Help clients break the lethal [wounds + unawareness] cycle

Five Requisites for Effective Clinical Service

Requisite 2) Special Knowledge of
the Clinical Assessment
- p. 3 of 4

By Peter K. Gerlach, MSW
Member NSRC Experts Council

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The Web address of this page is http://sfhelp.org/pro/req/knowledge.htm

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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?

+ + +

        This concludes outlining four areas of self-awareness required for effective service to these clients: (a) inner-family structure and leadership, (b) ruling subselves' key attitudes, (c) present vs. current knowledge status, and (d) process awareness.

Present vs. Required Knowledge

        The second self-awareness requisite is "How much do I know now about working with these clients, compared to what I need to know?" An effective way to answer that is to follow the links in these quizzes about relationships, communication, grieving, parenting, and stepfamilies. Then methodically follow the links in this article on four areas of requisite special knowledge. Each time you get a summary popup window, follow the "More detail" link at the bottom.

        Options:

  • Adopt a long-range view, and philosophy "Progress (at learning), not Perfection;"

  • Print and use these two pages as a checklist to guide and note your learning progress.

  • Augment the quizzes and this article by studying these questions and answers, browsing these Solutions articles, and invest in one or more of these selected titles over time.

  • Suggest some or all of this learning be included in any in-service or training program in your workplace.

Grow Personal Process Awareness

        Here process means "What's going on _ right now and _ over time (a) inside me, (b) inside the [client system + workplace system], and (c) between us?" Useful tools to help increase your process awareness in all three areas are:

  • having your Self (capital "S") guiding your other subselves; (essential!);

  • the Lesson-2 communication basics and skills (specially awareness and digging down ), and these blocks and tips;

  • mapping communication sequences and patterns , and these process factors;

  • diagramming the structure of a human system; and...

  • this summary of common surface and primary problems with these complex clients

        Beside special knowledge of (A) human systems and (B) themselves, effective professionals also need special... 

 Special Knowledge of the Therapeutic Process

        In addition to "normal" counseling and therapy basics, effective professionals will want to learn the following array of clinical topics. Many of them apply to any client. I include them because (I believe) many human-service professionals are not (a) aware of or (b) experienced with them. See if you agree if effective professionals need to know these special clinical assessment and intervention topics...

 How, When, and Why to assess clients for...

_ a)  Their nuclear-family's _ developmental stage (what kind of client are they?), and _ the intervention phase the work is beginning with.

_ b)  How clearly client spokespeople can articulate their presenting problems, and _ whether they're aware yet of the primary problems causing them. Since 1981, I have never met a client who was aware.

_ c)  False-self wounds in all nuclear (step)family members, and co-parents' awareness of _ their importance and _ how to recover from them.

_ d) The client's _ home and _ nuclear-family  nurturance levels , and _ the adults' awareness of them.

_ e) The _ type (absent > weak > strong, closed > open) and _ stability of client-system and subsystem boundaries , and _ whether co-parents are aware of these as family strengths and stressors.

_ f) The adults' _ awareness and _ use of effective -communication _ basics and _ skills - specially how effective co-parents are at problem solving general and family-related conflicts.

_ g) Whether client co-parents _ can differentiate between first-order and second-order change , and _ whether they know how this difference applies to their presenting and underlying problems.

_ h) adults' _ understanding and _ acceptance of stepfamily basics, including their significant risk of re/divorce because of five hazards , and _ knowledge of these myths and realities.

_ i ) adults' _ awareness of and _ strategies for managing _ values conflicts, _ loyalty (priority) conflicts, and _ associated relationship triangles .

_ k) possible addiction/s in grandparents' and co-parents' generations, _ whether any likely addicts are in true recovery now or not, and _ the extent and accuracy of co-parents' knowledge about addiction, recovery, and recovery resources;

_ l) the client's two nuclear-family structures : _ kids home, and _ kids visiting.

_ m) The client-system's strengths and stressors, and co-parents' awareness of each of these;

        And effective professionals will also want to learn about how, when, and why to assess divorced and stepfamily clients for...

_ n) Stepfamily- identity_ acceptance and _ understanding its implications .

_ o) Whether client co-parents have a meaningful family mission statement , and _ each co-parent's attitude about _ making and _ using such a statement in guiding their family.

_ p) Whether each re/married mate chose the right people to commit to, for the right reasons , at the right time.  If not, knowing _ how to adjust intervention goals to help the couple grieve lost re/marital dreams, and prepare themselves and their kids for probable psychological or legal divorce.

_ q) The degree of recent cooperation between co-parenting ex mates, and _ any significant barriers to caregiving teamwork in and between related homes, including membership conflicts .

_ r) How motivated each client co-parent is to reduce any significant teamwork barriers, and _ how effective  their strategies have been recently;

_ s) Client-adults' awareness of their biofamily- merger(adjustment) tasks, _ their nuclear family's status with these tasks, and _ any significant obstacles (e.g. wounds, ignorance, grief-blocks, and/or co-parent barriers) to progressing on their tasks.

_ t) Adults' _ understanding of healthy-grieving basics; _ the causes, implications, and symptoms of blocked grief; and their _ home's  and _ nuclear family's pro-grief or anti-grief policies

_ u) Significant blocked grief in kids and/or adults over _ childhood, _ biofamily, and _ stepfamily losses (broken bonds), and _ the impacts of any blocks on the recent family's nurturance level.

_ v) Client-adults' awareness of stepchild _ developmental and _  adjustment needs, and _ the status of each minor and adult child with their unique set of these needs.

_ x) Spouses' recent _ stated and _ demonstrated priorities , and _ whether mates' solidly accept that their remarriage needs to be (usually) second (to personal wholistic health ) for long-term success. Restated: assess whether each client bioparent wants to rank their marriage higher than their kids' short-term needs in impasses without compromises

_ y) How satisfied co-parents and kids are with current child _ visitation, _ custody, holiday, and/or financial-support arrangements, and _ how well co-parents can resolve disputes over these.

_ z) Whether current and/or "ex" relatives significantly support or stress the client's nuclear family system, and _ how effectively co-parents are coping with any significant stressors.

        These are common assessment factors typical professionals need to know about for effective long-term outcomes with divorced and stepfamily clients. Each item has related knowledge requisites about if, how, and when to intervene with a given client family system. Once these factors are assessed over time, professionals then need to know how to _ separate and _ rank "significant (presenting) problems" among the above, _ identify the primary problems causing them, _ avoid overwhelm and burn out, and _ weave these conclusions into an effective intervention strategy.

Requisite Clinical Knowledge about Special Interventions

        In addition to the special clinical assessment knowledge above, effective professionals want to know how to help clients _ become aware of, _ accept, _ rank, and _ reduce whichever of these 11 primary problems are relevant to their situation. Clinicians will strategically choose among these interventions based on a given client family's type and initial focus (therapy phase).

        The following can be misleading, because it is organized into discrete knowledge areas. In the therapeutic process, clinicians will probably want to use the following as a buffet to select from dynamically so applying these interventions will overlap organically, rather than follow a rigid "syllabus." The order of these general interventions in the work is important: success with later interventions depends on major progress with earlier ones.

 Preparing Clients for Effective Interventions

        Note - the lay guidebook for topics 2-9 is Stepfamily Courtship (Xlibris.com, 2003)

Topic 1) Know how to _ effectively stabilize any "crisis" the client-family adults are experiencing, and _ motivate them to continue therapy for long-term benefits (all clients). This often manifests as helping all co-parents feel clear on and hopeful about reducing presenting (surface) problems focusing on children and/or ex mates. A special case of is knowing how to effectively (a) stabilize stepfamily couples in major re/marital conflict, (b) clarify what each partner's primary needs are now, and (c) provide a framework for _ problem-solving, _ separating safely, or _ re/divorcing successfully.


Topic 2) Know how and when to prepare non-crisis divorced or stepfamily co-parents for long-term successful outcomes, by...

_  introducing the three common phases of pre and post-re/marriage family therapy, and helping them see which phase they're in; and...

_ encouraging the adults to adopt (a) a patient, long-range view vs. a short-term problem-solving focus; and to...

_ (b) avoid rigid black-white thinking and assumptions (signs of false-self dominance); and encouraging client adults to...

_ (c) adopt the curious, open "mind of a student" as they do this work together;


Topic 3) Know how and when to alert adult clients to fundamental realities that affect their family and this clinical work...

_ five common stepfamily hazards and _ related (a) surface and (b) primary problems; and (c) the concept of first-order (superficial) and second-order (lasting) change .

_ how these hazards and problems relate - specifically - to their current presenting (surface) problems; and how and when to...

_ introduce the 7 self-improvement Lessons adults can adapt to master their hazards and primary problems over time. Then professionals need to know how to...

_ overcome any c/overt (false-self) client "resistances" to the accepting and applying each of these four core concepts to their situation.


 Using the 12 Co-parent Safeguards (Projects) to Create Second-Order Systemic Changes

        After _ initially assessing client type, phase, and primary problems; and _ preparing clients for lasting (second-order) changes, professionals need to...


Topic 4) Know how and when to _ introduce and _ use Safeguard 1 concepts (all clients):

_ a) Know _ the justification for, _ goals of, and _ main steps in Lesson 1;

_ b) Know how to describe _ family nurturance levels , _ an inner-family of subselves (personality), and _ pseudo and true recovery from the six false-self wounds ; and...

_ c) Know how and when to motivate client co-parents to assess themselves and each other family co-parent for significant wounds, and _ help each other to evolve and implement an effective recovery plan.


Topic 5) Know how, and when
to
introduce and apply co-parent Lesson 2 concepts (all clients):

_ a) Know _ the justification for, _ goals of, and _ main steps in Lesson 2;

_ b) Know when and how to present effective-communication _ basics, _ skills , _ strengths, and _ common blocks; and...

_ c) motivate client adults to learn and apply these toward making second-order (lasting) changes in each primary (vs. presenting) _ inner-family and _ physical-family problem.


Topic 6) Know if, how, and when to introduce Safeguard-projects 3  and 4 : i.e. to invite divorced and stepfamily co-parents to...

_ agree on (a) what a stepfamily is, and (b) who comprises their nuclear stepfamily . This includes (c) knowing if, how, and when to _ describe what genograms are and _ how clients can make and use one to help with these two related projects;

_ accept their identity as a normal multi-home stepfamily, and...

_ accept what their identity means to their adults and kids. A key meaning to alert clients to is that the ~ 60 structural and dynamic differences between stepfamilies and intact ("traditional") biofamilies put co-parents (and supporters) at risk of up to 60 unrealistic expectations about their stepfamily roles and relationships.

_ accept that each living or dead bioparent of each minor and grown child is a full member of their nuclear divorced-family or stepfamily, regardless of _ co-parenting involvement and/or _ ex-mate problems;  and...

_ know how and when to _ help co-parents use a long-range view to _ accept that wanting to overcome any barriers to effective co-parenting teamwork (Lesson 7) helps raise their odds of _ forging a stable high-nurturance, multi-home nuclear family and _ protecting themselves and their dependent kids from the high risk of (re)divorce trauma.  


Topic 7) Know how and when to introduce and apply Safeguard-Lesson 3 : (all clients)

_ a) Know the _ justification for (benefits), _ goals of, and _ main steps comprising this healthy-grief project.

_ b) Know how and when to present _ three-level grieving basics, and the concepts of _  blocked grief, _ its common impacts, and _ personal and family grieving policies (pro or anti-grief);

_ c) Know how and when to motivate co-parents to identify key losses each nuclear-family adult and child has experienced (including ex mates and grandparents) from _ childhood, _ biofamily reorganization from death or divorce, and _ stepfamily formation ; and...

_ d) Know how and when to facilitate client co-parents'...

  • assessing their members for symptoms of blocked grief,

  • forming _ an effective family grief policy and _ strategy to free any blocked grief over time, and...

  • implementing their strategy successfully together as teammates (Topic 12). See Topic 13 for locating and using appropriate grief supports.

A key aspect of this clinical task is helping clients see and accept the causal connection between psychological wounds + ignorance + ineffective communication and significant grieving blocks in adults and kids;

        Recall - we're outlining the fourth and last area of requisite special knowledge professionals need to effectively _ assess and _ intervene with typical divorced-family and stepfamily clients.

Topic 8) KNOW if, how, and when to introduce and apply family mission statements: (all clients)

_ present and illustrate the concepts of personal, marital, and family mission or vision statements  (goals), and _ relate them to the client's presenting and primary problems;

_ use the co-parents' long-term attitude (1 above) to facilitate client co-parents evolving (a) personal and (b) a family mission statement, and discussing them constructively with other family members.

_ prepare clients to use their statements as guides in implementing all relevant Lessons in this self-improvement course.

Topic 9) Know how and when to facilitate Lesson 7 with _ courting and _ re/married co-parents:

_ Review  the five stepfamily hazards , and _ explain the concept of couples using these self-improvement Lessons to avoid the fourth hazard - i.e. to enable each partner (individually) to choose the right people (plural) to re/wed, for the right reasons , at the right time.  This is the single most effective intervention professionals can make toward protecting client families and society from the long-lasting trauma of re/divorce..

_ Know how and when to motivate courting couples to study and discuss these common stepfamily danger signs , key re/marital courtship questions , and general stepfamily ques-tions and answers.

_ Alert courting co-parents and their supporters to _ typical stepkids' adjustment needs, _ the 16 groups of things their three or more biofamilies must merge if they re/wed; and _ the common barriers to co-parenting teamwork they'll probably need to resolve together, long-term, for everyone's sakes.

_ Know how and when to encourage couples to rough-draft tentative co-parenting " job des-criptions" (including co-parenting ex-mates and/or relatives), to see what questions and conflicts occur.

_ Know when and how to refer courting couples to appropriate resources (e.g. Lessons 1-7 in this site and related guidebooks, and these) to help them make informed re/marital deci-sions.

_ Know if, how, and when to confront courting co-parents who minimize or ignore safeguards 1-7, and _ facilitate their breaking significant false-self denials ...

  • that the five hazards really do apply to them and their kids, creating...

  • high odds of eventual psychological and legal re/divorce and...

  • amplifying the psychological wounds of existing and any future children.

I propose that all human-service professionals - specially clergy and pre-marital counselors - have the same ethical responsibility to confront this as they do with apparent client abuse, addictions, child neglect, and criminal behavior.

Continue with more special clinical-intervention knowledge that effective stepfamily service-providers need.

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Updated  September 30, 2015