Effective clinical interventions with low-nurturance families

Facilitate effective communication
and problem-solving
- p. 2 of 4

By Peter K. Gerlach, MSW

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The Web address of this four-page article is http://sfhelp.org/pro/rx/cx.htm

Basic communication interventions, continued from p. 1

Intervention 2-7)  Define, illustrate, and model communication sequences, patterns, and outcomes

        Why? Clear understanding of these basic communication concepts is needed to effectively assess and improve communication effectiveness among subselves and people, using awareness, metatalk, and problem-solving skills.

Describe and illustrate the difference between what clients communicate about (the subject or topic), and how they communicate about the subject (their communication process). Then propose that a powerful way to improve family communication is for the adults to intentionally build the skill of being process aware - i.e. being conscious how they're communicating together in the present moment. The other half of this awareness is knowledge of communication basics & and blocks, & and how to avoid or reduce each of them.

Propose that any communication process can be broken into identifiable sequences of behavior between participants. A sequence starts when person A does something that causes person B to react. Then A reacts to B's reaction, and B reacts to A's reaction, and (so on). A communication sequence can have a clear ending ("Janice clicked off her cell phone.") or an arbitrary one ("Carlos changed the subject to dinner last night.").

        Sequences can be brief ("Hi - how are you?" / Fine, thanks.") or take several minutes, hours, or days. Whatever their length, all communication sequences have an outcome - i.e. (a) each participant felt they got their main current needs met well enough or not, (b) in a way that felt satisfying enough or not. "Win-win" outcomes & occur when all participants feel these two conditions were clearly met.

Propose that over time, most relationship partners develop unconscious sequences of communication sequences, or patterns. ("We begin to talk about money, we both get upset, and generally you walk out and we don't speak for several hours.")

Propose that an effective way of improving family communications is for adults to use the learned skills of awareness & and metatalk & to identify ineffective (lose / win, or lose / lose) sequences, patterns, and outcomes together. This empowers them to cooperatively identify and reduce chronic communication blocks and improve their communication outcomes (meet everyone's current primary needs well enough.)

Option - review some or all of these communication process (metatalk) terms & with client adults, and suggest that they intentionally learn to weave them into their vocabularies. This will help them be more descriptive and aware in discussing sequences and patterns, and spotting and reducing process blocks.

Follow up as appropriate to see if clients are motivated to experiment with identifying and discussing effective and ineffective sequences and patterns. If not, suspect one or more family adults are often controlled by a false self. See Lesson-1 assessment and intervention options.

2-8)  Inventory the client's current communication strengths

        Why? To (a) teach clients how to identify and describe their strengths, (b) have them experience the satisfaction of affirming their set of strengths, (c) illustrate strengths they can help each other and any kids develop, (d) strengthen their metatalk and awareness skills, and (e) provide balance (+) for their communication blocks (-).

Propose that a "communication strength" is any individual, joint, or group (family) ability, attitude, priority, knowledge, or behavior that usually promotes effective thinking, communication, and problem-solving among subselves and people.

Suggest that over time, client adults have developed a set of personal and family communication strengths, and ask if the adults can name them. Use this inventory & to raise their awareness and promote discussion.

Discuss what the adults learned from the inventory (including new concepts and terms), and suggest they help each other and other family members (a) stay aware of and (b) verbally affirm their communication strengths as they help each other to improve them. Note - shame-based (wounded) clients will usually negate or discount their strengths. Noting this objectively in sessions can promote Lesson 1 interventions.

Options -

  • affirm clients' thinking & and communication strengths as the work unfolds (e.g. "Are you aware of how you've helped us stay focused on our topic, and avoided distractions and interruptions here?"), and...

  • ask how that feels when you do. Then...

  • suggest they affirm each other at home. Wounded people (i.e. their false selves) usually won't follow through in doing this, tho they agree it would be helpful.

Intervention 2-9)  Refresh clients on psychological wounds as needed, and relate them to communication outcomes

        Why? My clinical experience with over 1,000 typical clients shows that most low-nurturance (Midwestern-US, Anglo) family adults are significantly-wounded survivors of childhood neglect and trauma -  Grown Wounded Children, or GWCs. False-self (psychological) wounds prevent effective communication even among adults who are practiced at most of the Lesson-2 basics and skills. Describing this connection adds another incremental reason for wounded clients to hit bottom and commit to wound reduction (Lesson 1) and protecting their descendents from wounds.

Review or present the concept of personality subselves & as needed (ref. Lesson 1) and check clients' acceptance of the concept. If they don't fully accept it, use some version of this letter and this safe exercise to invite their acceptance. Option - view ambivalence or reluctance to accept the reality of personality subselves as normal well-meaning, distrustful Guardian subselves controlling the person without their awareness.

Clarify or review the concepts of true Self (capital "S") and false self, and check for client understanding and acceptance. Option - review and discuss this comparison of common true Self / false self behavioral traits & as appropriate.

Review or present the concept of false-self wounds &, and check to see if clients understand and accept the concept.

Review or present the concept of communication-sequence outcomes &.  Optional terminology - lose-lose / lose-win / win-lose / win-win (effective communication). Then ask for and objectively discuss client illustrations of recent communication outcomes. Expect this to be a new concept to typical clients, so reinforce it during subsequent sessions. Option - provide a copy of this example & of win-win process and outcomes, ask clients to discuss it and relate it to their usual process, and follow up with them on their reactions.

Propose that when a person is controlled by a false self & it's often difficult or impossible for them to achieve effective communication (win-win) outcomes. This is specially true if their current communication partner/s also have a disabled Self. Explain and illustrate this as needed - in general or using client examples.

Discuss these implications -

  • ideally, client adults will want to help each other work at Lesson 1 (reduce psychological wounds) and Lesson 2 (improve communication skills and effectiveness) concurrently; and...

  • if communication blocks persist despite clients using the Lesson-2 skills, assume one or more partners is controlled by a false self, and intervene accordingly.

2-10)  Explain, illustrate, and model E(motion)-levels, Empathic Listening, and "Hearing Checks"

        Why? These basic communication concepts significantly improve people's ability to spot, discuss,  and help each other correct common communication-process blocks.

Ask "On a scale of 1 to 10, how often do you each feel heard (vs. agreed with) well enough by your partner in important conversations?" Often, family members don't feel heard well enough by one or more other members. This is specially true with kids and in conflicts and crises.

Ask that client "What do you usually (a) feel (e.g. frustrated, annoyed, and disrespected) and (b) do when you don't feel heard well enough? Typical (unconscious) strategies are to blame, name-call, interrupt, talk more loudly, repress and numb out, and/or withdraw - none of which get partners' needs met.

Ask if clients agree that kids' and adults' degree of current emotionality can shift slowly or quickly from calm to very intense ("got upset, blew up, felt overwhelmed, lost it (my self control), had a melt down," etc.) depending on physical and/or environmental events;

Propose that personal "(E)motion levels" are like the mercury in a thermometer - rising and falling in reaction to local conditions. Then propose that current E-levels can be judged as "below or above the ears" - meaning the person may or may not be able to hear a partner clearly because of their own emotional intensity. Option - note that when E-levels are "above the ears," usually people only have a one-person awareness bubble - so effective communication isn't likely until the E-level/s drop "below the ears." .

        Reality-check this: ask if clients can recall being so "upset" that they could not really hear what another person was saying at the time. Then ask them to recall a recent time where they felt unheard because a partner's E-level was "above their ears." Ask if they can recall how they reacted to this. Typically, people talk more loudly, repeat, interrupt, get frustrated and/or angry, blame the other person, and/or leave.

Define a "hearing check" as using a mutual-respect attitude and empathic listening skill to...

  • intentionally put your own needs, opinions, and agenda aside for the moment,

  • focus on your partner and use awareness skill to observe without judgment what s/he seems to be thinking, feeling, needing, and doing - and who controls her or his personality now; and...

  • periodically summarize these impressions (a) in your own words (b) with comfortable eye contact, and then...

  • be quiet and note the other person's reactions (e.g. nodding, agreeing, correcting you, repeating, continuing...); and stay aware doing this.

  • Note that using empathic listening this does not necessarily mean you agree with what the other person is saying or doing!

  • Option - ask the clients to define empathy  to help them understand the label empathic listening. Thanks to Stephen Covey for this term, which I think is more descriptive than the traditional labels active listening, reflective listening, and mirroring.

Propose that a powerful option when a partner's E-level is too high is to do one or more "hearing checks" if (a) your true Self is guiding your personality and (b) your E-level s below your ears. Well-executed hearing checks will eventually bring the other person's E-level "below their ears" so they can resume hearing you.

Follow up to see if clients are trying out hearing checks with family members - and if so, what results they get (Do E-levels come down below the ears?). Model hearing checks as the work proceeds, noting that you're doing them, and asking clients how it feels. Encourage them to use hearing checks during every session to grow their understanding and habits.

        (a) Note and illustrate the option of any family member asking for a hearing check when they're not feeling heard on an important topic, and (b) contrast this with asking: "Did you hear me?" Hearing checks demonstrate whether the listener accurately got what their partner person wanted to send. Option - ask the clients to try asking and responding in their own styles to anchor this tool and provide experience.

Intervention 2-11)  Define, illustrate, and model awareness bubbles.  For perspective, see this.

        Why? Because (a) few typical clients (or professionals) are aware of this primal concept, and (b) awareness of it promotes effective metatalk and win-win communication.

Watch for the clients to illustrate an example of an ineffective bubble, and when it's appropriate to shift the focus to these interventions, then...

Review the effective-communication skill of awareness if/as appropriate, and say you're about to demonstrate one useful aspet of it.

Use the analogy of an invisible, flexible bubble around each person's head and chest (heart), and describe and illustrate four possibilities: "Right now I'm aware of...

  • me only or you only (a 'one-person bubble');

  • you and me equally (a 'two-person bubble'), or...

  • neither you nor me - e.g. you are and/or I am focused on the past, the future, or something else."

Note that at any moment, each partner has their own type of bubble, which can change quickly from one type to another.

Define "...aware of..." as including the person's current thoughts + emotions + body sensations + needs (discomforts) + non-verbal behaviors. Give examples as needed.

Ask the clients if this concept makes sense, and clarify any questions. Then propose that effective communication is most likely in calm and conflictual situations if each person wants to maintains a steady two-person (me + you) awareness bubble. Ask clients if that makes sense, and respond as appropriate.

2-12)  Define, illustrate, and model "R(espect) messages"

        Why? To empower and motivate clients to spot and avoid or reduce 1-up and 1-down R-messages that frequently degrade their internal and mutual communication outcomes.

Review the most fundamental of six universal communication needs is to feel genuinely respected by (a) yourself and (b) every communication partner. Confirm that clients agree with this premise.

Ask clients to describe (a) a recent instance where they felt disrespected by the verbal and/or nonverbal behavior of an adult or child, and (b) how they responded to that.

Propose that when clients feel disrespected by a communication partner, they're apt to feel hurt and irritated or angry ("upset"), so (a) their false self may take over, (b) their E(motion) level will usually rise "above their ears", which (c) hinders their ability to hear the other person well (include them in their awareness bubble).

Review or describe, illustrate, and discuss the concept of awareness "bubbles," and propose that objective awareness of them in important communications enables partners to metatalk about, and problem-solve, communication blocks effectively.  most clients

2-13)  If/when appropriate, describe and illustrate mapping communication sequences to help assess situational or chronic process-blocks.


2-14) Follow up on and reinforce each of these items in future sessions.

        Why? Because these concepts and techniques are new to typical clients, and need repetitive reinforcement and affirmation until the benefits become self evident and second-order changes stabilize.


        You've just read 12 multi-step Lesson-2 interventions useful with all individual, couple, and family clients, regardless of presenting problems. Other interventions build on these to promote any client learning to understand and wanting to practice the seven effective-communication skills.

B) Communication Skill-building Interventions (with all clients)

        The seven Lesson-2 skills build on each other, so the order of these interventions matters. Effective use of each skill depends on (a) knowledge of communication basics and (b) fluency with the prior skills. Effective clinicians will watch for chances in each session to make these interventions strategically. The most cost-effective way to present and illustrate these concepts is in a seminar or class for a group of family adults (or coworkers).

        The most effective way to teach these skills is in a seminar, following the foundation topics.       

        Numbering continues from the communication-founcation interventions above.

2-15)  (a) Define "skill," and (b) ask each partici-pating client to describe and illustrate how s/he learns new skills

2-16)  Overview the seven communication skills

2-17)  Describe, illustrate, and model communi-cation awareness

2-18)  Describe, illustrate, and model clear and fuzzy thinking

2-19)  Describe, illustrate, and model empathic listening and hearing checks

2-20)  Describe, illustrate, and model "digging down" to identify primary needs

2-21)  Describe, illustrate, and model respectful assertion

2-22)  Describe, illustrate, and model win-win problem-solving (conflict resolution)

2-23)  Describe, illustrate, and model metatalk

2-24)  Propose that all these skills are equally useful with personality subselves and people.

2-25)  Follow up in future sessions to affirm and strengthen clients' skills and their benefits

Define "Skill"

2-15)  (a) Define "skill," and (b) ask each participating client to describe and illustrate how s/he learns new skills.

        Why? To (a) clarify what a "skill" is, (b) validate that each client already knows how to learn new skills, and to (c) provide context for learning the Lesson-2 communication skills

Ask clients to say their definition of "a skill" or "talent" out loud, and give several examples of skills they have developed - e.g. planning a meal or party, driving a vehicle, and how to use a telephone or PC. Reassure them you're not asking in order to judge them, but to learn what they believe.

Refine their definition as needed - e.g. shift from "Something you do real well" to "A learned or instinctive behavior that is specially effective in filling someone's primary needs."

Pick one of their skills, and ask something like "Tell me how you learned to be proficient at that."

Option - then ask if the client agrees s/he already has the ability to learn new skills - like communicating more effectively.

Summarize the Skills

Intervention 2-16)  Overview the seven communication skills  and their purpose

        Why? To (a) provide clients with a conceptual framework for these seven skill-building interventions, and (b) relate them to the basic Lesson-2 interventions.

Recall that communication is an instinctive, learned animal behavior which aims to fill current needs - i.e. to reduce current discomforts and/or increase current pleasures.

Verbally summarize and illustrate each of the skills and/or review them from a handout one at a time.

Note that (a) the skills build on these basic concepts, and (b) are hierarchical - i.e. each one uses the prior skills in the set. For example, consistently-effective problem-solving requires (a) the person's true Self to lead their other subselves, (b) clear awareness of communication basics, and (c) fluency in all six prior skills.

Ask the client if this concepts make sense. Then ask if they've ever studied or practiced the seven skills before. Expect "No." Option - note that our culture is ignorant of effective-communication basics and skills, which - coupled with widespread unseen psychological wounding - promotes a wide range of personal and social "problems." One implication is that client adults have a unique chance (and responsibility) to teach their kids these basis and skills, because no one else will.

Option - note that the client family's nurturance level is directly proportional to the adults' (a) true Selves guiding them, and (b) their shared abilities to communicate effectively - i.e. to consistently practice, teach, and model these basics and skills.

Option - illustrate and discuss how the skills can reduce clients' communication blocks effectively, one at a time.

Ask clients...

  • if they have questions about the skills individually or together,

  • whether they've ever learned of them before (Expect "No"),

  • how the skills compare to the ways clients have been trying to satisfy their recent personal and social needs - including their presenting problems, And ask them...

  • whether their minor kids know effective versions of these skills yet (Expect "No.").

Options - ask...

  • if the client-adults' childhood caregivers and teachers were knew and used these skills. Expect "No," and suggest that unaware ancestors and the school system took communication for granted, and were generally ignorant of these skills.

  • if divorcing clients feel that unawareness of these skills might have contributed to their relationship and other problems, and/or might significantly contribute to current relationship problems with kids and co-parenting ex mates;

  • if "learning to communicate effectively" is among each adult's top current life priorities. Expect "No, " and ask what it would take to change this.

Ask if client adults are willing to invest (vs. "spend") time and money now in learning these skills. Note that the skills' real benefits will become clear from practice, not studying concepts. If clients seem ambivalent or dutiful vs. truly motivated to learn, (a) suspect false selves are in charge, and consider (b) empathically exploring the reasons for the ambivalence, or (c) accepting this and just "planting seeds" for future learning.

+ + +

Continue with more Lesson-2 communication skill-building interventions...

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Updated March 22, 2014