Family Systems Therapy

Family Systems Therapy
Murray Bowen

◦ trained as a psychiatrist and originally
practiced within the psychoanalytic model
◦ 1940s, Menninger Clinic – involved mothers
in the investigation and treatment of
schizophrenia
◦ 1954, National Institute of Mental Health
(NIMH) – began to include more family
members in his research and psychotherapy
with schizophrenic patients
◦ 1959, Georgetown University – established
Georgetown Family Center

◦ 1959 – 1962 – rather than developing a
theory about pathology, he focused on what
he saw as the common patterns of all ‘human
emotional systems’
◦ 1966 – published his first presentation of his
developing ideas; he used his concepts to
guide his intervention in a minor emotional
crisis in his own extended family
◦ Encouraged students to work on his theory;
from his trainees came the current leaders of
Bowenian Therapy

◦ a theory of human behavior that views
family as an emotional unit & uses systems
thinking to describe interactions in the unit
◦ it is the nature of the family that its
members are intensely connected
emotionally
◦ a change in one person’s functioning is
predictably followed by reciprocal changes
in the functioning of others

◦ Family Systems approach does not focus
on symptom reduction but improving the
intergenerational transmission process
◦ improvement in overall functioning will
ultimately reduce the family member’s
symptomatology

Key generator of anxiety in families is the
perception of either too much closeness or too
great a distance in a relationship.
When anxiety is low, we are able to think
about our situations and our very existence.
However, as anxiety increases, we become
less able to think and more emotionally
reactive to our situation.
Chronic Anxiety

Over time, the emotionally reactive person
becomes conflicted, distant, and emotionally
cut off.
Chronic Anxiety

Differentiation
◦ how one functions in response to one’s level
of anxiety
◦ capacity of an individual to function
autonomously by making self-directed
choices, while remaining emotionally
connected to a significant relationship system
◦ “The more differentiated a self, the more a
person can be individual while in emotional
contact with the group”

Emotional Fusion
◦ Tendency for family members to share an
emotional response as a result of poor
interpersonal boundaries
◦ undifferentiated person have only emotional
or only intellectual responses to anxiety-
producing situations
◦ this approach involves helping the client
understand the difference between and value
of both emotions and thoughts

Triangles
◦ smallest stable relationship
◦ triangling is said to occur when the
inevitable anxiety in a dyad is relieved by
involving a vulnerable third party who either
takes sides or provides a detour for the
anxiety

Nuclear Family Emotional System
◦ total degree to which emotional fusion can
occur in a family system
RELATIONSHIP FUSION TRIANGLING CLINICAL
DYSFUNCTION
Three categories of clinical dysfunction in
families:
1. Couple conflict
2. Dysfunction in a spouse
3. Dysfunction in a child

Family Projection Process
◦ describes how children develop symptoms
when they get caught up in the previous
generation’s anxiety about relationships
◦ child with least emotional separation from
his/her parents is said to be the most
vulnerable to developing symptoms
◦ occurs when a child anxiously responds to
the tension in parents’ relationship

Emotional Cutoff
◦ the way people manage the intensity of
fusion between the generation
◦ can be achieved through physical distance
or through forms of emotional withdrawal
◦ breaking away; more like an escape

Multigenerational Transmission
◦ patterns, themes and roles in a triangle are
passed down from generation to generation
through the projection of parent to child

Sibling Position
◦ a factor in determining personality: where a
person is in birth order has an influence on
how he or she relates to her parents and
siblings (Toman, 1961)
◦ eldest children - more likely to take on responsibility
and leadership
◦ younger siblings - more comfortable being
dependent and allowing others to make decisions
◦ middle children – having more flexibility to shift
between responsibility and dependence
◦ only child – responsible and have greater access to
the adult world

Family
The Model in Practice
Systems
Therapy

The goal of the therapy is to assist family
members toward greater levels of
differentiation, where there is less blaming,
decreased reactivity, and increased
responsibility for self.
The hallmarks of this therapy are anxiety
reduction and insight to family dynamics.
Goal

◦ maintain a ‘differentiated stance’ – to connect
with the family without becoming emotionally
reactive
◦ must be calm and interested
◦ getting the family into position to accept
responsibility for its own change
The Role of the Therapist

◦ Active in directing
◦ Clients are asked to talk directly to the
therapist so that the other family members
can ‘listen’ and really ‘hear’ without reacting
emotionally
◦ Enactments are halted so as to prevent the
escalation of the client’s anxiety
◦ Avoid asking for emotional responses; ask for
‘thoughts,’ ‘reactions,’ and ‘impressions’
Therapist Activity

◦ Minimal involvement of children
◦ Viewed as a detriangling maneuver
Children in Bowen’s Therapy

◦ Initial sessions focus on information gathering
in order to form ideas about the family’s
emotional processes
◦ Genogram (Guerin & Pendagast, 1976) – a
pictorial representation of family structure
along with specific information such as dates
of birth, deaths, and marriages as well as
descriptions of relationships
Family Evaluation: Genogram

◦ Therapist looks for patterns of regulating
closeness and distance, how anxiety is dealt
with, what triangles get activated, the degree
of adaptivity to changes and stressful events,
and any sign of ‘emotional cutoff’
Family Evaluation: Genogram

◦ Therapist asks questions that assume that the
adult client can be responsible for his/her
reactiveness to the other
◦ 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
Question that Encourage Differentiation

◦ Patterns of relating in the past continue in the
present family system
◦ 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
Creating a Multigenerational Lens

◦ Central technique in Bowenian therapy
◦ Client is first helped to recognize both the
subtle and the more obvious ways that they
are ‘triangled’ by others
◦ Therapist uses questions that facilitate the
family members’ awareness of their roles in
triangles
◦ Simple open-ended questions (who, what,
when, where)
Detriangling

◦ 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
◦ Goal: a family member must find a less
reactive position in the face of other’s anxiety
Detriangling

◦ Family therapy with an individual
◦ giving input and support for adult clients who
are attempting to develop greater
differentiation in their families
◦ Clients should feel in charge of their change
efforts
◦ Emphasis is on self-directed efforts to
detraingle from family of origin patterns
Coaching

◦ Clients practice controlling their emotional
reactivity in their family and report their
struggles and progress in following sessions
◦ Change is viewed as:
a. One takes a new position
b. Family members react
c. The new stance is maintained in the face
of pressure to revert to the original
position
Coaching

SAMPLE
CASE
George’s Anxiety
George, a 42-year-old Caucasian male, is referred by his
psychiatrist for psychotherapy around his depression and
anxiety. George is a bright and articulate doctorate-level
manager in a grant-funded educational foundation. He
has been depressed for two years and relates the onset of
his depression to being promoted.
According to George, he is happy and secure in his
marriage. He has been married for 12 yrs and has 2
daughters ages 9 and 5. He reports that the children are
doing well. However, he had difficulty maintaining the
boundary between work and home.

SESSION
ONE
• Focused on developing a therapeutic relationship and
assessing the client’s situation
• George reports there is no history of anxiety disorder in
his family
• He describes his mother an a unhappy person
• He further reports that at some point when he was a
teen, his father started to withdraw to his workshop in
the garage; George became closer to his mother
• He has 2 younger brothers, ages 34 and 32; all are
doing well – all have graduated from college, in stable
relationships

SESSION
ONE
• Therapist begins a therapeutic relationship with him;
George has been started on a course of antidepressant
medication, and benzodiazepine when his anxiety gets
out of control
• He reports another depressive episode when he first
moved out of the house during his junior year in college

SESSION
TWO
• Session is spent on developing a genogram
• Significant patterns emerged:
- He feels that his father withdrew from the family
when he became a teenager
- At a young age, he had the feeling that his father
was avoiding his mother
- He felt that he was elected to serve as his mother’s
companion when his father became less involved
- He reported that he spent the first two years of his
college career at a local community college because
his mother was not ready for him to move out

SESSION
TWO
- When asked about his current relationship with his
mother, he reports that at times it is strained
- When he calls his parents, his mother always adds
“helpful advice”
- Whenever he calls his parents, he talks to both of
them at the same time on the phone
• Client is engaged in the discussion on the nature of
emotional triangles
• He was encouraged to write letters to each of his
parents

SESSION
THREE
• Reported a significant decrease in his anxiety
• He has been able to stay out of employee conflict
• Self-soothing skills: he was able to talk to himself with a
supportive voice
• When asked whose critical voice he heard before, he
says it was his mother’s
• Exploration of his relationship with parents:
- Father continues to withdraw as a response to
mother’s depression
• George is unable to express his anger despite looking
angry; he states that he probably is but is unable to
own this feeling

SESSION
THREE
• He relates how, when he was teen, his parents were
unable to accept any negative feelings from him; they
would interpret it as being ungrateful
• Therapist discusses setting boundaries with his
parents, especially to his mother and her constant
giving of advice
• Therapist asks if he feels such a move is an expression
of his lack of gratitude towards his parents; George
affirms this
• Therapist asks George if he could write and send a
separate letter to each of his parent expressing
gratitude toward them; then in the future, a second
letter to each of them attempting to set some
boundaries

SESSION
FOUR
• George arrives with the letters
• He is visually brighter; Reports that he has been
significantly less depressed
• He describes how difficult it was to write them; States
how he let his emotions flow
• He reports that as he wrote the letters, he felt his
anxiety diminish
• Letter to his father discusses his dad’s abandonment
and his loss over not being closer to him, and ends with
an open invitation to talk in person
• Letter to his mother is considerably longer; he
discussed his feelings of inadequacy that resulted from
his mother’s advice giving

SESSION
FOUR
• Therapist asks how his parents would respond, George
becomes fearful, afraid that he may lose his
relationship with his parents
• Therapist states that in a healthy relationship, you can
say what is needed to say to another person any time

SESSION
FIVE
• George talks about the conflict he and his wife had
over expenses related to renovations
• He relates the conflict to miscommunication
• Therapist asks him to reflect on his feelings during the
argument, and relates that he was feeling abandoned
and unappreciated; He withdrew from her for a number
of days and a felt a slight increase in anxiety and
depression
• Therapist asks how he pulled out of his depressed
mood; he reports that it was his medicine and his ability
to calm himself with positive self-talk
• Rather than dwelling on the negative hurt feelings, he
decided to take responsibility for his feelings and try to
find way out

SESSION
FIVE
• He had insight that he was experiencing the same kind
of feelings he had had in his adolescence when his
mother would criticize him
• He had a productive conversation with his wife; they
were able to take responsibility for their own emotional
reactivity
• Therapist gives a positive feedback
• At the end of the session, George discloses that he has
decided to talk about his relationship with his mother in
person

SESSION
SIX
• George reports he has not felt at all depressed or
anxious between sessions; He attributes this to his
newfound ability not to be drawn into conflict at work
• He does not need the immediate approval of his staff to
feel good about himself; he has been able to relate to
his wife in a deeper level
• As a result, he reports having a better relationship with
his daughters
• He spends the last half of the session preparing for his
talk with his mother; he has decided to approach his
mother from a position of love; he states that his goal is
to have a closer relationship with him

SESSION
SEVEN
• George arrives for this session in good spirits and
discusses the reunion; he states that it went better than
he could have imagined
• George and his mother agreed that they wanted to be
closer, and his mother agreed to try not to criticize him;
if she fell into the old pattern, George was to confront
her
• Therapist mostly listens and at a few points gives some
positive feedback to support the change
• George reports that he is feeling no depressive or
anxiety symptoms; talks about stopping medication
• He is grateful for the ‘coaching’ he has received in
therapy
• Course of the therapy was reviewed, reinforcing

SESSION
SEVEN
• George is also offered with the option of returning for a
session sooner than four weeks should he feel the
need
• Therapist says goodbye, and George thanks the
therapist for helping him

References
Brown, Jenny. (1999). Bowen family systems theory and
practice: Illustration and critique. Australian and New
Zealand Journal of Family Therapy, Vol.20, No.2, pp. 94-
103.
Winek, J.L. (2009) Bowenian family therapy. Systemic
Family Therapy: From Theory to Practice. Sage
Publications, pp. 81-105.
Presented by
Aika Mae G. Borbon, RPm

Family Systems Therapy

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