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

2. 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

3. 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

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

6. 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

7. Basic Concepts Emotional Triangles
Involving a third party to deal with a problem
Driven by anxiety
The involvement of a third party spreads anxiety among 3 people BUT freezes conflict
Parents complaining to their children

8. 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?

9. 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

10. 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.

11. 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

12. 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?

13. 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.

14. 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

15. 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

16. 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.

17. 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

18. 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

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

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

21. Genograms

22. Genograms

23. 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.

24. 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?

25. 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?

26. 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”

27. 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?

28. 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?

29. 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

30. 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?”