MFT Clinical Vignette – Bowen Family Therapy – Flashcards

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Main Goals:
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1. Increase Differentiation& Decrease Anxiety 2. De-triangulation, lower anxiety to respond instead of react 3. Decrease emotional reactivity increase thoughtful responses 4. Increase intimacy one-on-one with important others
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Assumptions
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1. The past is currently influencing the present 2. There are inter-generational patterns in every family 3. Anxiety inhibits change and needs to be reduced to facilitate change 4. High autonomy and high intimacy are ideal 5. Symptoms are indicators of stress, anxiety, lower differentiation 6. More differentiated people will be able to withstand more stress and when they do become symptomatic, they'll recover more quickly
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Role of the therapist
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1. Calm 2. Coach or Role Model 3. Educator 4. Expert - Doesn't Join the System 5. Is part of the system (non-anxious and differentiated) 6. The client can only be as differentiated as we the therapist are
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Concepts
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- Differentiation of Self - Multigenerational Transmission Process - Undifferentiated Family Ego Mass - Nuclear Family - Cutoff - Triangulation - Sibling Position - Fusion (w/in individual & w/in relationships) 4 Sub Concepts that can be misused to manage anxiety and become problematic for a system 1. Conflict, 2. Dysfunction in person, 3. Triangulation, 4. Distance
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Family Lacking differentiation may become
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Emotionally Fused (Undifferentiated Family Ego Mass)
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Differentation Scale
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- Reflects extent to which person is able/unable to separate self from other and thought from emotion - Ranges between 1 to 100 - Bowen maintained people rarely reach higher than 70
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Differentation Goal
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Separate intrapersonal distress from interpersonal distress - Intrapersonal: separating thoughts from feelings to respond instead of react - Interpersonal: know where oneself ends and another begins without losing ones sense of self
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Multigenerational Patterns
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- Patterns across generations such as maternal/paternal, mental health/depression, substance/abuse patterns that the client is either replicating or rebelling against - Important to see how the pattern is evolving with generations
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Triangulate
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- The process in which a dyad draws in a third person to stabilize it - The third person is used to alleviate tension or anxiety - When triangles are ridgid or when they are inappropriate they are a problem
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Family Projection Process
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- Parents project their immaturity onto one or more of their children to sooth their anxiety - The child who is the focus of the parental anxiety will be less differentiated
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Emotional Cutoff
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- One person no longer emotionally engages with another person in the family system in order to manage anxiety - The reason this happens is because the person has such low differentiation that they can't tolerate the tension, they are so emotionally reactive they have to cutoff. - The client will look very differentiated and say everyone else is so emotional and I'm the only one who is calm.
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Sibling Position
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- Older Children: Responsibility and Authority - Later Born: Underdogs and question status quo - Youngest Child: Avoids responsibility in favor of freedom - Culture shapes the roles
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Bowenian Therapy is a
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Process Orientated Approach
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Interventions
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Primary: The therapist's ability to embody the theory and encourage differentiation 1. Genogram 2. Process Questions 3. Detriangulation 4. Education 5. Decrease Emotional Reactivity & Increase thoughtful responses 6. Calm Therapist 7. Coaching on changing patterns in FOO
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Termination
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Ongoing process since we're never fully differentiated
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Change Process
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1. Cognitive: reduced anxiety through separation of thoughts and emotions 2. Reduced anxiety leads to responsive thoughts and actions, changed affect, changed relationships 3. When we think (respond), change occurs (planning thinking) - When you know how you would like to behave in a certain emotional situations, you plan it, thus it makes it easier to carry through with different consequences
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Early Phase Goals
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1. Establish Therapeutic Relationship - Maintain calm neutral presense 2. Explore FOO and Intergenerational issues - Genogram, access intergenerational patterns & cutoffs 3. Identify level of differentiation and anxiety by inquiring about the problem issues - process questions
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Middle Phase Goals
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1. Address sources of anxiety and begin to decrease the anxiety that underlies symptoms - Process questions and - Explore genogram patterns - Detriangulate - Help family separate thoughts/feelings from self and others 2. Increase Differentiation of Family Members - Coach client to respond to problem situations in a differentiated way
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Late Phase Goals
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1. Facilitate change in family process brought on by increasing differentiation in family members - Coach members on how to respond to interventions - Use displacement stories - Coach members on how to maintain non-Anxious presence in response to family reactions 2. Highlight newly established differentiation and ability to balance individuality and togetherness - Identify/discuss gains and decrease levels of anxiety - Identify ways to interrupt dysfunctional generations processes
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