Toward effective service to individuals and low-nurturance families

Useful Clinical Intervention Techniques -
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By Peter K. Gerlach, MSW


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  Role Playing 

Goals -

Participants - the clinician and one or more client adults and/or kids.

Preparations -

Best time to do this -

Technique -

Next -

  Compose a Story, Poem, or Play 

        Often clients and clinicians limit themselves to "logical" real-world conceptualizations of presenting problems and solution-options. The unconscious mind can bypass practical limitations and suggest helpful new ways to frame a problem and it's solution. This exercise offers the client a way to use their unconscious mind (i.e. some subselves, often inner children) as a wise ally in filling key needs. It uses the reality that all folktales, parables, real-life stories, and dramas are ultimately about hero/ines overcoming obstacles to gain a significant reward or prize - e.g. the solution to a dilemma or stressful problem.

Goals - To have the client/s experience a presenting problem or situation and potential solution metaphorically, and possibly discover a new perspective (frame).

Participants - the clinician and one or more client adults or school-aged kids.

Preparations - have the client (a) restate a presenting (surface) problem and (b) summarize how they've tried to solve it so far, before and during clinical work. Ask them to affirm without blame that these attempts have not filled their needs well enough so far. Options:

  • review these ideas about how and why people change or don't change their attitudes, beliefs, and behaviors, and compare them to ideas.

  • Mention that one reason therapy / coaching / counseling helps to solve problems is by offering clients safe, interesting new experiences.

  • ask if the client has any ideas why this problem remains, and/or what s/he thinks will need to change in order to solve the problem. be prepared for "I don't know."

  • ask them to describe how their life will be better when they're ready to choose an effective solution. Notice the implied suggestions in this wording.

Best time to do this - when other attempts to solve a particular presenting problem haven't worked.

Technique - Ask if the client is willing to try a new way of discovering a solution to the presenting problem. Most clients will say "yes." Then ask if s/he or they have a favorite folktale, cartoon, or fictional story, and why that particular tale appeals to them. Then ask if s/he has ever composed a story or a play, or written the description of a real event before.

        If the client says "Yes," ask what the process of creating the story was like for them and how they felt about doing it. If the client says "No," or something like "I can't write," or "I have no imagination," ask if s/he ever fantasizes or daydreams. If so (which is likely), frame that as their mind's creative way of composing an absorbing story or drama. "So like the rest of us, you actually compose stories all the time, don't you?"

        Options - if appropriate...

  • Review the basic elements of most stories, parables, or plays:

    • one or more human, animal, or fantasy characters ("the hero/ine"),

    • some threat or problem or quest the character/s need to solve or overcome,

    • often a conflict between good and "evil," in some form,

    • various barriers and/or adventures that occur, and...

    • some resolution to the situation.

    Illustrate this with a story you both know.

  • Note the enormous power of Holy Books like the Bible (and Torah and Koran?), which are filled with teaching parables (stories) that have and do influence the lives of millions of people.

  • If their are two or more clients, note the possibility of them verbally composing a group story together. Illustrate this briefly by saying "Once upon a time there was a family / person / couple boy / girl who..." Then ask a client to add something to that. Then ask another client to build on that by adding part or all of a sentence or paragraph, like "...lived in a far-off land." Go back and forth or around the circle building a story a piece at a time, stressing that there is no right or wrong way to do this, and inviting clients not to be "logical" but trust their "Inner Story teller" to choose what comes next.

  • Reassure the client that if s/he composes something, she doesn't have to show it to anyone, including you.

  • Note that the process of creating the story is just as instructive as is the resulting tale, poem, or drama.

  • Suggest that the client's unconscious mind (or "Higher Self") already knows the best thing for him or her to do;

  • If you have a vignette that illustrates how this technique helped another client, describe that briefly. 

        After creating a context of permission, openness, and expectancy ("We can both wonder what creative suggestions your wise unconscious mind can offer."), ask if the client is willing to compose a fantasy or real-life story or play that at home that is similar in some way to the presenting problem s/he needs to solve. Option: add a time frame (", say, the next two weeks.") or leave it open ended.

        Use the client's observed reactions to this intervention to refine your opinion of whether s/he is governed by a false self in and out of the session. Option - discuss this with the client, if s/he is open to the idea of personality subselves. If s/he is, another option is to say something like "I'm really interested to learn which of your talented subselves decide to provide you with a story, and maybe even which subselves don't want you to do this."

Next -

 Create a Family-structure Map

            From a systems viewpoint, all families have a structure, which can be represented in simple graphic form. Family structures range from low-nurturance (dysfunctional) to high nurturance (functional). Often, adults and kids in multi-home divorcing families and stepfamilies are confused and/or conflicted about their family's composition and structure, but have no concepts or language to discuss this. This visual technique helps clients understand their family's structure, appreciate their strengths, and become more aware of needed improvements.

Goals - to help client adults and kids (a) learn the concept and vocabulary to discuss a baseline healthy-family structure, and (b) to see their current family-membership inclusions and exclusions, alliances and cutoffs, relationship rankings, boundaries, authority levels, and communication barriers in their related homes. An indirect goal is to add evidence where appropriate that one or more client co-parents are denying significant psychological wounds, and need to commit to personal wound recovery. 

Participants - the clinician and one or more client adults and/or older kids kids - particularly visual clients. This technique is most useful with divorcing, courting, and cohabiting-stepfamily clients who seem confused or conflicted about family membership, roles, and boundaries.. It can also be useful in diagramming the structure of an individual's inner family of subselves.

Preparations - Study this 5-page article to learn the concept. Then with your true Self guiding your personality, map your own (a) childhood and (b) current families, and (c) one or more client families you know well enough. Option - also try diagramming your inner family. Pay attention to the diagramming process (your thoughts, feelings, and awarenesses), as well as the diagrams you create. Then experience discussing the process and the diagrams with a supervisor or co-worker, and note any personal and clinical learnings. Create a sample diagram to use in illustrating the concept to clients.

Best time to do this - when working with a low-nurturance client family who is generally unresponsive or "resistant" to verbal interventions, and not in a crisis. Option - also use this with (a) a high-nurturance family to teach the clients the concept and affirm their present strengths, or (b) to help an individual client image how his or her personality subselves are organized.

        It may be useful to do this intervention after the client adults have created a and discussed a family genogram, and identified any conflicts over family membership ("Max, Jack's biomom is not a part of our family!"). It may also be useful to do this after encouraging client-adults to draft and discuss their family's mission statement.

Technique - there are two halves to this: (a) diagram the family, and (b) use the diagram to promote beneficial changes.

Create the Structural Diagram

 If other problems don't distract the client adults, ask if they're familiar with "organization charts." Assuming they are, ask if they'd like to learn what their family's organization chart would disclose. Get the adults' agreement that (a) "some organizations function better than others," and that (b) their family's overall function is to nurture (help each other fill all their members' needs) well enough in a ever-changing world. Option - ask each participating client (including older kids) to estimate from 1 (very low nurturance) to 10 (very high nurturance) how well their current family has been functioning recently.

        Explain the general structural mapping technique and what it can show, using a sample diagram of a high-nurturance family structure with several kids who live alternately in two co-parental homes. If the client family has such a family, propose that their multi-home family has two structures: "kids home," and "kids away."

        Next, describe, illustrate, and discuss typical low-nurturance family structures per these (or your own) examples. When you feel the client adults are ready, ask if they're willing to make a structral map of their family together. Review their options for doing so - e.g. (a) whether to involve older kids, ex mates, and key relatives or not, and/or (b) what things might sabotage their doing this honestly as partners.

        Frame this as a valuable learning experience, rather than a shame and blame hunt for "bad," "sick," or inept people. Note the options of including (a) a Higher Power, (b) emotionally-powerful dead or absent relatives, and/or (c) influential lay and/or professional supporters as dynamic members of the family structure.

       Options - (a) use the analogy of inspecting the structural soundness of their home and/or bodies, and (b) offer to work with them in diagramming, or to help evaluate the diagram they make on their own. (c) Give client-adults a copy of this article (or its Web address) to use as a reference, and (d) invite them to diagram their respective childhood-family structures for greater awareness..

Use the Diagram to Promote Useful Changes

        If there are significant structural problems, propose that (a) no one is at fault or to blame, and that (b) this is a useful chance to discern some primary problems that need improvement for their family's long-term health and prosperity. Invite the clients to stay focused, rank-order multiple problems (which is likely), and commit to patiently improving one or a few problems at a time using appropriate Lesson-2 skills. If appropriate, teach or refresh the adults on the idea of surface (presenting) problems and underlying primary problems (unmet needs).

        An honest structural diagram may reveal one or more problems like these:

  • A stepparent ad/or co-parenting ex mate feels discounted or excluded by other adults and/or kids - and/or excludes themselves - from full family membership and appropriate authority.

  • One or more children are discounted and/or excluded by one or more adults and/or other children;

  • A child, relative, or a coalition is running a home and/or the whole family, rather than the adult co-parents;

  • A couple is allowing alliances between two or more other family members to sabotage the primacy and integrity their relationship, The usual primary problems are a mix of unwise commitment decisions + unawareness + excessive fears and guilts + role-confusions + unresolved loyalty conflicts and relationship triangles, + marriage not genuinely in second placed + psychological wounds .

  • A prior divorce is emotionally unfinished. The usual primary problems are premature re/marriage and/or blocked or incomplete grief, and denied psychological wounds.

  • Two or more residents in one home and/or between co-parenting homes are blocked in communicating and problem-solving effectively. The usual primary problems are ignorance of effective communication basics and skills + denied psychological wounds;

  • An adult has an inappropriate role as a "child's friend" rather than a family co-leader;

  • A home or whole family is polarized into separate (bioparent + kid/s) and (stepparent + kids) coallitions, rather than an integrated "us" group.


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Updated September 29, 2015