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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:

The premises underlying this nonprofit, ad-free site Normal personality subselves - text Grown Wounded Children (GWCs) and what it means to be a GWC The [wounds + unawareness] cycle - text Three steps you can take to break this cycle These clinical and lay terms

        Before continuing, pause and reflect - why are you reading this article? What do you need?

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        This page introduces a series of articles on effective clinical interventions with typical divorcing-family and stepfamily clients. This series builds on articles on the four other parts of the clinical model proposed in this site - specially on clinician qualifications and effective client assessments.

        Here, an intervention is any intentional or reflexive behavior by a clinician (counselor or therapist) that causes significant change in the client's family system - in someone's opinion. Some interventions described here apply to up to all six client-types, and others are unique to a given type. Use this glossary as needed to compare the terminology in these articles with your definitions. 

       Though the interventions described here are discrete and modular, note that in real life, family-system stressors (adult wounds, ignorance, and unfilled primary needs) are interactive, not discrete. Thus actual interventions need to fluidly build on and refer to each other. Paradoxically, clinicians need to be "organic," while keeping themselves and the clients steadily focused on a prioritized set of treatment goals.

Contents

• What is an effective clinical intervention?

• Summary of common clinical interventions

• What's unique about intervening with typical divorcing-family and stepfamily clients?

• Key interventions for all divorcing-family and stepfamily clients, from most to least impactful.

What is an Effective Clinical Intervention?

        This model proposes that all human behavior (thoughts + emotions + actions) is caused by current primary (vs. surface) needs - physical, emotional, and/or spiritual discomforts. To nurture means "to fill someone's needs." Families exist and persist across eras and cultures because they're generally more effective at filling some key adult and child primary needs than other human systems. 

        Professional counseling and therapy aim to help clients make second-order (core attitude) changes that promote nurturing themselves and others better. Counseling provides strategic knowledge that may or may not promote better nurturing. Therapy expands counseling to systematically identify and reduce mental, psychological, and spiritual blocks to effective personal and family nurturance. From 36 years' didactic and experiential research, this model proposes that typical divorcing and stepfamily clients are stressed by up to five interactive blocks, or hazards. The first four apply to all families.

        Effective clinical strategies with typical divorcing-biofamily and stepfamily members will use "standard" + special systemic interventions to avoid and reduce these hazards. I assume you're familiar with the standard (basic) interventions summarized below. These Web pages focus on intervention-options that are designed for typical divorcing-family and stepfamily clients. 

        By definition, effective clinical interventions will fill clearly these clients'...

• surface needs ("presenting problems") - e.g. "Please help us deal with my hostile ex spouse," and the...

• immediate and long-term primary needs that client family members are unaware of, but the clinician knows - e.g. "You really need to want to learn about family nurturance + healing psychological wounds + communication basics and blocks + how to assess for and free up blocked grief."

This implies that effective interventions require a clinician to (a) know how to assess each client system for these two levels of needs, (b) form specific related short and long-term case goals (a "treatment plan"), and (c) devise interventions to reach the goals - i.e. to fill the client-family's and clinician's needs well enough, according to all participants.

        Pause, and compare this definition to your own. What do you notice?

        The unique composition, history, and situation of each client family precludes anything like an intervention "cookbook," with a few general exceptions. The client's immediate needs; the perception, intuition, experience, knowledge, values, and skill-mix of the clinician; and relevant service-provider policy constraints; will shape what interventions are appropriate, why, and when. Making spontaneous effective judgments on these is an acquired skill and art.

Review: Types of Clinical Interventions

        For perspective on these intervention pages, review these "standard" interventions that may promote effective clinical work with most clients. If you feel comfortable with these, skip the comments after the table and go here. A meta-intervention that transcends all others is the clinician's ongoing process awareness: consciously and unconsciously sensing moment by moment "What's going on inside each of my clients + inside me + between us all? "What's going on" includes thinking + feeling + needing + doing - moment by moment, and over time.

        Veteran clinicians will be able to spontaneously list and describe their own set of  "standard" interventions, and discuss when each one is appropriate (useful) in the work. Trainees are learning how to do that. Basic interventions like these are like an artist's collection of brushes and pigments. The art of effective therapy is in knowing how and when to use any of these to fill all participants' current surface and primary needs well enough. 

reducing distractions reframing / rephrasing metatalk, mirroring assigning tasks respectful confrontation "grief work" Taking notes in session role playing sentence completions strategic helplessness strategic phone calls, letters, and emails

generalizing goal setting clarifying / "digging down " validating and affirming fantasy  / guided imagery following up strategic silence and brevity handouts and games in/direct questioning inner-family techniques diagrams and maps changing or mixing clinical modalities

video and/or audio recording seeding / suggesting prioritizing and re/focusing teaching and modeling family sculptures / psychodrama nurturing humor paradoxical interventions summarizing (recapping) clinician's use of self "future self" interviews proposing termination referral and collaboration

         Here's a little detail on most of these - in general, and relative to divorcing and stepfamily clients:

       1)  Asking about distractions at the beginning of a session - e.g. "As we begin, what are you (each) aware of now?" A variation that yields more information is "Would each of you guesstimate what the person on your right is aware of / thinking / feeling / needing now?" Variation of this opening question can uncover physical, mental, or emotional distractions that a client might not otherwise mention. ("I'm worried that I locked my keys in the car.") This intervention teaches, demonstrates, and promotes process awareness.

        2)  Goal setting - identifying specifically what the client needs from the clinical work. Useful for all clients, this early and ongoing intervention is essential with stepfamily clients because they're usually multi-problem, unfocused, and chaotic - personally, and in and between their co-parenting homes. A primary need typical co-parents usually bring is not knowing how to focus, rank, and work on their problems a few at a time as teammates, and (a) not being aware of this or (b) knowing how to change it. Variations of this intervention include defining (c) session goals ("What would you like to leave our meeting with?") and (d) overall clinical-process goals ("How will you know when we're done with this work?"). The client's and clinician's goals will often differ as the work unfolds, because qualified clinicians know more about immediate and long-term primary needs and relevant topics.

        3)  Seeding - is intentionally using words, phrases, and behaviors that plant a new idea, attitude, or option in the attending clients' un/conscious awareness. Seeding leaves the client free to keep their existing beliefs and reflexes, and avoid change-related anxieties. The clinician may strategically build (focus more concretely) on seeds later in the work. Because typical divorcing and re/married co-parents are wounded (e.g. anxious and insecure) and unaware (vs. stupid), patient, strategic seeding is specially useful with them as the work unfolds.

        4) Teaching - providing accurate, clear new information - or new framing - relevant to the client's declared and unacknowledged needs. This core intervention is useful across all three phases of the work with these clients because of their major unawarenesses. Asking strategic open-ended questions is an effective indirect way of teaching - e.g. "What would you be worrying about if you didn't need to worry about this (presenting problem)?"

        5) Reframing - offering a different interpretation of some emotionally-charged aspect of the client's personality or life - e.g.

• "You'd be in harm's way without normal, healthy guilt and shame...",

• "Grieving is painful, and is essential for making new bonds and relationships."; and

• "Often, co-parents are pleased to realize that their stepfamily offers some unique benefits to all their members that make solving the challenges worthwhile." 

A universally-helpful reframe is encouraging judgmental (wounded) clients to let go of the toxic belief that emotions like anger, shame, fear, hostility, and guilt are "negative." ("How do you feel about the idea that all human emotions are natural reflexes that can help us learn what we and other people need at the moment?")

        6) Clarifying and (re)focusing - these standard interventions are specially useful with typical multi-problem, disorganized, chaotic, overwhelmed divorcing and stepfamily clients. Modeling these interventions in the session and using metatalk to describe them ("Notice what I'm doing now, and how you react to it...") helps motivate clients to build their own abilities to focus and clarify. Because these multi-problem clients usually have a high need to vent and bounce from topic to topic, and often display fuzzy thinking, the clinician steadily (vs. rigidly) focusing the work on one or two key goals can help everyone end each meeting feeling productive. One of many benefits to intervening with respectful, brief " hearing checks" is helping a speaker clarify what s/he means, thinks, and needs now.

        Three key focal areas to be aware of are time ("I notice you're focusing on the past, now"), persons, roles, or relationships ("If I ask what you're feeling now, you often talk about your daughter"), and topic ("We've just shifted from your loyalty conflict to talking about your vacation.")

        7) "Digging down" - this Lesson-2 skill is an exceptionally useful concept and strategic intervention with all adults and kids. It helps promote desired second-order (lasting) changes by identifying (a) surface needs, (b) the current primary needs causing them, and (c) who's responsible for filling them. Most co-parents are aware of this skill, so teaching and modeling it for them early in the work will usually grow their problem-solving effectiveness, confidence, and teamwork - if co-parents' true Selves lead their personalities.

        8) Empathic listening, validating, praising, and encouraging - because typical divorcing and stepfamily adults and kids carry special burdens of shame, guilt, anxiety, and self-doubt, these basic clinical interventions are specially helpful with them - unless insincere, ambivalent, or overdone. A related intervention is teaching clients to _ become aware of their current process, and help each other do hearing checks ("So you're saying that...") in session and at home.

        9) Imaging, metaphors, and guided imagery - these are specially helpful for "visually-oriented" (vs. kinesthetic or aural) clients, particularly in the third (inner-family) stage of the work. Sometimes asking clients to draw / paint / collage certain things moves the work ahead. 

        10) Fantasy - this can be an assessment tool and a "seeding" intervention. E.g. - "How will your daily life be different after you solve this problem?" / "What will happen if you don't decide to solve this problem?" / "Imagine talking with your elderly (future) self about your major life decisions, as you're preparing to die. If you make no changes now, how would that conversation go? (or "How would you want to feel?" / ... have that conversation turn out?" / "What questions would you want to ask? etc.") There are many variations to this, useful in a range of therapeutic strategies - including grief-work. 

        More useful clinical interventions with these five client types ...

        11) "Sculpting" - guiding clients to physically pose and interact to symbolize a current or desired relationship. Showing two or more client-family members how to do a two-part relationship or family sculpture can be a therapeutic "new experience" which bypasses defensive intellectualizing and overanalyzing ("analysis paralysis") that many wounded clients (specially males) choose. Two options  to sculpt are: "how you are now;" and "how you'd like all (or both) of you to be." At the right time in the work, and with attention paid to participant safety and dignity, this non-verbal intervention can break impasses, open up major new awarenesses, and often lead to release tears and nurturing laughter. This is specially useful with adults and kids.

 

        12) Assigning tasks ("homework") - most stepfamily clients and many divorcing clients have a lot to learn. Giving attending clients a series of reading, journaling, confronting, discussion, experimenting, questionnaires, and "family- research" assignments ("Find out from ______ if s/he ...") can help the work in many ways:

• make the client co-responsible for the changes they want;

• illuminate subliminal anxieties, guilts, ignorances, family secrets, distortions, and shames; and...

• constructively disturb the "family dance" in and between co-parenting homes, to raise awareness and promote useful confrontation and change. A group of tasks can be to use or make...

        13) Checklists, questionnaires, games, and diagrams. You'll find many examples throughout this site and in the related guidebooks. These experiential interventions educate, assess, clarify, and promote focused awareness and discussion in session and as homework. Copies of checklists and questionnaires can be given to non-attending client family members and related professionals. These can also document  clinical and client-family progress - e.g. "Save this family (or relationship) strengths worksheet, fill it out together next year, and enjoy seeing what you all have changed." The index link to each of these 12 co-parent projects shows worksheets and checklists you can use or edit.

        Three graphical intervention-tools are specially useful with all clients: multi-generational genograms , household and nuclear-family structural maps , and communication-sequence maps . A flip-chart easel and/or dry-marker or chalkboard in the meeting room allow real-time diagramming and illustration.

         Two non-competitive board games that can be specially helpful (and fun!) for courting and newly-re/married stepfamilies are the Ungame, and LifeStories. They provide safe, enjoyable ways for adults and kids of any age to get to know each other.

        14) Following through - Many psychologically- woundedpeople have a pair of inner-family Guardian subselves who manifests as a People-Pleaser /Good Client, who enthuses over homework assignments and agrees to them, and a Procrastinator who "puts them off," (alternative: a "Forgetter" subself). Following through on homework repeatedly says "I'm serious about them," "I expect you to follow through as your part of our clinical contract," and "If you seem to avoid them, I'll call you on that and ask to explore it with you."

        15) Nurturing Humor - this mood-moderating intervention is useful in any clinical setting, if moderate, genuine, and not sarcastic, demeaning, defocusing, or distracting. A common symptom of false selves is the Pleaser personality part who overuses humor to win approval and avoid scary conflict and (feared and expected) rejection. Another symptom of this protective Guardian subself is a client smiling and joking as s/he describes a trauma, loss, shame, or fear.

        16) Respectful disagreement and confrontation, including blocking client attempts to control the work. This has many uses, including clinician-client role and  boundary -setting, modeling respectful assertion , "I" messages , and win-win problem-solving vs. whining, threatening, withdrawing, avoiding, etc.

        17) Strategic silence and/or brevity.  As client discomfort mounts, specially with direct eye contact, these respectful interventions may promote a guarded client to own and demonstrate their current feelings, thoughts, and surface needs. An alternative is an over-concerned (false-self ruled) clinician rescuing and enabling - i.e. taking too much responsibility for filling the client's needs.

        18) Paradox (double bind) - this is a class of artful multi-level interventions which promote client change by sincerely prescribing against it - e.g. by prescribing the presenting symptom, or instructing the clients to "heal by getting worse." Respectfully used, paradoxic interventions are specially helpful with over-intellectual and approach-avoid (wounded) clients whose false selves play variations of the "Go ahead, try to help me" / "Yes, but..." / " That won't work because...") recreational game. These interventions can also help illuminate primary problems causing the surface (presenting) problems, at times. 

        Examples 15-17 above belong to a class of frustrating interventions. Well used, these can help insecure clients take responsibility for filling their own needs. Other examples are answering a client's question with "I don't know," or mirroring a question without answering ("You want to know if I approve of your decision").

        19) "Grief-work" is a group of empathic, strategic interventions which aim to facilitate blocked grievers move through one or more of the three mourning levels. Grief-focused interventions are more apt to produce second-order (lasting) systemic changes after teaching the client healthy-mourning basics (Lesson 3) and promoting their Selves to lead their personality. Describing these interventions is beyond the scope of this summary, and is a clinical specialty for some therapists. This model proposes that blocked grief often stresses for these complex client families.

        20) Inner-family therapy interventions are powerful in the third (intrapsychic) phase of the work, specially if inner-family concepts have been seeded in prior phases. These aim to help individuals harmonize their subselves into a true team under the leadership of the resident true Self. Examples: building an inner-family roster, re-doing (early traumas); subself job retraining, rescuing (parts stuck in the past); collaborating with the client's true Self to co-direct the work; direct access (communicating directly with a client subself); and so on. The Lesson 1 guidebook for inner-family work is Who's Really Running Your Life? (Xlibris.com, 2002; 2nd ed.)

        21) Recapping past achievements and current goals. Summing up the key process and content aspects of each session, and/or inviting the attending clients to do that, promotes focusing and ranking, process awareness and metatalk skills, reinforcing key learnings or realities, and models a helpful behavior clients can use at home. Recapping key targets and events across a series of clinical meetings can provide useful perspective and highlight progress (or lack of it) - e.g. "Across these last __ meetings, the key issues we've worked on are ..."; and "I need to verify our goals. You've told me the issues you still want to improve are ..." Recapping from case notes promotes continuity and/or closure if the work pauses, stops, or resumes.

        22) Questioning. This multi-purpose class of interventions is a clinical sub-specialty and an art. Beside harvesting information, direct and implied questions can also be valuable seeding, teaching, clarifying, and focusing interventions. Qualified clinicians will strategically shift real-time between open-ended and closed (yes / no) questions, and can teach this distinction as a useful co-parenting skill.

        23) Note taking. Because typical stepfamily clients are structurally and dynamically complex, I find it helpful to take brief shorthand notes as each session unfolds. I explain what I'm doing and why, and ask if clients are comfortable with it. I say "These are our (vs. 'my') notes, and I show them to no one else, without your permission. You can read them any time." In 36 years' practice, no clients have ever asked me not to do this, or to read the notes. The notes may be a word, a phrase, a symbol, or a quote that I clarify and expand on after  the session. They include _ process comments ("Jerry avoids eye contact with me and Anne"); _ diagnostic opinions ("blocked grief"); and _ reminders ("follow up on this / give homework / refer to .... "). 

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        This summary of basic clinical interventions is illustrative, not exhaustive. With several exceptions, they're all "talk-therapy" oriented. They all aim to produce some desired systemic changes , based on prior assessment of the client's and clinician's respective surface and needs . Do you see your favorite  interventions here? See any new ones you want to explore or develop? Do you ever review which interventions you use often, and how effective they are? Note the distinction between clinical interventions and modalities - e.g. individual, conjoint, group, play, co-therapist, multi-family group, telephone, etc. Choosing and changing a modality for a given client are intervention options.

Continue with an outline of key interventions for each type of client:

• biofamilies adjusting to mate death or divorce (pre-courtship)

• courting co-parents (pre-legal stepfamilies)

• legal (re/married) stepfamilies - non-marital presenting problems

• legal stepfamilies - marital presenting problems

• re/divorcing stepfamilies

 Option: see this for more detail on key interventions and techniques.

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Updated 09-30-2015