Exploring Family Theory in Clinical Practice

1966, The Use of Family Theory in Clinical Practice. 1974, Toward the Differentiation of Self in One's Family of Origin. 1978, Family Therapy in Clinical Practice, Northvale, NJ: Jason Aronson Inc., 1978. 1988, Family Evaluation: An Approach Based on Bowen Theory, co-written with Kerr, M.E. at The Family Center at Georgetown University Hospital, New York: Norton & Co., 1988.

Murray Bowen was born in 1913 in Tennessee and died in 1990. *He trained as a psychiatrist and originally practiced within the psychoanalytic model.* At the Menninger Clinic in the late 1940s, he started to *involve mothers in the investigation and treatment of schizophrenic patients.* His devotion to his own psychoanalytic training was set aside after his move to the National Institute of Mental Health (NIMH) in 1954, as he began to shift from an *individual focus to an appreciation of the dimensions of families as systems.* At the NIMH, Bowen began to include more family members in his research and psychotherapy with schizophrenic patients. In 1959, he moved to Georgetown University and established the Georgetown Family Centre (where he was director until his death). It was here that his developing theory was extended to less severe emotional problems. Between 1959 and 1962 he undertook detailed research into families across several generations. Rather than developing a theory about pathology, Bowen focused on what he saw as the common patterns of all "human emotional systems." With such a focus on the qualitative similarities of all families, Bowen was known to say frequently, *"There is a little schizophrenia in all of us."*

Murray Bowen's family systems theory ("Bowen theory") was one of the first comprehensive theories of family systems functioning. In 1967, he surprised a national family therapy conference by talking about his own family experience, rather than presenting the anticipated formal paper. Bowen proceeded to encourage students to work on triangles and intergenerational patterns in their own families of origin rather than undertaking individual psychotherapy. *Bowen's focus was on patterns that develop in families in order to defuse anxiety. * A key generator of anxiety in families is the perception of either *too much closeness* or *too great a distance in a relationship.* The degree of anxiety in any one family will be determined by the current levels of external stress and the sensitivities to particular themes that have been transmitted down the generations. If family members do not have the capacity to think through their responses to relationship dilemmas, but rather react anxiously to perceived emotional demands, a state of chronic anxiety or reactivity may be set in place. The main goal of Bowenian therapy is to reduce chronic anxiety by(1) *facilitating awareness of how the emotional system functions*; and (2) *increasing levels of differentiation*, where the focus is on making changes for the self rather than on trying to change others.

Eight interlocking concepts make up Bowen's theory. The eighth attempts to link his theory to the evolution of society, and has little relevance to the practice of his therapy. 1 - Emotional Fusion and Differentiation of Self 2 - Triangles 3 - Nuclear Family Emotional System 3a. Couple Conflict 3b. Symptoms in a Spouse 3c. Symptoms in a Child 4 - Family Projection Process 5 - Emotional Cutoff 6 - Multi-generational Transmission Process 7 - Sibling Positions 8 - Societal Emotional Process

*"Fusion" or "lack of differentiation"* occurs when individual choices are set aside in the service of achieving harmony within the system. Fusion can be expressed either as: -a sense of intense responsibility for another's reactions, or -by "emotional cutoff" from the tension within a relationship Bowen's research led him to suggest that varying degrees of fusion are discernible in all families. *"Differentiation"* is the capacity of the individual to function autonomously by making self-directed choices, while remaining emotionally connected to the intensity of a significant relationship system. Unlike the poorly differentiated self, the differentiated self assumes responsibility for one's own happiness and comfort and avoids thinking that tends to blame and hold others responsible for one's own happiness or failures A reasonably differentiated person is capable of genuine concern for others without expecting something in return. Bowen's notion of fusion has a different focus than *Minuchin's concept of enmeshment, which is based on a lack of boundary between subsystems.* But *Minuchin's* structural terms *"enmeshment" and "disengagement"* are *similar* to *Bowen's* notion of *"fusion."* Fusion describes each person's reactions within a relationship, rather than the overall structure of family relationships. A person in a fused relationship reacts immediately (as if with a reflex, knee jerk response) to the perceived demands of another person, without being able to think through the choices or talk over relationship matters directly with the other person. Energy is invested in taking things personally (ensuring the emotional comfort of another), or in distancing oneself (ensuring one's own). The greater a family's tendency to fuse, the less flexibility it will have in adapting to stress. For Bowen, *"complete differentiation"* is said to exist in a *person who has resolved their emotional attachment to their family (i.e., shifted out of their roles in relationship triangles) and can therefore function as an individual within the family group.* Bowen did acknowledge that this was a lifelong process and that *total differentiation is not possible to attain.*

Bowen described triangles as the smallest stable relationship unit. The process of triangling is central to his theory. Some people use the term "triangulation" (deriving from Minuchin), but *Bowen always spoke of "triangling."* *Triangling* occurs when the *inevitable anxiety in a dyad (a couple) is relieved by involving a vulnerable third party who either takes sides or provides a detour for the anxiety.*

An example of this pattern would be when Person A in a marriage begins feeling uncomfortable with too much closeness to Person B. S/he may begin withdrawing, perhaps to another activity such as work (the third point of the triangle). Person B then pursues Person A, which results in increased withdrawal to the initial triangled-in person or activity. Person B then feels neglected and seeks out an ally who will sympathize with his/her sense of exclusion. This in turn leads to Person A feeling like the odd one out and moving anxiously closer to Person B. Under stress, the triangling process feeds on itself and interlocking triangles are formed throughout the system. This can spill over into the wider community, when family members find allies, or enemies to unite against, such as doctors, teachers and therapists. Under calm conditions it is difficult to identify triangles, but they emerge clearly under stress. *Triangles are linked closely with Bowen's concept of differentiation, in that the greater the degree of fusion in a relationship, the more heightened is the pull to preserve emotional stability by forming a triangle.* *Bowen did not suggest that the process of triangling was necessarily dysfunctional,* but the concept is a useful way of grasping the notion that the original tension gets acted out elsewhere. *Triangling can become problematic when a third party's involvement distracts the members of a dyad from resolving their relationship impasse.* If a third party is drawn in, the focus shifts to criticizing or worrying about the new outsider, *which in turn prevents the original complainants from resolving their tension.* According to Bowen, triangles tend to repeat themselves across generations. When one member of a relationship triangle departs or dies, another person can be drawn into the same role (e.g., 'villain', 'rescuer', 'victim', 'black sheep', 'martyr'). For example, a son may move into the role of peacemaker after the death of his mother, who had mediated the tension between the son's father and brother. This ongoing triangle serves to detour the anxiety that had been played out between fathers and sons in the family over the generations.

In positing the "nuclear family emotional system," Bowen focused on the impact of "undifferentiation" on the emotional functioning of a single generation family. He asserts that relationship fusion, which leads to triangling, is the fuel for symptom formation which is manifested in one of three categories. These are: a. couple conflict; b. illness in a spouse; c. projection of a problem onto one or more children.

The single generation unit usually starts with a dyad -- a couple who, according to Bowen, will be at approximately equal levels of differentiation (i.e., both have the same degree of need to be validated through the relationship). *Bowen believed that permission to disagree is one of the most important contracts between individuals in an intimate relationship.* In a fused relationship, partners interpret the emotional state of the other as their responsibility *(think of "co-dependence")*, and the other's stated disagreement as a personal affront to them. A typical pattern in such emotionally intense relationships is a cycle of closeness followed by conflict to create distance, which in turn is followed by the couple making up and resuming the intense closeness. This pattern is a "conflictual cocoon," where anxiety is bound within the conflict cycle without spilling over to involve children. Bowen suggested the following three ways in which couple conflict can be functional for a fused relationship, in which *"each person is attempting to become more whole through the other":* 1. Conflict can provide a strong sense of emotional contact with the important other. 2. Conflict can justify people's maintaining a comfortable distance from each other without feeling guilty about it. 3. Conflict can allow one person to project anxieties they have about themselves onto the other, thereby preserving their positive view of self.

In a fused relationship, where each partner looks to the other's qualities to fit his / her learned manner of relating to significant others, a pattern of reciprocity can be set in motion that pushes each spouse's role to opposite extremes. Drawing from his analytic background, Bowen described this fusion as *"the reciprocal side of each spouse's transference."* For example, what may start as an overly responsible spouse feeling compatible with a more dependent partner, can escalate to an increasingly controlling spouse with the other giving up any sense of contributing to the relationship. Both are equally undifferentiated in that they are defining themselves according to the reactions of the other. However, *the spouse who makes the most adjustments in the self in order to preserve relationship harmony* is said by Bowen to be *prone to developing symptoms.* The person who gets polarized in the under-functioning position is most vulnerable to symptoms of helplessness such as depression, substance abuse and chronic pain. The over-functioning person might also be the one to develop symptoms, as s/he becomes overburdened by attempts to make things 'right' for others.

The third symptom of fusion in a family is when a child develops behavioral or emotional problems. This comes under Bowen's fourth theoretical concept, the Family Projection Process.

In the previous two categories the couple relationship is the focus of anxiety without it significantly impacting the functioning of the next generation. By contrast, the *family projection process describes how children develop symptoms when they get caught up in the previous generation's anxiety about relationships.* The child with the *least emotional separation from his/her parents* is said to be the most vulnerable to developing symptoms. Bowen describes this as occurring when a child responds anxiously to the tension in the parents' relationship, which in turn is mistaken for a problem in the child. A *detouring triangle* is thus set in motion, as attention and protectiveness are shifted to the child. Within this *cycle of reciprocal anxiety*, a child becomes more demanding or more impaired. An example would be when an illness in a child distracts one parent from the pursuit of closeness in the marriage. As tension in the marriage is relieved, both spouses become invested in treating their child's condition, which may in turn become chronic or psychosomatic. As in all of Bowen's constructs, *"intergenerational projection"* is said to occur in all families in varying degrees. Many intergenerational influences may determine which child becomes the focus of family anxiety and at what stage of the life cycle this occurs. The impact of crises and their timing also influences the vulnerability of certain children.

Bowen describes "emotional cutoff" as *the way people manage the intensity of fusion between the generations.* A "cutoff" can be *achieved through physical distance or through forms of emotional withdrawal.* Bowen distinguishes between "breaking away" from the family and "growing away" from the family. ' *Growing away* is viewed as *part of differentiation* -- adult family members follow independent goals while also recognizing that they are part of their family system. A *"cutoff"* is more *like an escape*; people decide to be completely different from their family of origin. While immediate pressure might be relieved by cutoff, patterns of reactivity in intense relationships remain unchanged and versions of the past, or its mirror image, are repeated. If one does not see himself as part of the system, his only options are either to get others to change or to withdraw. If one sees himself as part of the system, he has a new option: to stay in contact with others and change self. Cutoffs are not always dramatic rifts. An example of a covert emotional cutoff would be one family member maintaining an anxious silence in the face of another's anger. The pull to restore harmony overwhelms the ability to stay in contact with the issue that has been raised.

*A central hypothesis of Bowen's theory is that the more people maintain emotional contact with the previous generation, the less reactive they will be in current relationships.* Conversely, when there are emotional cutoffs, the current family group can experience intense emotional pressure without effective escape valves. This family tension is like walking on eggshells, as issues which remain unresolved from the cutoff are carefully avoided. Triangling provides a detour, as family members enlist the support of others for their own position in relation to the cutoff.

This concept of Bowen's theory describes how patterns, themes and positions (roles) in a triangle are passed down from generation to generation *through the projection from parent to child.* The impact will be different for each child, depending on the degree of triangling they have with their parents. Bowen's focus on at least three generations of a family when dealing with a presenting symptom is a trademark of his theory. The attention to family patterns over time is not just an evaluative tool, but an intervention that helps family members get sufficient distance from their current struggle with symptoms to see how they might change their own part in the transmission of anxiety over the generations. As Monica McGoldrick (1995) writes in applying Bowenian concepts: *By learning about your family and its history and getting to know what made family members tick, how they related, and where they got stuck, you can consider your own role, not simply as victim or reactor to your experiences but as an active player in interactions that repeat themselves.*

Employing Walter Toman's sibling profiles, Bowen considered that *sibling position could provide useful information in understanding the roles individuals tend to take in relationships.* For example, Toman's profiles describe eldest children as more likely to take on responsibility and leadership, with younger siblings more comfortable being dependent and allowing others to make decisions. Middle children are described as having more flexibility to shift between responsibility and dependence and 'only' children are seen as being responsible and having greater access to the adult world. Bowen noted that these generalized traits are not universally applicable and that it is possible for a younger sibling to become the "functional eldest." Bowen was especially interested in which sibling position in a family is most vulnerable to triangling with parents. It may be that a parent identifies strongly with a child in the same sibling position as their own, or that a previous cross-generational triangle (e.g., an eldest child aligned with a grandparent against a parent) may be repeated. If one sibling in the previous generation suffered a serious illness or died, it is more likely that the child of the present generation in the same sibling position will be viewed as more vulnerable and therefore more likely to detour tensions from the parental dyad. Helping the client understand and think beyond the limitations of their own sibling position and role is a goal of Bowenian family of origin work. Clients are encouraged to consider how assumptions about relationships are fuelled by their sibling role experience. As with other aspects of Bowen's theory, the impact of gender and ethnicity on sibling role is not considered. For example, there is no exploration of how a family's ethnicity influences which birth order position and which gender is more valued, or how the gender of any sibling position tends to influence whether the role is primarily relational (female) or task-oriented (male).

http://www.youtube.com/watch?v=tKCe3G5G_Uw (triangles) http://www.youtube.com/watch?v=hZH9JTxO_eg (emotional cutoff)

Bowen's is *not* a technique-focused model which incorporates specific descriptions of how to structure therapy sessions. The goal of therapy is to assist family members *towards greater levels of differentiation,* where there is less blaming, decreased reactivity, and increased responsibility for self in the emotional system. Perhaps the most distinctive aspects of Bowen's therapy are his emphasis on the therapist's own family of origin work, the central role of the therapist in directing conversation, and his minimal focus on children in the process of therapy.

Bowen views therapy in three broad stages. *Stage one* aims to reduce clients' anxiety about the symptom by encouraging them to learn how the symptom is part of their pattern of relating. *Stage two* focuses adult clients on 'self' issues so as to *increase their levels of differentiation.* Clients are helped to resist the pull of what Bowen termed the 'togetherness force' in the family. *Latter phases of therapy:* adult clients are coached in differentiating themselves from their family of origin, the assumption being that *gains in differentiation will automatically flow over* into decreased anxiety and greater self-responsibility within the nuclear family system.

The role of the therapist is to connect with a family without becoming emotionally reactive. *Emphasis is given to the therapist maintaining a "differentiated" stance.* This means that the therapist is not drawn into an overly-responsible /under-responsible reciprocity in attempts to be helpful. A therapist position of calm and interested investigation is important, so that the family begins to learn about itself as an emotional system. *Bowen instructs therapists to move out of a healing or helping position, where families passively wait for a cure, "to getting the family into position to accept responsibility for its own change."* Bowen warns of the problems of therapists *losing sight of their part in the system of interactions, where they may be inducted into a mediating role in a triangle with the family.* Hence, there is a high priority given to understanding and making changes within the therapist's own family of origin. In training, the *emphasis is on the trainees' level of differentiation, and not on therapeutic technique.* The therapist's resolution of family of origin issues is reflected in the: *...ability to be in emotional contact with a difficult, emotionally-charged problem and not feel compelled to preach about what others should do, not rush in to fix the problem, and not pretend to be detached by emotionally insulating oneself (Kerr and Bowen, 1988).*

The therapist is active in directing the therapeutic conversation. *Enactments are halted so as to prevent the escalation of clients' anxiety.* Clients are asked to talk directly to the therapist so that other family members can "listen and 'really hear' without reacting emotionally, for the first time in their lives together" (Bowen, 1971). Bowen himself *would avoid couple interaction in the room and concentrate on interviewing one spouse in the presence of the other.* Bowen clearly avoided asking for emotional responses, which he saw as less likely to lead to differentiation of self, *preferring mostly to ask for 'thoughts', 'reactions' and 'impressions."* He called this activity "externalizing the thinking of each client in the presence of the other."

A surprising feature of Bowen's family therapy is *his tendency to minimize the involvement of children.* While Bowen might include children in the beginning stage of therapy, he would soon dismiss them, *focusing on the adults as the most influential members of a family system.* Excluding a child from therapy responsibility is *viewed as a detriangling maneuver.* When parents cannot use the child as a 'triangle person' for issues between them, and the therapist resists taking the replacement role in the triangle, parents can begin differentiating their respective selves from one other.

The beginning sessions in Bowenian therapy focus on information-gathering in order to form ideas about the family's emotional processes, which concurrently provides information to family members about the presenting problem in its systemic context. The presenting problem is tracked through the history of the nuclear family and into the extended family system. A multigenerational *genogram* is a useful tool for recording this information. The therapist looks for clues about the emotional process of the particular family, *including patterns of regulating closeness and distance, how anxiety is dealt with in the system, what triangles get activated, the degree of adaptivity to changes and stressful events, and any signs of emotional 'cutoff'.* Information collected is acknowledged to be extremely subjective, especially when extended family are discussed; but stories about past generations are viewed as useful clues to the roles people occupy in triangles and the tensions that remain unresolved from *their families of origin.*

If for example, a member of the extended family is described as 'the rebel', the therapist explores what events gave rise to this label, who else has occupied this role across the generations, and how triangles formed around family crises involving 'rebellion'. *Calming family members' anxiety in the early stages of therapy* might involve helping them to make connections between the development of symptoms and potent themes in a family's history Another aim *will be to loosen the central triangle that has formed around, and maintains, the presenting problem.* Teaching clients about systems concepts as they operate in their own family is part of therapy at this stage. This does not mean attempting to convince people to do things differently but *to encourage family members to see beyond their biases so that it is possible for them to consider each person's part in the family patterns.*

The therapist asks questions that assume that the adult client can be responsible for his / her reactivity to the other. An example would be, "How do you understand the way you seem to take your child's acting out *so personally?"* In response to such questions, family members are encouraged to take an "I" position where they speak about how they view the problem, without attacking, or defending against, another family member. Clients are taught to make personal statements about their thoughts and feelings in order to facilitate a greater sense of responsibility in a relationship. For example, an accusatory statement such as, "You are so selfish to cause this much worry for your parents!," is shifted to, "I am really concerned that this might affect your school grades." The parent is encouraged to "own" their worries, rather than to project their anxieties through blaming statements. *Developing such a "self-focus"* is said to be crucial in lowering anxiety and enabling "person to person" relationships where each family member can think about the part they play in problematic interactions.

Bowen's multigenerational model goes beyond the view that the past influences the present, to the view that *patterns of relating in the past continue in the present family system.* Hence, the therapist uses questions to encourage clients to think about the connection between their present problem and the ways previous generations have dealt with similar relationship issues. For example, if the onset of a symptom followed a death in the family, the therapist asks about how grief has been dealt with in previous generations. Questions seek to uncover family belief systems as well as the way relationships have shifted in response to loss. Tracking symptoms and exploring related themes *over at least three generations* makes it more difficult for individuals to blame one another for individual deficiencies. As therapist and family members see how patterns repeat over generations, it is possible to identify the "automatic" reactions of family members towards each other. The ability to act on the basis of more awareness of relationship process (not blaming self or others, but seeing the part each plays) can, if done repeatedly in important relationships, *lead to some reduction in emotional reactivity and chronic anxiety.*

*This is probably the central technique in Bowenian therapy.* The client is first helped to recognize both the subtle and the more obvious ways that they are "triangled" by others, and the ways in which they attempt to triangle others in their turn. The therapist uses questions to facilitate the family members' awareness of their roles in family triangles. Simple open-ended tracking questions, using the *four "Ws" (who, what, when and where)* help clients to become "detectives" in their own interpersonal systems. It is often very difficult for family members to identify the triangles they participate in, and the sometimes covert ways in which they detour anxiety. An example would be a client who was struggling to understand her negativity towards her father. When questioning included her mother's role in these emotions, the client began to see that her view of her father was influenced by her position in a triangle. As her *mother's ally in this triangle,* she viewed her father as the inadequate husband who left her mother feeling needy.

Once triangles have been identified, family members are helped to plan ways of communicating a neutral position to others, leaving the dyad to communicate directly with each other. The goal is for a family member to *find a less reactive position* in the face of the other's anxiety. This will require different stances in different systems, ranging from refusing to discuss the deficiencies of another behind his/her back, to reversing one's usual reaction in a triangle. For example, when the *predictable pattern* in the family system is to keep distance between those who haven't been able to work out their problems, the therapist helps a family member to plan strategies *that shift their usual role in maintaining the avoidance.* The family member might encourage more involvement between the conflictual twosome, or change the subject when invited to discuss the conflict. Reversal is a key detriangling technique. When, for example, family member A complains about how uncaring another person (B) is, person C reverses the predictable sympathetic response, substituting a casual comment about how considerate person B seems for not putting demands on A's time and energy. Unlike a *strategic* intervention, the *goal of any detriangling stance is not to change the other's relationship but to express one's neutrality about it.* A calm and thoughtful neutral stance prevents one from anxiously reacting to the tension of another relationship by "taking sides."

Another distinguishing feature of Bowen's model is its validity in working with a single adult. The term *"coaching"* describes the *work of the therapist giving input and support for adult clients who are attempting to develop greater differentiation in their families of origin. * Clients should feel in charge of their own change efforts, with the therapist acting as a consultant. Bowen thought that a person's efforts to be more differentiated would be more productive when the focus shifted away from the intensity of the nuclear family to the previous generation. The emphasis is on self-directed efforts to detriangle from family of origin patterns. An individual's efforts can modify a triangle, which in turn ripples through to change in the whole extended family. Bowen described 'coaching' as "family psychotherapy with one family member." This therapy takes on the flavor of teaching, as clients learn about the predictable patterns of triangles. The therapist supports their efforts in returning to their families to observe and learn about these patterns.

Clients practice controlling their emotional reactivity in their family and report their struggles and progress in following sessions. During family of origin coaching, clients use letters, telephone calls, visits and research about previous generations to gain a systemic perspective on their family's emotional processes and a sense of their own inheritance of these patterns. The therapist prepares clients for the anxiety they will encounter if they shift from their customary roles in their families of origin. Any such changes will inevitably disturb the predictable balance of family patterns and therefore heighten anxiety and resistance. Change is viewed as a three step process where: *a. one takes a new position, b. family members react and c. the new stance is maintained in the face of pressure to revert to the original position* Bowen emphasized that it is what happens in step 'c' that really determines whether change occurs.

Since the early 1980s, the work of Carter, McGoldrick and their colleagues has expanded Bowen's framework to include attention to the family life cycle. As well as the *"vertical" flow of anxiety* through the generations, Carter included an assessment of *"horizontal" stress* as families move through various stages of the life cycle. Vertical and horizontal patterns converge, as multigenerational tensions impact on the ways that life cycle tasks and disruptions are negotiated. The stress of life cycle changes affects the choice of family of origin issues focused upon in the current generation. Using a life cycle perspective, symptom development is viewed in the context of an unresolved adjustment to a life cycle task. Acknowledging the significance of gender, race, ethnicity and class on a family's progression through life cycle stages was an important development in family assessment (i.e., McGoldrick et al.'s work). This much broader focus provides a *'multi-contextual lens'.* These variables are part of the context of the family's *"horizontal" story* and underlie the potent themes of a family's multigenerational legacy.

*Theoretical View of Cause/Maintenance of Disorder or Pathology:* -Unless individuals examine and rectify patterns passed down from previous generations, they are likely to repeat these behaviors in their own families. --The possibility of repeating certain behaviors in interpersonal relations is particularly likely if family members, especially between the generations, are characteristically either emotionally overinvolved (fused) with each other or emotionally cut off (psychologically or physically) from each other. -*Key element:* there is a chronic anxiety in all of life that comes with the territory of living - anxiety is both emotional and physical and is shared. Some individuals are more affected than others by this anxiety because of the way previous generations in their families have channeled the transmission of it to them.

His team observed that in parent-child relationships situations with very highly involved-low interpersonal boundaries (enmeshment or fusion) emotional tensions increase to the point that a "triangle" evolves. Redefined differentiation: as a function of family tolerance for individual differences and self-expression. --Differentiation without relatedness *(isolation)* brings with it problems of loneliness and alienation --Relatedness without differentiation *(fusion)* may bring with it the danger of losing one's sense of self in relationships, of having one's selfhood compromised or sacrificed when relating to others.

To address chronic anxiety and emotional processes in families and society, Bowen emphasized 8 basic concepts that are interrelated and logically connected. Through understanding these concepts, a therapist understands and successfully treats a family. *Major therapeutic goals* -Focus on the promotion of differentiation in regard to self/family and intellect/emotion. This approach is not technique oriented because of the tendency to get caught up and overpowered by particular techniques at particular times. --*Goal for the individual* in the interpersonal domain is to *achieve a sense of separateness in relation or differentiated relatedness* -Call attention to family history and the importance of noticing and dealing with past patterns in order to avoid repeating these behaviors in interpersonal relationships.

*Assessment process/goals* -Genograms - visual representation of a person's family tree depicted in geometic figures, lines, and words. Include info related to at least 3 generations of a family and its members' relationships with each other. It helps people gather info, hypothesize, and track relationship changes in the context of historical and contemporary events. -Data in a genogram can be scanned for: repetitive patterns (such as triangles, cutoffs, and coalitions), coincidences (such as the death of members or age of symptom onset), and the impact of change and untimely life cycle transitions --Works seamlessly with genogram study because it focuses on recursive, repetitive, chronic cycling of symptoms between marital partners, parents, grandparents, and children.

Going home again: the family therapist instructs the individual client/family members to return home in order to get to know their family of origin better. With this info, individuals can differentiate themselves more clearly. *Therapeutic techniques* -Homework (tasks to do outside the therapy session) - Bowen practiced structural and strategic behavioral types of family therapy emphasizing working between sessions. *Detriangulation:* the process of being in contact and emotionally separate. Operates at 2 levels: *1.* A person resolves anxiety over family situations and does not project feelings onto another, *2.* Bowen therapists help individuals separate themselves from becoming a focus when tension or anxiety arises in the family. Through this procedure, they do not become targets/scapegoats for others who may be overcome with anxiety.

Person-to-person relationships: 2 family members relate personally to each other about each other, they do not talk about others (triangling) and do not talk about impersonal issues. Helps promote individuation and intimacy.

*Differentiation of self:* the degree to which a person is able to distinguish between the subjective feeling process and the more objective intellectual (thinking) process. A healthy emotional detachment or the ability to maintain objectivity by separating affect from cognition. A failure to differentiate results in fusion, in which people are dominated by their automatic emotional system. Individuals who do not resolve their emotional issues within their families of origin often project such issues onto spouses resulting in marital distress. Over generations, children most involve in family fusion move toward a lower level of differentiation of self.

Asking questions: by asking questions, people involved in Bowen family therapy learn to understand the reactions to those in their families better. Technique of coaching was developed to allow adult individuals and couple to disengage from family triangles, control distress (reactivity), and create one-on-one relationships with parents and key members. Modeling: the therapist models differentiation of self by remaining detriangled and by actively taking I-positions, which facilitates family members in defining themselves in relation to each other.

*Role of the therapist* Role of the therapist Bowen family therapists need to stress their distinctiveness in emphasizing specific theoretical techniques and factors (who they are working with, as well as how and when treatment occurs). Differentiation of the therapist is crucial. Individuals who have had negative family-of-origin experiences may find that they cannot deal successfully with families or do not wish to work with families. *The Bowen family therapist must maintain a calm presence and be differentiated from his/her family of origin.* Objectivity and neutrality are important behavioral characteristics for therapists to display. Usually is involved in coaching and teaching occurring at more cognitive levels so that emotional issues to not cloud communication messages. Should not encourage people to wallow in emotionalism and confusion but should teach them to transcend it by setting examples as reasonable, neutral, self-controlled adults. Therapist instructs individuals to search for clues as to where the various pressures on the family have been expressed and how effectively the family has adapted to stress since its inception. Therapists become interpreters with their clients in assessing and working through multigenerational patterns of fusion and cutoffs. Unresolved areas of difficulty become resolved.

*Mechanisms of change* -Bowen family therapy has much in common with psychodynamic therapy on the surface. --An emphasis should be placed on the fact that the past is active in the present --Importance of social and historical data in the lives of families --Initial experiences associated with bonding and connectedness are particularly relevant. --Focus on how intrapersonal and interpersonal aspects of life affect each other - the way people relate to themselves influences how they interact with others. --Change is usually gradual and requires hard work with a heavy investment of time and resources à an in depth treatment perspective -At the heart of treatment, from these viewpoints, is a belief that changes in families and their members occur best when the family is examined in the context of its history and development.

Conscious and unconscious processes are collectively and individually the focus of therapeutic interventions. it is through the process of differentiation that families and the individuals in them change Process and outcome: primary outcome is that family members will understand intergenerational patterns and gain insight into historical circumstances that have influenced the ways they currently interact. It is expected that with this knowledge is a focus on changing intergenerational inferences operating with the current family. Individuals should be able to relate at an autonomous, cognitive level and projective patterns of blame should be changed.

The *whole family is usually not seen*, the *focus and place where change is emphasized is the individual or couple.* --He concluded that trainees whose work focused on creating one-on-one, well-delineated relationships with one's parents essentially raised one's own level of differentiation, increasing a therapist's ability to function in marriage, parenting, and practice of therapy

*Applicability:* Appropriate populations for treatment approach Some feminists criticize the approach for being too male-oriented and politically conservative. Evidence exists that differentiation is a concept applicable at a multicultural level. However, psychological well-being in adulthood may well be affected by factors outside of the family, such as peer relationships, employment or societal influences. Client families in which there are severe dysfunctions or low differentiation of self may benefit most from this emphasis. Most people cannot afford to invest as heavily in this process as is necessary. The number of people who can benefit from this approach is limited.

*(1) Figure/Approach: *Murray Bowen* *(2) Theoretical View of Cause/Maintenance of Disorder or Pathology:* Bowen felt that severe problems within the family unit stem from a multigenerational transmission process whereby levels of differentiation among family members can become progressively lower from one generation to the next. *Diathesis-stress model of psychosis*, which holds that illnesses do not necessarily emerge unless a person is stressed and cannot mobilize self-observation and self-regulation skills. *Differentiation of self* refers to one's ability to separate one's own intellectual and emotional functioning from that of the family. *Whenever two people have problems with each other, one or both will "triangle in" a third member.* Bowen emphasized people respond to anxiety between each other by shifting the focus to a third person, triangulation. In a triangle, two are on the inside and one is on the outside. *Emotional cutoff* refers to the mechanisms people use to reduce anxiety from their unresolved emotional issues with parents, siblings, and other members from the family of origin. *To avoid sensitive issues*, they *either move away from their families and rarely go home; or, if they remain in physical contact with their families, to avoid sensitive issues, they use silence or divert the conversation.* Though cutoff may diminish their immediate anxiety, these unresolved problems contaminate other relationships, especially when those relationships are stressed. *(3) Theoretical Rationale for Intervention Approach:* Observed that in parent-child relationships situations with very highly involved-low interpersonal boundaries (enmeshment or fusion), emotional tensions increase to the point that a "triangle" (inclusion of a third person) evolves to shift the focus. *(4) Major Therapeutic Goals:* Bowen developed an extended family systems therapy with the goal to increase individual family member's level of differentiation.

*(5) Assessment Processes/Goals:* To diffuse family enmeshment, to increase individual differences and self-focus, and to promote give and take in family-of-origin relationships. *(6) Therapeutic Techniques:* The use of genograms to map "symptom-bearers" in relation to their extended families, and them look for intense relationship and triangles that might be helping to maintain the client's distress. "Coaching" allows adult individuals and couple to disengage from family triangle, control distress (reactivity), and create one-on-one relationships with parents and key family members. Marriage counseling was also a way to prevent enmeshment problems from emerging between parents and their children *(7) Role of the Therapist:* A therapeutic stance of a dispassionate, object "coach", believing that conflict between two people will resolve automatically if both remain in emotional contact with a third person who can relate actively to both without taking sides with either. *(8) Mechanisms of Change:* To block pathological multigenerational transmission processes via enhancing partner's self-differentiation. Placed a good deal of clinical attention on the subtle ways in which distressed couples almost inevitably seemed to be able to intuitively to recruit in ("triangulate") a third force, (whether an affair partner, family member or even abstract values and standards) to stabilize a dyad in danger of spinning out of control. *(9) Issues of Resistance:* Once set during rearing, differentiation of self is very difficult to increase later in life. Has tremendous implications for therapists working with issues of partner selection and maturity in couple therapy. *(10) Applicability: Appropriate Populations for Treatment Approach (Gladding Chpt. 9, Pg. 222-223):* In general, it can be used with a wide range of families and some evidence exists it is applicable at a multicultural level. There have been criticism from feminists about the approach being too male-oriented and politically conservative. The time and money it requires from clients may keep some families from investing in the process as necessary *(11) Relevant Ethical Issues (Gladding Chpt. 9, Pg. 223):* Requires a high degree of investment in time and money, limiting the families that can benefit from this theory.