|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
Peter K. Gerlach, MSW
Member NSRC Experts Council
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This article is one of a series on
professional counseling, coaching, and therapy with (a) low-nurturance
(dysfunctional) families and with (b) typical
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
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To get the most from this article, first read...
This article is based on
clinical experience with members of over 1,000 typical Midwestern
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
They may be referred by themselves, someone
else, or the legal system.
hilights special intake information with these clients beyond
that which is normally collected. Experience shows that
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...
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
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
Challenge - respect the client's need to explain and vent about their
presenting problems, and still preserve time for other key intake questions.
would you describe the main purpose of your family? This sets
the stage for proposing a family
client adults significantly
The initial answer to
this must be inferred from the clients'
(GWCs) are unaware
"Will other family members participate in working
"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),
would you rank your family adults' ability to permanently resolve significant
marital and family problems? The model proposes that
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?
would you describe your family's current
This model proposes that personal and family stress is often
promoted by incomplete or blocked grief.
criminal behavior contributing to your situation? These are common
symptoms (surface problems) in low-nurturance families, indicating
What do you need from me (the clinician) -
How will you judge whether our work is
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
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
If either of you partners has used
individual and/or marital therapy before, when, why, and what resulted from it?
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
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?
do you mates and your children have to help you adjust to this
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
(b) knowledge of and
expectations about stepfamily life, and (c)
their ability to make wise
The intake process offers a unique chance to alert these couples to
they face, and to motivate them to prepare for them by working
before exchan-ging vows. Many intake questions are
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
"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
"How did you meet, and how long have you been
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
"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.
you each see yourselves, your kids, and their other bioparent/s and
relatives as a
Typical couples will say
something like "I/we never thought of that before."
If one or both say "Yes," ask "Who do
in your stepfamily?" This tests for potential
either partner excludes their kids' other bioparent/s and/or any new
mate and stepkids of theirs from stepfamily membership, correct
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
"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
they need to
Options - (a) provide one or more
handouts on these (e.g. the two prior links); and/or (b) refer them to...
the couple a summary of these courtship danger
signs, and assess for each sign as time permits.
"Have you two drafted a family
on effective grieving?" The usual response is some confusion, and
"No, why?" Explain what such a policy is,
(possible handout), and propose that a knowledgeable stepfamily grieving
policy is essential to combat blocked or
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
basics and of (b) the
and effects of blocked grief and
(c) what to do about it.
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.
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.
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
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
provide a handout, and refer the couple
in this Web site and/or the related guidebook
a High-nurturance Stepfamily, by Peter Gerlach, MSW; Xlibris.com,
are your stepfamily's strengths? Bragging is OK!" Provide a copy
of the three-part strengths inventory at
appropriate, summarize the [wounds + unawareness]
and how it may relate to the couple's family. Refer the
couple to this slide presentation
http://sfhelp.org/gwcguide1.htm. Unless one or both partners
are in true (vs. pseudo) personal wound-recovery now or is using their relationship
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
If the couple has begun to
plan a commitment service, suggest that the officiating clergyperson
review and discuss...
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.
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
intake suggestions for committed and re/divorcing stepfamily clients. Do you
need a break first?
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January 16, 2015