Help clients bvreak the lethal [wounds + unawareness] cycle!


Introduction to Effective
Clinical Interventions
 with Low-nurturance Families

By Peter K. Gerlach, MSW
Member NSRC Experts Council

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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?

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       This article begins a series based on this clinical model's framework for assessing low-nurturance client families for a group of common primary stressors. A "low nurturance family" is one in which members seldom get their primary needs met in wholistically-healthy ways. An effective intervention is an instinctive or intentional behavior of the clinician which significantly raises the family's nurturance level, in the opinion of all involved. This article ...
  • offers an introductory perspective,

  • defines "effective intervention" in this context,

  • summarizes what's different about intervening with these complex, multi-problem clients

  Perspective

        Needs are caused by current emotional, physical and/or spiritual discomforts. A problem occurs when one or more people have unmet current personal and/or social needs. Typical problems have surface symptoms (e.g. "I need to get gas for the car."), and underlying primary discomforts that cause them ("I need to end my anxieties about being stranded far from home, being harmed, and worrying everyone.") People hire mental-health professionals because they can't fill one or more of their current primary needs themselves.

        To intervene means to "come between." Here, this means to strategically "come between" clients and their current ineffective ways of thinking, perceiving, and behaving, to empower them to consistently fill their primary needs themselves.

Two Levels of Systemic Change

        One implication is that there are two levels of systemic change, which Dr, Paul Watzlawick and colleagues have labeled first order and second order. First-order change shifts surface needs (symptoms), and second-order change permanently alters a person's (subselves') primary beliefs, priorities, values, attitudes, and perceptions. The former promotes trying fruitlessly to change unwanted and harmful behaviors like smoking, over-eating, impulse-spending, lying, rageful outbursts, affairs, and addictions  ("bad habits").

        Even if a clinician is (a) aware of both levels of change and (b) is adept at helping the client discern his/her/their current primary needs, it's unlikely the client family will be able to fully satisfy them if one or more of their adults is governed by a false self. Implication: Clinicians need to assess for false-self domination in various sessions and client situations, and watch for strategic chances to use Lesson-1 interventions as appropriate.

Why People Hire Clinicians

        This clinical model proposes that typical clients can't fill their current needs well enough often enough because.they're unaware of...

  • often or always being governed a well-meaning "false self" - i.e. by one or more personality subselves who distrust and disable the wise resident true Self, which is usually capable of filling current primary needs; and they're unaware of...

  • the difference between surface needs and primary needs; and...

  • how to accurately discern and fill their and others' primary needs (think, communicate, and problem-solve) effectively and cooperatively. ...

Also, their well-meaning false selves steadily seek relief from discomforts now (immediate gratification), and therefore persistently focus on surface problems.

Hazards and Projects

         One of the unique features of this clinical model is that it proposes five widespread systemic stressors (hazards) that promote most personal and family "problems":

  • undetected psychological wounds in one or more adults and kids, caused by inadequate early-childhood nurturance and cultural unawareness;

  • adult unawareness of a group of inner and social dynamic and key topics;

  • incomplete or blocked grief in one or more client family members;

  • wounds + unawareness + neediness + societal ignorance and permissions cause many couples to commit to the wrong people, for the wrong reasons, at the wrong time - specially in stepfamilu unions; and...

  • stepfamily adults can find little effective help in their communities and the media when they need it.

Premise: These stressors are symptoms of the lethal [wounds + unawareness] cycle that is silently weakening our families and spreading down our generations. So the core intervention here is societal: (a) alerting people to this cycle and its toxic effects, and (b) motivating and empowering them to mute or stop it in their relationships, homes, and communities. This non-profit Web site exists to do just that.

        This clinical model also proposes a sequence of 8 self-improvement Lessons  that aware clients can learn, adapt, and use to avoid or reduce these four or five stressors and enjoy high-nurturance relationships, homes, and families.

        These articles for professionals necessarily distort reality in several ways. First, they focus separate-ly on assessment and intervention, when in real life these occur interactively as the work evolves. Second, focusing on specific interventions ignores the reality that each client family and session is unique, so the intervention examples here must be illustrative, not absolute.

        Use the following index for information on each Project's key interventions.

Interventions with All Clients

Lesson 1a) - present the basic concept of personality subselves and relate it to the clients' presenting problems. See * Lesson 1b) below

Project 2) - improve thinking, communicating, and problem-solving effectiveness

Lesson 3) - facilitate a healthy family grieving policy, and facilitate freeing any family members' blocked grief

Project 6) - encourage client adults to evolve and use a meaningful family mission statement

Project 8) - help committed couples strengthen their relationship

Lesson 10) - help families with one or more minor or adult children build co-parenting teamwork, co-parent effectively, and increase their nurturance level

Lesson 11) - encourage family adults to build and use a support network to fit their needs

Lesson 12) - grow adult awareness of their personal and family balances over time, and facilitate their improving these balances effectively

Interventions with Courting Co-parents

Project 3) - (a) facilitate client adults accepting their stepfamily identity and what it means,  and (b) identify and resolve any major family membership (inclusion / exclusion) conflicts

Lesson 7) - (a) facilitate client adults learning stepfamily basics, (b) identify any major stepfamily misconceptions, and (c) propose and discuss  probable realities for each of them.

Project 7) - use the prior six Projects to motivate and empower courting co-parents to choose the right people to commit to, for the right reasons, at the right time.

Interventions with Committed Stepfamily Co-parents and Kids

Lesson 7) - facilitate family adults evolving and following an effective biofamily-merger plan

Projects 10, 11, and 12 - per the above

* Lesson 1b) - facilitate effective inner-family therapy if one or more adults has hit personal bottom and is motivated to admit and reduce psychological wounds, free their true Self, and and harmonize their subselves.

Interventions with Re/divorcing Families

Help the couple review (a) the wisdom of their courtship-commitment decisions, and (b) options for saving the relationship. If it is beyond salvage, (c) facilitate a successful re/divorce for the client family, including appropriate grieving in kids and adults.

  What is an Effective Clinical Intervention?

        The premises above suggests that to intervene effectively, clinicians, supervisors, case managers, and consultants need to...

  • understand and fully accept the factors above,

  • use them to assess clients accurately with a two-level, long-range systemic paradigm, and...

  • (a) teach and (b) empower clients to make wholistically-healthy, second-order (core attitude) changes to their inner-personal, family, and social systems.

Empowering typical clients requires qualified clinicians to (a) assess their knowledge and beliefs, and educate them on these basic ideas as needed; (b) answer related questions, and (c) facilitate wounded client adults to enable their true Selves to guide their other subselves (personality). This is often not possible, because wounded adults have not hit true bottom yet, and are not motivated to make second-order changes in their lives.

        Pause and reflect: how does this proposal compare with your current beliefs and practices? Who's

 answering - your true Self, or a protective false self? How do you know?

  What's Unique About These Interventions?

        From extensive post-graduate education + personal wound-recovery + 36 years' research and practice, the assessment and intervention paradigms described in these articles are significantly different than traditional therapeutic frameworks. These combined differences may inhibit clinicians who are uncomfortable with changing their beliefs and behaviors from experimenting with these techniques.

        The differences result from adopting the old idea that normal people have an inner-family system of semi-independent personality "parts" or subselves that is often dominated by a well-meaning "false self." This unseen dynamic promotes most presenting problems. Few clinicians and fewer lay people accept this, so far. If you're skeptical, read my letter to you, and try this safe, interesting exercise. Then see what you think.

        Another uniqueness is that these interventions are systemic, hierarchical, and multi-modal.

  • A systemic view requires clinicians to believe that clients' personal and dyadic "problems" (unmet needs) are caused by the combined, interactive dysfunction of individuals' inner and relationship subsystems, rather than by discrete individual problems like "alcoholism," "affairs," or "depression." A systemic view also will determine if and how clinicians assess and intervene with a client-family's structure.

        Problem-focused and client-centered practitioners may find this systemic framing alien and perhaps unacceptable;

  • A hierarchical view invites clinicians to assess and intervene considering...

    • interactive "layers" of individual needs (surface, intermediate, and primary), and...

    • subsystem interactions (inner-families of subselves + dyads + subsystems - e.g. marital + parental + sibling + multi-home subsystems - e.g. custodial, non-custodial, and relatives' related homes.    

  • A multi-modal view posits that effective interventions with these clients are proportional to the clinician's motivation and ability to shift dynamically between individual, dyadic, and family modalities as session dynamics and treatment goals evolve. This also applies to co-therapists, supervisors, case managers, and consultants. 

Clinicians who are uncomfortable and/or inexperienced with these views are likely to get limited results at best with this or their own clinical model - unless their governing subselves will try these views with an open mind.

        This 12-part scheme of interventions here is also unique in that it uses integrated concepts of family-system nurturance levels + effective systemic communication + bonding and healthy three-level grieving of broken bonds. Individually, these concepts are not new. What may be new to some clinicians is the interactive combination of these elements and the other factors summarized above in assessing clients and making case goals and strategic interventions over time..

  • they view client families in a variable time-frame -  i.e. these interventions work backwards from long-term family welfare to avoiding and reducing primary problems in the present. And for stepfamily clients, they...

  • use an experience-based framework of unique norms, realities, developmental stages, and interactive problems based on 27 years' research and experience. 

        Finally, some professionals may not have evaluated the pros and cons of using the client typology in this model. It is is based on the developmental phases of typical low-nurturance families, and provides a practical framework for deciding which interventions are appropriate for which client. Within that, it is a guide to how relatively important each intervention is. For example, most Lesson 7, 4, and 7 interventions are best used with type-2 clients - courting stepfamilies.

        Reading the outlines of these interventions will provide a wide-angle context for understanding the overall strategy behind them. It will not provide enough information to decide whether to adopt individual  interventions or not. Tailoring them to fit your style and circumstances and trying them with a variety of clients following appropriate differential systemic assessments is the best way to judge their effects and worth.    

 Recap

        This article is the first of a series for clinicians on effective interventions with low-nurturance families and psychologically-recovering persons - Grown Wounded Children (GWCs). It (a) offers basic perspective on two levels of systemic change, and the five stressors that promote most presenting problems. Ther article also proposes two reasons typical clients can't fill key current primary needs well enough, often enough - so (some) seek professional help.

        The article suggests that the 12 sets of interventions outlined in this series are significantly different from general clinical traditional for several reasons. An implication is that many veteran "traditional" clinicians will discount or reject this paradigm because it differs too much from what they're used to. Clinicians guided by true Selves will be most apt to try these ieas with an open mind, and judge them by results with a range of clients over time.

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Updated September 29, 2015