Toward effective service to individuals and low-nurturance families

Effective Intakes with
Low-nurturance / Wounded Clients
p. 2 of 2

Initial assessment and interventions

By Peter K. Gerlach, MSW

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

Continued from p. 1... 

  Intake with Typical Committed and Re/married Stepfamily Co-parents

        This model spans...

  • stepfamily couples denying major relationship problems,

  • couples admitting and wanting to reduce such problems, and...

  • re/divorcing stepfamilies.

Intake with these clients is similar to that for courting-stepfamily couples, and adds unique questions for each type. For perspective on what follows, read...

A) Intake with All Post-courtship (Committed) Stepfamily Clients

  • Note the difference between surface and underlying primary problems (unmet needs) and propose and discuss probable primary problems causing the client's presenting problems. This is a new idea to typical couples. For example, "Would you agree that your arguing about child discipline (the surface problem) is really about your not having an effective way to resolve values conflicts (one of several primary problems) yet?"

  • Probe for unacknowledged systemic problems, including significant relationship (re/marital) dissatisfactions. Common presenting (surface) problems include stress over...

  • adult co-parenting (and other) values and loyalty conflicts, and associated relationship triangles;

  • finances, debts, asset-ownership, and money management,

  • "difficult" ex mates,

  • first and last names, and family role titles;

  • household chores, responsibilities, and cooperation;

  • stepparent-stepchild and/or stepsibling roles and relationships;

  • Stepfamily identity ("We're just a regular (bio)family, not a 'stepfamily' or 'blended family'!");

  • Stepfamily membership (inclusion / exclusion) conflicts - .specially over respecting the needs, values, and opinions of stepkids' "other parent/s" and their relatives.

  • Unrealistic expectations about stepfamily realities, roles, relationships, holidays, rituals, and development; and....

  • Each partner's recent true (vs. described) priorities. 

B) Intake With Maritally-conflicted Stepfamily Couples

         These questions are in addition to normal marital-assessment questions and those on the prior page. Option - use linked articles below as client handouts during intake, and/or provide a list of their Web addresses. Key intake themes with troubled stepfamily couples are:

  • Are one or both mates significantly wounded? If so, are they (a) aware of what this means, and (b) in true (vs. pseudo) recovery yet?

  • Did either mate probably make unwise commitment choices?  If so, this (a) strongly suggests significant psychological wounds and unawareness, and (b) can't be undone.

  • Are both mates motivated to assess whether blocked grief is contributing to their stress?

  • Is either partner seriously considering separation or re/divorce? If so, see the next section.

         Intake options after learning the presenting (surface) problems, including any current crises:

  • Ask who referred the client couple. If it was a lawyer or family-court judge, see this.

  • Ask if each partner was aware of these five widespread stepfamily hazards and these basic stepfamily problems when they committed to each other. If not (which is usual), summarize them, and perhaps provide a handout describing them.

  • Ask the partners to describe how they typically try to resolve conflicts with each other and what the usual outcomes are (i.e. who usually gets their primary needs met well enough). Options -

    • use one of their presenting problems as an illustration. Usually couples will describe some mix of these strategies, rather than consistent win-win problem-solving. Suggest that no matter what happens, the couple and their stepfamily can benefit from learning to use the seven Lesson-2 skills together;

    • show the couple this Lesson-2 guidebook and suggest they invest in it.

  • Ask if the couple can describe a values conflict, and if they have an effective strategy for resolving them. Expect "No."

  • Ask if the couple can describe a loyalty conflict, and if they have an effective strategy for identifying and permanently resolving them. Expect "No."

  • Ask if the couple can describe a relationship triangle, and if they have an effective strategy for resolving them. Expect "No."

  • Ask each partner to identify their key marital strengths and limitations (vs. "weaknesses"). Option - provide the couple with a copy of an inventory like this.

  • Ask each partner to describe their mate's current top three or four life priorities, as indicated by their actions, not words. Option - propose that their best chance to master relationship problems depends on each mate consistently ranking their relationship second, behind personal integrity  and wholistic health, except in emergencies. Difficulty accepting and doing - e.g. a bioparent saying "My kids will always come first," suggests false-self dominance and wounds, and possible incomplete grief.

  • Ask each partner what they think has to happen - specifically - in order to resolve their respective presenting (surface) problems. The way they answer is as instructive as what they answer.

  • Ask each partner to describe specifically what they think is in the way of making these requisite changes. Use empathic listening to affirm their answers.

  • Ask if past or present addiction, abuse, or marital affairs are contributing to the couple's relationship problems. If so, (a) identify these as symptoms of the primary problems, and (b) ask further questions as appropriate.

  • Ask if the couple was or is working with another counselor, mediator, or therapist. If so, ask if s/he or they have any professional training in stepfamily norms and dynamics. Expect "I don't know," or "Probably not." Sometimes re/marital problems are amplified by misinformed or ignorant lay and/or professional advice - e.g. "Stepfamilies are pretty much the same as biofamilies," or "Your kids should always come first.".

C) intake Options with Couples Considering Re/divorce

        For perspective, first read the articles above and this introduction to stepfamily re/divorce. Recall that the "/" notes it may be a stepparent's first union.

        An effective intake with these clients will gauge...

  • how wounded each partner is - specially whether either mate cannot bond;

  • whether one or both made unwise commitment choices governed by a false self,

  • how each partner feels about re/divorce (opposed > ambivalent > committed to it),

  • what problem-solving options they've tried, and what happened with each option;

  • whether either mate is psychologically divorced already, and...

  • who referred the couple. If it is a lawyer, professional mediator, or judge, see this and this.

       One partner may want professional help to save the relationship and/or to justify their position, and the other may want help in planning, adjusting to, and grieving a divorce. It's usually appropriate for the intake person to say something like "I / We respect your respective rights to decide what's best for you each and your family. I'm / We're here to help you make the clearest, wisest decisions you can, for all your sakes." Pastoral clinicians may need to say more.

  • If only one mate attends the intake, ask if the other partner is willing to participate. If so, ask if the attending person will reschedule the intake so both are present. Rationale: observing partners' reactions to the intake questions and each other's responses provides a lot of initial information.

  • Ask couples to review these normal relationship needs (e.g. in a checklist), and to identify (a) which needs are not being met well enough, and (b) why. Block any blaming (a false-self symptom), note the R(espect)-messages that partners exchange, and invite them to respond as teammates vs. opponents. Key questions:

    • "How often do you each feel heard (vs. agreed with) by your partner?" Option - ask if mates' are aware of - and use - active or reflective (empathic) listening skills.

    • "How often do you each feel respected by (vs. agreed with) by your partner?"  Feeling too disrespected too often suggests psychological wounds and ineffective assertion and listening skills;

    • "What do you see as your partner's main life priorities recently?"

    • How have each of you tried to fill each major unmet primary need, and what happened when you tried? Responses will usually indicate (a) how wounded each mate is and (b) what the couple's style of problem-solving is.

  • If one or both mates are ambivalent about re/divorce (a possible sign of false-self dominance), ask appropriate questions from these.

  • If the partners seem to genuinely love each other and have become overwhelmed by wounds + communication blocks + stepfamily problems, ask if they're willing to commit several months to learning how to resolve each of these to preserve their union and protect their kids.

  • If both mates seem resigned to divorce, ask them each to...

    • review these 29 options together to see if they have overlooked any;

    • (a) describe their version of a "successful re/divorce," and (b) whether they're each willing to invest in constructive coaching toward achieving that.

  • Ask how their relationship situation is affecting each custodial and visiting child, and what they think each child needs from each of them now. Option - review these adjustment needs with the couple and observe their reactions.

  • As the intake proceeds, assess whether each mate is guided by their true Self or not using criteria like these. If one or both seem ruled by a false self, explain the subself / wounds (and perhaps the five hazards) concepts briefly, and ask if one or both mates are willing to explore this for their kids' sakes, whether they re/divorce or not.

  • Close the intake by...

    • recapping each partner's respective presenting problems and goals, and the probable primary problems causing them;

    • summarizing your observations and suggestions;

    • explaining any referrals and reference materials; and...

    • discussing options for further work, and agreeing on one.

  Intake with Persons Seeking Wound-recovery

        From 36 years' clinical experience with hundreds of self-referred troubled Midwestern US families, this systemic model proposes that a key reason for personal, marital, and family stress is that one or more adults are significantly- wounded survivors of low-nurturance (traumatic) childhoods. The model offers effective strategies to...

  • help such survivors break normal denials of their wounds and their impacts, and...

  • intentionally reduce their wounds over time, using inner-family-system therapy.

These goals start with an effective intake. In what follows, GWC means Grown Wounded Child.

        If you're skeptical about the widespread reality of non-pathological personality subselves, read this letter to you when you/re undistracted. Then see what you learn from this safe, interesting experience. An implicit question clinicians face is deciding whether their true Self is guiding their personality or not - in general, with each client, and in each session. The same questions pertain to case managers, supervisors, and consultants.

        To get the most from this section, review...

  • these slide presentations introducing personality subselves, the unseen [wounds + unawareness] cycle, and wound recovery. If you have trouble viewing the slides, see this;

  • these core premises, and this overview of the clinical model;

  • these introductory articles on "inner families" of subselves, and subself Q&A;

  • this true example of personality subselves in action;

  • this overview of Lesson 1 in this nonprofit, divorce-prevention site, and this index of Lesson-1  articles; and...

  • this summary of four requisites for effective clinical service to wounded persons and their families. 

        Intake may focus on one person, on a couple, or the GWC  and their current family. Here are useful intake suggestions for each situation.

A) Intake with Individual GWCs

  • Which of the six psychological wounds are affecting the client's life, and what have been recent behavioral symptoms of this?;

  • Has  the client  hit true bottom yet - i.e. is s/he stably motivated to make second-order (core attitude) changes now? Often this doesn't happen until mid-life or later.

  • Is s/he in true or pseudo (trial) recovery yet? Pseudo recovery results in no lasting behavioral changes;

  • What are (a) the client's current wound-recovery objectives, and (b) strategies to attain them? Typical client's goals are superficial, fuzzy, and/or general ("I want to feel better about myself, and have more energy."); and need focus and refinement;

  • Which subselves have recently or habitually dominated the client's thoughts, feelings, and decisions, and how might that effect clinical recovery work?

  • How supportive or toxic is the client's social environment (family + work or school + any religious community) relative to effective wound-reduction (opposed > neutral > helpful)?;

  • What other stressors is the client trying to manage concurrent with personal wound-recovery, and how effectively are her/his ruling subselves balancing these recently?; and...

  • Is s/he genuinely receptive to trying some form of internal family therapy ("parts work") now? If not, what (or who) hinders this?  

B) Intake Options With Recovering GWCs and their Families

        In my clinical experience since 1981, most troubled American adults are survivors of low-nurturance childhoods (Grown Wounded Children - GWCs). Few of them want to know that, or what it means for them and their families. A basic goal of this clinical model and non-profit Web site is to educate and motivate lay and professional GWCs to break their protective denials, and learn their options for reducing their false-self wounds and protecting their descendents from inheriting the toxic effects of the pervasive [wounds + unawareness] cycle.

        Skillful intake with any client will quickly reveal whether the participating adults and other family members are (a) significantly wounded, and (b) genuinely ready for true (vs. pseudo) wound-reduction ("recovery"). Implications: clinicians must be (a) in recovery or guided by their true Selves and (b) familiar with wound-symptoms and signs that an adult has hit true (vs. pseudo) bottom.

         Typical adults in, or ready for, true recovery ( type-6 clients, in this model) merit unique intake questions like these:

  • "Are you aware of (a) the [wounds + unawareness] cycle and (b) how it may be affecting your family and descendents?" Expect "no." Options - outline the cycle, and/or provide an introductory handout or reference to this slide presentation;

  • "Do you feel you got enough of your needs met as a young child?" Options (a) have the client review these family-nurturance traits before answering, and/or (b) use a copy of the linked summary to help clients answer. This is not about blaming childhood caregivers, who were probably unaware GWCs who did the best nurturing they could.

  • Outline the concepts of personality subselves and psychological wounds as appropriate. Then ask something like "Do these ideas make sense to you?" If not, explore why - without judgment. If so, outline the six psychological wounds and symptoms of each, as appropriate. Then and ask something like...

  • "Who do you feel has been governing your life, recently - your true Self, or other well-meaning subselves (a false self)?" Option - review and discuss key behavioral and emotional traits of true Self and false dominance.

  • "Do you have a strategy to reduce the wounds you have, so far?" If "yes," ask "Describe your strategy, and what results you've experienced so far."

  • "How do you feel your inherited wounds are affecting (a) your primary relationship, and (b) each minor or adult child in your family so far?" Responses can invite a wide range of additional questions, depending on time and other topics.

  • How would you describe your current personal and family priorities? This tests how the GWC ranks personal recovery, relative to other concerns.

  • "Are other family adults and older kids supporting or hindering your recovery goals and work?" This tests for (a) family-member understanding of wounds and recovery, and (b) support and "resistances."

        This is a complex topic, so intake/initial assessment questions will probably continue in early clinical sessions. See these assessment options for more perspective.

  Recap      

        This two-page article is based on my 36 years' clinical experience with over 1,000 typical Midwestern-US adult Anglo clients and some of their kids. It proposes effective clinical intake options and suggestions for six types of clients served by this unique clinical model.

        Key premises here are (a) effective intake with these complex, multi-problem clients a) is best done in person by someone with these requisites, (b) is the first chance to make useful interventions, and is (c) more complex than intake with typical biofamily clients.

Next - read this general perspective on assessing these clients or use the index to choose another article.

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Updated September 30, 2015