Help clients understand and break the [wounds + unawareness] cycle

Introduction to Effective Assessment of Low-nurturance Family Clients - p. 5 of 5

Who, What, and How to Assess

By Peter K. Gerlach, MSW

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The Web address of this five-page article is http://sfhelp.org/pro/dx/basics.htm

        This concludes a five-page outline of key assessment-options for the six types of low-nurturance clients covered by this clinical model.

3, Part 2) - ASSESS SUBSYSTEMS AFFECTING the CLIENT FAMILY

        Typical low-nurturance family systems are in/directly affected by several lay and professional sub-systems, like schools, social-service and medical organizations, the regional family-law system, religious communities, support groups, and mental-health persons and organizations. Each of these subsystems ranges from (a) low to high nurturance, and (b) nurturing to stressful with the client-family system.

        For example, a local school can stress a client family by confronting the adults with requests or de-mands that they "fix" a child who is underachieving and/or acting out. An alternative view is that the school is helping family adults by alerting them to a significant parental problem, and inviting them to join them in helping the child. Glass half-full, or half empty?

        Because typical low-nurturance families are complex multi-problem systems, identifying and asses-sing the systemic impact of related social subsystems can require excessive time and energy from re-sponsible clinicians. Implication - Assessing this half of a client's metasystem requires wide-angle aware-ness, clear clinical focus and plans, balance, and triaging available time, energy, and focus.

        Basic subsystem variables to assess are...

What are the lay and professional systems currently affecting this client family?

Who initiated each one's involvement, when, and why?

What is the apparent nurturance-level of each of these programs or organizations now? See this, this, and this as practical resources for this assessment; and...

What's the recent impact of this subsystem recently on the client-family system's nurturance level - e.g. mostly nurturing (helping adults and kids fill current primary needs, to mixed impacts, to mostly stressful (amplifying present needs and adding new ones)?

        And for each stressful subsystem...

What options do the clinician and his or her agency and/or program have to improve any significantly-stressful subsystem's impact on the client's family? Stay aware of the relevance  of the Serenity Prayer in deciding this. Finally...

Are there lay and/or professional family-support resources like churches, hospital outpatient programs, support, self-help, and chat groups, Web sites, and state and federal social-service programs, that could significantly help the client family that client adults aren't aware of or aren't using now?

        5)  Assess the ongoing clinical process for (a) blocks and (b) how client adults are reacting to strategic interventions over time - i.e. do the adults' ruling subselves...

  • allow second-order (core attitude) systemic changes, or...

  • make only first-order (temporary, cosmetic) changes, or...

  • resist any significant systemic changes to their boundaries, roles, rules, goals, values, and memberships?

        Premise: two or more people or personality subselves who communicate over time evolve identifiable sequences and patterns that help or hinder filling their primary needs. Clinicians need to assess these sequences as the work proceeds, and intervene strategically to reduce or remove significant process-blocks. Chronic communication (process) blocks usually indicate wounds + unawareness + ignorance in the clinician, any supervisor or case manager, and one or more participating client adults.

        Status check: How do you feel about this premise about what to assess clinically with average low-nurturance family clients?

 _ I agree totally, and want to weave these premises into my work;

_ I agree with some of these five factors, and will experiment with some or all of them to see what happens;

_ I have a different idea of how to assess low-nurturance families, which works well enough for me now.

When to Assess these Factors

        Effective clinicians will continually assess themselves and any professional co-workers for requisite qualifications for work with these complex families, and acquire any that are missing. A primary responsibility of supervisors and case managers is to honestly assess (a) themselves and (b) each clinician they work with for these requisites, and to take appropriate action.

        Clinicians will assess many things about each client family system over time, beginning with the first contact. This assessment is evolving, organic process, because...

the client-family's members, roles, rules, (some) values, boundaries, goals and environment constantly change as the family system evolves; and...

the elements of the clinical metasystem dynamically change and interact with each other and their common environment over time, shifting their members' beliefs, behaviors, roles, boundaries, and priorities; and...

each client contact reveals more information about the family system's history, rules, roles, and dynamics, and how the participating family members are reacting to recent clinical interventions.

 Is There a Best Way to Assess These Complex Clients?

        After 36 years' clinical experience with members of hundreds of low-nurturance divorcing families and stepfamilies, my bias is "yes."  Two main ways to assess a client family system over time are by observing (a) their spontaneous behaviors (and lack of them), and (b) their reactions to strategic interventions, like questions, suggestions, role plays, confrontations, strategic omissions and silences, practices, and homework.

        Assessment questions can be verbal or written, as in an intake questionnaire and topical worksheets. Some cases will also include assessment information from other human-service providers working with the client family members - e.g. teachers, doctors, mediators, attorneys, clergy, social and welfare workers, law-enforcement professionals, etc. 

        Each clinician, supervisor, and case manager evolves a preferred way to assess new and existing clients. The "best way" is to (a) clearly define effective clinical service, and then (b) use whatever mix of assessment techniques yields enough systemic information to allow effective interventions with this client family. Effective interventions  promote systemic changes that clients and professionals agree are beneficial (fill client-family needs) short and long term

Assessment Resources in This Site

  • A summary checklist of assessment factors for all six client-types

  • Sample intake forms for divorcing-family and stepfamily clients

  • An index of all clinical articles in this non-profit site, and...

  • This collection of assessment worksheets and checklists for clients and clinicians.

  • This extensive array of articles about common family-system "problems" (stressors), and options for avoiding and reducing them based on applying these foundation-concepts and the 12 Projects.

  • These lay, communication, and professional glossaries to promote clear thinking and productive discussions, and thereby minimize misunderstandings, confusions, and frustrations during the work.

Recap

        This five-page article offers a framework of experience-based suggestions about effective clinical asse3ssment of low-nurturance families and individual trauma-recoverers, using this model. The domains are based on defining "effective assessment" as "a clinician-unique mix of beliefs, attitudes, and techniques that yields enough information to design effective interventions that fit each unique client." Comprehensive ssessment extends beyond learning the client's presenting (surface) problems, including these domains:

  • the clinician (assess for personal and systemic requisites); and...

  • who comprises the client's nuclear and extended-family systems, and...

  • the clinical metasystem - e.g. (a)  the client family system + (b) each lay and professional subsystem recently influencing the client-family's stability, nurturance level ("functionality"), and wholistic health; and assess...

  • clinical-process sequences, patterns, and blocks; and...

  • how the client-system reacts to strategic clinical interventions, over time: open to constructive second-order change > mixed > closed to constructive change.

These domains apply to all client family systems. Each of the six client types in this model has unique things to assess. 

        This article overviews variables that every clinician (including supervisors, consultants, and case managers) will blend to form their unique preferred method of client evaluation. From clinical experience since 1981, I propose the best assessment choices in each variable for effective long-term clinical outcomes with typical divorcing-family and stepfamily clients.

        Pause and reflect - did you get what you needed from reading this article? If so, what do you want to do now with these ideas and resources? If not, what do you need now?

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Created October 05, 2015