.
Many (most?) degreed and licensed clinicians (therapists, counselors, clinical
social workers and psychologists, and psychiatrists), are ...
-
of stepfamily
basics,
realities,
,
and implications;
and ...
-
carry significant
semi-conscious biases about divorce, death, grieving, interfaith and
interracial remarriage, stepkids, stepparenting, and stepfamilies, and ...
-
carry significant
psychological
that
perceptions and judgments; and...
-
they often don't know this, or
discount or deny
it.
These factors combine to
raise the odds of _ inept assessments and _ ineffective or
harmful clinical interventions compared to working clinically with
typical biofamily clients.
|
Clinicians, agencies, and clients benefit by systematically assessing for
missing qualifications in (a) therapists and
their (b) supervisors and/or (c) program or case managers before attempting work
with typical stepfamily clients. |
The effectiveness of interventions in a session and across sessions increases
when a qualified clinician frequently
re/appraises...
-
help in clarifying?
-
validation and affirmation?
-
to vent (empathic listening)?
-
education (information and/or
experiential learning)?
|
|
-
"Can these co-parents
articulate their current primary needs now?"
-
"Do they and I agree on what they need
(a) right
now and (b) over time? and...
-
What do I need right now,
and do my needs mesh with my client's needs ?
See this framework on
effective clinical interventions with
stepfamily clients for more perspective and options.
<< terms
index
>>
Clinical
Modality -
Modality refers to (a) who delivers direct therapy to
(b) which members of a client family. Service providers and stepfamily clients both want the best therapeutic
outcomes for the least money, energy, and time. A relevant professional question is "Is
there a best therapeutic modality with typical
Options include ...
-
individual counselors or
therapists with or without consultants, supervisors, and/or case
managers. They may work in a private practice or a public or private
agency;
-
male and/or female
co-therapists working
with or without consultants and
common or different supervisors or case managers. A variation is
individual work with clients with a co-therapist or consultant observing
via a one-way window; and ...
-
multi-disciplinary
teams
(e.g. a therapist + stepfamily consultant + school counselor + dietician +
doctor or psychiatrist + communication and/or career coach + financial
advisor) coordinated by a case manager.
-
The attending clients may
be...
-
individual adults or children,
-
re/married or committed couples,
-
three or more related co-parents (e.g. both ex mates and one or two
stepparents), or...
-
a group of family adults and kids including key
relatives; or...
-
a
group of co-parents from several stepfamilies.
In my experience,
the
optimal target in
stepfamily work is to engage all related co-parents in the
The next best choice is to work with the re/married
couple and perhaps key children.
Any modality can
(a) provide service until the client terminates, or (b) limit
professional services by time, sessions, or dollars - as in an HMO, PPO, or EAP.
Because typical stepfamily clients have many concurrent stressors
and are structurally
than intact biofamilies,
trying to provide
effective
systemic interventions in six to ten hourly sessions is usually impossible.
Professionals, clients, and supporters working within such limits
do well to reduce their expectations of lasting therapeutic benefits and
focusing on seeding future changes, rather than making current changes.
For perspective, see this case example.
The
"best" modality at any time depends on...
-
how
the family's co-parents are and whether they're into meaningful
personal
from them; and...
-
where the client family
is in their developmental cycle, and...
-
the apparent set of systemic primary needs that
are currently unfilled; and...
-
the
nuclear (multi-home) family's
and...
-
the co-parents' degree of
basic knowledge about stepfamilies,
communication,
healthy grieving, and
relationships, and...
-
the client family's (a) financial resources (including
insurance) and (b) professional fee structures; and...
-
the availability of local clinicians and
supporters with requisite knowledge,
attitudes, skills, traits, and resources.
The client's presenting problems usually
don't determine
the most effective modality because initiating adults commonly aren't aware of what
their primary problems are. An exception is when the presenting problems are
criminal behavior, and/or advanced
A professionally-led family intervention and multi-disciplinary inpatient group and family therapy with
a well-structured follow-up program is often the most cost-effective
modality for the latter.
Note the difference between clinical modality and the type of
intervention. There are several hundred discrete types of individual,
marital, family, and group therapy. The wider a clinician's knowledge of these
intervention schemes and the more creative and flexible s/he is at
strategically orchestrating them and therapy modalities as the work unfolds,
the higher the odds for effective therapeutic outcomes.
<< terms
index
>>
Change
- Effective clinical work with stepfamilies (or anyone) usually aims to
produce lasting, short-term and long-term systemic changes that fill the primary
needs of all members and raise the family's nurturance level. Premise: there are
three types of human change:
-
intentional or unconscious
first order (superficial)
behavioral
change,
-
second order changes in core beliefs
and attitudes, which usually cause systemic behavioral changes, and...
-
natural change - e.g.
gradual spontaneous shifts in attitudes, values, and behaviors from aging
and increasing experiential learning and awareness.
|
One reason clients hire clinicians is to help them make desired personal,
marital, or family changes they haven't been able
to make on their own. It can save a great deal of time, money, and
effort if the client and clinician/s are clear on the differences on
these three at the outset of the work. Can you describe the differences?
First-order changes
(a) are a sign of probable false-self dominance, and (b) usually don't fill needs for long. Do you agree? |
A common example of first-order change outcomes are repeated dieting attempts that
don't keep unwanted pounds off permanently. Addiction relapses is another
widespread example. American (and global?) unawareness of second order change is witnessed by our multi-billion dollar
dieting, criminal justice, and addiction-management industries. I propose that
the global 12-step movement exists because
average
people aren't aware of our implacable need to make
second-order changes
to truly manage toxic compulsions and other chronic life stressors.
It appears that 12-step programs consistently succeed better than other
compulsion-reduction options
because they innately encourage second-order (attitude) changes. For example, they propose shifting from "I don't need help - I can do it (my life and addiction
management) on my own" to "No, I humbly acknowledge that I need
Spiritual and human help all the time." That can be restated as changing
from "I can control my life" to accepting calmly "No, I usually
can't." The related 12-step slogan is "Let, go, let God."
Another second-order change the 12-steps encourage is shifting from "It
isn't my fault," to "I am responsible for my own
health and happiness, and you are responsible for yours." Fritz Perls'
says this with blunt eloquence. Another
core second-order change for many sufferers is shifting from believing "I am
alone" to "I am not alone: there really is a
compassionate, responsive Higher Power that I can turn to in all situations."
Most unaware people focus fruitlessly on
first-order changes because they don't know...
-
the three types of
change above,
-
that their true Self is
and can't mediate with the conflicted subselves ("Change!" <> "NO
don't
change. It's not safe!") which are causing first-order changes; and...
-
how to
below their surface needs to discern and fill the
primary needs that cause them.
Clinicians can empower clients by
helping them learn and apply these three things. To make second-order changes,
client-adults need their
to consistently guide their
of other
subselves
Premise: when client and clinician agree that the client's presenting problems
are symptoms of underlying primary needs in each person
involved, self-motivated second-order change becomes far more likely. All
articles in this site and chapters in the related guidebooks assume that
most presenting stepfamily problems are not the
true
problems (unmet needs). From
36 years' professional
observation, the site and books also assume that most stepfamily (and other) clients
and professionals are unaware of
this.
|
The core challenge we clinicians face
with all clients is to respectfully,
strategically encourage appropriate second order changes so
they gain lasting, desired internal and interpersonal
changes. Implicit questions to answer are (a) what specific primary needs
of my clients are unmet, and (b) what blocks co-parents from making
second-order changes to fill those needs? |
When clients (or professionals) are unable to fill current needs,
they're trying to
fill them (i.e. with first-order changes) often is the problem. This
suggests that clinicians and
clients should assess this "way" without blame, and
identify what second-order changes in whom would yield "better" outcomes.
This premise also applies to ineffective therapy: the
ways the
clinician is framing the problem and intervening are at least part of
the therapeutic impasse. If interventions are based on resolving surface
problems via first-order changes, mutual satisfaction is unlikely. Do you agree?
Note the reality that some systemic changes cause
(broken bonds), and
others don't. The former require appropriate
(
to restabilize and move on. Two key therapeutic topics are (a) how clients can
identify and safely make desired second-order changes, and then (b) how family
members can help each other to adjust to the impacts of major changes.
The overlapping multi-year processes of
biofamily
and co-parent
each cause webs of intentional and unforeseen first and second-order changes for
all adults and kids. Most co-parents profit from intentionally evolving
awareness and skill at personal and family change-management.
See
this for a deeper exploration of systemic
change, this lay article on first and
second-order changes, and this article on
co-parents managing family changes. Option: use either of the latter two as
client handouts.
<< terms
index
>>
Client
"Resistance" - In our
context, resistance can mean client reluctance to (a) acknowledge their
responsibility in promoting and/or resolving their presenting problems, or to
(b)
accept and act on the clinician's suggestions for helpful change.
Clinicians and supervisors can frame such reluctance as ...
-
a therapeutic
problem to be solved by the clinician, and/or...
-
a deficit or
"weakness" in the client's personality (which puts the
clinician in a disrespectful
position), or as...
-
a deficit in the clinician's
skill as an effective change-facilitator, or...
-
as
evidence that some
of the client's ruling
don't feel safe enough
yet to accept personal
responsibility and/or follow the clinician's suggestions. The underlying
need is for such subselves to genuinely trust the resident true Self, a
Higher Power, and selected other people. When such trust is weak or absent,
clients (and clinicians) experience
"Do it!" NO - don't do it!" A common symptom: thinking or saying "I'm
really torn about ___."
Clinical experience since 1981 leads me to propose that the last of these is generally the most
helpful way to interpret stepfamily (and other) client "resistance."
All psychological defenses ("resistances"), including
can be viewed as symptoms of one or more
personality subselves distrusting that risking
second order change
is safe and useful now.
Note the reality that professionals routinely combat their own set of
resistances (subself conflicts) on risking chancy or instinctual interventions
or not risking them. Clinician's preferred strategies for admitting and
resolving their own inner conflicts are likely to affect how they perceive and
react to client "resistances," "ambivalences," and "double messages." The same
applies to how supervisors and case managers respond to clinician "resistances."
To
experience the value of this framing, professionals need to (a) know and (b) be
comfortable with
the inner-family systems (IFS) model, and
(c)
facile at applying the model to assessments and intervention planning and
implementing. Clinical
effectiveness rises when supervisors, case managers, clinicians, and consultants share the same knowledge and framing.
Is this true in your setting yet?
How would you describe (a) your own view of "resistance," and (b) how you react to
it? Do these usually help or hinder you in filling your needs?
terms
index
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Updated
September 30, 2015
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