Here, an intervention is some planned or instinctive behavior
by a counselor or therapist which causes a meaningful change in a
client system of subselves or people. Effective interventions
reduce or resolve client's primary "problems" - i.e. empower them to
safely fill their primary needs.
This is one of three checklists on effective clinical
interventions
with
of divorcing-family and stepfamily clients. It is based on 26 years' study and live clinical experience with
many hundreds
of typical marital and family clients. The checklist assumes you
are familiar with all five elements of this
The other checklists summarize key interventions with
divorcing-families and stepfamily
clients, and with individual persons
(wound-recovery work).
These reference checklists aim to help clinicians, supervisors, and consultants (a) plan
effective treatment strategies and (b) measure progress in their
work with a given client family. Links connect to background on the
primary problems and/or to outlines and examples of each
intervention.
Premise: typical
adults and children are unaware of their current internal and
external processes - i.e. their thoughts, feelings,
needs, body signals, and behaviors, and what these mean. They
also are usually unaware of behavioral sequences and patterns
(repeated behavioral sequences). Teaching clients to become more
process aware - in and out of clinical sessions - can help empower
them to fill their primary needs more effectively. Implication:
to raise clients' process-awareness, clinicians need to be steadily
process-aware themselves.
Prerequisites to any of these interventions are (a) validating any
"crisis" the client adults are experiencing, and (b) working to
stabilize it. Suggestions on doing effective crisis intervention are
beyond the scope of this article and series.
Selected Process
Interventions
Premise: Effective clinical outcomes (filling
are most likely if clinicians (a) automatically monitor three
inter-related processes in every client contact, and (b) use this
awareness to tune session dynamics to fit desired local and
long-term outcomes. The processes are...
-
their own dynamic thoughts,
feelings, senses, needs, and body sensations, and (b)
whether their true Self
is
their
or not; and...
-
empathically sense these variables
in each other person present; and monitor...
-
current verbal and non-verbal
behaviors, and behavior
among all people in each session and across multiple
sessions.
Skilled supervisors and consultants can help
clinicians learn to be steadily aware of these three inter-related
domains and how to use their awareness strategically. Clinicians
with harmonious subselves are most apt to develop and use accurate
empathy and
Reality check:
on a scale of one
(I'm never aware of these three domains)
to ten (I'm clearly aware of them all the time),
my recent process-awareness skill is about a ___.
See if you think that adopting any of these process
interventions would significantly improve your clinical outcomes
with any clients. Options -
-
try each intervention in different
situations, and note the results over time...
-
use this checklist to promote
constructive supervisory and/or self-critique guidance
-
modify this checklist, give a copy
to clients, and ask for feedback on which of this interventions
they find helpful. This can also act as a reminder to them
outside clinical meetings, and a guide for teaching their kids
to be process-aware..
__ 1) Process awareness
- Teach clients
to (a) be objectively aware of the three process-domains above, and
(b) encourage them to help each other be aware of them at home. The
more aware they are, the more options they have for accurately
discerning and filling their current primary needs.
Awareness is the most basic of
seven learnable thinking and communicating
See Project
2 and its
guidebook for many skill-building
resources.
__ 2)
Distraction-checks - Begin any clinical session by asking each
person present to check themselves for physical, mental, or
emotional distractions that might hinder with the work. One way of
doing that is to ask each person
"What are you aware of (in
yourself) now? Is anything distracting you from being fully present
here?" If the answer is "Yes," the clinician needs to decide
whether to ask for more information and focus on reducing the
distraction, or ignoring it. Option: to help decide this, ask
something like "On a scale of one (little) to ten (total), how big
is this distraction for you now?"
__ 3) Role definitions
- Some clients - specially those dominated by a false self and/or
who have never experienced professional therapy or counseling before
- are unclear what their and the clinician's roles
(responsibilities) are. This can cause unrealistic expectations and
hinder effective session and overall clinical outcomes. Guard
against this by saying something in the first meeting (and
subsequently as appropriate) like -
"Your family members are my employer now. I'm here to help you learn
how to fill your primary needs without helpers like me." Some
clients who are dominated by insecure or overwhelmed inner children
fear taking full responsibility for themselves, and insist that the
clinician and/or other family members are responsible for solving
their problems.
__ 4) Session objectives (needs) -
At the start of every session, ask each participating client to
identify what s/he wants to get - specifically - from the meeting.
This can sound like...
-
"What would you like to walk out of
this meeting with?"; or...
-
"What do you need to get from this
meeting?"; or...
-
"Pause and reflect - why did you
come here today?"
Clients often respond with surface
generalities like "to feel better," "to fix my problem," "I want to
talk about..."; or "I want (someone present) to understand
(something general)." The second half of this process intervention
is to help clients "dig down" to discern their underlying primary
needs.
If the clinician asks awareness-raising questions like these at the
start of several successive sessions, clients often will become
self-motivated to walk in the door with a clear idea of what they
need from the meeting.
__ 5) Need-blocks -
Once clients identify their primary needs from the session
(vs. overall), ask them "Why
did you need to come here to fill that need? What prevents
you from filling your need outside this meeting?" A related
question is "What do you need from me in this meeting?" Doing
some version of this can illuminate one or more unidentified primary
problems (needs) - e.g. "Well, this is the only place my partner and
I can talk without distractions." - which suggests the real
problem/s are (a) one or more people are ruled by a false self,
and/or (b) one or both partners don't give high priority to "talking
together" for some reason/s.
__ 6) Session-process options
- (a) Teach
participating client adults the different process options you and they
can select from, and (b) facilitate their awareness of which of these
options they're choosing as the session unfolds:
-
venting - needing to describe
current thoughts, feelings, and needs, and be empathically
understood and accepted. A common kind of venting is... .
-
explaining - clients usually
need family members and the clinician to understand and
empathize with why they did or didn't do something in some
situation/s. This is specially true if a client feels
misunderstood or blamed for something unfairly (feels criticized
and/or attacked).
-
problem-solving (conflict resolution) - assessing primary
needs and brainstorming win-win ways to fill them. As the work unfolds,
help
client-adults stay objectively
of their process and avoid these common problem-solving
For instance, if clients get stuck in venting, explaining,
blaming, or defocusing, interrupt them and ask something like
"In the last __ minutes, have you (or we) been
problem-solving, or doing something else? Is this what you
came here to do?"
-
clarifying and/or
affirming someone's perceptions, values (including
priorities), needs, and/or goals
-
learning / teaching - clients
and the clinician gaining new
information from each other in the context of the presenting and primary problems
- e.g. "Let me suggest the important difference between guilt
and shame," or "Let me summarize the
and the purpose they all serve." Learning can be didactic and/or
experiential ("Let's do a role play of __").
Option: review these options
briefly at the start of a session, and ask "Which of these would be
most helpful in our meeting?" If different family members have
conflicting needs on how to use the session, use that to
model cooperative prioritizing and win-win
("Let's explore how each of you can get enough of your needs met
here...") Note that the phrase
"I need to process (something)
with you" is a catchall phrase for needing several or all of
these.
__ 7) Hearing checks
- Premise: most client adults and all client children don't
know how to listen
in conflictual, confusing, or scary situations - and they don't know
they don't know. So a powerful process intervention is to (a) ask a
client to "say back" what they just heard from someone in the
session, or (b) observe that you (the clinician) just listened
empathically (did a "hearing check.") When someone does a hearing
check, invite the clients to notice the first speaker's reaction ("I
see Alice is nodding her head now"), and ask the original speaker
"Are you feeling heard well enough now?" If the answer
is "Yes," affirm the listener ("Looks like that was an effective
hearing check. Notice how you both feel right now...")
__ 8) Focusing - help
clients grow objectively aware of where they and the group are
focusing (a) recently (e.g. in the last 10"), (b) in the session so
far, (c) across several sessions, and/or (d) outside the sessions.
Variables:
-
time frame -
discussing the past, the present, or the future - e.g. "How does
focusing so intently on the past (or future) help you fill your
current primary needs?"
-
person/s -
focusing on the needs, traits, and/or behaviors of yourself,
another person, or several other people. A related intervention
is to discuss two or more clients'
in the session and/or elsewhere.
-
relationships -
focusing on filling partners' needs in a marriage or a
parent-child, sibling-sibling, ex-mate, or other family
relationship;
-
topic - focusing
on session (clinical) goal/s or something else - e.g. "I notice
we started by focusing on reducing Marge's fear of bankruptcy,
and now we've switched to your frustrations from the financial
values-differences between Marge and Robert. Are you all feeling
done with the first topic?"
-
process - which
of the session-process options above are participants focusing
on so far?
__ 9) Strategic silence
- (a) the clinician's silence and/or intentional avoidance of
eye contact, and/or (b) asking clients to be silent for a time, can
promote useful personal and group awarenesses. This can be specially
useful if a client is talking incessantly or obsessively, which
usually indicates they're controlled by a false self.
__ 10) Awareness
checks - at any point in the session, the clinician can say to
one or more people "Pause, breathe, and reflect - what are you aware
of now?" This can be more revealing than "What are you thinking
or feeling now?"
__ 11) Balance checks
- at strategic points, ask clients something like "How do you feel
about who's doing most of the talking in our meeting (or several
meetings)?" If the clinician notices one or more clients choosing to
be silent "too much," s/he can invite that person to speak, or ask
"Is there something that would make it more comfortable for you to
say what you feel and need here?".
__ 12) Outcomes - At
the end of a session or series of sessions, ask clients something
like "Are you (each) getting enough of what you came here for?"
Alternative: "Do you feel we're making enough progress on your goals
here?" Option: whether the answer is "Yes" or "No," discuss
why.
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