Toward effective service to
Effective Intakes with
Low-nurturance / Wounded Clients
p. 2 of 2
Initial assessment and interventions
Peter K. Gerlach, MSW
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,
admitting and wanting to reduce such problems, and...
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
Note the difference between surface and underlying primary
problems (unmet needs) and propose
and discuss probable
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
(one of several primary
Probe for unacknowledged
systemic problems, including significant relationship (re/marital) dissatisfactions. Common
presenting (surface) problems include stress over...
adult co-parenting (and other)
and associated relationship
debts, asset-ownership, and money management,
first and last
names, and family
household chores, responsibilities, and
("We're just a regular
not a 'stepfamily' or 'blended
(inclusion / exclusion) conflicts - .specially over respecting the
needs, values, and opinions of stepkids' "other parent/s" and their
expectations about stepfamily realities,
Each partner's recent true (vs.
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
If so, are they
(a) aware of what this
and (b) in true (vs. pseudo)
Did either mate probably make unwise
If so, this (a) strongly suggests significant psychological wounds
and unawareness, and (b) can't be undone.
Are both mates motivated to assess whether
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
Ask who referred the client couple. If it
was a lawyer or family-court judge, see
if each partner was aware of these five widespread stepfamily
and these basic stepfamily
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
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
strategies, rather than consistent win-win
that no matter what happens, the couple and their stepfamily can
benefit from learning to use the seven Lesson-2
the couple this Lesson-2
and suggest they invest in it.
Ask if the couple can describe a
and if they have an effective strategy for resolving them.
Ask if the couple can describe a
and if they have an effective strategy for identifying and permanently
resolving them. Expect "No."
Ask if the couple can describe a
and if they have an effective strategy for resolving them.
Ask each partner to identify their key
marital strengths and limitations (vs. "weaknesses"). Option -
provide the couple with a copy of an inventory like
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
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
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
to affirm their answers.
Ask if past or present
are contributing to the couple's relationship problems. If so,
(a) identify these as symptoms of the
and (b) ask
further questions as appropriate.
Ask if the couple was or is working with
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
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...
each partner is
- specially whether either mate cannot
whether one or both made
governed by a false self,
how each partner feels about re/divorce
(opposed > ambivalent > committed to it),
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
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
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
partners exchange, and invite them to respond as teammates
"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)
"How often do you each feel
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
each mate is and (b) what the couple's style of
If one or both mates are ambivalent about
re/divorce (a possible sign of false-self dominance), ask appropriate questions from
If the partners seem to genuinely love each
other and have become overwhelmed by
ask if they're willing to commit several months to learning how to
resolve each of these to preserve their union and protect their
If both mates seem resigned to divorce, ask
them each to...
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
Close the intake
recapping each partner's respective
presenting problems and goals, and the probable primary problems
summarizing your observations and
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
model proposes that
a key reason for personal, marital,
and family stress is that one or more adults are significantly-
(traumatic) childhoods. The model offers effective strategies to...
help such survivors
of their wounds and their
their wounds over time, using
These goals start with an effective intake. In what follows,
Grown Wounded Child.
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
An implicit question clinicians face is
deciding whether their true Self is
their personality or not - in general, with each client, and in each session. The
same questions pertain to case managers, supervisors, and consultants.
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
these core premises, and this overview of the clinical
these introductory articles on "inner
families" of subselves, and subself
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
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
yet - i.e. is s/he stably motivated to make second-order (core attitude)
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;
(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
have recently or habitually dominated the
client's thoughts, feelings, and decisions, and how might that effect
clinical recovery work?
toxic is the client's social environment (family + work or school + any
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
these recently?; and...
Is s/he genuinely receptive to trying some form of
("parts work") now?
If not, what (or who) hinders this?
B) Intake Options With
Recovering GWCs and their
clinical experience since 1981, most troubled American adults are survivors
- GWCs). Few of them want to know that, or what it
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
learn their options for
and protecting their descendents from
inheriting the toxic effects of the pervasive [wounds + unawareness]
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
recovery or guided by their true Selves and (b) familiar with
wound-symptoms and signs that an adult has hit true (vs. pseudo)
Typical adults in, or ready for, true recovery (
in this model) merit unique intake questions like these:
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
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
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
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)
is a complex topic, so intake/initial assessment questions will probably
continue in early clinical sessions. See these assessment options for more
This two-page article is based on my
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
Key premises here are (a) effective intake with these complex, multi-problem
clients a) is best done in person by someone with these
(b) is the first chance to make useful interventions, and is (c) more
complex than intake with typical biofamily clients.
- read this general perspective on assessing
these clients or use the index to choose
+ + +
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September 30, 2015