Discussion

Discussion Paper Four: Laura’s Case Study and Family Systems Theory The purpose of this paper is to discuss the application of family systems theory to the case study of Laura. Laura has been diagnosed with depression and anxiety by her family doctor and referred to therapy. The use of family systems therapy can help Laura to better deal with her issue of social anxiety. By helping Laura to develop a higher level of differentiation of self, and reducing fusion in her family system, Laura will be better able to cope more effectively with not just social anxiety but with all stressful situations.

Laura’s Presenting Problem and Issue

Laura reports that she has historically had chronic feelings of depression and dissatisfaction with her life in multiple areas. Laura’s family background includes severe physical, verbal and psychological abuse by her parents. Although Laura is now removed from her previous abusive family situation, she will still feel the impacts from it. Increasing stress, and a lengthy eight-month bout of depressive feelings led Laura to consult her family physician for help. Laura states that her increasing stress factors include workload at her job, the onset of menopause, and growing resentment and guilt regarding her role in her aging mother’s care. In addition to these issues, Laura also has revealed that she has symptoms that would meet the criterial for social phobia, generalized.

Laura’s Issue

Laura’s social anxiety will be the focus of this paper, and how the application of Family Systems Theory could potentially help her to eliminate this symptom of dysfunction. Social phobia, or social anxiety is an anxiety characterized by the fear of many types of social situations, and the belief by an individual that they will be humiliated, embarrassed, or judged by others (Peleg & Zoabi, 2014). Laura describes her fears in parties, meetings, and other work situations that others will reject her or find fault with her. Laura does recognize that this is a problem for her and would like to overcome it in order to advance in her work more easily and be able to create more of a supportive social circle.

Family Systems Theory Overview

Bowen’s family systems theory, developed by Murray Bowen and published in its first form in 1966, was one of the first theories of family system functioning that was comprehensive (Brown, 1999). Bowen’s first focus was on the relationships between patients with schizophrenia and their mothers which were enmeshed (Haefner, 2014). Bowen viewed families as an intensely connected emotional system, with complex interactions, and where family patterns and problems repeated over generations. Family systems therapy attempts to reveal problems and issues that may be hidden in current and historical triangles, recognize the shared affects between members of the family unit that can escalate and may have been passed down over generations, and empower clients and their current family unit to take responsibility for their own healing and increased function with the recognition of these patterns and their own roles in them.

According to Bowen, the members of a family profoundly affect each other’s thoughts, feelings and actions. The members are interdependent and any change in the function of one member is followed reciprocally by changes in all other members. Anxiety in a family can quickly escalate due to this process, with the member that is the most accommodating

“absorbing” the system anxiety and suffering the most negative effects (Kerr, 2000). Bowen felt that chronic anxiety was the source of family dysfunction (Haefner, 2014).

The most important concepts of family therapy, in my opinion, are differentiation and emotional fusion. Differentiation represents the ability of an individual to function autonomously by making choices that benefit the individual, while they are still able to remain emotionally connected to important relationships (Haefner, 2014). Clients are given knowledge to be able to choose to react more from a logical point of view, rather than emotional, in some situations, and to be able to maintain their own level of stasis rather than escalation. Lower levels of differentiation have been linked to higher levels of social anxiety, and this is an important fact to consider when working with Laura and her husband (Peleg & Zoabi, 2014). Fusion is a lack of differentiation, and dysfunctional relationships between family members and person’s reactions within a relationship. Fusion can consist of enmeshment or withdrawal. Triangling occurs when anxiety and tension between two persons is passed on to a third party or entity, relieving the anxiety and serving as a distraction from real issues. For Laura and her husband, several issues could serve as triangulation subjects, including her social anxiety, her work, her feelings regarding her aging mother, or her overall depression.

There are a few more important concepts to understand when using family therapy. The nuclear family emotional system refers to the impacts of undifferentiation on emotional functioning in a single generation family. The family projection process describes how the next generation is passed down symptoms and anxieties. Emotional cutoff is one way people manage fusion between generations. Multi-generational transmission process is a concept regarding how patterns, themes, and positions in triangulations are passed down from generation to generation. Finally, sibling positions considers how roles in relationships are affected by an individual’s sibling position in their family (Brown, 1999).

Application of Family Systems Theory with Laura

Initial sessions with Laura and her husband will focus on gathering information in order to form impressions about the family’s emotional processes. This will also provide information to Laura and her husband about Laura’s social anxiety in its systemic context. Reducing Laura’s anxiety can be helped as she learns how this symptom is part of her pattern of relating, and how it was passed down generationally. Together they can develop a multigenerational genogram which will assist in tracking this problem from their family system and back into the history of their extended families. The therapist can ask Laura and her husband questions regarding their sibling positions in their childhood families, which can provide insight into the roles they each take in their relationship. The therapist can also investigate the possibility of “cutoff” – has Laura sought to escape from her former family situation, while maintaining former patterns of reactivity? Has the new contact with her mother in the form of being a caregiver for her caused a reignition of her former role as the focus of family anxiety? Important themes in their family histories can be connected to development of symptoms (Haefner, 2014). Information gathering is considered subjective, but still valuable with the insight it provides into past roles, triangulations, and tensions that remain from their childhood and family interactions (Brown,

1999).

In therapy sessions, assisting Laura and her husband in letting go of blaming and emotional reactivity, and developing and increasing more differentiation of self is the goal. The focus is on them making changes for themselves rather than trying to change others. The therapist should avoid being drawn into any triangulations during this process however and remain a placid and calm observer. Bowen (1976) felt that relationship fusion and triangling are the fuel for symptom formation of issues such as social anxiety. The therapist should provide Laura and her husband with education regarding how the emotional system functions as this knowledge will help reduce chronic anxiety for Laura and her husband. If we assume that

Laura’s relationship started with equal levels of differentiation (typical according to Bowen

(1976)), she and her husband may be experiencing a fused relationship where they have each defined themselves by the other partner’s reactions. With higher levels of fusion, an individual will have lower levels of flexibility to adapt to stress from outside sources. This fits with Laura and her increasing levels of social anxiety that coincide with increasing work stress and the addition of the care of her mother. Additionally, fusion can be manifested as ‘disengagement’ which fits with what Laura reports as keeping her distance from her husband and being hesitant to open up to him and share thoughts and feelings. Her knee jerk reaction is to distance herself instead of talking over relationship issues with him. Laura may also be the spouse who is making the most adjustments in self in order to preserve the harmony in the relationship. This would result in her being stuck in the under functioning position and having symptoms such as her social anxiety (Brown, 1999). Triangulation exists between Laura, her husband, and her social anxiety which acts as a barrier and distraction between them. This triangulation will have developed as they avoided discussion of their own marital difficulties, diminishing their marital anxiety and increasing it in another area, in this case Laura’s social anxiety (Haefner, 2014). Detriangling can be assisted by helping them recognize the way they are triangled, and by asking questions that help them to be aware of their roles in these triangles. These can be simple openended tracking questions used to gather as much information as possible, such as “How do you feel when Laura describes her anxiety?” or “How do you feel about your husband’s reaction to your anxiety?” Laura and her husband will both seek to find a way to be less reactive in the face of each other’s anxiety (Brown, 1999).

Summary

Overall, I believe family therapy can serve as means to long term improvement of function for Laura and her interactions with those around her. Giving Laura a clearer picture of the cycle of the effects on others in a system may help her see that her social anxiety may be exacerbated as she withdraws, others she has anxiety regarding sense her withdrawal and perceive it as rejection, withdraw themselves, and begin a worsening cycle of interactions. One potential drawback is that the wide focus of family systems therapy may be a negative if Laura’s goals are limited to the immediate relief of her social anxiety. A therapist working with Bowen’s family systems therapy would see Laura’s reduction of social anxiety as just the first step toward working on detriangling and improved levels of differentiation going forward, and this may represent a conflict between goals for the therapist and Laura. Additionally, as a highly educated individual who holds a law degree and practices law, there is a likelihood that Laura may be offended by the feminist perspective’s criticism of this theory as having a patriarchal perspective and Bowen’s assumptions about male/female roles and family organization (Brown, 1999). The time investment required for this therapy may be a barrier to overcome with Laura, as she already feels overwhelmed with her work responsibilities and growing involvement in her mother’s care. Finally, since Laura has herself reported that she is uncomfortable sharing private thoughts and feelings with her husband, it will be important to make sure she understands that his involvement is key to the success of the therapy and the mechanics and theory behind how it works. I do believe that increased knowledge of the theories behind family systems, her role in them, and the passing down of dysfunction, will help Laura to better understand and overcome many of her issues, have greater life satisfaction, and have a more meaningful and open relationship with her husband.

References

Bowen, M. (1976). Theory In the Practice of Psychotherapy. In P.J. Guerin (Ed.), Family

Therapy: Theory and Practice. New York: Gardner Press.

Brown, J. (1999). Bowen Family Systems Theory and Practice: Illustration and Critique. Australian and New Zealand Journal of Family Therapy. 20(2) Pages 94-103. Retreived from https://www.thefsi.com.au.

Haefner, J. (2014). An Application of Bowen Family Systems Theory. Issues in Mental Health Nursing. 35(11). Pages 835-841. https://doi-org.ezproxy.uta.edu/

10.3109/01612840.2014.921257.

Kerr, M. (2000). One Family’s Story: A Primer on Bowen Theory. The Bowen Center for the

Study of the Family. http://www.thebowencenter.org.

McBride, C., & Atkinson, L. (2009). Attachement Theory and Cognitive-Behavioral Therapy. In J. H. Obegi & E. Berant (Eds.), Attachment theory and research in clinical work with adults. (pp. 434-458). New York: Guilford.

Peleg, O., & Zoabi, M. (2014). Social Anxiety and Differentiation of Self: A Comparison of Jewish and Arab college Students. Personality and Individual Differences. 68. Pages 221- 228. https://doi.org/10.1016/j.paid/2014.04.032.