Bowen Family Systems Therapy (Intergenerational Family Therapy) Koken Aile Terapisi

Starting point Murray Bowen National Institute of Mental Health (NIMH) Worked with schizophrenia Noticed mother-child symbiosis Anxious attachment: pathological form of closeness driven by anxiety 31 years in Georgetown Similar observations in less severe families

Other important Bowenians Betty Carter & Monica McGoldrick More attention to issues of family life cycle Feminism Michael Kerr Current director of the Georgetown Family Center

Main Ideas Human relationships are driven by two polarizing forces: Individuality vs. togetherness Family is with you wherever you go Unresolved emotionality to parents is the main problem Superman and kryptonite ( a piece of the home planet)

5 Basic Concepts 1. Differentiation of self 2. Triangles 3. Family projection process 4. Multigenerational transmission process 5. Sibling position

Basic concepts Differentiation of self Capacity to think and reflect, rather than being emotionally reactive Differentiated person is able to balance thinking and feeling Undifferentiated person is either submissive or defiant Differentiation = maturity Ex: What do you think? I feel sad

Basic Concepts Emotional Triangles Involving a third party to deal with a problem Driven by anxiety Triangulation freezes conflict in place and becomes a chronic diversion that undermines relationships Most family problems are triangular Teaching a mother better parenting techniques won’t resolve the problem if she is over-involved with her son as a result of her husband’s emotional distance

Basic Concepts Family projection processes (1) the parent focuses on a child out of fear that something is wrong with the child; (2) the parent interprets the child's behavior as confirming the fear; and (3) the parent treats the child as if something is really wrong with the child. Self-fulfilling prophecy?

Family projection processes Heightened needs for attention and approval Difficulty dealing with expectations The tendency to blame oneself or others Feeling responsible for the happiness of others or that others are responsible for one's own happiness

Case Study Martha's anxiety about Amy began before Amy was born. Martha feared she would transfer inadequacies she had felt as a child, and still felt, to her own child. This was one reason Martha had mixed feelings about being a mother. Like many parents, Martha felt a mother's most important task was to make a child feel loved. In the name of showing love, she was acutely responsive to Amy's desires for attention. If Amy seemed bored and out of sorts, Martha was there with an idea or plan. She believed a child's road to confidence and independence was in the child feeling secure about herself. Martha did not recognize how sensitive she was to any sign in Amy that she might be upset or troubled and how quickly she would move in to fix the problem. Martha loved Amy deeply. She and Amy often seemed like one person in the way they were attuned to each other. As a very small toddler, Amy was as sensitive to her mother's moods and wants as Martha was to Amy's moods and wants.

Case Study At some point in the unfolding of their relationship, Martha began to feel irritated at times by what Martha regarded as Amy's "insatiable need" for attention. Martha would try to distance from Amy's neediness, but not very successfully because Amy had ways to involve her mother with her. Martha flip-flopped between pleading with and cajoling Amy one minute and being angry at and directive of her the next. It seemed to lock them together even more tightly. Martha looked to Michael to take over at such times. Despite calling Amy's need for attention insatiable, Martha felt Amy really needed more of her time and she faulted herself for not being able to give enough. She wanted Michael to help with the task. It bothered Martha if Amy seemed upset with her. Amy's upsets triggered guilt in Martha and a fear that they were no longer close companions. She wanted to soothe Amy and feel close to her

Case Study Martha and Amy had turmoil in their relationship during Amy's elementary school years, but things got worse in middle school. Amy began having academic problems and complained about feeling lost in the larger school. She seemed unhappy to Martha. Martha talked to Michael and to the pediatrician about getting therapy for Amy. They hired tutors for Amy in two of her subjects, even though they knew that part of the problem was Amy not working hard in those subjects. When Amy's grades did not improve, Michael criticized her for not taking advantage of the help they were giving and not appreciating them as parents. Martha scolded Michael for being too hard on Amy, but inwardly she felt even more critical of her than Michael did. She had worked hard to prevent these very problems in Amy. How could Amy disappoint her so much?

Basic Concepts Multigenerational emotional processes Undifferentiated family ego mass = fusion Emotional reactivity Emotional over involvement Emotional cutoffs Ex: A husband who is emotionally distant. Mom is anxiously attached to one of the child.

Basic Concepts Emotional cutoff The way some people manage anxiety between generations The greater the fusion, more likelihood of emotional cutoff Not to be confused with autonomy

Basic Concepts Societal emotional processes Importance of social influence on how families function Sexism, patriarchy, culture, racism, oppression Families with higher levels of differentiation were better able to resist destructive social influences

Basic Concepts Sibling position Oldest child: leadership position, overachievers Youngest child: follower, baby, attention seeker People in the same sibling position might be different based on their level of differentiation i.e. Rather than being comfortable with responsibility and leadership, an oldest child who is anxiously focused on may grow up to be markedly indecisive and highly reactive to expectations.

Normal Family Development Family Life Cycle Leave home Joining of families through marriage Shift your primary attachment from parents to partners Families with young children Adolescence Launching of children and moving on Families in later life Variations: divorce, remarriage, off-track paths

Development of Problems Stress that exceeds a person’s ability to manage it, which depends on differentiation Differentiation is a quality of relationships Intergenerational emotional fusion – anxious attachment

How does therapy work? Therapy is not about change or intervention Opportunity to learn about self and family

Main techniques Genogram Process questions Neutralize triangles “I” positions Relationship experiments Coaching

Genograms

Genograms

Genograms Genograms are like skeletons Asking questions bring the family history to life Pay attention to patterns and structures Pay attention to stressors and coping mechanisms Pay attention to relationships between the family members Look for multigenerational transmission processes Parents’ and children’s beliefs are highly correlated Violence, divorce, marital quality, depression, alcoholism tend to be transmitted intergenarationally.

Asking questions about the genogram What attracted your parents to each other? What was their relationship like? What were the problems during that period? When were the children born? How did the parents adapt to the children?

Therapeutic Techniques Process questions Slow people down Diminish their anxiety Start them thinking about themselves and others “When your boyfriend neglects you, how do you deal with it?” “When your daughter goes on dates, what goes on inside you?

Therapeutic Techniques Detriangulation of the marital couple Fortify the couple’s emotional functioning by increasing partners’ ability to manage their own anxiety I-POSITIONS “you are lazy” vs. “I wish you helped me more”

Therapeutic Techniques Relationship experiment Help clients understand what it’s like to act counter to their usual emotionally driven responses Ex: How would it be to act less worried about your partner’s work?

Bowenian Couples Therapy Pursuer-Distancer Relationship experiments: Pursuers are asked to restrain their pursuit, and distancers are encouraged to connect with partners. Help pursuer explore his/her inner emptiness What else is in your life besides X or Y?

Bowenian Couples Therapy Therapist’s role: Connect with each person Avoid triangulation: remain neutral and objective Emotional reactivity is toxic so “feel less, think more” Encourage thinking rather than feeling

Process vs. content Paying attention to content means the therapist is being emotionally reactive Pay attention to interactional dynamics DISPLACEMENT Stories: “Last year, I worked with a couple….” “Do you think anyone could get over this much anger and hurt?”