Clinical Applications of Bowen Family Systems Theory

Peter Titelman

• Publisher: Routledge
• Year: 2014
• eBook ISBN: 9781317790365
• Topic: Social Sciences
• Subtopic: Mental Health in Psychology
• Index: Social Sciences

One look inside Clinical Applications of Bowen Family Systems Theory, and you'll see that your most current clinical dilemmas are not as difficult to solve as you think. You'll find plenty of information to assist you in treating a vast audience of populations--the elderly, college students, troubled couples, remarried families, and children with severe medical problems. You'll also find that you're able to apply the Bowen systems theory to nearly every clinical situation--emotional dysfunction in children, alcoholism, incest, divorce, depression, phobias, and obsessive-compulsive disorders.Clinical Applications of Bowen Family Systems Theory is an ideal companion for family therapists, clinical psychologists, clinical social workers, psychiatrists, psychiatric nurses, and counselors. You'll find your working comprehension of Murray Bowen's work will grow, and you'll become more adept at applying what you read in real-life clinical situations, especially in these related areas:

• family systems assessment based on the Bowen Theory
• marital fusion and differentiation
• bridging emotional cut-off from a former spouse
• dealing with a child-focused divorce
• case studies of alcoholism and family systemsClinical Applications of Bowen Family Systems Theory is the first book to collect, illustrate, and walk you through a full application of this highly effective treatment method in any number of clinical settings. Both beginning and experienced therapists will find interesting reading in the history of the theory, and the result will be interested clients who begin to create functional, thriving personal histories for themselves.

PART I:
BOWEN FAMILY SYSTEMS THEORY, ASSESSMENT, AND THERAPY

Chapter 1

Overview of the Bowen Theoretical-Therapeutic System

Peter Titelman

INTRODUCTION

This chapter describes the relationship between Bowen family systems theory and Bowen family systems therapy. Its purpose is to provide a theoretical framework for understanding the application of Bowen theory in the diverse arena of clinical practice.

This chapter is divided into the following sections: (1) the relationship between theory and therapy, (2) historical development of Bowen theory and its relation to Bowen family systems therapy, (3) differentiation of self, (4) Bowen's perspective on the therapeutic relationship, (5) the role of the therapist or coach, and (6) functions of the therapist or coach.

THE RELATIONSHIP BETWEEN THEORY AND THERAPY

What does the term theory refer to in Bowen's thinking? Theory as “science” can refer to an organized body of knowledge within the framework of the natural sciences. At another level, theory can refer to Bowen's understanding that all individual and family behavior must be understood in terms of a variation of natural systems theory. Darwin's theory of evolution was the foundation for the development of Bowen theory. At times the term theory, for Bowen, served as a shorthand reference to natural systems theory in general and Darwinian evolutionary theory in particular. According to Bowen (1981), “Evolutionary biology accounts for process and the relationship system [conceptualized in the eight concepts of Bowen theory] accounts for content.” And theory in its most concrete form can be a reference to Bowen's eight clinical concepts, the theory of differentiation, and the paradigm of the family as an emotional unit that underlies his theory.

In Bowen's (1978) theoretical-therapeutic system: “… the term family therapy is derived from the way the therapist thinks about the family. It refers to the effort to modify the family relationship system, whether the effort is with multiple family members, the two spouses together, or only one family member” (p. 310). In other words, family therapy is defined by the way in which the therapist thinks about the family, and the therapy is designed to help bring about change in the family, whether the change is brought about through one or more family members (Bowen, 1978, p. 212).

Bowen therapy follows a blueprint based on Bowen theory, as theory always guides therapy. Bowen was antitechnique. He opposed using therapeutic techniques separated from a solid theoretical foundation. The therapist's efforts are based on two factors: One factor involves the therapist's efforts toward defining a self in his/her own family. The second factor is based on the therapist's understanding of Bowen theory and its relationship to natural systems theory.

Bowen theory is antithetical to models that view the human predicament in terms of health versus pathology and in terms of discrete, differential diagnosis. For Bowen, the issue of diagnosis involved perceiving emotional problems along a continuum, with quantitative differences existing between families and between individuals. A focus on the phenomenology of symptoms is secondary to the underlying issue with which all individuals and families are struggling—the balance of the instinctual, emotional forces of individuality and togetherness. Bowen (1978) defined differentiation in the following way: “… the degree to which people are able to distinguish between the feeling process and the intellectual process (p. 355)…. The concept defines people according to the degree of fusion, or differentiation between emotional and intellectual functioning” (p. 362). In contrast, traditional theories place individuals in discrete diagnostic categories from normal to psychotic, with other categories in between.

The goal of Bowen family systems therapy is to increase the capacity of one or more members to adapt to and deal with the vicissitudes of life. Graefe (1995) describes the differentiation effort using a metaphor from sailing: “You cannot change the velocity of the winds, but you can change the direction of the sails” (p. 2).

In other words, the Bowen approach is focused on facilitating the effort of the family member, the differentiating one, to gain the tools to be able to deal with the emotional process within one's self and in relation to one's family in the face of anxiety-provoking life situations and events both in the present and the future. This focus on emotional process is in contrast to approaches that focus on content, that is, the alleviation of concrete specific symptoms or problems. From the Bowen perspective, in order for differentiation of self to take place, anxiety has to be reduced to a manageable degree. Predictably, presenting symptoms or problems begin to modify or disappear as anxiety decreases. This in turn creates the opportunity for working toward solid change.

HISTORICAL DEVELOPMENT OF BOWEN THEORY AND ITS RELATION TO BOWEN FAMILY SYSTEMS THERAPY

The central focus in Bowen theory is the family, which is conceived of as a multigenerational emotional unit occuring in the context of nature. The following stages in the evolution of the Bowen theory will be explored: (1) the movement from the concept of the “undifferentiated family ego mass,” to the nuclear family emotional systems and extended family emotional systems, to the family conceived of as a multigenerational emotional unit; (2) the movement from the concept of the triangle to the concept of interlocking triangles; and (3) the movement from focusing on fusion to focusing on the interlocking process of fusion and cutoff.

The Family As a Multigenerational Emotional Unit

Bowen initially spoke of how the child and adult are embedded in an emotional oneness that he described as the “undifferentiated family ego mass.” He later abandoned this term for several reasons: First, he believed that the term was not consistent with the terms of evolutionary biology. Second, although Dr. Bowen believed that the term “undifferentiated family ego mass” described the sticky fusion of individuals within their nuclear family, he believed the use of the term ego was too psychological and psychoanalytic and, unfortunately, would cause people to perceive Bowen theory as a psychological theory rather than as one grounded in evolutionary biology. Third, as Bowen's theory became more and more clear in its multigenerational focus—expanding beyond the three generations that consisted of the nuclear and immediate extended family systems—he chose to replace the term undifferentiated family ego mass, and then nuclear and extended family emotional systems, with the concept of the family as a multigenerational emotional unit or system. The latter includes the individual's evolutionary descent and relationship to all biological life; his/her level of differentiation and functioning position, both within the context of the evolution of the multigenerational family, as a part of all life, with its variability and stability; and the multigenerational transmission process in which an individual exists like a grain of sand on a beach. Just as each grain of sand is unique yet similar to all other grains of sand in relation to its origin, each family member is unique but still shares similarities with all other members of his/her family.

From a Bowen perspective, differentiation, as a phenomenon of life and as a process, is both formed and modified in relation to one's family of origin and one's multigenerational extended family. It is based on instinctual emotion, as Kerr and Bowen (1988) describe it:

Saying that human relationship process is rooted in instincts has much in common with what occurs in other forms of life, and has a function in evolutionary terms… This way of thinking about what “energizes” the phenomenon being described is contained in the concept of the family emotional system, (p. 11)

In addition to describing the family as an emotional system, based on instincts that are shared with all animals and that are the basis of the natural history of man's emotional reactivity within the family, the concept of functioning position is central to the evolving focus on the family as a multigenerational emotional system. People are born and are fitted into functioning positions based on a number of variables: gender, birth order, family patterns, and nodal events occurring in the multigenerational family. Extreme nodal events such as disease, death, unemployment, and emigration can modify a functioning position. Typical functioning positions are: “responsible oldest,” “irresponsible youngest,” “leader of the clan,” “family historian,” “mediator,” “sick one,” and “smart one.”

Kerr and Bowen (1988) define the concept of functioning position in the following manner:

[It] predicts that every family emotional system generates certain functions. These functions are performed by certain individuals in the system. When one individual performs certain functions, other individuals will not perform them. An individual is born into a sibling position. By virtue of being born in a specific position, the individual takes on the functions associated with it. An individual's personality is shaped, to some extent, by being in a certain functioning position in the family. An oldest child for example, functions in certain predictable ways in relationship to his parents and younger siblings. The nature of his functioning shapes the development and nature of his personality, and his personality, as it develops, shapes the nature of his functioning, (p. 315)

Toman's research proves that the predicted relationship between personality development and functioning position exists (Kerr and Bowen, 1988, p. 315). A person's functioning position has a significant influence on his/her beliefs, values, attitudes, feelings, and behavior. To some extent, these expectations are built into the situation, for example, for an oldest child to feel responsible for younger siblings. Even if parents try not to make the oldest child responsible for younger siblings, the process is so automatic that it will likely occur anyway (Kerr and Bowen, 1988, p. 55). Functioning positions operate in reciprocal relationship to one another; for example, the interplay between overfunctioning and underfunctioning and pursuit and distance.

From Triangles to Interlocking Triangles

A second concept that Bowen elaborated on was interlocking triangles. As this author wrote previously (Titelman, 1987):

The evolution and the broadening of the concept of differentiation of self, from the focus on the nuclear family emotional system to a focus on marital fusion, and then to the current focus on each spouse's unresolved attachment to his or her family of origin, involved several phases. Initially, the focus was on the concept of fusion/undifferentiation in the context of the nuclear family emotional system. A second phase emerged with the clarification of the concept of the emotional triangle; with this came a shift of focus, theoretically and clinically, toward the marital pair. (pp. 17–18)

The concept of interlocking triangles is:

… the phenomenon that emerges when, anxiety having overloaded the system, and the initial triangle is unable to stabilize the situation, others are triangled into the process, thus forming a series of interlocking triangles. (Titelman, 1987, p. 19)

Two-person, three-person, and multiperson relationships are stable, or unstable, depending on the relationship between two variables: level of differentiation and anxiety. A two-person relationship can be open and stable until a certain level of stress is experienced, and then triangulation ensues. When a triangle is formed, it temporarily functions as if it were a stable structure. In general, a three-person system handling stress is somewhat more stable than a two-person system, given the same level of differentiation of the members of that system.

The triangle is characterized by a rigid or fixed dysfunctional stability involving a lack of openness among all three members and a relative lack of differentiation. The triangle is similar to a three-legged stool that is more stable than an overly stressed and fused dyad. The latter cannot stand; it collapses. However, when the triangle is overloaded by the combination of stress and undifferentiation, the distancing between two of its members, or the fusion between two members, is akin to pulling out one leg from the three-legged stool; the triangle becomes unstable.

When differentiation is relatively high and stress is low, three people operate as a “threesome” or an open three-person system. An open three-person system consists of three relatively differentiated one-to-one relationships. This open system is characterized by functional stability, openness of communication, and differentiation among all three members. A threesome or an open three-person relationship is a very stable and functional structure. Theoretically, a differentiated three-person relationship is more stable and flexible than an open, two-person differentiated relationship: when normal nodal events, stressors, and life-cycle events unfold, there is more flexibility and possibility for coping with stress when it is more widely distributed.

The three-person unit is the basic building block of the family both biologically and psychologically for several reasons: (1) it takes a male and a female to create a child; (2) differentiation is best accomplished when the young adult leaves home through leaving a stable twosome, for whom he/she does not have to caretake, and then proceeds to form a new twosome; and (3) conflict between one parent and a child is automatically modified by the soothing contact with a nonanxious, nontriangled second parent.

According to Bowen (1974), “In a calm threesome the togetherness is always moving around and a good percentage of the communication in each twosome is about self to the other self” (p. 17). For example, if a teenage son and his mother argue over any given issue, and it is not a recurring pattern, the father, if he is not emotionally reactive to either the perspective of his wife or that of his son, may defuse their conflict by his nonreactive presence or position.

If a three-legg...

Table of contents

• Cover
• Half Title
• Series Page
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• About the Editor
• Contributors
• Foreword
• Acknowledgments
• Introduction
• PART I: BOWEN FAMILY SYSTEMS THEORY, ASSESSMENT, AND THERAPY
• PART II: CLINICAL APPLICATIONS
• Index