Improve Your Human-service Effectiveness

Four Requisites for
Effective Human Service

Do you have them?

By Peter K. Gerlach, MSW
 

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

Updated  September 30, 2015

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        Typical divorcing families and stepfamilies are complex, multi-problem client systems. From 36 years' study and clinical experience, I propose that therapists, counselors, supervisors, case managers, and consultants ("clinicians") need four things for effective long-term clinical outcomes with these clients:

        This series of Web pages explores each of these requisites.

1) Special Didactic and Experiential Knowledge

        For effective outcomes with this model and these clients, typical clinicians need knowledge beyond what they got in their professional training. They (you) probably will have to learn this knowledge through self-improvement and experiential learning, because effective formal training in these subjects appears to be rare. This nonprofit Web site offers basic information on these requisite topics, based on several decades of professional research and clinical experience:   

  • family-systems principles, as applied to client and metasystem assessment and interventions. This includes knowledge of normal personal and family developmental phases;

  • understanding what causes and blocks first-order and second-order systemic changes, and how this relates to clinical assessment and intervention;

  • developmental needs of typical minor kids, and how to assess kids' status on (a) them, and (b) up to 30 common family-adjustment needs when parents separate and divorce, and start or join a stepfamily;

  • normal personal and family developmental stages, and how they shape typical adults' and kids' priorities and current primary needs;

  • principles of effective child-nurturance, family nurturance levels, and how to assess the level of any family, starting with yours;

  • understand the [wounds + unawareness] cycle, and how it affects human personality formation, composition, and functioning; psychological wound-assessment;

  • effective thinking, communicating, and problem-solving basics and skills;

  • human bonding (attachment) and loss (broken bonds), and how to use a three-level model of healthy grief to (a) assess for blocked grief and free it up; and to (b) facilitate clients forming a pro-grief family;

  • typical barriers to co-parental teamwork between divorcing and stepfamily co-parents, and how empower clients to reduce them;

  • stepfamily facts, myths and realities, developmental phases, and common stressors, and how to overcome five hazards and facilitate high nurturance levels in typical client families;

  • clinical options for identifying and empowering clients to resolve common family role and relationship problems like these using some version of this three-level concept; and...

  • special knowledge of the therapeutic process with these complex, multi-problem clients, including the use of healthy spirituality and inner-family systems therapy concepts and techniques.

        Use these quizzes to sense what you need to learn about these topics. Then study (a) this curriculum over time to increase your knowledge, and/or (b) invest in these guidebooks, and/or (c) review the assessment and intervention overviews to see required didactic and experiential clinical knowledge and skills.

        Clinicians need to use their knowledge of all these topics to assess these complex client systems and intervene effectively. Learning the mosaic of these topics and how to apply them effectively can form the framework of a self-improvement curriculum and a productive in-service program.

  Requisite 2) Key Personal Traits

        Typical clinicians using this model need three personal traits to apply their growing knowledge of the topics above effectively with trauma-recoverers and low-nurturance families:

  • ongoing self-awareness of...

    • their sensory inputs, and present-moment mental, emotional, and spiritual dynamics;

    • their dynamic system of personality subselves and who leads them;

    • their subselves' attitudes about (a) these complex client family systems and (b) clinical work with them; and...

    • personal spirituality; and clinicians also need...

  • steady process-awareness; and...

  • special clinical skills.

Each trait can be intentionally developed over time, within the clinician's limits. Here's some perspective on each trait:

Trait 1: Ongoing Self-awareness

        How would you define awareness to an average 11-year-old? Compared to the awareness practiced by veteran Zen students, average adults in our over-stimulated, hyperactive culture are largely unaware of themselves and their environment. This is a fundamental stressor in all low-nurturance families and organizations. One reason clients seek clinical help is because (Self-led) professionals are more aware than they are, and can facilitate their "in-sight."

        Premise - most (all?) adults and kids have a constantly active Observer subself. Like a competent news reporter or scientist, its innate talents are to...

  • be steadily, objectively aware of inner and outer environmental realities and dynamics now and over time; and to...

  • report them clearly and accurately without interpretation to other Regular subselves so they can decide what to do next.

Options - (a) use parts work to guide this talented subself toward improved self and environmental present-moment awareness, and (b) teach receptive clients to do the same. 

       "Self awareness" has several components: thoughts + emotions + "senses" + bodily sensations + needs + inner-family composition and dynamics + active-subself attitudes and priorities. Awareness of these dynamic, concurrent variables can focus on (a) the present moment and on (b) patterns in them over time (patterns and "habits").

        Experiment with this exercise to help build your personal awareness, and consider modeling and teaching it to family-members, clients, and colleagues. Undistracted journaling, meditation, professional massage, retreats in natural settings, and reflective movement like Tai Chi help to evolve nonjudgmental awareness of current thoughts, feelings, needs, and sensory information. The core requisite here is for clinicians' ruling subselves  to want to develop their levels of awareness.

  Inner-family Awareness

        From 17 years' study and personal and clinical experience, a core premise in this clinical model is that normal (vs. "pathological") personalities are composed of talented, dynamic subselves or "parts," like members of an orchestra or sports team. Subselves range at any moment from inactive to active, and cause our thoughts, emotions, needs, senses, some bodily reactions, and most non-autonomic behaviors. A crucial variable for clinicians and each client is which subselves lead this "inner family" situationally and over time - the resident true Self and other Managers, or some inner kids and their well-meaning Guardians - a "false self."

        Once clinicians understand, validate, and accept the inner-family concept, they need to (a) evolve an accurate roster their subselves, and (b) intentionally develop habitual awareness of which subselves are guiding their personality in and out of client sessions. For an initial sense of who's leading your personality subselves recently, meditate on this and this. For a more thorough exploration, study this slide presentation, follow the links here, and invest in this guidebook. If you're skeptical about the concept, read my letter to you, and try this safe, interesting exercise.

Status Check

        To make this essential awareness requisite less abstract, meditate on which of these best describes you now: T(rue), F(alse), or ? [I'm not sure, or it depends on (what?)]

I feel well-grounded in the idea of normal personality subselves now, and how they "behave" or I am highly motivated to learn more about this and how to apply it now.  (T  F  ?)

I'm usually clear on which of my subselves determines my personal and professional goals, values, and behaviors, or I'm proactively working to become clear on this now.  (T  F  ?)

I'm skilled at assessing whether clients and colleagues are controlled by false selves now, or I'm making significant progress at acquiring and practicing this vital skill.  (T  F  ?)

I'm presently (a) comfortable with, and (b) fluent at describing, the six false-self wounds this site proposes as being a primary cause of personal, family, and societal "problems;"  or I'm proactively working to become more comfortable and fluent with these wounds.
(T  F  ?)

Because of the core impact of personality subselves on clinical dynamics, I believe that clinicians need to be comfortable with and adept at providing intrapsychic (individual) + dyadic + and family therapy to their clients for best outcomes. (T  F  ?)

If these traits don't describe my co-workers and professional colleagues now, I'm strongly motivated to encourage them to evaluate the [wounds + ignorance] cycle and what it means to our ourselves, our families, our clients, our profession, and our society. (T  F  ?)

I'm confidant that my true Self just responded to these items. (T  F  ?)  If not, who did?

        Pause and reflect what you're aware of now - what are your subselves saying? 

        Another essential aspect of self-awareness is...

  Awareness of Your (Subselves') Key Attitudes

         As you know, attitudes are un/conscious opinions of something's or someone's...

  • value (trivial <> vital)

  • safety (nourishing <> toxic)

  • likelihood (impossible <> certain)

  • morality (good <> evil)

  • usefulness (worthless <> effective)

  • relevance (appropriate <> inappropriate)

For simplicity, we often use the shorthand "good > bad," "healthy > unhealthy," and "right > wrong" to express concurrent general or specific attitudes. Your attitudes come from your dominant subselves, and affect every aspect of your life and work. Attitudes range from nourishing and healthy to toxic and lethal.

        Two groups of attitudes are key in providing effective human-service work to trauma-recoverers and divorcing-family and stepfamily clients. One has to do with "appropriate" professional therapy focuses, modalities, standards, and practices. The other has to do with these clients themselves. To illustrate this large subject, rate yourself on these typical attitudes in each domain. Then imagine assessing each client adult strategically for their attitudes on these key subjects, and deciding if, when, and how to help raise their self-awareness of them.

        Changing someone's attitude - including your own - is a complex and potentially-useful intervention. Do you have an effective way of doing that now? One approach is to identify which subself or subselves "owns" the target attitude, and use respectful parts work to negotiate with him/her to adopt a healthier belief.

        Pause for a moment and reflect - what are your subselves saying and feeling now?

        To augment inner awareness, effective clinicians also develop...

Trait 2: Process (Environmental) Awareness

        Process awareness is being habitually conscious of dynamic variables in me + in you + between us + around us - now, and over time. This consciousness is provided by the tireless Observer and other active subselves. Key process variables include...

  • (a) what am I thinking, feeling, sensing, hearing, smelling, doing, and needing; (b) what are my breathing and body telling me now, and (c) which subselves are guiding my personality now and over time?

  • (a) what do you seem to be thinking, feeling, sensing, hearing, smelling, and needing; (b) what is your body doing now (e.g. posture, eye contact, voice dynamics, breathing, etc.); and (c) which subselves seem to be guiding your personality now and over time?; and...

  • what are our recent, current, and chronic communication dynamics? e.g. -

    • what are we focused on (e.g. surface or primary needs?), and how does that relate to (a) the client's presenting problems, and/or (b) what I think the client needs to learn and/or be aware of? 

    • each participant's current communication needs, and do they mesh or conflict?

    • do we each / all have two-person awareness bubbles, or something else?

    • where are each of us focused: the past, the present, or the future?

    • are we each receiving believable =/= R(espect) messages, or something else?

    • are we communication effectively? If not, why, and what are my options?

  • Is anyone in this session significantly distracted so they can't focus on our work? If so, what do they need now? "Distraction" usually results from several subselves ignoring the Self (capital "S") and "talking over" each other about differing perceptions, needs, and priorities. If this is chronic, clients may be unaware of being unfocused and grounded until the clinician asks them to breathe, reflect, and identify any physical, emotional, and/or mental "distractions."

        Effective clinical training and supervision will motivate clinicians to learn to automatically monitor these concurrent process variables, and develop wise judgment about when to act on their awareness in every situation.

Recall why you're reading this, and continue with a summary of special clinical skills required for each phase of the work with these clients. Do you need a break first?

        Besides steady self and process awarenesses, another personal trait needed for effective outcomes with trauma-survivors and low-nurturance family clients is...

Trait 3: Special Clinical Skills

        Premise: a skill is a learned mental, emotional, spiritual, and/or physical ability to achieve some specific effect on the environment - like maintaining a high-nurturance family in a changing world. Some skills are more impactful and difficult to achieve than others - e.g. effective brain surgery vs. creating attractive Easter eggs. Some skills are innate ("Miko really knows how to tell a good story"), and others are developed via focused study, practice, and experience.

        You may distinguish between a skill and an art, which adds personal creativity, intuition, and vision to a skill. Some educators are skilled at transferring knowledge to others. Others are artists that inspire students to love learning and applying knowledge to achieve their life purposes. Do you see systemic clinical work as a skill, an art, or both?

        Providing effective systemic therapy is a set of learned and/or innate skills to (a) assess the functioning (nurturance level) of a human system, and (b) intervene strategically to promote lasting (second-order) changes. Some people are naturally gifted with one or both abilities, and the rest of us must develop them over time. These skills are enhanced by didactic and experiential knowledge (requisite 1).

        Because typical divorcing families and stepfamilies are so complex and different from intact biofamily systems, human-service professionals need to develop special skills to fill their and their clients' primary needs effectively. As you know, being knowledgeable about a skill differs from demonstrating it.

      Basic clinical skills required for effective service to any client include...

  • process awareness

  • effective communication

  • needs assessment

  • listening empathically

  • effective problem-solving

  • directing / asserting

  • empathic listrening

  • role playing

  • stabilizing crises

  • seeding (suggesting) ideas

  • prescribing symptom/s

  • focusing

  • goal setting

  • affirming / validating

  • indirect suggestions

  • teaching / coaching

  • affirming and encouraging

  • referring

  • strategic helplessness

  • selective self-revelation

  • strategic humor

  • directing

  • ranking (prioritizing)

  • paradoxic interventions

  • imagery / story telling

  • clarifying / simplifying

  • confronting / frustrating

  • strategic questioning

  • facilitating safe change

  • restating / reframing

  • assign tasks and follow up

Pause and reflect - which of these skills do you feel competent-enough at now, and which do you need to develop? Are you proactively doing so?

        Effective work with childhood-trauma survivors and divorcing families and stepfamilies requires developing extra skills (a) in general, and (b) for each phase of the work. Let's overview each of these. Option - use this as a checklist for skills you have and others you want to develop.

In General, develop competencies at...

  • applying systemic principles to each client case and session, including the metasystem of the clinician + client family (+ clinical organization If any) + any active consultants and/or organizations like schools, churches, and legal, medical, welfare, and law-enforcement agencies;

  • building initial client trust in the clinician's special knowledge and competence ("I'm very familiar with the problems you're describing.");

  • discerning (a) the client type and (b) the initial phase of the work, and assessing accordingly;

  • assessing multi-home family-system structures, teaching clients about them when appropriate, and intervening where needed to improve the structure;

  • assessing each client's inner and outer family strengths, and encouraging clients to identify, affirm, and enjoy them regularly;

  • assessing client adults and kids for false-self dominance and wounds, and what to do about them;

  • developing and implement a healthy family grieving policy over time;

  • assessing client adults and kids for (a) significant past and recent losses  (broken bonds), grieving permissions and policies, and incomplete or blocked grief, and (b) what to do about any problems with these; 

  • alerting clients to the difference between surface and primary needs, and why and how to identify the latter in important and conflictual situations;

  • assessing for communication and problem-solving ignorance and problems, and competence at helping to motivate clients to understand and improve these. This includes competence at helping client adults understand, avoid, or spot and resolve significant values and loyalty conflicts and persecutor-victim-rescuer (PVR) relationship triangles.

 And effective clinicians will work at developing special competence at...

  • strategically shifting clinical modalities between individual, dyadic (marital or parent-child), and family (group), as the work progresses;

  • helping clients learn to manage personal and family change effectively.

  • helping clients adults and kids understand the difference between guilt and shame, and why this is important to their family members;

  • educate clients as appropriate on the [wounds + unawareness] cycle

  • (a) identify any excessive and/or unrealistic divorce-related guilts, and (b) reduce them to normal. This may require some form of i nner-family therapy;

  • engaging kids' "other parents" (ex mates) and/or their relatives in the work;

  • helping parents (a) understand, accept, and evaluate the special family-adjustment needs of each minor child, and (b) agree on how to help kids fill these and concurrent developmental needs cooperatively.

  • assessing and intervening effectively with these presenting and underlying problems;

  • using personal and client spirituality as a resource;

  • using handouts and homework assignments to facilitate the work;

  • evaluating professional consultants (e.g. a grief, wound-recovery, or child therapist), and (b) if, how, and when to use them in the work;

  • advising local law, school, welfare, and medical systems on the adjustment and long-term needs of these complex client families;

  • clarifying couples' current and long-term priorities;

  • motivating couples to maintain a stable, long-range viewpoint (e.g. 25-30 years),

  • motivating couples to rank-order their current and long-term primary (vs. surface) needs;

  • assess the client-family's support system, and motivate clients to use relevant resources (e.g. wound recovery, divorce recovery, and stepfamily education and support) that other clients don't require; and...

  • know how to spot and admit personal burnout, and what to do about it; and...

  • know how to judge and use effective supervision and peer support; and...

  • know if, how, and when to promote effective clinical termination.

        Pause and reflect - what are you aware of as you read this summary of required general clinical skills?

Recall why you're reading this, and continue with a summary of special clinical skills required for each phase of the work with these clients. Do you need a break before continuing?

+ + +

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