Help clients break the lethal [wounds + unawareness] cycle

Overview: Key Clinical Assessment
Factors
, by Client Type

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?

+ + +

        To get the most from this article, first read...
  • the introduction to this series of clinical articles,

  • the overview of this clinical model,

  • these requisites for effective service to the clients covered by this model, and...

  • this perspective on assessing these client systems.

Perspective

        This clinical model proposes that typical divorcing-family and stepfamily clients have special needs and adjustment tasks to complete as they evolve, compared to average intact biofamilies. These needs and tasks justify questions beyond biofamily clinical assessment.

        This article summarizes the extra topics to assess for five stages of the divorce/mate-death > re/marriage family-life cycle. These key assessment topics are in addition to (a) normal demographic, historic, and socio-economic assessment data, and (b) discerning the client's presenting problems.

        Assessing client families occurs in three phases - (a) initial contacts, (b) during the work, and (c) ideally, after termination. The first assessment question is "If crisis -intervention seems warranted, what's needed for whom, and why?"

        Assessment targets vary by where the client-family is in its life cycle:

1)  A separated, divorcing, or widowed (single-parent) nuclear biofamily ("embryo stepfamily") where one or both bioparents may may seek a new partner; or...

2)  A courting (psychological) stepfamily that includes one or more co-parent couples who are dating "seriously" (exclusively); or...

3)  A cohabiting or re/wedded (committed) stepfamily; or...

4A separated or re/divorcing stepfamily.

5Any family including one or more adults proactively seeking to reduce psychological (false-self) wounds (recover).

        Links below lead to articles with more detail and/or client-assessment worksheets. This index links to intervention-options for each major assessment target.

       Option - tailor the list below and use it as a checklist in working with any client family.


Assess All Client Families Over Time for...

1)  If crisis intervention is merited now, why, and what's required?

2Who referred this client, and why - self, family court, or someone else?

3Nuclear and extended family-system composition and structure, and (c) client-adult awareness of these. This includes assessing for significant cutoffs and alliances between any extended-family members;

4)  Committed-couple and nuclear-family strengths, including the (a) degree (none > minor > moderate > major) and (b) impact of family-members' spiritual faith on their nurturance level (none > little > moderate > high);

5)  Adult awareness of (a) family-nurturance factors, and (b) historic and recent nuclear-family nurturance levels (very low to very high)

6Adult (a) clarity and (b) agreement on, and (c) usage of long-range family goals (a family mission or vision)

7(a) significant co-parent psychjological wounds , (b) adults' awareness of the wounds and their impacts, and (c) any efforts to reduce them so far

8)  Recent individual family-adult priorities , as judged by their actions, not their words

9Client-adult awareness of (a) surface and primary needs, and (b) first-order and second-order systemic changes, and motivation to use these awarenesses in daily affairs, and model and teach their kids about them;

10)  Adult and family communication and problem-solving (a) knowledge, (b) process awareness, and (c)  effectiveness - in general, and in conflicts;

11)  Co-parents' (a) awareness of, and (b) ability to effectively resolve (a) values conflicts, (b) loyalty conflicts, and (c) relationship triangles

12)  (a) Client-adult awareness of healthy-grieving basics, (b) their family's recent grieving policy, (c) any incomplete or blocked grief in adults and kids, and (d) any efforts to free that up

13(a) Past and present addictions in co-parents' family trees, (b) the status of each one  (active, in pseudo recovery, or in true recovery), (c) significant impacts on the family, and if appropriate, (d) the family adults' knowledge of addiction and recovery basics and resources;

14)  Mates' (a) awareness of and (b) ability to negotiate their primary relationship needs  (problem-solve) effectively

15)  (a) The status of any child custody, visitation, and financial-support arrangements (verbal or legal / effective or not / cooperative or conflictual). and (b) If there is a legal parenting agreement, does it increase or decrease the family's nurturance level? 

16(a) Cause/s and (b) status of past and current legal actions among family members - e.g. divorce settlements, custody battles, contested parenting agreements, and/or orders of protection.

17)  (a) Effectiveness of the family's support system, (b) co-parents' motivations to use it, and (c) practical options to improve these.

18)  Co-parents' knowledge of kids' developmental and family-adjustment needs, and each child's status with them

19Clarity, compatibility, and viability of co-parents' and kids' roles

20Nature and impact of any special nuclear-family stressors, including child visitation, custody, and financial support

21The degree of current co-parent, marital, household, and nuclear-family balances

        How do you feel about this proposed set of universal assessment factors? Can you think of other key assessment factors that apply to any typical client family? Now let's add a summary of...

Client-specific Assessment Factors

Assessment Focus
(beyond presenting problems)

Client Type (family developmental stage)
Divorcing
biofamily
Courting
co-parents
Cohabiting/
re/married
stepfamily
Adult
wound recovery
Re/divorcing
stepfamily

22) Courtship danger signs

23) Partners' (a) awareness of Lessons 1-7, and (b) their abilities and motivations to make three right remarriage decisions

no yes maybe ? no
24)  Adequacy of co-parents' knowledge about stepfamilies

25)  Acceptance of stepfamily identity and what it means 

26)  Realism of co-parents' stepfamily expectations

27)  Co-parent clarity and harmony on stepfamily membership

28)  Status and effectiveness of  co-parents' biofamily-merger plan

no
yes

yes
maybe no

29)  Client-adult awareness of (a) Significant barriers to co-parenting teamwork , and (b) current resoltion options

30)  Any of these common surface problems

yes yes yes ? yes
31) Untried marital options, and adults' ability to plan a successful (re)divorce yes no yes maybe yes
30)  yes yes      

Notes

        These assessment factors derive from the four or five hazards that typical low-nurturance families face, and are in roughly the same order as the 7 Lessons that this clinical model advocates. Most are primary problems (unfilled needs), rather than typical presenting (surface) problems. This implies that ef-fective clinicians will usually assess for these factors regardless of what the clients or referrers request.

        Assessing most of these factors thoroly requires evaluating a group of related subtopics. For exam-ple, assessing "communication knowledge and effectiveness" requires assessing each co-parent for (a) knowledge of and (b) motivation to use communication basics and each of the seven skills + any toxic (need-blocking) sequences and patterns + co-parents' motivation and ability to spot and resolve major communication blocks + co-parents' motivation to admit and change any toxic attitudes and behaviors.

        Most of these factors are complex and can't be accurately assessed in one session. Assessments can be refined by observation and questioning, and/or by giving the client co-parents a worksheet or informational handout  - e.g. about stepfamily realities, the five hazards, grieving and/or communication basics, or stepchild needs - and discussing their responses and reactions in subsequent sessions.

        Typical clients' will not be aware of or understand many of these factors. An early step in asses-sing most factors is to ask if co-parents can describe them. ("Are you aware of what a values conflict is?") If they can, a next useful question to ask is "How do you feel (this factor) recently has affected your relationship / family nurturance level / personal recovery / ability to grieve / co-parenting effectiveness / presenting problems (etc.)?"

        When and how a clinician (a) assesses for each of these factors and (b) reacts to the client's responses are usually interventions. For instance, asking "Are you partners each clear on the difference between problem solving and fighting or arguing?" alerts the couple that (a) there is a difference, which (b) (the clinician feels) is important, and (c) promotes their thinking about the how they respond to family conflicts.

        In each session starting with intake, the clinician must empathically balance her or his need to assess these many factors with the client's immediate needs - i.e. to vent, get information, raise hope, clarify and/or validate something, comply with a court order, problem-solve, prove something to someone, or something else.

        A clinician's style will determine if and when they explain what they're assessing for and why to the client family members. My experience is that usually summary explanations build client trust and lower session anxiety - specially if the clinician's attitude seems to be "If this (assessment factor) is a problem for your family now, I can help you reduce it."

        Clinicians can summarize their ongoing assessment results on a client profile form. Discussing the profile with client co-parents and inviting their input benefits everyone. Two common benefits are that typical co-parents can (a) see - often for the first time - how complex building a high-nurturance family (specially a stepfamily) is, and can (b) validate that the five hazards really do apply to all their nuclear stepfamily members and key relatives.

        Options: print and use this article to...

  • evolve your own assessment summary for these or other clients,

  • help interns learn this clinical model, and/or to...

  • help standardize client assessments and treatment plans in a multi-clinician organization.

        A key meta-assessment to make after accumulating preliminary judgments: decide which of these factors have the most impact on the client-family's (a) nurturance level and (b) long-term wholistic health  and development. This promotes prioritizing interventions, which is specially important if professional service is limited by insurance coverage or other factors.

        For more details and options on assessing these key factors, see...

  • separated or divorcing biofamilies (embryo stepfamilies)

  • courting (pre-commitment) stepfamilies

  • cohabiting or re/married (committed) stepfamilies denying primary-relationship problems

  • cohabiting or re/married (committed) stepfamilies admitting primary-relationship problems

  • one or more co-parents seeks inner-family therapy (personal psychological wound reduction)

  • psychologically or legally re/divorcing stepfamilies

        For  perspective on, and options for, intervening on these factors, see this.

        Pause and reflect - why did you read this article? Did you get what you needed? What do you need to do with these ideas?

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        Pause, breathe, and reflect - why did you read this article? Did you get what you needed? If not, what do you need? Who's answering these questions - your true Self, or "someone else."?

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Updated October 05, 2015