Help clients understand and break the lethal [wounds + unawareness] cycle!

Checklist: Intervention Options for
Common Process "Problems,"

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?

+ + +

        Here, an intervention is some planned or instinctive behavior by a counselor or therapist which causes a meaningful change in a client's system of subselves or relationships. Effective interventions reduce or resolve client's primary "problems" - i.e. empower clients to safely fill their primary needs.

       This is a checklist of effective clinical interventions with six types 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 clinical model. Also see these related checklists of key (a) therapeutic-process interventions and (b) intrapsychic interventions for clients needing to reduce psychological wounds.

        This is meant to be a reference tool for clinicians, supervisors, and consultants to help (a) plan treatment strategies and (b) measure progress in the work with a given client family. Links connect to background on the primary problems and/or to outlines and examples of each intervention. Depending on the type of client, interventions (a) apply to a family, a committed couple, or an individual. They range between therapeutic-process interventions to didactic and experiential educational interventions. Key therapeutic-process interventions are summarized in this checklist.

Common Intervention Goals

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

10explore 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 "process awareness," 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 true Self is steadily guiding their personality during each session. Another factor is whether the clinician's Observer 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 Cynic / Doubter subself.

3) a client subself tries to control 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 scared or shamed 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 Inner Critic or Judge may be protecting vulnerable shamed, guilty, and/or scared inner kids.

11) an adult client adopts a helpless "victim" role, 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 Manager subselves 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 Egotist and/or Entitled inner kids and/or Guardians. The Magician 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  awareness bubble" 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 Shamed Child and/or Guilty Child 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 Abandoned Child and/or Good (dutiful, responsible) Child and the protective People-pleaser 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 1-up (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 needs, 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 

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Updated 04-30-2013