Toward effective service to individuals, divorcing-families, and stepfamilies

A Checklist of Requisite Clinical Attitudes

See what your subselves believe about your clients and your work with them

By Peter K. Gerlach, MSW

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  The Web address of this article is http://sfhelp.org/pro/req/attitude-wks.htm

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        Premise - a requisite for effective clinical work with trauma-recoverers and divorcing-family and stepfamily clients is to be aware of your dominant subselves' key attitudes. As you know, attitudes are un/conscious opinions of something's or someone's...

  • priority (trivial > vital)

  • value (nourishing > toxic)

  • likelihood (impossible > certain)

  • morality (good > evil)

  • usefulness (worthless > effective)

  • relevance (appropriate > inappropriate)

To simplify this variety, we often use the shorthand attitude "good > bad," and "right > wrong" to judge many things, as in "that was good communication."

        Try out the ideas that (a) each of your attitudes comes from one or more of your active subselves; (b) subselves may conflict in their attitudes, producing "confusion," "ambivalence," and "seeing two sides" to some subjects ("Divorce is always wrong!" / "No it's not!").

        Implication - to shift any of your attitudes about clients or clinical work, you may need to (a) be clear on what subselves comprise your personality, (b) which subselves cause the attitude you want to change, and (c) have your true Self explore what - if anything - blocks each such subself from adopting a more helpful attitude, and (d) negotiating for that change. Not doing some form of this "parts work" will usually produce first-order (temporary, superficial) attitude changes.

        Two groups of attitudes in clinicians, supervisors, consultants, and clinical and program directors are key in promoting effective outcomes with these clients;

  • clinical focuses, modalities, standards, and practices; and...

  • the clients themselves.

Let's look at some key attitudes in each domain. Option - use this as a checklist to profile your key attitudes, and star or hilight any you wish to explore further or change.

Requisite Attitudes about Therapy and Counseling

        Rank your stance on each of these attitudes: do you Agree, Disagree, or feel something else (?)...

        1)  long-term problem prevention vs. short-term problem reduction. I want to maximize my ongoing and long-term professional satisfaction by investing most of my time, skills, and energy in preventing family stress and divorce, rather than in helping to reduce existing client-family stressors. (A  D  ?)

        2)  mixed clinical modalities - effective clinical service to divorcing-family and stepfamily clients requires a progressive balance of family-system + dyadic + intrapsychic (inner-family systems therapy) modalities. Ignoring, discounting, or favoring any of these modalities will significantly reduce my odds of successful outcomes. I also need my supervisor, consultants, case manager/s, clinical or program director, and any co-therapists to fully share this attitude. (A  D  ?)

        3)  grief therapy - Blocked or incomplete grief is a significant stressor in typical wounded persons and low-nurturance families. Typical clients don't (want to) know this, and usually won't include it in their presenting problems. So I need to include assessing each client for...

  • their knowledge of grieving basics,

  • their family grieving policy, and...

  • significant unfinished or blocked grief.

I also need to grow my competence at (a) modeling and teaching "good grief" to my clients, and (b) motivating and empowering them to free any blocked grief among their adults and kids. I also need the professionals I work with to share this attitude. (A  D  ?)  See Lesson 3.

        4)  insight ("talk") therapy vs. experiential therapy - My odds for effective clinical outcomes rise if I  balance didactic teaching equally with offering clients experiential learning . This balance is most likely if my true Self usually guides my personality (A  D  ?)

        Evidence of this pro-experiential attitude include a clinician's wanting to weave things like role-plays; guided imagery; sentence completions, client homework exercises; and group, art, Gestalt, massage, poetry, psychosynthesis, EMDR, and voice-dialog interventions and modalities into the work.

        5)  time-limited therapy - low-nurturance and wounded clients usually have multiple concurrent stressors that need to be identified, sorted, ranked, and reduced one or a few at a time over many sessions. If circumstances limit the number of clinical sessions or hours, my goals are to help adult clients ...

  • learn how to identify and separate multiple problems (primary needs), and to...

  • problem-solve effectively, while...

  • teaching them what I can on relevant topics, and...

  • alerting them to useful resources for filling their needs together. (A  D  ?)

        6) I accept that brief, problem-centered, Rogerian, non-systemic, and cognitive therapies are less apt to produce desired clinical outcomes than long-term, multi-phase systemic attitudes and treatment strategies. (A  D  ?)

        More requisite clinician attitudes about the therapeutic process...

        7)  including spirituality - using my own spirituality strategically and empathically encouraging clients to develop and use their spiritual faith (if it's not fear-based or shame-based) are helpful clinical choices - as long as I don't preach or evangelize. This attitude opens up a range of spirituality-based interventions (for clients believing in a Higher Power ) not otherwise available. Stable client faith in a benign Higher Power is usually required for true (vs. pseudo) recovery from false-self wounds. (A  D  ?)

        8)  communication assessment and skill-building - I believe that...

  • assessing client thinking and communication effectiveness,

  • teaching effective communication and problem-solving basics and skills, and...

  • proactively modeling these steadily in every clinical contact and session...

are essential for effective service to all clients. This means that I and any colleagues need to know these basics and skills thoroughly, and how to teach them strategically to every client. (A  D  ?) 

        9)  supportive-only vs. strategic confrontational and frustrating interventions - respectfully confronting clients (e.g. "My sense is that you're in protective denial about your partner's addiction and your own codependence;" or "I notice you steadily avoid doing the homework I suggest.") and strategically frustrating them (e.g. "I'm stumped about what to do about your problem.") can be just as productive in growing client competence as supportive interventions.  (A  D  ?)

        10)  responsibility for desired changes - each participating client adult is responsible for achieving desired personal and family-system changes. I am responsible for respectfully encouraging client adults to take this responsibility, and to find necessary resources to fill their own needs. (A  D  ?) The alternative is "I am responsible for filling the client's needs," which is an inherited view from non-systemic medical-model service. Unless clients are disabled, this attitude is inherently enabling and promotes client's self-distrust and dependence, and choosing a victim role in some or all situations

        11)  surface and primary needs - I expect that (a) typical clients will be unaware of the difference between surface needs ("presenting problems") and underlying primary needs, and that (b) any client or co-worker will benefit from my teaching this difference, and modeling how to dig down  to discern current primary needs. (A  D  ?)

          In addition to these requisite attitudes about the clinical process, effective clinicians also need...

Helpful Attitudes about Client Traits and Behaviors

        Premises: we all "leak" our true beliefs and priorities to other people via tiny voice, face, and body cues, despite wishes to disguise them. Our ever-alert subselves perceive these cues subconsciously, decode them, and trigger hormones, thoughts, "senses," and autonomic body responses. Therefore some semi-conscious attitudes can promote or hinder successful intervention outcomes, and may increase client distress (unmet needs).

       For example, judgmental attitudes that can hinder effective work with these clients are...

"Divorce is a personal failure and a moral wrong."

"Stepfamilies are abnormal and second best.

"Most stepkids don't turn out as well as biokids." and...

"Parents who neglect or abuse their children are morally weak, irresponsible, and despicable."

        Choose the open, curious "mind of a student" now. Take some undistracted time to respond to this attitude inventory, and return. As you respond, imagine a typical client adult taking the inventory. Consider how you might use the inventory strategically (e.g. as an intake or "homework" handout) to help clients and co-workers raise their attitude awareness, and make better choices. You or a client shifting attitudes to mostly 4's and 5's on these inventory topics is a second-order change.  

 Clients' Attitudes

           Strategically assessing clients' attitudes about key topics like those on the inventory above promotes effective clinical outcomes. A set of attitudes that can be helpful or harmful relates to what divorced parents feel about themselves, each other, and "divorce." Think of a divorced mom and dad you've worked with, and keep them in mind as you review this article. Then imagine how they and/or other family adults would each react to the article, and how you might use it to help them reduce post-divorce barriers to effective co-parenting and personal-wound recovery.

        Try this status check, and see what you learn:

  • I can define "attitude" clearly, and I'm clear on where most attitudes come from.  (True  False  ?)

  • I know how to identify a client's attitudes about key subjects now. (T  F  ?)

  • I know when and how to talk productively with clients about their attitudes now. (T  F  ?)

  • I know how to help typical minor kids understand what "attitudes" are, and how to interest them in judging whether attitudes are helpful or toxic.  (T  F  ?) 

  • I know how to facilitate clients changing toxic attitudes to healthier ones.  (T  F  ?)

  • I can describe (a) the difference between first-order and second-order changes, and (b) how this difference relates to clients' presenting problems and clinical effectiveness.  (T  F  ?)

  • I'm usually clear on which subselves are guiding my personality.  (T  F  ?client needs and

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        Pause for a moment and reflect: what are your subselves saying and feeling now? Recall why you used this worksheet - did you get what you needed? if so, what do you need to do now? If not - what do you need?

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Created  April 30, 2013