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Part Two The Classic Schools of Family Therapy

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Chapter 4 Bowen Family Systems Therapy An Intergenerational Approach to Family Therapy

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Learning Outcomes

Describe the evolution of Bowen Family Systems Therapy. Describe the main tenets of Bowen Family Systems Theory. Describe healthy and unhealthy family development from a Bowen Family Systems Theory perspective. Describe the clinical goals and the conditions necessary for meeting those goals from a Bowen Family Systems Theory perspective. Discuss and demonstrate the assessment and intervention techniques of Bowen Family Systems Theory. Discuss methods for evaluating Bowen Family Systems Theory.

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The pioneers of family therapy recognized that people are products of their context , but they limited their focus to the nuclear family. Yes, our actions are influenced by what goes on in our families. But what are the forces, past and present, that mold those influences? What makes a husband distance himself from his family? What makes a wife neglect her own development to manage her children’s lives? Murray Bowen sought answers to such questions in the larger network of extended family relationships.

According to Bowen, human relationships are driven by two counterbalancing life forces: individuality and togetherness. We need companionship, and we need independence. What makes life interesting—and frustrating—is the tendency for those needs to polarize us. When one person presses for connection, the other may feel crowded and pull away. As time goes by, the pursuit of one and withdrawal of the other drives the pair through cycles of closeness and distance.

How successfully people reconcile these two polarities of human nature depends on their ability to manage emotionality, or to use Bowen’s term, their differentiation of self. More about this later.

While no one doubts the formative influence of the family, many people imagine that once they leave home they are grown-up, independent adults, free at last of their parents’ control. Some people take it as a sign of maturity to separate from their parents. Others wish they could be closer but find visits painful, and so they stay away to avoid disappointment. Once out of range of the immediate conflict, they forget and

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deny the discord. But our families remain with us wherever we go. As we will see, unresolved emotional reactivity to our parents is the most important unfinished business of our lives.

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Sketches of Leading Figures Murray Bowen’s interest in the family began when he was a psychiatrist at the Menninger Clinic in the late 1940s. Turning his attention to the enigma of schizophrenia, Bowen was struck by the exquisite emotional sensitivity between patients and their mothers. Others called it symbiosis, as though it were some kind of mutation. Bowen saw it as simply an exaggeration of a natural process, a more intense version of the tendency to react emotionally that exists in all relationships.

In 1954 Bowen moved to the National Institute of Mental Health (NIMH), where he initiated a project of hospitalizing entire families containing a schizophrenic member. What he found was that the volatile bond between mothers and their emotionally disturbed offspring inevitably involved the whole family. At the heart of the problem was anxious attachment, a pathological form of closeness driven by anxiety. In these troubled families, people were emotional prisoners of the way the others behaved. The hallmark of these emotionally stuck-together, or fused, relationships was a lack of personal autonomy.

When the NIMH project ended in 1959 and Bowen moved to Georgetown University, he began working with families whose problems were less severe. What he discovered were many of the same mechanisms he had observed in psychotic families. This convinced him that all families vary along a continuum from emotional fusion to differentiation.

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During his thirty-one years at Georgetown, Bowen developed a comprehensive theory of family therapy, inspired an entire generation of students, and became an internationally renowned leader of

Murray Bowen’s extended family systems model is the most comprehensive theory in family therapy. Andrea Schara/The Bowen Center for the Study of Family

the family therapy movement. He died after a long illness in October 1990.

Among the most prominent of Bowen’s students are Philip Guerin and Thomas Fogarty, who joined in 1973 to form the Center for Family Learning in New Rochelle, New York. Under Guerin’s leadership, the Center for Family Learning became one of the major centers of family therapy training. Guerin is a laid-back, virtuoso therapist and teacher, and two of his books, The Evaluation and Treatment of Marital Conflict and Working with Relationship Triangles, are among the most useful in all the family therapy literature.

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Philip Guerin’s applications of Bowen theory have produced some of the most sophisticated clinical books in family therapy. Psychotherapy Networker

Betty Carter and Monica McGoldrick are best known for their exposition of the family life cycle (Carter & McGoldrick, 1999) and for championing feminism in family therapy. Michael Kerr was a long-time student and colleague of Bowen’s and the director of training at the Georgetown Family Center. Kerr is perhaps the most faithful advocate of all Bowen’s students, as his brilliant account of Bowenian theory in the book Family Evaluation (Kerr & Bowen, 1988) richly demonstrates. Kerr is now Director of the Bowen Theory Academy in Islesboro, Maine.

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Theoretical Formulations Family therapy’s pioneers were pragmatists, more concerned with action than insight, more interested in technique than theory. Bowen was the exception. He was always more committed to systems theory as a way of thinking than as a set of interventions.

According to Bowen, we have less autonomy in our emotional lives than we like to think. Most of us are more reactive to one another than we realize. Bowen’s theory describes how the family, as a multigenerational network of relationships, shapes the interplay of individuality and togetherness using five interlocking concepts (Bowen, 1966, 1976): differentiation of self, triangles, multigenerational emotional processes, emotional cutoff, and societal emotional processes.

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Differentiation of Self

The cornerstone of Bowen’s theory is both an intrapsychic and an interpersonal concept. Roughly analogous to ego strength, differentiation of self is the capacity to think and reflect, to not respond automatically to emotional pressures (Kerr & Bowen, 1988). It is the ability to be flexible and act wisely, even in the face of anxiety.

Undifferentiated people are easily moved to emotionality. Their lives are ruled by reactivity to those around them. A differentiated person is able to balance thinking and feeling: capable of strong emotion and spontaneity but also possessing the self-restraint that comes with the ability to resist the pull of emotionality.

In contrast, undifferentiated people tend to react impetuously— submissively or defiantly—toward others. They find it difficult to maintain their own autonomy, especially around anxious issues. Asked what they think, they say what they feel; asked what they believe, they repeat what they’ve heard. They agree with whatever you say, or argue with everything. Differentiated people, on the other hand, are able to take stands on issues because they’re able to think things through, decide what they believe, and then act on those beliefs.

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Emotional Triangles

Take a minute to think about the most troublesome relationship in your life. That relationship almost certainly involves one or more third persons. Virtually all relationships are shadowed by third parties—relatives, friends, even memories.

What drives triangles is anxiety (Guerin, Fogarty, Fay, & Kautto, 1996). As anxiety increases, people experience a greater need for emotional closeness—or, to avoid pressure, a greater need for distance. The more people are driven by anxiety, the less tolerant they are of one another and the more they are polarized by differences.

When two people have problems they are unable to resolve, they get to the point where it’s hard to talk about certain things. Why go through all that aggravation? Eventually one or both partners will turn to someone else for sympathy. Or the conflict will draw in a third person trying to help. If the third party’s involvement is only temporary or pushes the two people to work out their differences, the triangle doesn’t become fixed. But if, as often happens, the third person stays involved, the triangle becomes a part of the relationship.

The involvement of a third party decreases anxiety in the twosome by spreading it through three relationships. Thus, for example, a wife upset with her husband’s distance may increase her involvement with the children. What makes this a triangle is diverting energy that might otherwise go into the marriage. The wife’s spending time with her daughter may take pressure off her husband; however, it also decreases the likelihood that husband and wife will develop interests they can share—and it undermines the daughter’s independence.

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A group of three isn’t necessarily a triangle. In a healthy threesome, each pair can interact independently; each person has options for his or her behavior; and each can take a position without trying to change the other two. In a triangle, on the other hand, each pair’s interaction is tied to the behavior of the third person; each person is driven by reactive emotion; none of them can take a position without feeling the need to change the other two; and each person is entangled in the relationship between the other two. Picture a rubber band around three people who can’t allow it to drop. It constrains their movement such that if two people get closer, the third must move farther away.

Some triangles seem so innocent that we hardly notice them. Most parents can’t resist complaining to their children about each other. “Your mother’s always late!” “Your father never lets anyone else drive!” These interchanges may seem harmless, but what makes triangles problematic is that they have a tendency to become habitual.

Triangulation lets off steam but freezes conflict in place. It isn’t that complaining or seeking solace is wrong, but rather that triangles become diversions that undermine relationships.

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Multigenerational Emotional Processes

Emotional forces in families operate over the years in interconnected patterns. Bowen originally used the term undifferentiated family ego mass to describe excessive emotional reactivity, or fusion in families. If you know someone who overreacts to what you’re trying to say, then you know how frustrating it can be to deal with emotionally reactive people.

Lack of differentiation in a family produces reactive children, which may be manifest as emotional overinvolvement or emotional cutoff from the parents, which in turn leads to fusion in new relationships—because people with limited emotional resources tend to project all their needs onto each other. Because this new fusion is unstable, it’s likely to produce one or more of the following: (1) emotional distance, (2) physical or emotional dysfunction, (3) overt conflict, or (4) projection of problems onto children. The intensity of these problems is related to the degree of undifferentiation, extent of emotional cutoff from families of origin, and level of stress in the system.

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A common case is when a husband who is emotionally reactive to his family keeps his distance from his wife. This predisposes her to focus on her children. Kept at arm’s length by her husband, she becomes anxiously attached to the children, usually with greatest intensity toward one child. This might be the oldest son or daughter, the youngest, or perhaps the child most like one of the parents. This isn’t caring concern; it’s anxious, enmeshed concern. Because it relieves his own anxiety, the husband may accept his wife’s overinvolvement with the children, reinforcing their entanglement and his distance.

The more a mother focuses her anxiety on a child, the more that child’s functioning is stunted. This immaturity encourages the mother to hover over the child, distracting her from her own anxieties but crippling the child emotionally.

In every generation the child most involved in the family’s fusion moves toward a lower level of differentiation (and chronic anxiety), while the least involved child moves toward a higher level of differentiation (and less anxiety).

Parents who anxiously intrude their concerns on their children leave them little choice but to conform or rebel. Instead of learning to think for themselves, such children function in reaction to others. When these children leave home, they expect to become authors of their own lives. They’re not going to turn out like their parents! Unfortunately, our inheritance usually catches up with us.

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Emotional Cutoff

Emotional cutoff describes how some people manage anxiety in relationships. The greater the fusion between parents and children, the greater the likelihood of a cutoff. Some people seek distance by moving away; others do so emotionally by avoiding intimacy or insulating themselves with the presence of third parties.

Michael Nichols (1986) describes how some people mistake emotional cutoff for maturity:

We take it as a sign of growth to separate from our parents, and we measure our maturity by independence of family ties. Yet many of us still respond to our families as though they were radioactive. Only one thing robs Superman of his extraordinary power: kryptonite, a piece of his home planet. A surprising number of adult men and women are similarly rendered helpless by even a brief visit from their parents. (p. 190)

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Betty Carter was a highly respected Bowenian therapist and a forceful advocate for gender equality. Betty Carter

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Societal Emotional Process

Bowen anticipated the contemporary concern about social influence on how families function. Kerr and Bowen (1988) cite the example of the high crime rate that results in communities with great social pressure. Bowen agreed that sexism and class and ethnic prejudice are toxic social emotional processes, but he believed that families with higher levels of differentiation were better able to resist these destructive social influences.

To the theoretical concerns of Bowenian therapists, Monica McGoldrick and Betty Carter added gender and ethnicity. These feminist Bowenians believe that ignoring gender inequalities helps perpetuate the forces that keep men and women trapped in inflexible roles. Moreover, they might point out that the previous sentence is inaccurate in implying that men and women alike are victims of gender bias. Women live with constraining social conditions and with men who profit from them—men who may not feel powerful with their wives and mothers but who take for granted social advantages that make it easier for men to get ahead in the world.

McGoldrick has also been a leader in calling attention to ethnic differences among families. Her book Ethnicity and Family Therapy (McGoldrick, Pearce, & Giordano, 1982) was a landmark in family therapy’s developing awareness of this issue. Without being sensitive to how cultural values differ from one ethnic group to the next, there is a danger of therapists imposing their own ways of looking at things on families who aren’t dysfunctional but simply different.

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Family Dynamics Bowen’s theory is perhaps the richest in all of family therapy in terms of explaining how families work—and how they get off track. Careful readers will discover that the following principles can help us take charge of our own lives. Because, of course, blaming other people for your life’s difficulties finally leads nowhere.

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Normal Family Functioning

Optimal development is thought to take place when family members are differentiated, anxiety is low, and partners are in good emotional contact with their own families. Most people leave home in the midst of transforming relationships with their parents from an adolescent to an adult basis. Thus the transformation is usually incomplete, and most of us, even as adults, continue to react with adolescent oversensitivity to our parents— or anyone else who pushes the same buttons.

Normally, but not optimally, people reduce contact with their parents and siblings to avoid the anxiety of dealing with them. Once out of the house and on their own, people tend to assume that they’ve put the old difficulties behind them. However, we all carry unfinished business in the form of unresolved sensitivities that flare up in intense relationships wherever we go. Having learned to ignore their role in family conflicts, most people are unable to prevent recurrences in new relationships.

Another heritage from the past is that the emotional attachment between intimate partners comes to resemble that which each had in their families of origin. People from undifferentiated families will continue to be undifferentiated when they form new families. Those who handled anxiety by withdrawal will tend to do the same in their marriages. Therefore, Bowen was convinced that differentiation of autonomous personalities, accomplished primarily in the family of origin, was both a description of normal development and a prescription for therapeutic progress.

Carter and McGoldrick (1999) describe the family life cycle as a process of expansion, contraction, and realignment of the relationship system to support the entry, exit, and development of family members.

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In the leaving home stage, the primary task for young adults is to separate from their families without cutting off or fleeing to an emotional substitute. This is the time to develop an autonomous self before pairing off to form a new union.

In the joining of families through marriage stage, the primary task is commitment to the new couple. But this is not simply a joining of two individuals; it is a transformation of two entire systems. While problems at this stage may seem to be primarily between the partners, they often reflect a failure to separate from families of origin or cutoffs that put too much pressure on a couple. The formation of an intimate partnership requires the partners to shift their primary emotional attachment from their parents and friends to their mates. Making wedding plans, choosing a place to live, buying a car, having a baby, and selecting schools are times when this struggle may become explicit.

Families with young children must make space for the new additions, cooperate in childrearing, keep the marriage from being submerged in parenting, and realign relationships with the extended family. Young mothers and fathers must meet their children’s needs for nurture and control, and they must learn to work together as a team. This is a stressful time, especially for new mothers, and it is the stage with the highest divorce rate.

Watch this video of a Bowenian therapist

interviewing a young mother about a recent loss in her family. What effect can a loss have on a young family?

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The reward for parents who survive the preceding stages is to have their children turn into adolescents. Adolescence is a time when children no longer want to be like mommy and daddy; they want to be themselves. They struggle to become autonomous individuals and to open family boundaries—and they struggle however hard they must. Parents with satisfying lives of their own welcome (or at least tolerate) the fresh air that blows through the house at this time. Those who insist on controlling their teenagers, as though they were still little ones, may provoke escalations of the rebelliousness that’s normal for this period.

In the launching of children and moving on stage, parents must let their children go and take hold of their own lives. This can be liberating or a time of midlife crisis (Nichols, 1986). Parents must not only deal with changes in their children’s and their own lives but also with changes in their relationship with aging parents, who may need increasing support or at least don’t want to act like parents anymore.

Families in later life must adjust to retirement, which not only means a loss of vocation but also increased proximity. With both partners home all day, the house may seem a lot smaller. Later in life families must cope with declining health, illness, and then death, the great equalizer.

One variation in the life cycle that can no longer be considered abnormal is divorce. With the divorce rate at 50 percent and the rate of redivorce at 61 percent (U.S. Bureau of the Census, 2014), divorce now strikes the majority of American families. The primary tasks of a divorcing couple are to end the marriage but maintain cooperation as parents. Some postdivorce families become single-parent families—consisting in the main of mothers and children—and in the vast majority of cases, staggering under the weight of financial strain. The alternative is remarriage and the formation of stepfamilies, in which, often, loneliness is swapped for conflict.

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Development of Behavior Disorders

Symptoms result from stress that exceeds a person’s ability to manage it. The ability to handle stress is a function of differentiation: The more well- differentiated people are, the more resilient they will be and the more flexible and sustaining their relationships. In less well-differentiated people, it takes less stress to produce symptoms.

If differentiation were reduced to maturity, this formula wouldn’t add much to the familiar diathesis-stress model, which says that illness develops when an individual’s vulnerability is overtaxed. The difference is that differentiation isn’t just a quality of individuals but also of relationships. A person’s basic level of differentiation is largely determined by the degree of autonomy achieved in his or her family, but the functional level of differentiation is influenced by the quality of current relationships. Thus a somewhat immature person who manages to develop healthy relationships will be at less risk than an equally immature person who’s alone or in unhealthy relationships. Symptoms develop when the level of anxiety exceeds the system’s ability to handle it.

The most vulnerable individual (in terms of isolation and lack of differentiation) is most likely to absorb the anxiety in a system and develop symptoms. For example, a child of ten with a conduct disorder is likely to be the most triangled child in the family and thereby the one most emotionally caught up in the conflict between the parents or most affected by one of the parent’s anxieties.

According to Bowen, the underlying factor in the genesis of psychological problems is emotional fusion, passed down from one generation to the next. The greater the fusion, the more one is programmed by primitive emotional forces, and the more vulnerable to the emotionality of others.

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Emotional fusion is based on anxious attachment, which may be manifest either as dependency or isolation. Both the overly dependent and the emotionally isolated person respond to stress with emotional reactivity. The following clinical vignette illustrates how emotional fusion in the family of origin is transmitted.

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Case Study

Janet and Warren Langdon requested help for their son Martin after Mrs. Langdon found marijuana in a plastic bag at the bottom of his underwear drawer. Mr. and Mrs. Langdon didn’t object when the therapist said she’d like to meet with all three of them. It turned out that the discovery of marijuana was just the latest incident in a long series of battles between Mrs. Langdon and her son. Lots of fifteen-year-olds experiment with marijuana; not all of them leave the evidence around for their mothers to find.

After meeting with the family and then talking with the boy and his parents separately, the therapist concluded that Martin did not have a serious drug problem. Of greater concern, however, were the intensity of his shouting matches with his mother and his poor social adjustment at school. What she told the family was that she was concerned not only about the marijuana but also about these other signs of unhappy adjustment and that she’d like to extend the evaluation by having a couple of meetings with Martin and his parents separately. Mr. and Mrs. Langdon agreed without enthusiasm.

After his father died, Mr. Langdon and his older sister were raised by their mother. They were all she had left, and she devoted all her energy to shaping their lives. She was demanding and critical, and resentful of anything they wanted to do outside the family. By late adolescence, Warren could no longer tolerate his domineering mother. His sister was never able to break free; she remained single, living at home with her mother. Warren, however, was determined to become independent. Finally, in his mid- twenties, he left home and turned his back on his mother.

Janet Langdon came from a close-knit family. She and her four sisters were devoted to each other and remained best friends. After graduating from

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high school, Janet announced that she wanted to go to college. This was contrary to the family norm that daughters stay at home and prepare to be wives and mothers. Hence a major battle ensued between Janet and her parents; they were struggling to hold on, and she was struggling to break free. Finally she left for college, but she was ever after estranged from her parents.

Janet and Warren were immediately drawn to one another. Both were lonely and cut off from their families. After a brief, passionate courtship, they married. The honeymoon didn’t last long. Never having really differentiated from his dictatorial mother, Warren was exquisitely sensitive to criticism and control. He became furious at Janet’s slightest attempt to change his habits. Janet, on the other hand, sought to reestablish the closeness she’d had in her family. In order to be close, she and Warren would have to share interests and activities. But when she moved toward him, suggesting that they do something together, Warren got angry and resentful, feeling that she was impinging on his individuality. After several months of conflict, the two settled into a period of relative equilibrium. Warren put most of his energy into his work, leaving Janet to adjust to the distance between them. A year later Martin was born.

Both of them were delighted to have a baby, but what was for Warren a pleasant addition to the family was for Janet a way to fulfill a desperate need for closeness. The baby meant everything to her. While he was an infant, she was the perfect mother, loving him tenderly and caring for his every need. When Warren tried to become involved with his infant son, Janet hovered about making sure he didn’t “do anything wrong.” This infuriated Warren, and after a few bitter blowups he left Martin to his wife’s care.

As Martin learned to walk and talk, he got into mischief, as children do. He grabbed things, refused to stay in his playpen, and fussed whenever he

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didn’t get his way. His crying was unbearable to Janet, and she found herself unable to set limits on her precious child.

Martin grew up with a doting mother, thinking he was the center of the universe. Whenever he didn’t get what he wanted, he threw a tantrum. Bad as things got, at least the family existed in a kind of equilibrium. Warren was cut off from his wife and son, but he had his work. Janet was alienated from her husband, but she had her baby.

Martin’s difficulties began when he went off to school. Used to getting his own way, he found it difficult to get along with other children. His tantrums did nothing to endear him to his schoolmates or teachers. Other children avoided him, and he grew up having few friends. With teachers he acted out his father’s resistance to any effort to control him. When Janet heard complaints about Martin’s behavior, she sided with her son. “Those people don’t know how to deal with a creative child!”

Martin grew up with a terrible pattern of adjustment to school and friends but retained his close relationship with his mother. The crisis came with adolescence. Like his father before him, Martin tried to develop independent interests outside the home. However, he was less capable of separating than his father had been, and his mother was incapable of letting go. The result was the beginning of chronic conflicts between Martin and his mother. Even as they argued and fought, they remained focused on each other. Martin spent more time battling his mother than doing anything else with his life.

Martin’s history illustrates Bowen’s theory of behavior disorder. Symptoms break out when the vertical problems of anxiety and toxic family issues intersect with the horizontal stresses of transition points in the life cycle. Thus Martin’s greatest vulnerability came when the unresolved fusion he

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inherited from his mother intersected with the stress of his adolescent urge for independence.

According to Bowen, people tend to choose mates with similar levels of undifferentiation. When conflict develops, each partner will be aware of the emotional immaturity—of the other one. Each will be prepared for change— in the other one. He will discover that her treating him like a father entails not only affectionate clinging but also tirades and temper tantrums. She will discover that he withdraws the closeness she found so attractive in courtship as soon as she makes any demands. Sadly, what turned them on to each other carries the switch that turns them off.

What follows is marital conflict, dysfunction in one of the spouses, preoccupation with one of the children, or a combination of all three. Whatever the presenting problem, however, the dynamics are similar: undifferentiation in families of origin is transmitted to marital problems, which are projected onto a symptomatic spouse or child. Thus are the problems of the past visited on the future.

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Mechanisms of Change When people ask how therapy works, they’re usually interested in how therapists bring about change. That’s all very well, except for one thing: therapists don’t bring about change; they help clients bring about change in their own lives. Few schools of therapy appreciate this truth better than Bowen family systems therapy.

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Goals of Therapy

Bowenians don’t try to change people, nor are they much interested in solving problems. They see therapy as an opportunity for people to learn about themselves and their relationships so that they can assume responsibility for their own problems. This is not to say, however, that therapists sit back and allow families to sort out their own conflicts. On the contrary, Bowenian therapy is a process of active inquiry, in which the therapist, guided by the most comprehensive theory in family therapy, helps family members get past blaming in order to explore their own roles in family problems.

Tracing the pattern of family problems means paying attention to process and structure. Process refers to patterns of emotional reactivity; structure, to interlocking networks of triangles.

To change a system, modification must take place in the most important triangle in the family—the one involving the marital couple. If a therapist stays in contact with the partners while remaining emotionally neutral, they can begin the process of detriangulation and differentiation that will profoundly affect the entire family system.

The clinical methodology tied to this formulation calls for: (1) increasing the parents’ ability to manage their own anxiety, and thereby becoming better able to handle their children’s behavior and (2) fortifying the couple’s emotional functioning by increasing their ability to operate with less anxiety in their families of origin.

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Conditions for Behavior Change

Increasing the ability to distinguish between thinking and feeling, and learning to use that ability to resolve relationship problems is the guiding principle of Bowenian therapy. Lowering anxiety and increasing self-focus— the ability to see one’s own role in interpersonal processes—are the primary mechanisms of change.

Understanding, not action, is the vehicle of cure. Therefore, two of the most important elements in Bowenian therapy may not be apparent to someone who thinks in terms of techniques. The atmosphere of sessions is designed to minimize emotionality. Therapists ask questions to foster self- reflection, and they direct them at individuals one at a time, rather than encourage family dialogues—which have a tendency to get overheated. Because clients aren’t the only ones to respond emotionally to family dramas, Bowenian therapists strive to control their own reactivity and avoid triangulation. This is easier said than done. The keys to staying detriangled are avoiding taking sides and nudging each party toward accepting more responsibility for making things better.

Part of the process of differentiating a self is to develop a personal relationship with everyone in the extended family . The power of these connections may seem mysterious—particularly for people who don’t think of their well-being as dependent on family ties. A little reflection reveals that increasing the number of relationships will enable an individual to spread out his or her emotional energy. Instead of concentrating one’s investment in one or two family relationships, it’s diffused into several.

Freud had a similar notion on an intrapsychic level. In “The Project for a Scientific Psychology,” Freud described his neurological model of the mind. The immature mind has few outlets (cathexes) for channeling psychic

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energy and hence little flexibility or capacity for delay. The mature mind, on the other hand, has many channels of response, which permits greater flexibility. Bowen’s notion of increasing the emotional family network is like Freud’s model, writ large.

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Therapy The major techniques in Bowenian therapy include genograms, process questions, relationship experiments, detriangling, coaching, taking “I- positions,” and displacement stories. Because seeing one’s own role in family problems as well as how those problems are embedded in the history of the extended family are so important in Bowenian therapy, assessment is more critical in this approach than most.

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Assessment

Assessment begins with a history of the presenting problem. Exact dates are noted and later checked for their relationship to events in the extended family. Next comes a history of the nuclear family, including when the parents met, their courtship, their marriage, and childrearing. Particular attention is paid to where the family lived and when they moved, especially in relation to the location of the extended family. The next part of the evaluation is devoted to the history of both spouses’ births, sibling positions, significant facts about their childhoods, and the functioning of their parents. All of this information is recorded on a genogram, covering at least three generations.

Genograms are schematic diagrams showing family members and their relationships to one another. Included are ages, dates of marriage, deaths, and geographical locations. Men are represented by squares and women by circles, with their ages inside the figures. Horizontal lines indicate marriages, with the date of the marriage written on the line; vertical lines connect parents and children (Figure 4.1 ).

1For more detailed suggestions, see McGoldrick & Gerson, 1985.

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Figure 4.1 Basic Symbols Used in Genograms

What makes a genogram more than a static portrait of a family’s history is the inclusion of relationship conflicts, cutoffs, and triangles. The fact that Uncle Fred was an alcoholic or that Great Grandmother Sophie migrated from Russia is relatively meaningless without some understanding of the patterns of emotional processes passed down through the generations.

Dates of important events, such as deaths, marriages, and divorces, deserve careful study. These events send emotional shock waves throughout the family, which may open lines of communication, or these issues may get buried and family members may be progressively more cut off. Another significant piece of information on the genogram is the location of various segments of the family. Dates, relationships, and localities provide a framework to explore emotional boundaries, fusion, cutoffs, critical conflicts, amount of openness, and the number of current and potential relationships in the family.

Figure 4.2 shows symbols that can be used to describe the relationship dynamics among family

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Figure 4.2 Genogram Symbols for Relationship Dynamics

Figure 4.3 Genogram of Sigmund Freud’s Family

members. Three parallel lines are used to indicate overly close (or fused) relationships; a zigzag line, conflict; a dotted line, emotional distance; and a broken line, estrangement (or cutoff). When these symbols are used, triangular patterns across three generations often become vividly clear—as

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shown in an abbreviated diagram of Sigmund Freud’s family (Figure 4.3 ).

The history of a nuclear family begins with the courtship of the parents: What attracted them to each other? What was the early period of their relationship like? What were the problems during that period? When were the children born, and how did the parents adapt to the new additions?

Of particular interest are the stresses a family has endured and how they have adapted. This information helps to evaluate the intensity of chronic anxiety in a family and whether it is linked more to an overload of difficult life events or to a low level of adaptiveness in the family.

As Figure 4.4 shows, the bare facts of a nuclear family genogram only provide a skeleton on which to flesh out information about the Langdon family.

In gathering information about extended families, a therapist should ascertain which members of the clan are most involved with the family being assessed, for it is the nature of ongoing ties to the extended family that has a great impact on both parents and their role in the nuclear family. Of equal importance, however,

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Figure 4.4 Langdon Family Genogram

is finding out who is not involved, because people with whom contact has been cut off can be an even greater source of anxiety than the people with whom contact has been maintained.

Watch this video of a therapist constructing a

family genogram. Which questions would you ask when constructing a genogram?

Philip Guerin demonstrates the kinds of questions for constructing a genogram in the following vignette.

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“The Infamous Jersey Shore” Therapist: So, are you ready? Your attorney tells me that you’re in the middle of divorce litigation and it’s getting rough. Is that the main reason you came in this morning?

Patient: Yes. I’m very sad, and I wish I could make it all go away.

Therapist: How long have you been married?

Patient: We were married in ’92.

Therapist: How old are you now?

Patient: 45 this past June. My birthday is June 6th.

Therapist: Where were you born?

Patient: In Mantoloking, New Jersey, as small town on the coast— the infamous Jersey Shore.

Therapist: Do you ever wish you were back there?

Patient: Only in the summer.

Therapist: How often do you go back?

Patient: Every year, at least for a few days.

Therapist: Is there anyone from your old clan still there?

Patient: My dad is still there. He’s 75, been retired about five years.

Therapist: How about your mom?

Patient: She died of uterine cancer six years ago. My father tried to keep on working—he was an attorney—but his heart just wasn’t in it.

Therapist: How old was your mother? How long had she been sick?

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Patient: Mom was 67. She was first diagnosed 2½ years before she died.

Therapist: Tell me about that time in your life.

Patient: I can remember the phone call the day she got the news from the endometrial biopsy . . . it’s like it was yesterday.

Therapist: What makes you so clear about that day?

Patient: I don’t know for sure, but I think it feels like the beginning of the end of our idyllic life. . . .

Therapist: How many siblings do you have?

Patient: Three, two sisters and a brother.

Therapist: And where do you fit in that chain?

Patient: You probably could have guessed—I’m the oldest.

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Therapeutic Techniques

Bowenian therapists believe that understanding how family systems operate is more important than devising techniques to change them. Bowen himself spoke of technique with disdain, and he was distressed to see therapists relying on formulaic interventions.

If there were a magic bullet in Bowenian therapy— one essential technique —it would be the process question. Process questions are designed to explore what’s going on inside people and between them: “When your boyfriend neglects you, how do you react?” “What about your wife’s criticism upsets you most?” “When your daughter goes on dates, what do you worry about?” Process questions are designed to slow people down and start them thinking—not just about how others are upsetting them but about how they participate in interpersonal problems.

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Case Study

In interviewing a couple in which the husband was a recovering alcoholic with a history of abuse, the therapist asked, “Where are you with the thoughts about the damage you’ve done to your wife and kids with your alcoholism?”

When the man acknowledged responsibility for his abusive behavior and seemed genuinely remorseful, the therapist asked about his progress toward recovery, using process questions to focus on rational planning and personal responsibility. For example:

“What makes that step so hard?”

“Pride.”

“How does that manifest itself?”

“I get nasty.”

Notice how this line of questioning explores not only the man’s personal progress but also how his problems affect others in the family. Relationships take place in a systemic web of connections, but individuals are responsible for their own behavior.

Then the therapist shifted to open a discussion of the wife’s role in the couple’s difficulties. “So, you’re getting better at taking responsibility for the drinking and the behavior connected with it? Do you think your wife appreciates what you’re doing and the progress you’re making?” And then a few minutes later: “Has your wife ever been able to talk to you about the things she’s contributed to the relationship going sour?”

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When the therapist asked the wife about her thinking, she reiterated all the annoying things her husband was doing—pressuring her to forgive him and get back together. Although he would eventually like her to consider her own role in the process, the therapist tried to empathize with her upset. “So, he’s just bugging you by trying to get you to change your mind?” Then after a few minutes, the therapist tried to shift the wife to thinking more and feeling less. “Can you give me a summary of your thinking—how you came to that conclusion?” And when the wife again got angry and blamed her husband, the therapist just listened. A moment later he asked, “What do you do in the face of that abuse?”

“I get upset.”

“Do you understand what it is about you that sets him off?”

“No.”

“Has he ever been able to tell you?”

Notice how the therapist attempts to explore the process of the couple’s relationship, asking both partners to think about what’s going on between them, increase their awareness of their own contributions, and consider what they’re planning to do to take responsibility to make things better.

Self-Focus

Part of being a grown-up is taking responsibility for one’s own emotions and the behavior those emotions drive. Self-focus does not release others from responsibility; it is a way for people to have more control in their own lives. Self-focus gives people more options for movement than a helpless victim has. “What percentage would you say is his (her) contribution, and what percentage is yours?” “What part might you be playing?” “What are your goals?” “What have you been doing to achieve them?” “What else?”

Philip Guerin, perhaps more than any other Bowenian, has developed clinical models that feature specific techniques for specific problems. As an example, he categorized marital conflict into four stages of severity with detailed suggestions for treating each stage (Guerin, Fay, Burden, & Kautto, 1987). In Working with Relationship Triangles, Guerin and his colleagues bring this same systematic approach to understanding and resolving triangles (Guerin, Fogarty, Fay, & Kautto, 1996). In early marriage, the “In-Law Triangle” is most common. Primacy of attachment and influence are the underlying issues.

In the “Wedding Gift Triangle” a young husband turns over his relationship with his mother to his wife. (“Thanks, honey.”) The wife and her mother-in- law form a bond while the husband remains distant. He may like this at first but later become jealous. Guerin recommends separating the wife from

overinvolvement with her mother-in-law and exploring her relationship as a wife rather than only as a mother and daughter-in-law. She might be asked to consider how her involvement in her primary parental triangle may have set her up for her present position in the in-law triangle. If there is conflict between the wife and her mother-in-law about influence over the husband, the two of them should be helped to understand what properly belongs to a son’s relationship with his mother and what belongs in his relationship with his wife.

The “Loyalty Alignment Triangle” is one in which a partner and his or her parents remain overly close, with the new mate on the outside. In such cases, one or both partners never really left the family of origin. Here, most of the work should be aimed at helping the adult child work through his or her relationship with his or her parents. This doesn’t mean cutting off from them but transforming the relationship from an adolescent to an adult-to- adult basis. In the “Dominant Father-in-Law Triangle” a wife and her idealized father are united in implicit criticism of the husband. This can occur even, or especially, if the wife’s father is dead. It’s hard to live up to a myth.

In such cases, as with all triangles, the focus should not be on the content of the quarrels but on the triangular process underlying them. The goal is to foster an increasing primacy of the marital bond without doing damage to the relationships the partners have with their parents.

The second major technique in Bowenian therapy, after the process question, is the relationship experiment. Process questions are designed to help family members realize that it isn’t what other people do but how they respond that perpetuates their problems. Relationship experiments are designed to help clients try something different from their usual emotionally driven responses. Some of these experiments may help

resolve problems, but their primary purpose is to help clients develop the ability to resist being driven by their emotions.

Case Study

The Kennedys came to therapy because sixteen-year-old David was doing badly in school. David was on the verge of flunking out of an exclusive private school partly because he was a poor student and partly because his evenings with friends included heavy drinking and marijuana smoking. His father had gotten after him to study harder and had suspended his driving privileges after he came home one school night quite drunk. Unfortunately, these efforts hadn’t been very effective because David didn’t respect his father, who was an alcoholic and frequently falling down drunk around the house. David’s stepmother, who’d been living with them for only two years, had little ability to control him, and she knew enough not to try.

I told the parents that I wouldn’t see them in family therapy because David didn’t respect the father who was drunk every night and who, I added, didn’t show any signs of being ready to do anything about his drinking. I did agree, however, to see David to try to help him finish the school year with passing grades.

David was able to pass the eleventh grade, and I continued to see him into the following year, not entirely comfortable in my role as substitute father figure. Although I maintained my resolve not to do therapy with a family that included a member who was actively abusing alcohol, I did meet with the family during three or four crises. The first three crises occurred when Mr. Kennedy’s drinking (and, it turned out, cocaine abuse) got way out of control and his father and wife insisted that he reenter treatment.

The most prominent triangle in this case was that Mr. Kennedy’s wife and father got together to pressure him to quit drinking. He had gone to rehab several times, but even the few times he’d actually finished a program, he soon returned to drinking. The only reason he ever sought help was as a result of ultimatums from his wife and father. His wife threatened to leave

him, and his father threatened to cut him off from the family estate. This case would go nowhere until this triangle could be modified.

I encouraged Mr. Kennedy’s wife and father to work on being less reactive while separating from each other around the issue of Mr. Kennedy’s drinking. Mr. Kennedy needed to take a stand for himself, rather than comply with his wife’s and his father’s wishes. In fact, I wondered aloud with him if taking an honest stance with his family wouldn’t mean telling them that he didn’t intend to quit drinking. What he decided to tell them was that while he was willing to work on controlling his drinking and use of cocaine, he didn’t intend to quit.

I encouraged Mr. Kennedy’s father to back off and let the other two battle it out. Reluctantly, he agreed to do so. I then got Mrs. Kennedy to make a clear statement about how she felt about her husband’s drinking but to discontinue her fruitless efforts to make him stop. I encouraged her to maintain her connection with her father-in-law but without talking about her husband all the time. Two months later, Mr. Kennedy decided to stop drinking and using cocaine.

This time he successfully completed a twenty-eight-day rehab program and entered AA and NA. Six weeks later he once again relapsed. Over the following eight months, Mr. Kennedy’s drinking and cocaine abuse got much worse. Finally, after a serious altercation with a Jamaican drug dealer, Mr. Kennedy made a serious decision to get sober. This time, instead of going to the respected local rehabilitation center that his father had recommended, he did some research on his own and decided to enter a famous drug treatment center in California. As of this writing, Mr. Kennedy has been sober for ten years.

Bowenian Therapy with Couples The secret of couples therapy is to stay connected with both partners without letting them triangle you. Bowen would speak with each person one at a time, often beginning with the more motivated partner. He would ask questions, verify facts, and listen to people’s stories. But he would frame each question to stimulate thinking rather than encourage expression of feelings. His objective was to explore the perceptions and opinions of each partner without siding emotionally with either one. It’s taking sides that keeps people from learning to deal with each other.

When things are calm, feelings can be dealt with more objectively and partners can talk rationally with each other. But when feeling outruns thinking, it’s best to ask questions that get couples to think more and feel less—and to talk to the therapist rather than to each other. (It’s easier to hear when you aren’t busy preparing to respond.) If all else fails to cool things down, Fogarty (1976b) recommends seeing spouses in separate sessions.

As partners talk, the therapist concentrates on the process of their interaction, not on the details under discussion. Focusing on content is a sign that the therapist is emotionally entangled. It may be hard to avoid being drawn in by hot topics like money, sex, and discipline of children. But a therapist’s job isn’t to settle disputes—it’s to help couples do so. The aim is to get clients to express thoughts and opinions to the therapist in the presence of their partners. Should one break down in tears, the therapist remains calm and inquires about the thoughts that touched off the tears. If a couple begins arguing, the therapist becomes more active, calmly questioning one, then the other, focusing on their respective thoughts. Asking for detailed descriptions of events is one of the best ways to cool overheated emotion and make room for reason.

Bowenian couples therapy is designed to reduce anxiety and foster self- focus. Monkey Business/Fotolia

Metaphors of complementarity are helpful to highlight the process of interactions. Fogarty (1976b), for example, described the pursuer– distancer dynamic. The more one presses for communication and togetherness, the more the other distances—watches television, works late, or goes off with the children. Frequently, partners pursue and distance in different areas. Men commonly distance themselves emotionally but pursue sexually. The trick, according to Fogarty, is “Never pursue a distancer.” Instead, help pursuers explore their own inner emptiness. “What’s in your life besides the other person?”

To underscore the need for objectivity, Bowen spoke of the therapist as a “coach” or “consultant.” He didn’t mean to imply indifference but rather to emphasize the neutrality required to avoid triangulation. In traditional terms

this is known as managing countertransference. Just as analysts are analyzed themselves so they can recognize countertransference , Bowen considered differentiating a self in one’s own family the best way to avoid being emotionally triangled by clients.

To help partners define differentiated identities, it’s useful for a therapist to take “I-positions” (Guerin, 1971)—that is, to make nonreactive observations and statements of opinion. The more a therapist takes an autonomous position in relation to a family, the easier it is for family members to define themselves to each other. Gradually, family members learn to calmly state their own beliefs and to act on them without attacking others or becoming overly upset by their responses.

After sufficient harmony had been won with progress toward self- differentiation, Bowen taught couples how emotional systems operate and encouraged them to explore those webs of relationship in their own families (Bowen, 1971).

For example, a woman locked into the role of emotional pursuer might be asked to describe her relationship with her father and then compare it with her current relationships. If lessening her preoccupation with her husband and children seems advisable, the therapist might encourage her to connect with the most emotionally distant member of her family, often her father. The idea wouldn’t be to shift her attachment from one set of relationships to another but to help her understand that the intensity of her need was due in part to unfinished business.

Michael Kerr (1971) suggests that when relationship problems in the nuclear family are being discussed, therapists should occasionally ask questions about similar patterns in the family of origin. If family members see that they are repeating earlier patterns, they are more likely to recognize their own emotional reactivity. Recently, this author saw a couple unable to

decide what to do with their mentally ill teenage daughter. Although the daughter was virtually uncontrollable, her mother found it difficult to consider hospitalization. When asked what her own mother would have done, without hesitating she replied that her long-suffering mother would have been too guilt-ridden even to consider placement—“no matter how much she and the rest of the family might suffer.” Little more needed to be said.

Bowenian Therapy with Individuals Bowen’s success at differentiating from his own family convinced him that a single highly motivated individual can be the fulcrum for changing an entire family system (Anonymous, 1972). The goal of working with individuals is the same as with larger units: developing person-to-person relationships, seeing family members as people rather than emotionally charged images, learning to recognize triangles, and, finally, detriangling oneself (Bowen, 1974).

The process of change is begun by learning more about the larger family— who made up the family, where they lived, what they did, and what they were like. Sometimes a “good relationship” turns out to be one in which tension is managed by distancing: infrequent contact, superficial conversation, and gossiping about other family members. Therefore, it’s useful to ask for descriptions rather than conclusions—not, “Do you have a good relationship with your parents?” but, “Where do your parents live? How often do you see them? What do you and your mother talk about when you’re alone together? Do you ever go out to lunch, just you and your dad?”

Gathering information about the family is an excellent vehicle for the second step toward differentiation, establishing person-to-person relationships with as many family members as possible. This means getting in touch and speaking personally with them, not about other people or impersonal topics. If this sounds easy, try it. Few of us can spend more than a few minutes talking personally with certain family members without getting anxious. When this happens, we’re tempted to withdraw, or triangle in another person. Gradually extending the time of personal conversation improves the relationship and helps differentiate a self.

Ultimately, differentiating yourself requires ceasing to participate in interpersonal triangles. The goal is to relate to people without gossiping or

taking sides and without counterattacking or defending yourself.

Triangles can be identified by asking who or what people go to when they distance from someone with whom they have been close. One sign of a triangle is its repetitive pattern. The dynamic of a triangle is predictable because it’s reactive and automatic.

Suppose that every time you talk to your mother she starts complaining about your father. Maybe it feels good to be confided in. Maybe you have fantasies about rescuing your parents—or at least your mother. In fact, the triangling is destructive to all three relationships: you and dad, dad and mom, and, yes, you and mom. In triangles, one pair is close and two are distant (Figure 4.5 ). Sympathizing with mom alienates dad. It also makes it less likely that she’ll work out her complaints with him.

Once you recognize a triangle for what it is, you can stop participating in it. The idea is to do something to get the other two people to work out their own relationship. The most direct approach is simply to suggest that they do so. In the example just given, you might suggest that your mother discuss her concerns with your father, and refuse to listen to more complaints. Less direct but more powerful is to tell dad that his wife has been complaining about him, and you don’t know why she doesn’t tell him about it. She’ll be annoyed but not forever. A more devious ploy is to overagree with mom’s complaints.

Figure 4.5 Cross-Generational Triangle

When she says he’s messy, you say he’s a complete slob; when she says he’s not very thoughtful, you say he’s an ogre. Pretty soon she’ll begin to defend him. Maybe she’ll decide to work out her complaints with him, or maybe she won’t. Either way you’ll have removed yourself from the triangle.

Once you look for them, you’ll find triangles everywhere. Common examples include griping with colleagues about the boss, telling someone that your partner doesn’t understand you, undercutting your spouse with the kids, and watching television to avoid talking to your family. Breaking free of triangles may not be easy, but the rewards are great. The payoff comes not only from enriching those relationships but also from enhancing your ability to relate to anyone—friends, colleagues, clients, and your spouse and children. Furthermore, if you can remain in emotional contact but change the part you play in your family—and maintain the change despite pressures to change back—the family will have to accommodate to your change.

Useful guidelines to help families avoid falling back into unproductive but familiar patterns have been enumerated by Carter and Orfanidis (1976), Guerin and Fogarty (1972), and Herz (1991). You can also read about how to work on family tensions by resolving your own emotional sensitivities in two marvelous books by Harriet Lerner: The Dance of Anger (Lerner, 1985) and The Dance of Intimacy (Lerner, 1989).

Evaluating Therapy Theory and Results What makes Bowen’s theory so useful is that it explains the emotional forces that regulate how we relate to other people. The single greatest impediment to understanding one another is our tendency to become emotionally reactive. Like all things about relationships, emotionality is a two-way street: Some people express themselves with such emotionalism that others react to that pressure rather than hearing what the person is trying to say. Bowenian theory locates the origin of this reactivity in the lack of differentiation of self and explains how to reduce emotionalism and move toward self-control—by cultivating relationships widely in the family and learning to listen without becoming defensive or untrue to one’s own beliefs.

In Bowenian theory, anxiety is the underlying explanation (for why people are dependent or avoidant and why they become emotionally reactive), reminiscent of Freudian conflict theory (which explains all symptoms as the result of conflicts about sex and aggression). The second pivotal concept in the Bowenian system is differentiation. Since differentiation is roughly synonymous with maturity, students might ask, To what extent is the proposition that more differentiated people function better a circular argument? In respect to the Bowenian tradition of asking questions rather than imposing opinions, we’ll let this stand as an open question for your consideration.

A possible shortcoming of the Bowenian approach is that in concentrating on individuals and their extended family relationships, it may neglect the power of working directly with the nuclear family. In many cases the most expedient way to resolve family problems is to bring everyone in the household together and encourage them to face each other and address their conflicts. These discussions become may heated and contentious, but a skilled therapist can help family members realize what they’re doing and guide them toward understanding.

There are times when families are so belligerent that their dialogues must be interrupted to help individuals get beyond defensiveness to the hurt feelings underneath. At such times, it’s useful, perhaps imperative, to block family members from arguing with each other. But an approach, such as Bowen’s, that encourages therapists to always speak to individual family members one at a time underutilizes the power of working with families in action.

Phil Guerin and Tom Fogarty have made notable contributions, not only in promulgating Bowenian theory but also in refining techniques of therapy. Both are master therapists. Betty Carter and Monica McGoldrick have made more of a contribution in studying how families work: the family life cycle, ethnic diversity, and the pervasive role of gender inequality. Because they are students of the family as well as therapists, some of their interventions have a decidedly educational flavor. In working with stepfamilies, for example, Betty Carter takes the stance of an expert and teaches the stepparent not to try to assume an equal position with the biological parent. Stepparents have to earn moral authority; meanwhile, what works best is supporting the role of the biological parent. Just as Bowen’s approach is influenced by his personal experience, it seems that both Carter and McGoldrick infuse their work as family therapists with their experience as career women and their convictions about the price of inequality.

Family researchers have tested the empirical validity of some of the propositions of Bowen’s theory, most prominently the concept of differentiation of self. Three psychometrically sound measures of differentiation of self have been developed. Haber’s (1993) Level of Differentiation of Self Scale contains twenty-four items that focus on emotional maturity, such as “I make decisions based on my own set of values and beliefs” and “When I have a problem that upsets me, I am still able to consider different options for solving the problem.” This scale significantly correlates (negatively) with chronic anxiety and psychological distress, which is consistent with Bowen theory. Skowron’s Differentiation of Self Inventory (DSI) (Skowron & Friedlander, 1998) contains four subscales: Emotional Cutoff (“I need to distance myself when people get too close to me,” “I would never consider turning to any of my family members for emotional support.”); “I”-Position (“I do not change my behavior simply to please another person”); Emotional Reactivity (“at times my feelings get the best of me and I have trouble thinking clearly”); and Fusion with Others (“it has been said of me that I am still very attached to my parents”). As Bowen theory predicts, the DSI correlates significantly with chronic anxiety, psychological distress, and marital satisfaction. Chabot Emotional Differentiation Scale (CED) was designed to measure the intrapsychic aspect of differentiation—the ability to think rationally in emotionally charged situations (Licht & Chabot, 2006). The CED asks subjects to respond to seventeen questions that assess integration of thinking and feeling in nonstressful periods and periods of prolonged stress, as well as when relationships are going well and when there are difficulties in relationships.

Research has supported Bowen’s notion that differentiation is related to trait anxiety (negatively) (Griffin & Apostal, 1993; Haber, 1993; Skowron & Friedlander, 1998; Peleg-Popko, 2002; Peleg & Yitzhak, 2011), psychological and physical health problems (negatively) (Davis & Jones, 1992; Haber, 1993; Bohlander, 1995; Skowron & Friedlander, 1998;

Elieson & Rubin, 2001; Bartle-Harlin & Probst, 2004), and marital satisfaction (positively) (Haber, 1984; Richards, 1989; Skowron & Friedlander, 1998; Skowron, 2000). Several studies have shown a significant relationship between triangulation and marital distress (Vuchinich, Emery, & Cassidy, 1988; Wood, Watkins, Boyle, Nogueira, Zimand, & Carroll, 1989; Gehring & Marti,1993; Peleg, 2008) as well as problems in intimate relationships (West, Zarski, & Harvill, 1986; Protinsky & Gilkey, 1996). Finally, consistent with Bowen’s belief in the multigenerational transmission of emotional process, researchers have found that parents’ and children’s beliefs are highly correlated (e.g., Troll & Bengston, 1979) and that violence (e.g., Alexander, Moore, & Alexander, 1991), divorce (e.g., Amato, 1996), marital quality (e.g., Feng, Giarrusso, Bengston, & Fry, 1999), eating disorders (e.g., Whitehouse & Harris, 1998), depression (Whitbeck et al., 1992), and alcoholism (e.g., Sher, Gershuny, Peterson, & Raskin, 1997) are transmitted from one generation to the next.

Additionally, some have proposed therapy models that utilize a Bowenian theoretical framework to address a host of presenting complaints. For instance, Kolbert and colleagues have suggested that Bowenian family therapy could be incorporated into individual therapy with adolescents whose families cannot (and in some cases should not) participate in joint sessions (Kolbert, Crothers, & Field, 2013). Others have similarly proposed models inspired by Bowenian family therapy to treat adults who were abused as children (MacKay, 2012), adolescent runaways (Coco & Courtney, 2003), and the homeless (Hertleing & Killmer, 2004). While these authors provide data from successful case studies, to date there are no controlled outcome studies testing the effectiveness of Bowenian therapy (Johnson & Lebow, 2000; Miller, Johnson, Sandberg, Stringer-Seibold, & Gfeller-Strouts, 2000). This, of course, is not surprising, considering that research is usually conducted by academics, most of whom are more interested in behavioral models than in traditional approaches like psychoanalysis and Bowen systems theory.

Ultimately, the status of extended family systems therapy rests not on empirical research but on the elegance of Murray Bowen’s theory, clinical experiences with this approach, and the personal experiences of those who have worked at differentiating themselves in their families of origin. Bowen himself was decidedly cool to empirical research (Bowen, 1976), preferring instead to refine and integrate theory and practice. Like psychoanalysis, Bowen systems theory is probably best judged not as true or false but as useful or not useful. On balance, it seems eminently useful.

Summary Bowen’s conceptual lens was wider than that of most family therapists, but his actual unit of treatment was smaller. His concern was always with the multigenerational family system, even though he usually met with individuals or couples. Since first introducing the three-generational hypothesis of schizophrenia , he was aware of how interlocking triangles connect one generation to the next—like threads interwoven in a family tapestry. Although Bowenian therapists are unique in sending patients home to repair their relationships with parents, the idea of intergenerational connections has been very influential in the field.

According to Bowen, the major problem in families is emotional fusion; the major goal is differentiation. Emotional fusion grows out of an instinctual need for others but is an unhealthy exaggeration of this need. Some people manifest fusion directly as an excessive need for togetherness; others mask it with a façade of independence. In either case, contagious anxiety drives automatic responses in close relationships and limits autonomous functioning.

In addition to extending his analysis of family problems deeper into the anxieties of individuals, Bowen also extended the focus wider, making the triangle the universal unit of analysis—in principle and practice. When people can’t settle their differences, the automatic tendency to involve third parties stabilizes relationships but freezes conflict in place. Bowen’s

recognition that the majority of family problems have triangular complications was one of the seminal ideas in family therapy.

Bowen discouraged therapists from trying to fix relationships and instead encouraged them to remain neutral while exploring the emotional processes in conflictual relationships with process questions. Bowenian therapists rarely give advice. They just keep asking questions. The goal isn’t to solve people’s problems but to help them learn to see their own role in how their family system operates. This self-discovery isn’t merely a matter of introspection, because understanding is seen as a tool for repairing relationships and enhancing one’s own autonomous functioning.

Six techniques are prominent in the practice of Bowen family systems therapy:

Genogram. In addition to recording biographic data, the genogram is used to trace relationship conflicts, cutoffs, and triangles. This process of collecting information is sometimes therapeutic in and of itself: Family members often say, “It never occurred to me how all those events fit together.” The most comprehensive guide to working with genograms is Genograms in Family Assessment (McGoldrick & Gerson, 1985). Neutralizing Triangles. If a therapist can remain free of the emotional reactivity families bring to therapy, clients will be better able to reduce their own emotionality and begin to think more clearly about their problems. The danger is that the same process of emotional triangulation families use to stabilize their conflicts will engulf the therapist. If so, therapy will be stalemated. On the other hand, if the therapist can remain free of reactive emotional entanglements—in other words, stay detriangled—the family system and its members will calm down to the point where they can begin to work out their dilemmas.

Process Questions. Each family member is asked a series of questions aimed at toning down emotion and fostering objective reflection. Process questions are also used to help manage and neutralize triangles, including the potential triangle(s) that may develop between the therapist and various family members. The process question is aimed at calming anxiety and gaining access to information on how the family perceives the problem and how the mechanisms driving the problem operate. If process questions decrease anxiety, people will be better able to think clearly. This clarity allows them to discover more potential options for managing their problems. Relationship Experiments. Relationship experiments are carried out around structural alterations in key triangles. The goal is to help family members become aware of systems processes and learn to recognize their own role in them. Perhaps the best illustrations of such experiments are those developed by Fogarty for use with emotional pursuers and distancers. Pursuers are encouraged to restrain their pursuit, stop making demands, decrease pressure for emotional connection, and see what happens, in themselves and in the relationship. This exercise isn’t designed to be a magic cure (as some people hope) but to help clarify the emotional processes involved. Distancers are encouraged to move toward their partners and communicate personal thoughts and feelings—in other words, to find an alternative to avoiding or capitulating to the other person’s demands. Coaching. Coaching is the Bowenian alternative to the more emotionally involved role common to other forms of therapy. By acting as a coach, the Bowenian therapist hopes to avoid taking over for clients or becoming embroiled in family triangles. Coaching doesn’t mean telling people what to do. It means asking questions designed to help people figure out family emotional processes and their role in them. The “I”-Position. An “I”-position is a calm and clear statement of personal opinion. In situations of increased tension, it often has a stabilizing effect for one person to be able to detach from the

emotionality and adopt an “I”-position. Taking a personal stance— saying what you feel instead of what others are doing—is one of the most direct ways to break cycles of emotional reactivity. It’s the difference between saying “You’re lazy” and “I wish you would help me more” or between “You’re always spoiling the children” and “I think we should be stricter with them.” It’s a big difference.

Bowenian therapists not only encourage clients to take “I”-positions, but they also do so themselves. For example, after a family session, the mother pulls the therapist aside and confides that her husband has terminal cancer but she doesn’t want the children to know. What to do? Take an “I”- position: Say to the mother, “I believe your children have a right to know about this.” What she does, of course, is up to her.

Finally, although students of family therapy are likely to evaluate different approaches according to how much sense they make and how useful they promise to be, Bowen himself considered his most important contribution to be showing the way to make human behavior a science. Far more important than developing methods and techniques of family therapy, Murray Bowen made profound contributions to our understanding of how we function as individuals, how we get along with our families, and how these are related.

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