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

A Sample Intake Checklist for
Stepfamily Clients

Information Clinicians Need
for Effective Treatment Plans

By Peter K. Gerlach, MSW
Member NSRC Experts Council

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        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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        Here "intake" means collecting initial information about a client's (a) presenting problems and (b) stepfamily, taken by an agency intake worker or a clinician over the phone or in person. The choice, order, and selection of specific intake questions is a matter of style and type of service provided. This checklist comes from my clinical work with over 1,000 typical divorced-family and stepfamily co-parents since 1981.

        This page distills basic information that can help...

  • clinical directors and case managers to decide what worker/s to assign or what referral to make, and/or help...

  • clinicians to decide on initial interview questions and preliminary interventions.

Premises

        These intake questions reflect some basic conclusions from 36 years' clinical work with well over 500 self-referred and court-referred Midwestern Anglo divorcing and stepfamily clients:

        1) Typical co-parents requesting therapy are often (a) unclear on what they need, and/or (b) focused on resolving surface (presenting) "problems," rather than these underlying causes. So a well-designed intake protocol goes beyond just collecting demographic, historic, and financial data and current presenting problems;

        2) Well-designed intake questions can be safe, meaningful early interventions, because they raise client awareness and clarity, and may offer useful reframings and new terminology;

        3) Some intake questions apply to all stepfamily clients, and others are unique depending on what phase of the work they're initiating;

        4) Typical co-parents are ambivalent or opposed to including minor-kids' "other co-parents" in defining "our family." Intake dialog can respectfully suggest that all co-parenting adults and dependent kids form the client's nuclear (step)family.

           5) Expect multiple concurrent presenting problems, so use empathic listening to clarify, identify, and separate them. Note whether the client (a) is aware of this, and (b) can separate their current problems (most can't).

        6) Three basic intake questions are:

What, specifically, do you need (a) in your family and (b) from therapy?

What have you already tried (to fill those needs)?  and...

What do you feel is in the way of filling them - specifically?

        I assume you're familiar with "standard" intake questions, so these are specifically oriented to initial contacts with separated or divorcing biofamily-client and stepfamily-client contacts. The general purpose of this checklist is to gather enough initial information to learn...

  • What type of client is this, and who's involved?

  • Who referred them (self, a judge, or other), and why?

  • What are their presenting problems?

  • What are the probable underlying primary problems?

        Intake Interview Themes

        Premise: client "problems" are unfilled needs - psychological or spiritual discomforts. They have problems because they (a) can't identify, separate, and rank their primary needs, (b) lack relevant knowledge, and/or (c) they don't know how to problem-solve effectively. Often, the way co-parents are trying to solve their problems becomes the problem.
  • Note that the intake questions' content, sequence, and delivery can be useful interventions;

  • Notice whether the client/s use appropriate stepfamily titles and role labels - e.g. "my stepson ..." You have a choice whether to ask questions using appropriate role labels - "And does your husband acknowledge that you are his daughter's stepmother, and she is your stepdaughter?"

  • "The client" includes at least all people living part-time or full time in three or more related co-parenting homes. Exception: if a bioparent's former mate is dead, tho their genes, past values and attitudes, and psychological influence can still be powerful.
     

Before the first contact with a divorcing-family client

Ask the initiating client family member/s to define for themselves and bring in:

1)  What are your key adult and biofamily strengths now? Option: co-parents and relevant older children fill out this Stepfamily Strengths" inventory.

2)  Do both co-parents agree that divorce is the most practical option for your family now?

3)  What, specifically, do you want from therapy?

4)  What have you co-parents (each) already tried?  With what specific results? 

5)  What's in the way now (of getting more of what you each want)?

6)  

First-meeting Options

        Define your client as the multi-home family (system) including any living ex mates (co-parents) and their families;. Note and use any resistances to this framing. Omitting ex (bioparenting) mates promotes stepfamily stress;

Normalize: (a) Frame stepfamilies as normal, with special tasks; (b) Validate feelings of marital / household confusion and frustration (if present) as normal  - specially soon after cohabiting and re/marriage.

Lower initial anxiety:

  • Suggest that tailored education often suffices, vs. therapy or counseling;

  • Build trust: "we'll sort, prioritize, and focus if there are several problems" (which is almost certain).

  • Assure clients that your goal is impartiality to all their stepfamily members, present and absent. Explore whether absent co-parents might participate, and under what circumstances;

        Frame the therapy goals as (a) empowering the client co-parents to identify and fix their own problems, and (b) improve their multi-home family's nurturance level.

        Use and promote stepfamily terms and titles, and learn clients’ family terminologies; note, explore, and affirm client dis/comfort with stepfamily titles and terms (e.g. “my stepchild” vs. “Amy”).

Options:

  1. Outline the five re/divorce factors above, and relate to the current assessment > intervention  process;

  2. As both an assessment tool and intervention, ask client co-parent/s present to guide you in drawing a (multi-home) three-generational “map” (genogram) of their whole stepfamily (this takes a big flipchart or blackboard!); This is an efficient way of (a) learning all the players, (b) making a preliminary co-parental GWC assessment; and (c) teaching those present to visually conceptualize “who we all are.”

               Verbally frame their genogram as “your whole stepfamily,” and ask for reactions. Stress that all bioparents of minor and grown stepkids are full co-parents. Suggest co-parents reproduce the exercise with their kids and other key relatives;

  3. Give the client/s a selection of stepfamily educational materials for home study.

  4. Assess the client home/s and whole stepfamily per the four-axis typology above, form Tx goals, and proceed accordingly.

Key Assessment (Dx) Factors

Overall: use the 7 self-improvement Lessons as a Dx framework for individual co-parents and co-parent  couple/s. Tailor to fit the client-system's type and situation;

Assess who’s now in charge of each co-parenting home, using structural diagrams [5]. Identify intra and inter-home alliances, coalitions, and hostilities. Who supports and who resists the co-parents’ re/marriage(s)? 

Affirm and balance - Have the client co-parents define their specific marital, household, and multi-home family strengths and (human) assets. Refer to these as you go to build hope, and offset overwhelm and pessimism;

Assess relationship priorities: in each major household: which relationships get the most energy? Assess re/marital vs. parental relationship primacy: note actions, vs. words. Justify re/marital primacy as protecting dependent children against major re/divorce trauma;

Assess for GWC co-parents: using the genogram, assess all co-parents for significant childhood trauma and dysfunction. Family-tree symptoms: divorces / desertions / abortions / chronic illness / job and geographic instability / family secrets / addictions / verbal - physical - spiritual abuse / hospitalizations / suicide / bankruptcy / recurrent legal trouble / affairs /  murder... Where these are apparent: is the co-parent in true or pseudo recovery, or denial?

Assess for blocked grief: Can co-parents describe ...

1) the three grief levels and stages within each?

2) The symptoms of blocked grief, and implications of it?

3) the major losses they and each child have sustained from death / divorce and parental re/marriage?

4) Whether any family member significantly blocked in grieving major or collective losses?

5) The present policy that governs grieving in their home? 

Assess child dynamics:

1) current child visitation dynamics;

2) status of any child custody, parenting agreement, or financial support disputes, including prior or present court actions;

3) review the 30+ unique stepchild developmental tasks: assess (a) co-parents' awareness of the tasks, and (b) each custodial or visiting child's status with them.

Dx for dwelling stressors: is the client family living in his former personal dwelling, hers, or one new to all? How are all co-parents and kids adjusting to "invasions", and/or losses from moving to a new location? How satisfied are clients with space allocations, privacy, etc.?

Dx ex-mates' status: Grieving or blocked ? \ supportive -> indifferent -> hostile to ex’s re/marriage? To ex’s new mate? \ stepfamily knowledge and identity? \ co-parenting communications’ (specially problem-solving) effectiveness? \ co-parenting role clarity? \ new romantic relationship (with another stepparent)? \ relationship strengths and stressors?

Dx re/marital health - how satisfied is each partner? Explore how _ understood and _ supported each stepparent feels by their current partner re conflicts over stepkids and ex-mates.

Dx co-parent verbal-communications effectiveness: how does each co-parent rate their present verbal problem-solving ability as a couple? How satisfied is each co-parent on their partner’s present ability to hear them? Note specially how values conflicts over money, co-parenting, and home-management are handled. Can each co-parent clearly describe the key differences between “fiting” or “arguing”, and “problem-solving”? (Can the clinician?)

Assess for addictions: check all three generations of each co-parent. Any evidence of active substance / activity / relationship dependencies? If so - status of client-family's addiction knowledge, recovery, and resources?

Assess for prior stepfamily/remarital counseling experiences: If any, what were the outcomes? Was the clinician stepfamily-trained? (often, any prior Tx was ineffective or negative, if the clinician was untrained and used a biofamily-systems Tx  model);

Assess stepfamily knowledge - Assess the degree of co-parent stepfamily/stepparent education: how realistic are each co-parents' expectations about their stepfamily / co-parenting / partner / stepchild behaviors? Educate clients as needed to the 60+ stepfamily vs. biofamily structural and dynamics differences, and common co-parent myths.

Assess co-parent role-clarity: Does each co-parenting couple have a clear idea of what they’re trying to achieve with their stepfamily? Can each co-parent name their current specific "job responsibilities" in guiding each resident and visiting child in the stepfamily? Do step and bioparents agree on these? Do the stepkids? Do key relatives? If not - how effectively does the family handle the disagreements?

Assess presenting problems and attempted solutions: (often will be covered in several of the above foci) who wants what (specifically)? Who's tried what? What happened? What options toward resolution are untried, if any? If nothing changes significantly - what's likely to happen? (Note: unrecovering GWC co-parents typically use bi-polar thinking: only two solutions to any problem)…

Questions About the Presenting Problem/s

        

Questions About the Client Family

_ "Who comprises your present family?"

_ "Who's home are you living in now?" (a prior-marriage home, or a new one?)

_ "Who has been living in each (co-parenting) home recently? Has that changed in any major way in the last (six to 12) months?"

_ "What physical and legal child custody arrangement do you have?"

_ "If there are child visitations, who goes where, how often, for how long, who transports the child/ren, and how satisfied are all concerned with the present arrangement?"

_ "Is there a legal parenting agreement that governs child visitations? If so, how effective is it, as judged by each co-parent and each affected child?"

_ "Are all prior divorces legally finished?" if not, "What's needed to finalize?"

_ "Have any of your co-parents or children been in therapy before? if so, "When, for how long, what at was the goal, and generally how helpful was it?"

_ "Has there been any court litigation between any co-parents or kin in your family? If so, (a) who initiated it, (b) why, (c) what was the legal (vs. psychological) result, and (d) how did that process affect relations in and between your co-parenting homes?"

_ "Has the Department of Children and Family Services (or your state's equivalent) ever been called in about anything in your present or past family? If so, who called, why, when, and what was the outcome?

_ "Do you feel that anyone in your past or present families was or is addicted to (a) substances (including food), (b) activities, (c) mood states (like anger/excitement, sexual arousal, or other), or (d) relationships (co-dependence)? If so, who, to what, and are they in effective recovery now? The answers to these questions can trigger a group of addiction-specific intake questions.

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Updated  September 29, 2015