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

Useful Clinical Intervention Techniques -
p. 1 of x

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 summarizes some useful techniques I've developed since 1981 in working with self-referred and court-referred divorcing-family, stepfamily, and trauma-recovery clients. These techniques (interventions) may or may not fit your style. Either way, I hope reading these examples will raise your awareness, creativity, and professional effectiveness with these complex, needy client families.

Selected Intervention Techniques

        These teaching techniques are useful with most client families. Use them strategically to augment other interventions:

  Clarify Client Priorities  

        This technique is useful with (a) Grown Wounded Children (GWCs) whose false self consistently neglects their wholistic health, and with (b) conflicted mates whose ruling subselves chronically rank their relationship too low. It prepares such couples to admit and resolve major loyalty conflicts.

  Grown Wounded Children

        Before hitting true bottom and progressing on wound-recovery, most typical GWCs (survivors of childhood neglect) habitually neglect their own health, needs, and welfare. They may or may not admit this to themselves or other people, and/or they rationalize it or say "I can't help it."

Goals: This clinical technique will not correct the client's self neglect (excessive shame), but can help them break some denial about it and its implications - like admitting the reality of their personality subselves and related psychological wounds, and the value of personal wound recovery.

Participants - a client adult and the clinician

Best time to do this - before confronting the GWC on his/her psychological wounds, or soon afterwards.

Preparations - agree with the client on definitions of needs, wholistic heath, shame and guilt, and neglect. Option - first review this Bill of Personal Rights with the client, and ask him or her to identify which of them s/he currently lives by.

Technique - at an appropriate point in the work flow, ask the client something like "Help me understand  what your top 4 or 5  life priorities have been in - say - the last x months. There's no right or wrong answer." Use empathic listening to acknowledge the client's answer without judgment or comment.

        If s/he includes "my wholistic health" or equivalent, decide whether this matches your perception of the client's recent behaviors. If so, affirm that and congratulate the client. If not, factually confront him or her on examples of behavior that indicate self abandonment and neglect - e.g. "You've taught me that you often skip breakfast, use cigarettes and anti-depression medication, and work 60 or more hours each week - is that so?"

        If the client doesn't include some version of "my health or welfare" in describing recent priorities, point that out objectively - "I notice you don't include your own welfare and health in your priorities. Are you aware of that?" Options - ask (a) "What do you feel your self-neglect is teaching your kids about valuing and caring for themselves?", and/or (b) "How would you describe each of your childhood caregivers' attitudes about self-love and self-care?" This technique can lead to a range of strategic Lesson-1 interventions about subselves, psychological wounds, and wound-recovery if the client is receptive.

  Troubled Couples

        Premise: to maintain a stable, mutually-satisfying primary relationship and high-nurturance family, each mate must want to (a) adopt a long-range view (e.g. the next 25-35 years), and to (b) put their integrity wholistic health and first, their relationship second, and all else third - except in emergencies. Typical troubled couples are (a) unaware of their recent life priorities, and/or may be (b) denying them and their implications. Mates who are ruled by a well-meaning false self will often say "the right thing" about their recent priorities, while their actions show something different. If confronted on this double message, they'll typically deny, discount, and/or rationalize it. 

       When bioparents actions consistently demonstrate that their job, their kids' welfare, or something else is more important than their primary relationship, marital and family stresses bloom. Typical courting co-parents do rank their thrilling new relationship first or second. Stepfamily mergers inexorably force bioparents to choose - repeatedly - between their re/marriage and their kids, for years. Typical unaware mates don't have honest, focused discussions about their priorities after they commit and cohabit. One or both mates not steadily valuing their relationship highly usually indicates (a) significant false-self wounds,  (b) unresolved guilt about marital or parental "failure" and kids' pain, and/or (c) making up to three unwise courtship choices.

Goals of this technique are:

  • propose and explain the priority scheme above, and learn clients' receptivity to it;

  • raise partners' awareness of their recent real priorities,

  • promote clients learning to discuss their priorities cooperatively;

  • identify skewed priorities, and discuss implications and options constructively.

Participants - the clinician and a client couple

Best time to do this - after learning and affirming each mate's presenting problems and relationship needs, affirming their major relationship strengths, starting to build foundations of effective communication and problem-solving, and learning their impressions of what hinders their relationship. You can try the technique before or after the couple admits they have significant relationship problems. This technique is specially helpful in exposing one surface cause of a stepfamily couple's trouble resolving loyalty conflicts and relationship triangles.

Preparations - (a) confirm you agree with this priority scheme. If you don't, or are ambivalent, don't use it; (b) wait until the couple's shared focus is on a significant relationship problem, their E-levels  are "below their ears," and (ideally), their true Selves are guiding their respective personalities.

Technique - Say something like "Would you each be willing to spend about 15" doing an interesting, safe exercise that will shed some light on (one or more relationship or other family) problems?" Framing it this way usually will get a "Yes."

        Say "I'd like to learn how you each see an important factor in your partner." Pick one partner to go first ("A") , and ask "(Name), would you describe what you observe your partner's top 3 to 5 life priorities are in the last x months, as judged by her/his actions vs. their words? There is no right or wrong here - just observe as though you were an objective scientist or news reporter." Let partner "B" know s/hell soon have a chance to describe her or his own opinion, and to summarize on their partner's recent top priorities.

        Note "A's" answers, and nonjudgmentally affirm them with empatic listening ("hearing checks.") If an answer is too general or vague, ask "A" to be more specific - e.g. if s/he says "To have a happy family," ask "A" to explain what that means ("How would your partner judge if you all had a 'happy family'?"). Collect and paraphrase at least three priorities - five is better. Thank partner "A," and say "We'll learn your mate's opinion of her/his priorities in a moment, but first let's balance the scales. Before we do, each of you take a moment to breathe, focus, and notice what you're aware of now. there is no right or wrong..." Note each client's body language, breathing, and eye focus.

       Ask client "B" to thoughtfully describe "A's" recent life priorities as judged by actions, not words. Block any attempt to judge, generalize, or evaluate, and keep "B" focused on the exercise. Affirm each answer with a hearing check, and take notes so you can review the answers in a moment.

       After both people have described their partner's apparent recent priorities, then ask each to describe their own priorities in the chosen time frame. Record answers in a table like this, and invite clients to make their own tables to refer to later.

Partner A

Partner B

B's priorities (1 - 5) A's priorities (1 - 5)
A's own priorities (1 - 5) B's own priorities (1 - 5)

        When you're done, ask "What are you aware of now?" and/or "What do you learn from this exercise?" Option - confirm that the couple has never done this exercise before. After they respond, discuss (a) how well the partners agreed on assessing each other's priorities, and (b) if and where their primary relationship ranks in each quadrant of the table. If it ranks high for both mates, affirm that and congratulate them on this strength. If not, discuss the implications, without judgment.

        In low-nurturance families and/or significantly conflictual or unbalanced partnerships, the relationship will often rank low for one or both people or will not appear on the list at all. This raises the odds that (a) one or both are wounded and may be unable to genuinely bond, and/or (b) one or both re/married for the wrong reasons.

Next - select among these other Project 8 interventions, focus on strengthening couple communication effectiveness (Lesson 2), or pick another clinical target.

Sculpting Exercises 

        Having clients do something physical in a session can be more effective than talking to provide strategic experiential learning. "Sculpting" is one way of doing this with two or more people. Four of many possibilities are (a) the "I'm right!" exercise for chronic arguers; demonstrations of (b) a family loyalty-conflict and  (c) a relationship triangle with adults and kids, demo, and (d) inner and outer family sculpting.

  "No, I'm Right!"

        Chronic arguing or fighting between adults or adults and kids is a common stressor in many families. It is usually a symptom of deeper issues like psychological wounds, incomplete grief, and ignorance of effective-communication basics and skills.

Goals - this technique promotes two arguers experience the lose-lose futility and silliness of each seeking to "win" a dispute. This experience can raise client receptivity to learning the win-win problem solving attitudes and skills in Lesson 2.

Participants - the clinician and two adult or child clients, alone, or in a group.

Best time to do this - when (a) all clients in the session are undistracted and guided by their true Selves, and (b) the common focus is on replacing specific or chronic arguing or fighting with win-win problem solving.  

Preparations -

  • have both people admit without guilt or shame that they often get into mutually-frustrating power struggles or frustrating arguments in which neither of them gets their main needs met.

  • Identify a safe-enough example (one which will not raise any clients' E-levels "above their ears") of something that triggers a chronic argument.

  • It may help to (a) define win-win and lose-lose communication outcomes, and/or (b) discuss the "payoffs" of habitual power struggles or arguments, before using this sculpting technique.

Technique - Ask if clients are willing to try a brief, safe, interesting, exercise to lay the groundwork for reducing chronic arguing. If more than two clients are present, ask the "non-arguers" to be students and observers. Stand up, and ask the arguers to stand in front of you and face each other about a foot apart, with adequate space around them. Ask each to extend their dominant (usually right) arms with their forearms pointed up, and to clasp hands comfortably. Then ask the two to maintain comfortable eye contact throughout the exercise. Option - ask "How does this feel, so far?"

        Explain that this exercise is not about physical strength or force, but about learning. Coach each person to maintain eye contact as you talk, and expect some discomfort at this. Ask the people to mentally focus on the selected dispute, and be open to noticing their thoughts and feelings without judgment. Then ask one person to start the exercise by firmly moving their partner's hand 90 degrees (usually counterclockwise) to be parallel to the floor, and say with some firmness "I'm right!"

        Then ask the other partner - keeping good eye contact - to rotate the other person's arm 180 degrees in the other direction (parallel to the floor), and say firmly "No, I'm right!" Then ask both people to repeat this cycle over and over again, with increasing intensity and vocal volume - keeping good eye contract. If clients stop or deflect, ask them to stay focused and keep doing the cycle. Options - suggests that clients use spontaneous variations like "You know I'm right!" or "I'm always right," "I am smarter / wiser / superior to you," or "You're totally wrong here." Invite the people to get some real emotion into their statements, without clowning or burlesquing. Then say calmly "Now keep this up for the rest of your life," and possibly sit down. A common result is that one or both start to grin or laugh as they experience the lesson.

Next - Begin or continue teaching clients effective-communication basics and skills (Project 2), and encourage them to practice. See role-playing.

  Loyalty-conflict Sculpting

        Illustrate family loyalty conflicts experientially using this exercise with three clients like a stepparent, bioparent, and stepchild.

Goals - to help clients...

  • understand and feel what it's like for each person in the conflict,

  • see what a better alternative looks and feels like,

  • experience how to talk cooperatively about loyalty conflicts, and...

  • give clients an exercise they can use with other family members and supporters to promote common understanding and useful problems solving.  

Participants - two or more clients family members, alone or in a group.

Best time to do this - in a family session, immediately after an adult or child complains about being "caught in the middle," or when the discussion focuses on family members "taking sides." With courting couples, initiate the exercise without waiting for such an opportunity, for typical couples are on "good behavior" and will usually discount or deny serious loyalty conflicts. All participants should be physically and emotionally undistracted, and guided by their true Self.

Preparations - (a) do the priority exercise first, to sensitize couples to the core issue of who really comes first with each of them. (b) Optionally, use Lesson 7 interventions first to help clients accept their identity as a normal multi-home stepfamily , and what that means. One meaning is that they will be continually confronted with values and loyalty conflicts and associated triangles for years. (c) Clinicians may explain and illustrate the concept of loyalty conflicts befor or after the exercise. Arrange the furniture to provide a clear space perhaps 12 feet by 5 feet. Allow at least 30" to do this exercise.

Technique - Ask if clients are willing to try a safe interesting exercise that will help them understand and resolve various family members feeling "stuck in the middle" between two or more other members. If more than three clients are present, ask the non-participants to act as observers and reporters.

        Ask the three clients to stand side by side facing you, and appoint or select one person to be "in the middle." Have them move apart, and ask the middle person to extend their arms straight out on either side. Then ask each "outside" person to face the middle person and grasp her or his outstretched hand or wrist firmly with both their hands. Option - ask "What does this feel like, so far?"

        Now ask each of the outside people to tug on the middle person's arm, and demand "Be with me!" / "Side with me!" / "Choose me!" Encourage the middle person to say anything they want to, as the others tug and demand on them. Options - ask the middle person to say something like (a) "Please stop pulling on me - I feel stuck in the middle between you two!"; (b) "Hey - we have another loyalty conflict going. Let's do some win-win problem-solving instead, OK?"; and/or (c) "I hate having to choose between you two!" 

Keep this up for several minutes, asking clients to improvise in what they ask or say, and to escalate their tugging and demanding. Note their body posture and voice dynamics as the exercise progresses. If anyone's E-level goes "above their ears" or (more commonly) someone start laughing, stop the exercise,

        With the clients still standing, ask each person to pause, breathe, and and describe what they're aware of. Ask "is this what it feels like for each of you at home sometimes?" Then say something like "This is a common, unavoidable dilemma in all divorcing families and stepfamilies. It can be called a  'loyalty conflict' because each outside person demands that the middle person be loyal to (support) them over one or more other people. Often there are more than three people involved, and several loyalty conflicts can occur at once (along with relationship triangles). Option - repeat the exercise until all three people have been in the middle. If there are observers, ask what they're aware of.

        If time and stamina allow, ask "Please show me (vs. tell me) how each of you would like this tug of war to go." Options -

  • ask the three to remember and sketch a real recent loyalty conflict involving them, and stand in a circle facing each other with comfortable eye contact. Ask each of them to say something like "Right now, what I need from each of you is..." Direct the others use empathic listening to affirm they hear the speaker clearly. Reiterate that needs - physical, emotional, and spiritual discomforts - are normal, and that win-win problem-solving aims to fill everyone's current needs well enough.

  • ask mates to define their current long-term priorities, and propose that by putting their marriage second (below personal health and integrity) in loyalty conflicts without acceptable compromises, they're really putting the kids' needs first long-term by avoiding possible redivorce trauma.   

  • summarize useful terminology for members to adopt and teach other family members, to help everyone validate, discuss, and resolve (or avoid) loyalty conflicts effectively - e.g. loyalty (or inclusion) conflict or equivalent, in the middle, marital priorities, relationship triangle, values conflict, compromise, impasse, dig down, assert, hearing check, and primary needs.

  • Ask "who in your home and family is responsible for avoiding - or spotting and resolving - loyalty conflicts? (Best answer - "all of our adults.")

        Have everyone sit down and ask (a) their reactions to this exercise, and (b) what they learned from it. Then ask what they want to do the next time a loyalty conflict occurs in or between their homes.

Next - Options 

  • Invite the family to (a) discuss loyalty conflicts in a family meeting, and/or (b) choose a "loyalty conflict 'scout,' to help spot and alert other members to this kind of conflict; and/or (c) teach other family members and supporters about this concept;

  • explain and illustrate values conflicts and/or relationship triangles, and how they relate to typical loyalty conflicts and each other.

  • introduce the idea of a family strategy (plan) to (a) avoid and (m) spot and resolve situational or chronic loyalty conflicts. If useful, discuss mates' current priorities, and/or do (or recall) this priority exercise. Use priorities to overcome loyalty-conflict impasses when viable compromises can't be found.

  • choose relevant Lesson-2 (communication), 3 (stepfamily identity and membership), 4 (realistic expectations), 7 (wise courtship choices), 8 (remarital), 9 (merging biofamilies), or 10 (forging a co-parenting team) interventions;

  • focus on identifying and resolving excessive guilts (a) in stepparents "forcing" their mates to choose between them and a biochild (or someone), and/or (b) in bioparents for honestly ranking their kids ahead of their adult partner "too often." The latter may be a symptom of significant false-self wounds, incomplete or blocked grief of prior losses (broken bonds), and/or re/marrying too soon.

  • follow up in future session to learn if client adults (a) have discussed and adopted this priority scheme, (b) told other members of these loyalty conflicts, and (c) are helping other family adults and kids avoid or manage loyalty conflicts more effectively.

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Return to the techniques index, or continue with sculpting techniques to illustrate (a) relationship triangles, and (b) present and desired external and internal family dynamics.

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Updated April 30, 2013