01) Define and rank the
presenting (surface) and underlying primary systemic problems
02) Explain and model
empathic listening and "hearing checks"
03) define needs,
and propose that "problems" are unmet needs
04) introduce the concept
of family "nurturance levels," and relate that to the client's
situation
05) ask clients to define
"effective communication," and propose your definition
06) ask clients to rank
themselves 1-10 recently as "effective communicators"
07) explain and illustrate
surface and primary problems
08) check co-parents for
acceptance of stepfamily identity and understanding the implications
of it
09) ask participating
co-parents to identify their top 3-5 priorities, recently
10)
explore resolving any significant family-membership conflicts
11) ask client adults to
define (a) a "values conflict," and (b) their current strategy for
resolving them in their family
12) ask client adults to
define (a) a "loyalty" (inclusion/exclusion) conflict, and (b) their
current strategy for resolving them in their family
13) ask client adults to
define (a) a "relationship triangle," and (b) their current strategy
for resolving them in their family
Introduce the concept of
the [wounds + unawareness] cycle
Clinical-process
Problems and Interventions
To
provide effective service, the clinician must usually be
objectively aware of the
interactive dynamic processes in themselves + in each
other person present in a session + among all session participants. This
talent and learned skill is called
which is a mix of real-time observation + intuition + empathy + conceptual knowledge.
A key factor in effective (useful) process-awareness is whether the clinician's
is steadily
their
personality during each session. Another factor is whether the
clinician's
subself is available and able to provide accurate impressions to the Self.
With experience, training, and maturity, each clinician develops strategies
to correct a range of "process problems." The links in this
section lead to summaries of my strategies, developed over
17,000 hours of direct clinical practice with persons, couples, and
families. These are meant to suggest possibilities to you, not to decree what you
"should" do.
These
process problems are divided into two groups:
-
those mainly caused by false-self dominance
and wounds (a disabled true Self), and
-
those probably caused by ignorance alone, or
ignorance and
wounds.
Several process problems can occur at once, and/or
several participating clients can cause a concurrent mix of these problems. Interventions are suggested for each group, rather than for
individual process problems. The problems are not prioritized - they all tend to hinder effective clinical work. This is an
illustrative, rather than exhaustive or "complete" checklist.
Common False-self Client Behaviors
1) General case: one or more participating client-family
members demonstrate clear symptoms of
false-self control in and outside of clinical sessions. See this for
perspective and intervention options.
2) a client is significantly skeptical about
the clinical process and/or the clinician's authority and/or
effectiveness ("I really doubt that you can help us."). This
usually indicates local personality control by a distrustful, dedicated
subself.
3) a client
subself tries to
the session,
and/or to challenge the clinician's authority and/or leadership.
Variation: the client gets into dogmatic "power struggles" ("I'm right,
you're wrong!") with the clinician and/or another family member.
4) a client frequently says "yes, but...",
and/or argues and debates with the clinician or other participants.
See #s
5) a client is consistently late to
sessions, and/or cancels frequently. This may indicate a
rebellious child controlling their personality, and/or another subself
covertly expressing anger and/or anxiety at having to "go to therapy
(and experience major discomforts and losses)."
6) a client
consistently vents, complains,
whines, blames others, and/or plays "poor me;" rather than
learn and problem-solve. This usually indicates dominance of one
or more
or
inner kids (kids) and their Guardians who fear confrontation and
self-responsibility.
7) a client repeatedly focuses on the past
or the future, rather than working to identify and fill current and
near-future needs. See # 5.
8) a client is
frequently vague, verbose, and
unfocused (rambles). By implication, the controlling subself
doesn't trust the Self to identify problems and resolve them without
causing someone major discomfort and risk.
9) a client ignores the clinician's
invitations to do "homework" assignments and excuses
and/or rationalizes doing so. See #s 3, 4, and 7 above.
10) an
adult or child client repeatedly ignores,
disrespects, blames, or discounts another family member,
and avoids self-responsibility and accountability. The
well-meaning
or Judge may be protecting vulnerable shamed, guilty, and/or scared
inner kids.
11) an
adult client adopts a helpless
and insists the clinician or another family member must tell him
or her what to do. This usually indicates that one or more
shamed, guilty, and scared inner kids and their Guardians distrust the
to protect them, and need to take over the personality.
12) a client frequently sends mixed or
double messages, and acknowledges or denies this. This usually
indicates that their personality leadership alternates between two or
more subselves who (a) distrust the true Self, and (b) disagree on
something - like whether to risk making some personality-system or
family-system changes or not.
13) a
child or adult client frequently interrupts and "talks over" other
participants, and tends to dominate the sessions. This may
indicate personality control by the
and/or
inner kids and/or Guardians. The
may insist this is justified and appropriate behavior, and that
discomforts from it are "not my problem." This protective false-self
behavior promotes a "1-person
that inhibits effective group problem-solving.
14) a client
compulsively over-focuses on explaining
(justifying and defending) their actions in and/or out of the session.
This usually implies one or more Guardian subselves distrust the Self to
protect an active
and/or
from painful ridicule and embarrassment.
15) a client repeatedly disrupts or
distracts others during the session, and may claim "I can't help it,"
and/or blame another person for it. This generally signifies
their true Self's inability to calm and comfort other subselves and earn
their trust to manage the person's behavior safely in the clinical
process.
16) a client
compulsively tries to please
the clinician (be a 'good' client), and often discounts or avoids asserting their
own needs, feelings, and boundaries. This usually indicates an
and/or
and the protective
Guardian subself control the person's personality
17) a client is excessively
apologetic, self-doubting,
and/or self-critical during sessions and/or outside of them. This
is usually caused by an overactive Shamed and/or Guilty inner child.
This invites other people (including clinicians) to adopt a
(superior) relationship attitude, which blocks effective communication
and problem-solving.
18) a client is over-guarded and reticent,
(i.e. excessively anxious and distrusting), and contributes little to
clinical sessions despite respectful invitations to do so. This is
probably caused by dominant scared, guilty, lost, and shamed inner kids
and their diligent Guardians.
[Wounds + Ignorance] Process Problems
Other
process "problems" may be caused by a combination of false-self dominance
and/or ignorance of key concepts. Interventions :
1) a client is unclear and/or conflicted
about what s/he needs from the session. This can be false-self
dominance (e.g. unfamiliarity with identifying and validating personal
rights and
and/or shamed and/or guilty subselves avoiding doing so), and/or
ignorance of the therapeutic process and possible benefits.
2) a client is significantly distracted
(physically and/or emotionally) from being fully present during the
session. This includes being sleep-deprived, injured, disassociated,
and/or in an altered mind state from prescribed or other
chemicals.
4) a client is confused and/or conflicted
about what s/he needs from the clinician - i.e. on what the clinician's
role is
8) clients are forced to attend (e.g. by
court order), and are c/overtly resistant to or skeptical about the
utility of the therapeutic process and/or the authority and
competence of the clinician
11) client couples repeatedly bicker and
fight, rather than problem-solve.
26) a client shows inappropriate affect
(e.g. laughing at a sad or abusive situation)
27) a client is over-analytical and
intellectual, and withholds, mutes, or blocks appropriate emotional
responses
28) one or more clients is demonstrates
little or no process awareness in and/or outside the session
29) a client repeatedly uses one or more
effective-communication blocks in and/or out of the session
30) a client is emotionally over-reactive
during one or more sessions - e.g. raging, sobbing, pacing,
hyperventilating, screaming, storming out, throwing things
31) a client
The
Web address of this article is https://sfhelp.org/pro/rx/px_index.htm