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

Effective Intakes with
Low-nurturance / Wounded Clients 

p. 1 of 2

Initial client assessment and intervention

By Peter K. Gerlach, MSW
Member NSRC Experts Council

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The Web address of this 2-page article is http://sfhelp.org/pro/dx/intake.htm

        Clicking links here will open a new window or an informational popup, so turn off your browser's popup blocker or accept popups from this nonprofit, ad-free site . If the windows distract you, read the article before following any links.

        This article is one of a series on effective professional counseling, coaching, and therapy with (a) low-nurturance (dysfunctional) families and with (b) typical survivors of childhood neglect and trauma. These articles for professionals are under construction.

        This series assumes you're familiar with:

        Before continuing, pause and reflect - why are you reading this article? What do you need?

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        To get the most from this article, first read...

This article is based on 36 years' clinical experience with members of over 1,000 typical Midwestern divorcing families and stepfamilies.

        A clinical intake process (a) gathers initial information about a new client, (b) sets the tone of future work, (c) resolves practical issues like scheduling, fees, and insurance; and (d) provides initial interventions via the questions asked. The clients served by this unique model are typically complex, multi-home, multi-problem families who may feel they are in a crisis. They may be referred by themselves, someone else, or the legal system.

        This article hilights special intake information with these clients beyond that which is normally collected. Experience shows that typical unaware clients will not spontaneously reveal key information, so the intake person needs to ask for it. The information depends on the type of client. Because there is a lot of information to be learned, most cases will benefit from using some kind of intake form. Ideally, the intake will be in person after an initial phone call, because non-verbal behaviors provide useful assessment information.

        A primary intake question is - is the clinician and their organization, if any, qualified to provide the what the client needs? Toward answering that, the clinician needs to know...

  • The client type - a divorcing biofamily, a pre-commitment (courting) stepfamily, a cohabiting  stepfamily, and/or an individual seeking personal wound-recovery?

  • What are their presenting problems: why is this client seeking professional help?

  • Who referred them, and why?

Based on answers to these, effective intakes will gain selected information for each type of client like this:

Intake Questions for any Low-nurturance Client

  • What caused you to seek professional help? This seeks to learn if there was a precipitating event, including possible family-court involvement.

  • Who comprises your family now? Option - ask if there are any dead or absent family members who significant influence current family functioning.

  • "What do you need now - specifically - as a person, a couple, and a family?" Typical answers are surface needs vs. underlying primary needs.  Option - use empathic listening to suggest probable primary needs, and note the client's reaction. For example, if the client says "I need to stop all the yelling and arguing at home," say something like "So you'll feel better when your family members learn how to communicate and problem-solve more effectively."

        Challenge - respect the client's need to explain and vent about their presenting problems, and still preserve time for other key intake questions.

  • How would you describe the main purpose of your family? This sets the stage for proposing a family mission statement, if appropriate.

  • "Are any client adults significantly wounded?" The initial answer to this must be inferred from the clients' behaviors, for most Grown Wounded Children (GWCs) are unaware of and/or deny their psychological wounds.

  • "Will other family members participate in working with us?"

  • "If other family members are working with other professionals now (e.g. therapists, mediators, lawyers, custody evaluators, life or employment coaches, financial advisors, tutors, clergy), (a) who are they, (b) who initiated the work, (c) why, and (d) what is your status with each of them?

  • From one (we can never problem-solve effectively) to ten (we're always successful at problem solving), how would you rank your family adults'  ability to permanently resolve significant marital and family problems? The model proposes that ineffective thinking and communication is always a major cause of client problems.

  • If any family member is using regular medication now, why, for how long, and what effect is it having?

  • How would you describe your family's current policy about grieving significant losses? This model proposes that personal and family stress is often promoted by incomplete or blocked grief.

  • Are addiction, abuse, affairs, and/or criminal behavior contributing to your situation? These are common symptoms (surface problems) in low-nurturance families, indicating significantly-wounded, unaware adults. .

  • What do you need from me (the clinician) - specifically?

  • How will you judge whether our work is successful?

        The client's answers and the way they answer (angrily, timidly, apologetically, sadly, evasively, etc) often  suggest further questions.

        In addition to standard intake questions like these, this model suggests key questions for each main type of client: (a) divorcing, (b) courting and (c) committed stepfamily, and (d) redivorcing stepfamily.

Intake with Divorcing-biofamily Clients

        For perspective on these clients, read this overview first. Usually, one mate or the legal system initiates clinical contact. The latter requires special assessment questions.

  • From one (I don't want a divorce now) to ten (I'm totally sure I need to divorce now), where are each of you partners? The answer may be a range, like "I'm between a 6 and 8."

  • If either of you has filed for divorce, what's the status of the filing?

  • If you're living apart, who initiated that, how long has it been, who lives in each of your homes, how have you arranged any child visitations, and what are you each learning?

  • In your opinion, what has brought you mates to consider divorce? This is not about "Who's fault is this?"

  • What specific remedies have you tried so far, and what resulted?

  • If either of you partners has used individual and/or marital therapy before, when, why, and what resulted from it? This is a preliminary test for psychological wounds.

  • How are each of your children reacting to your marital problems?

  • What's the current status of your decisions on (a) child custody and (b) financial child support?

  • Do you have a mutually-acceptable parenting agreement drawn up yet? If so, how is it working? If not, what's in the way of agreeing?

  • How are other family members reacting to your considering divorce?

  • Are religious beliefs significant (stressors or strengths) in your situation?

  • What supports do you mates and your children have to help you adjust to this situation?

  • What would a "successful" divorce look like, in your situation?

Intake with Courting (Pre-legal) Stepfamilies

        For perspective, read this overview of typical courting co-parent clients first. These clients may seek professional help to (a) reduce existing problems with kids and/or ex-spouses, and/or to (b) learn what they need to know to make a successful re/marriage and stepfamily. Ideally, the intake should include both partners. The intake theme here is gauging (a) the couple's wounds, (b) knowledge of and expectations about stepfamily life, and (c) their ability to make wise commitment choices.

        The intake process offers a unique chance to alert these couples to the stepfamily hazards they face, and to motivate them to prepare for them by working on these Lessons together before exchan-ging vows. Many intake questions are interventions

 

        Useful intake questions:

  • "What are the names, ages, and principal dwellings of biological, adopted, and/or foster kids? Are they each fully aware of your relationship?" Some couples disguise or hide their dating to avoid upsetting one or more children (or other relatives). This is a sure sign of a low-nurturance family.

  • "If either of you were married before, when, how long, and what happened?" If appropriate, ask "On a scale of one (much unfinished business) to ten (all family members have thoroughly grieved and adjusted to the divorce), how would you rank your family members' degree of divorce adjustment?"

  • "How did you meet, and how long have you been dating?"

  • "What needs do you each hope to fill by your relationship?" This is a preliminary test for the key reasons the couple is considering co-commitment.

  • "Are you cohabiting now, or have you?" If so, it's more likely they have begun to experience common stepfamily stressors.

  • "Are you planning to marry? If so, when?" This is a preliminary test to see if the couple may be re/committing too soon.

  • "If either of you lived in a stepfamily before, what was that like for you?" This is an early gauge of their experiential knowledge and expectations.

  • "Do you each see yourselves, your kids, and their other bioparent/s and relatives as a stepfamily now?" Typical couples will say something like "I/we never thought of that before."

    • If one or both say "Yes," ask "Who do you include in your stepfamily?" This tests for potential membership and loyalty conflicts. If either partner excludes their kids' other bioparent/s and/or any new mate and stepkids of theirs from stepfamily membership, correct that misconception.

    • If one or both imply or say "No," ask why. Use this to define what a stepfamily is, and correct any client misconceptions about that. Either partner firmly denying or discounting their stepfamily identity suggests significant psychological wounds.

  • "Have either of you read anything recently about stepfamilies?" If they say "Yes," ask "What did you learn?" Whatever their response, summarize these five hazards and key problems they need to guard against. Options - (a) provide one or more handouts on these (e.g. the two prior links); and/or (b) refer them to...

  • Project 7 in this Web site (http://sfhelp.org/relate/mates/3choices.htm),

  • these Q&A articles (http://sfhelp.org/qa/q&a.htm), and/or...

  • the practical guidebook Stepfamily Courtship, by Peter Gerlach, MSW; Xlibris.com, 2002.

  • Give the couple a summary of these courtship danger signs, and assess for each sign as time permits.

  • "Have you two drafted a family policy on effective grieving?" The usual response is some confusion, and "No, why?" Explain what such a policy is, illustrate it, (possible handout), and propose that a knowledgeable stepfamily grieving policy is essential to combat blocked or incomplete grief.

        Note that Lesson 3 in this non-profit Web site, and two chapters in the above guidebook are devoted to helping the couple guard against incomplete or blocked grief. Option - provide copies of these abstract and tangible loss inventories, and suggest the couple fill them out and discuss them with other stepfamily members and supporters.

        A common clinical problem is (a) professional unawareness of healthy-grieving basics  and of (b) the symptoms and effects of blocked grief and (c) what to do about it.

  • "Can you describe (a) the specific family-adjustment needs of minor kids in their stepfamily, and (b) the status of each child in filling their mix of needs (OK / not OK)?" Usually couples can only name a few of these needs, so provide a copy of this summary and suggest the couple use it as a checklist together with other family adults and supporters.

  • "Can your family adults name some of the ~40 differences between the roles of stepparent and bioparent?". Whatever they answer, hilight key differences in this article, and provide a copy of it for them to study and discuss.

  • "Do you know any stepfamily co-parents re/married more than, say, five years?" If so, suggest the clients ask them what they've learned so far. If not, suggest the couple intentionally locate such veterans and interview them about their experience. Coach the couple to expect other stepfamilies to differ significantly from theirs, and to expect the basic stressors to be the same.

  • Ask the couple to describe the specific things about their biofamilies that typical courting couples and their relatives need to merge, starting in courtship. Expect them to not know. Then summarize this list, provide a handout, and refer the couple to Lesson 7 in this Web site and/or the related guidebook Build a High-nurturance Stepfamily, by Peter Gerlach, MSW; Xlibris.com, 2002.

  • "What are your stepfamily's strengths? Bragging is OK!" Provide a copy of the three-part strengths inventory at http://sfhelp.org/relate/mates/strenx0-intro.htm.

  • When appropriate, summarize the [wounds + unawareness] cycle and how it may relate to the couple's family. Refer the couple to this slide presentation and/or Lesson 1 - http://sfhelp.org/gwcguide1.htm. Unless one or both partners are in true (vs. pseudo) personal wound-recovery now or is using their relationship to avoid hitting bottom, this will often be premature. 

  • "Have you, or will you, use a current pre-re/marriage preparation service like Prepare/Enrich MC, REFOCCUS, and/or Relate?" If so, caution them that each of these is useful, and does not include testing for the mix of these five common stepfamily hazards.

  • If the couple has begun to plan a commitment service, suggest that the officiating clergyperson review and discuss...

  • "How are you each feeling about all that we've covered in this intake?" Appropriate responses are overwhelmed, anxious, startled, uneasy, skeptical, discouraged, motivated, determined, and wanting to know more. Other responses (e.g. intellectualizing, defending, discounting, idealizing, explaining (justifying and/or numbing) strongly suggest psychological wounds + neediness + protective denials.

  • "Are you each willing to invest in a thorough assessment of your readiness for stepfamily co-commitment with (a qualified professional)? If so, facilitate that. If not, explore why, and leave the door open.

        Thorough intake with typical courting co-parents can be extensive, and may need to be continued in the first clinical contact. Effective intakes with all six client-types served by this model require thorough knowledge of these topics.

Continue intake suggestions for committed and re/divorcing stepfamily clients. Do you need a break first?

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Created January 16, 2015