Help client break the lethal [wounds + unawareness] cycle

Clinical Intervention-options for
Significantly-wounded Adult Clients

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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       This article is one of a series on effective clinical interventions with six types of divorcing-family and stepfamily clients. It is based on 26 years' study and live clinical experience with hundreds of typical marital and family clients. The article assumes you are familiar with all five elements of this clinical model. If you haven't recently, please read these introductions to effective clinical assessments and interventions before continuing here.

        If you haven't recently, review these articles introducing personality subselves and wounds, and wound-recovery before reading further.

Perspective

        A core premise in this clinical model and nonprofit Web site is that normal personalities are comprised of semi-independent subselves or "parts." To survive low-nurturance families, children automatically evolve three or four groups of subselves, including a talented leader - the true Self.

        Depending on many environmental and genetic factors, such kids are often directed by inner children ("Vulnerable subselves") and their Guardian subselves - a "false self." These reactive personality parts distrust or ignore (disable) the true Self, and cause the growing child's thoughts, emotions, and behaviors - specially in stressful situations.

        Typical adults ruled by a well-meaning, short-sighted false self ("Grown Wounded Children, or GWCs") develop up to five related psychological "wounds" - excessive shame and guilts, excessive fears and/or reality distortions, significant trust imbalances, and possibly an inability to bond and exchange real love  - Reactive Attachment Disorder (RAD). 

        Adults whose personalities are lead by their Self (capital "S") or a "false self" display characteristic behaviors which allow a knowledgeable person to assess which subselves rule their personality in calm and stressful situations.  

        My 27-year clinical training and experience suggests that...

  • a high percentage of adults who seek clinical help (professional therapy or counseling) are significantly wounded (ruled by false selves), and...

  • very few know this, what it means, or what to do about it.

This creates a paradox and major clinical challenge: I believe the most impactful cause of most personal and family-system "problems" is significant psychological wounds, yet typical adult clients (i.e. their ruling subselves) are unaware of this, and are not motivated to learn about their wounds and proactively seek appropriate help to permanently reduce them.

        We are living a version of Hans Christian Anderson's famous folktale "The Emperor's New Clothes." Our society is pretending that inept parenting, child neglect, and psychological wounds are not pandemic and steadily degrading our culture. These wounds range in severity from minor to life-threatening. This article focuses on intervention-options with individual clients that the clinician deems to be "significantly wounded."

        Two useful criteria for making this subjective assessment are (a) whether the clinician believes the client's wounds and unawareness are significantly harming their personal wholistic health and longevity, and/or are (b) putting dependent children at significant risk of developing their own wounds, by promoting a low-nurturance family environment.

        Clinicians will experience three types of significantly-wounded adult clients who each merit unique clinical goals and intervention strategies:

Non-receptive - the adult's dominant subselves are too scared, distrustful, misinformed, and/or distracted to learn about subselves and wounds. The clinician's best intervention strategy is to accept this, "plant seeds" (summary knowledge and indirect suggestions) and let go of trying to promote meaningful short-term personal healing.

Intellectually-receptive - the adult's subselves are willing to learn about personality subselves and wounds, but are not genuinely motivated to assess for significant wounds and start reducing them. The clinician's best intervention strategy is to (a) educate the client on subselves and wounds within situational limits, and (b) "plant seeds' about the future personal and family benefits of wound-recovery. Trying to "sell" (persuade) such a client to recover has more to do with the clinician's needs to rescue or "fix" than the client's current needs;

Committed to recover - the adult's ruling subselves have "hit bottom," and are genuinely willing to learn about their wounds and start reduce them (i.e. to harmonize subselves under the leadership of the resident true Self and other Regular subselves) - in the midst of filling other daily primary needs. In other words, such client adults spontaneously make personal wound-recovery a high current life priority. The most effective intervention strategy with these clients is to encourage a long-term outlook and patient multi-modal individual ("intrapsychic") work over time.

        I and other proponents of the Center for Self Leadership (CSL) recommend some sequence of planned, paced "parts-work" interventions with adult clients who are motivated to free their Self and reduce their wounds over time. This individual work may occur simultaneously with intervening with the client's family system - specially if the family lacks high-nurturance traits (i.e. is "significantly dysfunctional").  The best case occurs when all adult client-family members are aware of subselves, wounds, and recovery; and genuinely support individual adults working to free their true Selves to harmonize and lead.

Intervention Options with Significantly-wounded Clients

        This section proposes four sequential interventions which (a) teach any adult client/s about the potential benefits of working to harmonize their subselves, and (b) may motivate them to learn more and apply their learnings:

1) introduce an illustrate the personality-subself concept. If clients seem disinterested, return the focus to their presenting problem/s for now. If they do seem interested, then...

2) add and illustrate the concepts of (a) psychological wounds, (b) Grown Wounded Children (GWCs), and (c) wound-recovery. If the client remains receptive, then...

3) sketch how a false self (i.e. selected subselves) may be contributing to his or her presenting problems, and how wound-recovery could benefit this client. Then...

4) Decide together whether to pusue that now or refocus on other clinical goals.

1) Introduce the Concept of Normal Subselves

        A keystone intervention with any adult client is to introduce the concept of normal personality subselves in a way s/he can relate to. It can take as little as five minutes. For example:

You - "You have a unique personality that helps define who you are, don't you?

Client - "Yes."

You -  "Have you ever wondered how your personality contributes to your (presenting) problems?"

Client - "My personality? No, not really."

You - I want to suggest an idea that may help you fill your needs better. You've probably been taught that your personality is a single "thing." You have one brain, and one personality, right?"

Client - "Yeah..."

You - An increasing number of mental-health researchers now propose that normal - vs."crazy" - personalities are composed of a number of specialized "parts," or "subselves," like the members of an orchestra or sports team. Each subself has a unique talent and role to play in the group. This means that your thoughts, feelings, and behaviors in any situation result from interactions among your "players," or subselves. Does that seem possible or reasonable?

Client - "Well... I guess so." (Note - in my experience, typical clients intuitively agree with this idea, unless they're fear based.) As some clients try out the new idea that they may be "controlled by a group of subselves," they may ask or wonder "Does this mean I (or another person) have a multiple personality (disorder)?" If so, an appropriate response is something like this:

You -  "Multiple Personality Disorder - MPD" is a real psychological condition, which psychiatrists now call Dissociative Identity Disorder (DID). (Option - explain dissociation in lay terms). Researchers now estimate that it affects perhaps 5% of typical Americans. DID is the extreme form of the normal personality-fragmentation into subselves that we're talking about here. It usually comes from massive childhood abuse and neglect.

        "I see none of the characteristic traits of this disorder in you (if true), like memory-loss episodes, periodic disorientations; or unusual changes in voice, mood, character, and speech patterns. Most normal people have an array of talented subselves, and their personality fragmentation is well short of DID."  

        If the client seems reassured that having discrete subselves does not mean that they are "crazy, weird, or psycho," then continue introducing the basic concepts as appropriate. If a client remains apprehensive about pathology, s/he is probably controlled by a Scared Child and/or a well-meaning Catastrophizer. Unless the client is motivated to explore this now, it's probably best to acknowledge and accept their anxiety, and be content with just presenting an overview of subselves, wounds, and recovery "as useful ideas."

        Option - one way of presenting these concepts that can minimize a fear-based client's anxiety and alarm is to describe a mythical or real "other person" who is controlled by a false self. Another option is for the clinician to affectionately use his or her own subselves as illustrations - e.g. "I have a dedicated Perfectionist subself who continually monitors me and insists that I must strive to be a 'perfect' therapist who never makes mistakes. When I do make mistakes, my Inner Critic relentlessly rants about them - like my (childhood caregiver) used to do."

        Continue presenting the concepts...

You - "As you know, some orchestras and teams function better than others for various reasons. The same is true of personalities like yours and mine. Let's say that personalities which "work well" produce feelings of security, satisfaction, serenity, and contentment. Personalities that are "out of harmony" cause normal people to feel significantly anxious, depressed, angry, hurt, confused, apathetic, manic, and so on. Have you felt any of those normal feelings recently?"

Client - "Yes, of course."

You - "This idea about personality subselves opens up some interesting possibilities. For example, what do you think would happen in your life if you had a way of improving and stabilizing the harmony among your subselves?"

Client - "Pretty weird idea! Is that possible?"

You - "Yes. I can show you how to do that, if you're interested. Are you open to learning a little more about your subselves and how they operate? We're building a foundation here that can help you (solve your presenting problems)."

Client - "OK, if it doesn't take too long or get too complicated."

You - use your own judgment to present and illustrate some key "facts" about normal personality subselves. Use these common questions and answers as a guide. Keys:

  • explain and discuss the concepts of "true Self" and "false self," perhaps using the metaphors of an orchestra conductor or sports-team coach guiding their players to peak performance. Relate these ideas to the client's presenting problems - e.g. "So your flying off the handle with (another family member) and then regretting it is probably caused by a 'false self' - that is, some subselves who distrust your true Self to lead, and 'take over' your personality to keep you safe."

Option - ask the client if they have ever experienced being in a group (a class, team, family, or committee) with an effective leader. If so, ask why the client describes the leader as "effective" - what traits did s/he have to merit that opinion?

  • propose that the client (your true Self) can learn to converse with their subselves and negotiate desired changes - e.g. "How would you like to get the subself who blows up at (some person) to remain calm, while you assert your feelings and needs?"

Option - invite the client to experience a safe inner dialog with a favorite subself now. Tailor this example to fit your situation.

  • emphasize that having many talented subselves combine to form a personality is normal. A common first-reaction is to associate the idea with having Multiple Personality Disorder (MPD) and being wacko, nuts, crazy, or mentally ill"

Option - if the client exhibits this normal reaction, frame it as an uninformed  subself trying to guard the host person against unsafe risk s and changes.

  • suggest that all subselves mean to comfort and protect the host person in various ways, and that there are no "bad" or "evil" subselves. Affirm that false selves can do harmful things, because they are overwhelmed, confused, terrified, and/or misinformed. Avoid getting into a lose-lose argument  (values conflict) about whether evil and/or the Devil really exists or not. 

  • Stay focused - remind your client that you're inviting her or him to learn about subselves to provide a new, effective way to help her or him reduce their presenting (and other) problems.

  • If the client seems significantly ambivalent, anxious, or skeptical about the subself concept, consider adapting key ideas in this letter to skeptics to widen their perspective and options.

  • Reinforce the client's understanding of the personality-subself concept by doing one or more of these:

    • give the client a copy of this introductory article, and discuss their reaction to it.

    • ask the client to review this Web slide presentation - or review it with them - and discuss their reactions and learnings.

    • ask the client to (a) read this Web example of how subselves affected relationships in a real stepfamily, and (b) begin to wonder how subselves are affecting the client's key relationships. Option - use this example of subselves affecting a conversation between ex mates as an illustration and thought-provoker.

    • Give a copy of this article to the client, and/or refer them to it on the Web: http://sfhelp.org/gwc/compare.htm. Then discuss their reactions to it.

        The overall goal of these interventions is to expand the clients awareness of how their "problems" and "happiness" are probably strongly affected by whether their personality is usually ruled by a true Self or a false-self. If the client is interested, the next goal is to...

2a) Introduce the Concept of Grown Wounded Children (GWCs)

        In my clinical experience, most typical adults seeking therapy (for any surface reason) were raised in a low-nurturance childhood environment, and bear significant false-self wounds. They usually minimize ("It wasn't so bad...") or rationalize ("My parents couldn't help it!") their early psychological neglect, and/or unconsciously mute or numb their feelings about it - specially their grief.

       Once clients understand the concept of personality subselves, suggest that...

  • all families (like theirs) exist because they are (usually) better able to fill the needs of (nurture) their kids and adults than other social groups; and...

  • some families are better able to nurture their members than others, over time; and...

  • children raised in low-nurturance families automatically develop an array of personality subselves  - a "false self" - to help them survive (vs. thrive). Do you believe this? Few parents and no kids are aware of this, or what it means.

  • A primal meaning is that kids and adults who are often ruled by a false self develop up to six psychological "wounds" which inexorably degrade their health, relationships, grieving, and psycho-social development. Summarize the wounds for your client, stressing that...

    • the primary wound is a discordant, fragmented personality with a disabled true Self.  This can cause up to five other wounds in varying degrees; and...

    • each wound has unique behavioral symptoms, allowing them to be differentially assessed;  and...

    • once wounds are identified and admitted, any person can proactively (a) reduce them and their toxic personal and family effects ("recover"), and (b) guard any dependent kids against inheriting versions of the wounds.

Option: introduce the terms Grown Wounded Child (GWC) and Grown Nurtured Child (GNC) or equivalent, to distinguish adults ruled by a false-self or their resident true Self. I suggest avoiding the label "healthy adult (or person)" because it implies that wounded people are "unhealthy." This can promote wound-denials and distortions, and inhibit effective recovery.

        The ideas above are usually a lot of new information for average clients, promoting many questions, awarenesses, and possible anxieties  - e.g. "Am I (or another key person) ruled by a false self? Do I have these wounds? If so - what does that mean?" As you explain each core concept, ask the client if it "makes sense," and whether s/he has any comments or questions. Option: Ask the client if s/he has heard each concept before or not, and/or how s/he feels the key people in his or her life would react to these ideas. Take your time building this knowledge foundation!

        As you explain the subself and wound concepts, note the client's verbal and nonverbal reactions. Ideally, you will be fluent in the typical behavioral traits of GWCs, allowing you to judge whether your client is significantly wounded or not. If s/he is, be alert to the person (a) c/overt discounting or rejecting these concepts and/or their personal relevance, and (b) overwhelming or alarming the client's ruling subselves. Perspective: typical GWCs aren't motivated to accept or apply these ideas until mid-life and possibly hitting a personal "bottom." There are exceptions!

2b) ...and if Appropriate, Introduce the Concept of Wound-recovery

        If your client came to therapy seeking to reduce stress among or with other people, s/he probably isn't interested in wound recovery. A possible exception is if s/he sees that one or more of the other "problem" people are wounded, and wants them to know that and to (want to) recover. If the latter is true, see and tailor this article on relating to a wounded mate, ex mate, relative/s, child, and co-workers. Also focus on teaching and motivating the client to strengthen her or his thinking,   communicating, and problem-solving skills.

        If you feel your client is genuinely interested in at least the concept of false-self wound- recovery, overview the concept briefly, and note his or her reaction - i.e. skeptical / distrustful to accepting / interested. Stress that:

  • the core recovery goal is to free the resident true Self (capital "S") to guide and harmonize the other subselves in all situations. "Freeing your Self" means patiently identifying each distrustful, reactive subself, and inviting them to try depending on the Self to keep them and the host person safe and healthy enough. It also means often giving distrustful subselves new personality roles ("jobs") to allay their fear that they'll no longer be needed if they trust the Self.

  • typical GWCs cannot heal their wounds completely, but can greatly reduce them and their effects - permanently and gain major life benefits. To attain the benefits, they also need to study and apply effective communication (Lesson 2) and healthy-grieving (Lesson 3) and relationship (Projects 8 and 10) basics.

  • a common symptom of psychological wounds is one or more active addictions and related reality distortions (e.g. minimizing, projection, and/or denials). Wounded people need to stabilize any addictions ("achieve stable sobriety") before attempting to reduce the underlying psychological wounds that cause them. A rough rule of thumb is the client must have had no relapses for at least a year before expecting to sustain genuine progress on freeing their Self. Note that most (all?) current 12-step programs don't acknowledge subselves or psychological wounds as promoting addictions. Restated: addiction "recovery" is the requisite gateway to full wound-recovery.

  • also note that if a client currently relies on some prescription drug/s for "mood control" (e.g. anti-depression, anti-anxiety, bipolar or attention-deficit moderation, etc.), these will usually inhibit effective wound-reduction. Most conventional or holistic doctors have no awareness of subselves and how they relate to their patients' "conditions," and will propose chemicals to promote comfort and relief (vs. healing).

        If and how subselves interact with a person's biochemistry needs much more research. I suspect that typical subselves can have powerful neurological, muscular, and hormonal effects on average people, and can significantly affect people's digestive, sleep, sexual, elimination, moods, and other bodily vital processes and cycles.

  • Option - preview and (a) invite your client to review this article on wound-recovery, and/or to study this introductory series on wound-recovery; and/or (b) verbally discuss points in these Web resources as appropriate. Doing focused therapy on client recovery is covered elsewhere in this site. 

       If the client seems genuinely (vs. dutifully) receptive, the next intervention is to...

3) Describe How Wound-recovery Might Reduce Presenting Problems

        Typical wounded clients may understand and accept the concepts of personality subselves, psychological wounds, and recovery, and may not intuitively see how to apply these concepts to reduce their current presenting problems. The goal of this third intervention is to raise their awareness and motivation to do this. By definition, each adult's family system, personality, history, ancestry, and presenting are unique. Yet the theme (vs. the details) of connecting their wounds to their presenting problems is universal.

        If appropriate (e.g. at the start of a new session), recap (a) the client's prioritized presenting problem/s and (b) key points of the subself / wounds / recovery concepts, and seek the client's agreement on these. Then...

  • ask if he /she / they are interested in better understanding how thier subselves may be contribution  

 

        This has been a general perspective on how to introduce the concepts of subselves, psychological wounds, and wound-recovery to average wounded clients. When to introduce these concepts is a subjective decision. In general, it's best to explore the client's presenting problems well first, gain the client's trust, and accumulate an opinion of how wounded they are and which wounds they have, over several contacts. Clinicians well versed in "parts work" can also guesstimate what subselves are controlling an individual client.  

        After introducing these concepts and gauging the client's reactions - and depending on their presenting problems - there are three main clinical directions to choose between:

1) The Client's Subselves aren't Ready to Accept Basic Concepts

2) The Client is Willing to Learn, but not to Recover

3) The Client is Genuinely Motivated to Learn and Reduce Their Wounds

Recap

 

 

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Created 08-16-2015