Understanding Bowenian Family Therapy Concepts

Hi, this is Dr. Diane Gayhart, and this is my lecture on Bowenian Intergenerational Family Therapy that goes with my textbook series on Mastering Competencies in Family Therapy and also the Theory and Treatment Planning in Family Therapy published by Cengage. And both digital and hard copies are available. So I want to begin by giving you a big picture of Bowenian Intergenerational Family Therapy. This theory is a little bit different than some of the other... theories because it's really goes into a lot of depth about the nature of being human rather than about families or family therapy specifically. It's a very theory heavy theory in that there's it's really about how you conceptualize and understand what's going on with families and their distress or even individuals who are in families in their distress than it is a very prescribed system for doing things. A lot of the theory focuses on increasing the client's awareness of how their current behavior is connected to their multi-generational processes. And so it's a very awareness-based approach, much like psychoanalytic therapy. And what's interesting here, too, is that the primary tool for change is really the therapist level of differentiation. So it's a therapist level of what is termed differentiation, which is kind of a measure of... psychological health and relational health well-being. We're going to go into detail about differentiation, but that's the primary tool. And so one of the tenets of this approach is that, you know, a therapist can't help a client become more differentiated than the therapist is. So much of the training in this approach is actually looking at the therapist's own processes, working on the therapist's own level of differentiation so they can help clients do the same. The Juice, Significant Contributions to the Field from Bowenian Therapy. So there are two main concepts that we're going to talk about, differentiation and genogram, that I think are very significant from Bowenian approach. So differentiation is defined by the person's ability to separate intrapersonal, so within the self, and interpersonal between people distress. So at the interpersonal level, differentiation looks like the ability to separate your thoughts from your feelings in order to respond rather than just react to a stressful situation. And interpersonal differentiation is knowing where one self ends and another begins without losing your sense of self. So being able to be intimate and connected, yet have a clear sense of self. And so these are the two processes that are part of differentiation. And it's a lifelong process to get good at this. And basically it's balancing two very... basic life forces, the need to be together with others with the need for autonomy. And so this is an ongoing balance and process across life and so this is what Bowenian therapy really looks at. Basically the theory goes that differentiated people are better able to handle the ups and downs of being in intimate relationships. And so that's why by increasing client's sense of differentiation, they're going to be able to navigate their family and personal intimate relationships better. The other really unique thing about Bowen therapy is that they use an assessment tool called a genogram. It's sort of like a family tree, but it's specifically made for addressing or identifying intergenerational patterns. And so, genograms are used by many therapists, family therapists, social workers, counselors, psychologists. It's a wonderful way to get a really, to get the big picture of the client's broader, you know, family, multi-generational processes, family background. For me, I find it just really helpful to remember who's who in the family, cast of characters. And so, this can be really useful no matter which approach you're looking for. And so, Basically, the process is helpful both for the therapist in terms of assessing and also for clients. I mean, yes, they're sitting there telling you all this, but oftentimes when they see it on paper and they see the dynamics. it shifts something in them. For example, I once worked with a client who had a grandfather who had sexually abused her. And it wasn't until she realized that, oh my God, you know, all of these people had been abused, you know, by my grandfather. It was, it was very transformational for her. And yes, she just sat there and gave me the information and I just notated and colored it in. And when she saw it on paper, it really shifted a lot of things. It was very significant for her. And so for many clients, um, You know, and there are other times where, you know, I once was doing an intake session and the client was describing, oh my God, you know, if I decide to marry this person, my family is going to cut me off. And, you know, she was young and I thought maybe she was exaggerating a little bit. But once I did her genogram, like, oh, yeah, yeah, they are going to probably cut you off. Exactly. You nailed that one. So it can be very helpful both ways. And you do get a lot of information and quickly. And it can be very helpful for both the therapist and for the client. And depending on what approach you use, genograms can be adapted. In fact, there are some solution-focused therapists who have adapted it looking at family strengths across generations. So the genogram can be very flexible even when working from other theoretical orientations. The big picture and overview of treatment. So Bowen therapy is very much what we would call a process-oriented therapy. The focus is on the client's process rather than symptom reduction and the whole process of what's going on in the room. It relies very much on the self of the therapist, the therapist's level of differentiation. The techniques and interventions are de-emphasized and it's more focusing on the therapist helping to facilitate the client in seeing the patterns. understanding the multi-generational transmission process and what's going on there, and helping the client learn how to differentiate themselves in the situations that are most closely related to their presenting problems. So basically, it's using insight and therapeutic relationship to increase the client's level of differentiation and having them transfer this to the outside world. And again, this is more in the traditional style of a psychoanalytic or psychodynamic approach than... some of the other systemic or structural approaches that are much more active, technique-based, have phases of treatment, etc. Making connection, the therapeutic relationship. So the therapeutic relationship is quite distinct in the Bowenian approach. So the focus again is on the differentiation and the emotional being of the therapist, how they are in the session. So So there's that belief that clients can only differentiate as much as a therapist is differentiated. And so the therapist really tries to bring this non-anxious presence to the therapy room. They're emotionally engaged in a way that is non-reactive to whatever the clients are saying. And in this sense, they're kind of role modeling how to be differentiated and how not to overreact and have knee jerk responses and get all worked up. So they bring what's called this non-anxious presence and they're role modeling for the client the differentiation process. And so that's the whole focus of the therapeutic relationship. And so it is probably a little, some people, you know, see the distance or can may experience it more as distance because they try not to actually activate emotions and instead try to help clients separate out the emotions from the thoughts and to... to have a more reflected response to what's going on rather than being reactive. So now we're going to talk about the viewing in case conceptualization in bohemian therapy which is really the heart of the approach. So, Bowenian therapists view family systems as primarily emotional systems. They actually, in some of the foundational theoretical writing on the theory, they talk about how the family's emotional process is actually like an extension of cellular differentiation process, where the term actually comes from. But on a more practical level, a family that lacks this differentiation becomes what they call, and this is a good, fun term out of the family therapy literature, the undifferentiated family ego mass where the whole all the members of the family experience themselves as almost one being and there's no differentiation and so when someone has a different opinion or preference or view of what happened this becomes very very threatening to the others and so that's how it's conceptualized and that's why it becomes problematic. There's no way for people to actually assert their individuality and so The therapists really focus on the family's unique emotional system more so than the environment or culture. How is the family functioning? How is it functioning as an emotional system? And then they look at how this system has impacts each person's behaviors, emotions, and the presenting symptoms. Another central concept in Bowenian therapy is a concept of chronic anxiety. This isn't kind of I mean this isn't like diagnosis DSM anxiety. This isn't really even existential anxiety. It's a different concept here. It's based on the biological phenomena that is present in all natural systems. It's a certain like levels of default anxiety and it's like an automatic physical and emotional reactions that really aren't mediated through the conscious or logical processes. This is a very specific type of chronic anxiety. And so you can see in families that they exhibit high levels of chronic anxiety sometimes and how they respond to crises or loss or conflict. And so by increasing the level of differentiation allows individuals and families to handle stressful life situations that are inherent to life using a level of clear-headedness. So rather than being so reactive, anxious, overwhelmed by life, There is this ability to separate the emotions from the thoughts and handle life in a much more thoughtful reflected way rather than just kind of panicking and being overwhelmed by the inherent stresses that come with being alive and being in a family. So another real key concept here is the multi-generational transmission process and this is where we start getting into something that's maybe a little more applicable and to working with families directly in session. So this multi-generational transmission process means that the emotional processes from prior generations are present and alive and they're transmitted from generation to generation through this family emotional system. So children can emerge with either higher, the same, or lower levels of differentiation than parents and we'll talk a little bit more about how triangulation will often lower the child's... the child is most triangulated into the couples marital system tends to have a lower level of differentiation. And then with certain families, you'll see it's lower and lower and lower, so there's just more and more emotional problems from generation to generation. When people, for example, go to therapy and try to improve themselves, they can end up with higher levels of differentiation. So there is an ebb and a flow. to this multi-generational transmission process, but basically, Bowenian therapists will look at, you know, if there has been, you know, often with like, for example, you know, immigration trauma, you know, families fleeing for political reasons, that this, and even if that happened two generations back, that that process, that experience of trauma affects and moves through the various generations until someone deals with it. And so that's part of the reason why I'm saying that Bowenian therapists are part of how they conceptualize. It doesn't mean you're doomed and you go on forever, but it may mean that that trauma that may be two generations back still has effects on you today in your family until it's been dealt with and processed. So much of what Bowenian therapists are looking for is they're assessing multi-generational patterns that relate, you know, to the client's presenting issues. So you can have depression, mental health issues, substance abuse issues, conflict. patterns you know between there can be patterns between and a house How children actually respond to their parents. Abuse can certainly go through multi-generational patterns and even roles in the system like you know there may be the hero child that you know each generation seems to have one or the problem child or the you know kind of wild crazy you know I don't follow rules and the one that does follow rules or whatever it might be and so when talking with clients when writing developing up their genograms the the therapist is looking for the patterns that go across generations. And so this can be mental health, it can be physical health, substance issues, just how people relate patterns for how, what do, you know, what are the mothers like? You can have, you know, kind of patterns of maternal patterns, you can have paternal patterns, how fathers are fathering, and that can be, you can see similarities from generation to generation. And so you're looking at how the client is either replicating or rebelling against whatever the family pattern might be. and to look at how the patterns are evolving with this current generation. And so you're always looking for these intergenerational patterns that people frequently begin to replicate. So as I mentioned earlier, that the level of differentiation, a person's level of differentiation, is the main goal and is constantly assessed throughout the process. They have developed a differentiation scale from 1 to 100, and Bowen actually maintained that most people rarely reach 100. higher than 70 in a lifetime. So this level of differentiation is looking at the extent to which a person is able to separate themselves from others as well as thought from emotion. And so the therapist assesses not only the client or the one with the presenting problem, but the level of differentiation for each person in the family system, which can be different. The concept of triangulation is very central in Bowenian therapy. What a triangle is, is when two people have some tension into their relationship and they draw in a third person to stabilize it. The most common form of this is a parent colluding with a child to stabilize the marriage of the tensions with the other parent. You can also pull in in-laws, you can triangulate friends. Some people conceptualize even alcohol or work as a way of triangulating, stabilizing the relationship that substances or a person is putting their energies into substance or work in order to stabilize the stress in another relationship. Of course an affair is a classic triangle. Triangles aren't inherently bad. We all do it. go down the hallway to go complain about your boss to a colleague. That's a form of triangulation. The thing is, if you do it consistently on a regular basis to stabilize the relationship, then that really becomes a problem. In general, creating a triangle between a parent and a child against another parent is usually not a good thing either. Along with affairs, generally, bad idea. But not all triangles are inherently evil. It's when they become rigid. It's when you don't go back and resolve the conflict and the tension with the initial party that it really does become a problem. So it's important to assess triangles because they are the basic building blocks of family and that families will to some extent create a certain amount of triangles to stabilize itself, but again, it's when they become rigid or when they're truly inappropriate that it's really a problem. So another process that Bowenian therapists look at is the family projection process. And this is the process in which one or more parents kind of project immaturity onto one or more of their kids. And this causes decreased differentiation in subsequent generations. And so this can often be when a mother is projecting her anxiety onto one child, and that thereby serves to soothe her own anxiety. So the child who is the focus of parental anxiety will always be the least differentiated child. And that's why different children can have different levels of differentiation. Now, in healthier families, that role is going to shift. To a certain degree, all these patterns can exist in one way or another. But it's healthier to have that role shift and obviously to have less of this projection process onto the children. Now the concept of emotional cutoff is a very interesting one. Because most people, what emotional cutoff is, is when one either emotionally cuts off or truly cuts all communication off with another party in the family system. And so often that person feels... and looks very differentiated because they are not being triggered by this other person anymore. And so, but the thing is here, what Bowen's printing out, the reason they're having to do cutoff is because their level of differentiation is so low that they cannot tolerate the tension with this other person. And so they're actually managing, they're so emotionally reactive and they're... unable to manage that, they have to cut off. So the more you can stay engaged without being able to harbor the anger, resentment, generally the healthier you can be. Now that said, there are times like when there's there has been abuse and it's not acknowledged, you know, there's certain forms of cutoff that may end up being appropriate in the sense that it is a relationship that continues to be extremely detrimental to a person. It doesn't mean that, you know, you need to always, you know, celebrate every holiday with your family of origin. It's not what they're saying, but they're looking for patterns of, you know, a person is having to separate themselves from their family of origin because they're so emotionally reactive. active. And so what Bowen is saying, the more differentiated a person is, the less cut off they need to do in order to manage their emotions. And so that doesn't mean you go back and expose yourself to, you know, extreme forms of abuse because Bowen said you had to. It just means you need to be watch clients for this pattern because they will often present as very, very differentiated and they feel like everyone else in the family is a lot of emotional upset and I'm the only one who's got it together. And that's what Bowen's talking about. You only have it together because you've been so... overwhelmed you had to totally disengage. So that's not what Bowen means by emotional cutoff. So it's also important to remember that you know a differentiated person is able to have you know intense emotional intimacy with other people. It doesn't mean they're just disconnected from everybody and they feel no feelings. So that's an important thing to recognize and understand because this can be a bit subtle when you're actually working with clients. Bowen also looked at sibling position and how this affects clients and their levels of differentiation and development. With the older children typically having more responsibility and authority and the later born kind of often feeling more like underdogs, questioning the status quo. And typically the youngest child will avoid responsibility in favor of freedom. So he also considered cultural background and how that shapes sibling position because there are many cultures that have very distinct roles for the eldest or the youngest child. And so the sibling position is also an indicator of the family's level of differentiation. So generally, the more the family members exhibit the expected characteristics of their sibling position, the higher the level of differentiation is in the family. This is, of course, in general. Another more esoteric concept in Bowen therapy is this concept of societal regression. And he's at a very broad theoretical level. He talks about... talks about how societies are experiencing sustained chronic anxiety and that they respond with more emotionally based reactive decisions. So that, that leads to lower levels of functioning. And so it's kind of can create a vicious cycle. And so basically, you know, within this though, you have people who kind of want to, you know, take conscious effort to rise above and become more differentiated, make better choices, be less reactive, you know, basically because they're, they don't want to suffer. They make conscious choices. to change what they're doing. And so there is this kind of cycle where the levels kind of rise and fall, but also based on social stresses and societal pressures and events. So now we're going to move on to talking about setting goals in Bowenian intergenerational family therapy. So Bowen therapy has two basic overarching, consider these kind of long-term goals. The one is increasing differentiation and this is the of main focus of the whole approach. This would certainly be a long-term goal in any bohemian treatment plan. And you can certainly break this up when you're writing treatment plans into differentiation, you know, in specific relationships or like at work versus at family. So it's a big goal, so you can break it into smaller pieces. And then also the other basic or overarching goal is to decrease emotional reactivity to chronic anxiety and stressors. And these two are correlated. As differentiation increases, anxiety is going to decrease. But it's helpful to separate this out based on the specific areas of functioning where you want them to, you know, decrease emotional reactivity, you know, with parents, with children, with spouse, whatever it might be, is when you're actually writing the goals. And so those are the two basic processes that you would see and that would just the whole focus of treatment will be these two basic goals. So now we're going to talk about interventions in Bowen therapy, which are in general a little more vague because it's very much a process-oriented approach. So in terms of intervention, the primary technique is for the therapist to embody differentiation, role model, interact that way with clients, to have them experience this. In some ways, you know, it's a type of corrective emotional experience if you're using psychodynamic. thinking. So they ask a lot of process questions, you know, so to help them separate thoughts from feelings, to help them, you know, separate self from others, you know, you know, why is it threatening when your, you know, partner has a different opinion than you, you know, how do you, why do you feel judged? You know, you know, are they actually judging? Can they have a separate opinion? These are the process sorts of questions that they would ask to help the clients begin to become more differentiated, see the different processes of what's going on. They actually encourage clients to take action to be more differentiated. So how could you respond next time when your partner has a different opinion that allows each of you to be separate individuals while still being connected? So they would encourage them to take those sorts of actions. Or to go... to go, well, I have go home again at the end here, you know, going home to visit with parents, and most people kind of regress back to being that, you know, teenager who feels attacked by every little comment that anyone says, you know, in the family. and so teaching them to go home again and to not have that reactivity, to step back with adult eyes and look at what's going on. They will encourage it in various ways based on the client situation. The most concrete type of goal is a genogram sitting down and often over more than one session, mapping out the intergenerational patterns to increase insight to help them see those patterns so they can make different choices. They also do detriangulation where they're helping, coaching clients and helping them how to not be pulling in the third person but instead directly resolve issues with the person that they're having the problem with. So if you're whining to your best friend about your partner, how can you talk to your coaching clients to go back and have that conversation directly with the partner? They also do relational experiments to have them practice doing different ways of relating and then more differentiated ways of relating. Those can be done both in and out of session. So there's a lot of different ways, but basically any way the therapist can think to help the client promote differentiation, reduce emotional reactivity is how they work through the process in Bowen therapy. There has been a specific model used for couples called the sexual crucible model developed by David Schnarch. And this is... He conceptualizes, he uses Bowen therapy primarily to conceptualize the marriage as a crucible. And he sees it as a, he uses the metaphor of the crucible, which is a vessel that is used as a transformational process. It's very volatile and the crucible contains it. And so basically the marriage is there to help people grow up and mature and learn to be more differentiated. And that's how he does the marital therapy. And so it really focuses on each person learning. Learning how to be differentiated, not demanding their partner be what they need them to be. I need you to be this way, partner, so I don't get anxious. Instead, SINAR directs clients to learn how to manage their own reactivity and relate in a much more differentiated way to their partner. That is one of the particular approach for couples. So now we're going to move on to research in the evidence space. So most of the research on Bowen intergenerational therapy has not been on outcomes or client progress as much as it has been on the validity of the concepts. And there is a relation in the evidence space between what they call differentiation and anxiety, marital satisfaction, and overall psychological distress. So there does seem to be some evidence base that this concept that they're calling differentiation is correlated to both, you know... in the way that they say it is. The more differentiated you are, the greater marital satisfaction, the less psychological distress and less anxiety. And so they've also looked at differentiation in terms of client perceptions of the therapeutic alliance, adolescent risk-taking behaviors, parent-parental outcomes, as well as adult well-being. So they've studied the concept of differentiation quite a bit in terms of trying to validate the model. And finally, we're going to wrap... wrap up by talking about using Bowen therapy with diverse populations. In particular, Bowen Therapy has been looked at and kind of adapted to by people who are concerned about using these concepts with women. Specifically, there was a project called the Women's Project that looked at some of these issues. And they raised issues of the gender power dynamics and how therapists were reinforcing many of these stereotypes. issues. And so they looked at using some of these gender role expectations to point out that many of these intergenerational beliefs were unfair and unrealistic. The Women's Project also emphasized women to take private time, so differentiate themselves in that way, and pushing men to take equal responsibility in the family relationship. So several women who worked with both Bowenian concepts and with other family therapy approaches It took on the, looking at gender roles in family in particular, and that's a very important thing, especially when you're looking at some of these multi-generational patterns. The gender patterns are usually quite pronounced, and addressing that and considering, you know, questions of equity and diversity across gender. In general, using Bowen therapy with diverse populations, a therapist wants to proceed with some amount of caution because there are some norms that are implied with this theory. And it is a therapy that's very much for more psychologically minded clients, similar to psychodynamic therapy. And so client groups who are hoping for much more concrete advice or an expert position may have some difficulty kind of engaging this more process-oriented stance at times. The biggest thing is to consider cultural norms and understanding what the concept of differentiation, because many people would see differentiation as very much in line with an individualistic culture and at odds at times with collectivistic cultures. And so this is very important that a therapist assess the values that the client's coming with, their cultural background and those values, and to be careful about how differentiation is being interpreted. with this particular family in light of their cultural values and norms because most people would say that differentiation is more aligned with individualistic values and collectivist values and that would need to be kind of calculated and assessed for making sure that this is an appropriate set of goals for the clients you're working with. So there are recommendations when using Bowen therapy with LGBTQ clients in terms of paying particular attention to intergenerational relationships and how that's playing out in the client's life, as well as considering a very multifaceted identity in terms of biological sex, gender identity, sex, social sex role, as well as sexual orientation. And to even consider this across generations is a recommendation when working with LGBTQ clients using Bowen Therapy. So in conclusion, I hope you have found this a useful introduction to Bowen Therapy and I encourage you to learn more.

This theory is a little bit different than some of the other... theories because it's really goes into a lot of depth about the nature of being human rather than about families or family therapy specifically. It's a very theory heavy theory in that there's it's really about how you conceptualize and understand what's going on with families and their distress or even individuals who are in families in their distress than it is a very prescribed system for doing things.

A lot of the theory focuses on increasing the client's awareness of how their current behavior is connected to their multi-generational processes. And so it's a very awareness-based approach, much like psychoanalytic therapy. And what's interesting here, too, is that the primary tool for change is really the therapist level of differentiation. So it's a therapist level of what is termed differentiation, which is kind of a measure of... psychological health and relational health well-being.

We're going to go into detail about differentiation, but that's the primary tool. And so one of the tenets of this approach is that, you know, a therapist can't help a client become more differentiated than the therapist is. So much of the training in this approach is actually looking at the therapist's own processes, working on the therapist's own level of differentiation so they can help clients do the same. The Juice, Significant Contributions to the Field from Bowenian Therapy.

So there are two main concepts that we're going to talk about, differentiation and genogram, that I think are very significant from Bowenian approach. So differentiation is defined by the person's ability to separate intrapersonal, so within the self, and interpersonal between people distress. So at the interpersonal level, differentiation looks like the ability to separate your thoughts from your feelings in order to respond rather than just react to a stressful situation. And interpersonal differentiation is knowing where one self ends and another begins without losing your sense of self. So being able to be intimate and connected, yet have a clear sense of self.

And so these are the two processes that are part of differentiation. And it's a lifelong process to get good at this. And basically it's balancing two very... basic life forces, the need to be together with others with the need for autonomy.

And so this is an ongoing balance and process across life and so this is what Bowenian therapy really looks at. Basically the theory goes that differentiated people are better able to handle the ups and downs of being in intimate relationships. And so that's why by increasing client's sense of differentiation, they're going to be able to navigate their family and personal intimate relationships better. The other really unique thing about Bowen therapy is that they use an assessment tool called a genogram.

It's sort of like a family tree, but it's specifically made for addressing or identifying intergenerational patterns. And so, genograms are used by many therapists, family therapists, social workers, counselors, psychologists. It's a wonderful way to get a really, to get the big picture of the client's broader, you know, family, multi-generational processes, family background. For me, I find it just really helpful to remember who's who in the family, cast of characters.

And so, this can be really useful no matter which approach you're looking for. And so, Basically, the process is helpful both for the therapist in terms of assessing and also for clients. I mean, yes, they're sitting there telling you all this, but oftentimes when they see it on paper and they see the dynamics.

it shifts something in them. For example, I once worked with a client who had a grandfather who had sexually abused her. And it wasn't until she realized that, oh my God, you know, all of these people had been abused, you know, by my grandfather. It was, it was very transformational for her. And yes, she just sat there and gave me the information and I just notated and colored it in.

And when she saw it on paper, it really shifted a lot of things. It was very significant for her. And so for many clients, um, You know, and there are other times where, you know, I once was doing an intake session and the client was describing, oh my God, you know, if I decide to marry this person, my family is going to cut me off.

And, you know, she was young and I thought maybe she was exaggerating a little bit. But once I did her genogram, like, oh, yeah, yeah, they are going to probably cut you off. Exactly.

You nailed that one. So it can be very helpful both ways. And you do get a lot of information and quickly.

And it can be very helpful for both the therapist and for the client. And depending on what approach you use, genograms can be adapted. In fact, there are some solution-focused therapists who have adapted it looking at family strengths across generations. So the genogram can be very flexible even when working from other theoretical orientations. The big picture and overview of treatment.

So Bowen therapy is very much what we would call a process-oriented therapy. The focus is on the client's process rather than symptom reduction and the whole process of what's going on in the room. It relies very much on the self of the therapist, the therapist's level of differentiation. The techniques and interventions are de-emphasized and it's more focusing on the therapist helping to facilitate the client in seeing the patterns. understanding the multi-generational transmission process and what's going on there, and helping the client learn how to differentiate themselves in the situations that are most closely related to their presenting problems.

So basically, it's using insight and therapeutic relationship to increase the client's level of differentiation and having them transfer this to the outside world. And again, this is more in the traditional style of a psychoanalytic or psychodynamic approach than... some of the other systemic or structural approaches that are much more active, technique-based, have phases of treatment, etc. Making connection, the therapeutic relationship.

So the therapeutic relationship is quite distinct in the Bowenian approach. So the focus again is on the differentiation and the emotional being of the therapist, how they are in the session. So So there's that belief that clients can only differentiate as much as a therapist is differentiated.

And so the therapist really tries to bring this non-anxious presence to the therapy room. They're emotionally engaged in a way that is non-reactive to whatever the clients are saying. And in this sense, they're kind of role modeling how to be differentiated and how not to overreact and have knee jerk responses and get all worked up.

So they bring what's called this non-anxious presence and they're role modeling for the client the differentiation process. And so that's the whole focus of the therapeutic relationship. And so it is probably a little, some people, you know, see the distance or can may experience it more as distance because they try not to actually activate emotions and instead try to help clients separate out the emotions from the thoughts and to...

to have a more reflected response to what's going on rather than being reactive. So now we're going to talk about the viewing in case conceptualization in bohemian therapy which is really the heart of the approach. So, Bowenian therapists view family systems as primarily emotional systems.

They actually, in some of the foundational theoretical writing on the theory, they talk about how the family's emotional process is actually like an extension of cellular differentiation process, where the term actually comes from. But on a more practical level, a family that lacks this differentiation becomes what they call, and this is a good, fun term out of the family therapy literature, the undifferentiated family ego mass where the whole all the members of the family experience themselves as almost one being and there's no differentiation and so when someone has a different opinion or preference or view of what happened this becomes very very threatening to the others and so that's how it's conceptualized and that's why it becomes problematic. There's no way for people to actually assert their individuality and so The therapists really focus on the family's unique emotional system more so than the environment or culture.

How is the family functioning? How is it functioning as an emotional system? And then they look at how this system has impacts each person's behaviors, emotions, and the presenting symptoms.

Another central concept in Bowenian therapy is a concept of chronic anxiety. This isn't kind of I mean this isn't like diagnosis DSM anxiety. This isn't really even existential anxiety. It's a different concept here.

It's based on the biological phenomena that is present in all natural systems. It's a certain like levels of default anxiety and it's like an automatic physical and emotional reactions that really aren't mediated through the conscious or logical processes. This is a very specific type of chronic anxiety. And so you can see in families that they exhibit high levels of chronic anxiety sometimes and how they respond to crises or loss or conflict.

And so by increasing the level of differentiation allows individuals and families to handle stressful life situations that are inherent to life using a level of clear-headedness. So rather than being so reactive, anxious, overwhelmed by life, There is this ability to separate the emotions from the thoughts and handle life in a much more thoughtful reflected way rather than just kind of panicking and being overwhelmed by the inherent stresses that come with being alive and being in a family. So another real key concept here is the multi-generational transmission process and this is where we start getting into something that's maybe a little more applicable and to working with families directly in session.

So this multi-generational transmission process means that the emotional processes from prior generations are present and alive and they're transmitted from generation to generation through this family emotional system. So children can emerge with either higher, the same, or lower levels of differentiation than parents and we'll talk a little bit more about how triangulation will often lower the child's... the child is most triangulated into the couples marital system tends to have a lower level of differentiation.

And then with certain families, you'll see it's lower and lower and lower, so there's just more and more emotional problems from generation to generation. When people, for example, go to therapy and try to improve themselves, they can end up with higher levels of differentiation. So there is an ebb and a flow. to this multi-generational transmission process, but basically, Bowenian therapists will look at, you know, if there has been, you know, often with like, for example, you know, immigration trauma, you know, families fleeing for political reasons, that this, and even if that happened two generations back, that that process, that experience of trauma affects and moves through the various generations until someone deals with it. And so that's part of the reason why I'm saying that Bowenian therapists are part of how they conceptualize.

It doesn't mean you're doomed and you go on forever, but it may mean that that trauma that may be two generations back still has effects on you today in your family until it's been dealt with and processed. So much of what Bowenian therapists are looking for is they're assessing multi-generational patterns that relate, you know, to the client's presenting issues. So you can have depression, mental health issues, substance abuse issues, conflict. patterns you know between there can be patterns between and a house How children actually respond to their parents.

Abuse can certainly go through multi-generational patterns and even roles in the system like you know there may be the hero child that you know each generation seems to have one or the problem child or the you know kind of wild crazy you know I don't follow rules and the one that does follow rules or whatever it might be and so when talking with clients when writing developing up their genograms the the therapist is looking for the patterns that go across generations. And so this can be mental health, it can be physical health, substance issues, just how people relate patterns for how, what do, you know, what are the mothers like? You can have, you know, kind of patterns of maternal patterns, you can have paternal patterns, how fathers are fathering, and that can be, you can see similarities from generation to generation.

And so you're looking at how the client is either replicating or rebelling against whatever the family pattern might be. and to look at how the patterns are evolving with this current generation. And so you're always looking for these intergenerational patterns that people frequently begin to replicate.

So as I mentioned earlier, that the level of differentiation, a person's level of differentiation, is the main goal and is constantly assessed throughout the process. They have developed a differentiation scale from 1 to 100, and Bowen actually maintained that most people rarely reach 100. higher than 70 in a lifetime. So this level of differentiation is looking at the extent to which a person is able to separate themselves from others as well as thought from emotion.

And so the therapist assesses not only the client or the one with the presenting problem, but the level of differentiation for each person in the family system, which can be different. The concept of triangulation is very central in Bowenian therapy. What a triangle is, is when two people have some tension into their relationship and they draw in a third person to stabilize it. The most common form of this is a parent colluding with a child to stabilize the marriage of the tensions with the other parent. You can also pull in in-laws, you can triangulate friends.

Some people conceptualize even alcohol or work as a way of triangulating, stabilizing the relationship that substances or a person is putting their energies into substance or work in order to stabilize the stress in another relationship. Of course an affair is a classic triangle. Triangles aren't inherently bad. We all do it. go down the hallway to go complain about your boss to a colleague.

That's a form of triangulation. The thing is, if you do it consistently on a regular basis to stabilize the relationship, then that really becomes a problem. In general, creating a triangle between a parent and a child against another parent is usually not a good thing either. Along with affairs, generally, bad idea. But not all triangles are inherently evil.

It's when they become rigid. It's when you don't go back and resolve the conflict and the tension with the initial party that it really does become a problem. So it's important to assess triangles because they are the basic building blocks of family and that families will to some extent create a certain amount of triangles to stabilize itself, but again, it's when they become rigid or when they're truly inappropriate that it's really a problem. So another process that Bowenian therapists look at is the family projection process.

And this is the process in which one or more parents kind of project immaturity onto one or more of their kids. And this causes decreased differentiation in subsequent generations. And so this can often be when a mother is projecting her anxiety onto one child, and that thereby serves to soothe her own anxiety.

So the child who is the focus of parental anxiety will always be the least differentiated child. And that's why different children can have different levels of differentiation. Now, in healthier families, that role is going to shift. To a certain degree, all these patterns can exist in one way or another. But it's healthier to have that role shift and obviously to have less of this projection process onto the children.

Now the concept of emotional cutoff is a very interesting one. Because most people, what emotional cutoff is, is when one either emotionally cuts off or truly cuts all communication off with another party in the family system. And so often that person feels...

and looks very differentiated because they are not being triggered by this other person anymore. And so, but the thing is here, what Bowen's printing out, the reason they're having to do cutoff is because their level of differentiation is so low that they cannot tolerate the tension with this other person. And so they're actually managing, they're so emotionally reactive and they're... unable to manage that, they have to cut off.

So the more you can stay engaged without being able to harbor the anger, resentment, generally the healthier you can be. Now that said, there are times like when there's there has been abuse and it's not acknowledged, you know, there's certain forms of cutoff that may end up being appropriate in the sense that it is a relationship that continues to be extremely detrimental to a person. It doesn't mean that, you know, you need to always, you know, celebrate every holiday with your family of origin.

It's not what they're saying, but they're looking for patterns of, you know, a person is having to separate themselves from their family of origin because they're so emotionally reactive. active. And so what Bowen is saying, the more differentiated a person is, the less cut off they need to do in order to manage their emotions.

And so that doesn't mean you go back and expose yourself to, you know, extreme forms of abuse because Bowen said you had to. It just means you need to be watch clients for this pattern because they will often present as very, very differentiated and they feel like everyone else in the family is a lot of emotional upset and I'm the only one who's got it together. And that's what Bowen's talking about. You only have it together because you've been so...

overwhelmed you had to totally disengage. So that's not what Bowen means by emotional cutoff. So it's also important to remember that you know a differentiated person is able to have you know intense emotional intimacy with other people.

It doesn't mean they're just disconnected from everybody and they feel no feelings. So that's an important thing to recognize and understand because this can be a bit subtle when you're actually working with clients. Bowen also looked at sibling position and how this affects clients and their levels of differentiation and development. With the older children typically having more responsibility and authority and the later born kind of often feeling more like underdogs, questioning the status quo. And typically the youngest child will avoid responsibility in favor of freedom.

So he also considered cultural background and how that shapes sibling position because there are many cultures that have very distinct roles for the eldest or the youngest child. And so the sibling position is also an indicator of the family's level of differentiation. So generally, the more the family members exhibit the expected characteristics of their sibling position, the higher the level of differentiation is in the family. This is, of course, in general. Another more esoteric concept in Bowen therapy is this concept of societal regression.

And he's at a very broad theoretical level. He talks about... talks about how societies are experiencing sustained chronic anxiety and that they respond with more emotionally based reactive decisions.

So that, that leads to lower levels of functioning. And so it's kind of can create a vicious cycle. And so basically, you know, within this though, you have people who kind of want to, you know, take conscious effort to rise above and become more differentiated, make better choices, be less reactive, you know, basically because they're, they don't want to suffer. They make conscious choices.

to change what they're doing. And so there is this kind of cycle where the levels kind of rise and fall, but also based on social stresses and societal pressures and events. So now we're going to move on to talking about setting goals in Bowenian intergenerational family therapy. So Bowen therapy has two basic overarching, consider these kind of long-term goals. The one is increasing differentiation and this is the of main focus of the whole approach.

This would certainly be a long-term goal in any bohemian treatment plan. And you can certainly break this up when you're writing treatment plans into differentiation, you know, in specific relationships or like at work versus at family. So it's a big goal, so you can break it into smaller pieces.

And then also the other basic or overarching goal is to decrease emotional reactivity to chronic anxiety and stressors. And these two are correlated. As differentiation increases, anxiety is going to decrease.

But it's helpful to separate this out based on the specific areas of functioning where you want them to, you know, decrease emotional reactivity, you know, with parents, with children, with spouse, whatever it might be, is when you're actually writing the goals. And so those are the two basic processes that you would see and that would just the whole focus of treatment will be these two basic goals. So now we're going to talk about interventions in Bowen therapy, which are in general a little more vague because it's very much a process-oriented approach.

So in terms of intervention, the primary technique is for the therapist to embody differentiation, role model, interact that way with clients, to have them experience this. In some ways, you know, it's a type of corrective emotional experience if you're using psychodynamic. thinking. So they ask a lot of process questions, you know, so to help them separate thoughts from feelings, to help them, you know, separate self from others, you know, you know, why is it threatening when your, you know, partner has a different opinion than you, you know, how do you, why do you feel judged? You know, you know, are they actually judging?

Can they have a separate opinion? These are the process sorts of questions that they would ask to help the clients begin to become more differentiated, see the different processes of what's going on. They actually encourage clients to take action to be more differentiated.

So how could you respond next time when your partner has a different opinion that allows each of you to be separate individuals while still being connected? So they would encourage them to take those sorts of actions. Or to go...

to go, well, I have go home again at the end here, you know, going home to visit with parents, and most people kind of regress back to being that, you know, teenager who feels attacked by every little comment that anyone says, you know, in the family. and so teaching them to go home again and to not have that reactivity, to step back with adult eyes and look at what's going on. They will encourage it in various ways based on the client situation.

The most concrete type of goal is a genogram sitting down and often over more than one session, mapping out the intergenerational patterns to increase insight to help them see those patterns so they can make different choices. They also do detriangulation where they're helping, coaching clients and helping them how to not be pulling in the third person but instead directly resolve issues with the person that they're having the problem with. So if you're whining to your best friend about your partner, how can you talk to your coaching clients to go back and have that conversation directly with the partner? They also do relational experiments to have them practice doing different ways of relating and then more differentiated ways of relating. Those can be done both in and out of session.

So there's a lot of different ways, but basically any way the therapist can think to help the client promote differentiation, reduce emotional reactivity is how they work through the process in Bowen therapy. There has been a specific model used for couples called the sexual crucible model developed by David Schnarch. And this is...

He conceptualizes, he uses Bowen therapy primarily to conceptualize the marriage as a crucible. And he sees it as a, he uses the metaphor of the crucible, which is a vessel that is used as a transformational process. It's very volatile and the crucible contains it. And so basically the marriage is there to help people grow up and mature and learn to be more differentiated. And that's how he does the marital therapy.

And so it really focuses on each person learning. Learning how to be differentiated, not demanding their partner be what they need them to be. I need you to be this way, partner, so I don't get anxious. Instead, SINAR directs clients to learn how to manage their own reactivity and relate in a much more differentiated way to their partner.

That is one of the particular approach for couples. So now we're going to move on to research in the evidence space. So most of the research on Bowen intergenerational therapy has not been on outcomes or client progress as much as it has been on the validity of the concepts.

And there is a relation in the evidence space between what they call differentiation and anxiety, marital satisfaction, and overall psychological distress. So there does seem to be some evidence base that this concept that they're calling differentiation is correlated to both, you know... in the way that they say it is.

The more differentiated you are, the greater marital satisfaction, the less psychological distress and less anxiety. And so they've also looked at differentiation in terms of client perceptions of the therapeutic alliance, adolescent risk-taking behaviors, parent-parental outcomes, as well as adult well-being. So they've studied the concept of differentiation quite a bit in terms of trying to validate the model.

And finally, we're going to wrap... wrap up by talking about using Bowen therapy with diverse populations. In particular, Bowen Therapy has been looked at and kind of adapted to by people who are concerned about using these concepts with women. Specifically, there was a project called the Women's Project that looked at some of these issues.

And they raised issues of the gender power dynamics and how therapists were reinforcing many of these stereotypes. issues. And so they looked at using some of these gender role expectations to point out that many of these intergenerational beliefs were unfair and unrealistic.

The Women's Project also emphasized women to take private time, so differentiate themselves in that way, and pushing men to take equal responsibility in the family relationship. So several women who worked with both Bowenian concepts and with other family therapy approaches It took on the, looking at gender roles in family in particular, and that's a very important thing, especially when you're looking at some of these multi-generational patterns. The gender patterns are usually quite pronounced, and addressing that and considering, you know, questions of equity and diversity across gender.

In general, using Bowen therapy with diverse populations, a therapist wants to proceed with some amount of caution because there are some norms that are implied with this theory. And it is a therapy that's very much for more psychologically minded clients, similar to psychodynamic therapy. And so client groups who are hoping for much more concrete advice or an expert position may have some difficulty kind of engaging this more process-oriented stance at times. The biggest thing is to consider cultural norms and understanding what the concept of differentiation, because many people would see differentiation as very much in line with an individualistic culture and at odds at times with collectivistic cultures. And so this is very important that a therapist assess the values that the client's coming with, their cultural background and those values, and to be careful about how differentiation is being interpreted.

with this particular family in light of their cultural values and norms because most people would say that differentiation is more aligned with individualistic values and collectivist values and that would need to be kind of calculated and assessed for making sure that this is an appropriate set of goals for the clients you're working with. So there are recommendations when using Bowen therapy with LGBTQ clients in terms of paying particular attention to intergenerational relationships and how that's playing out in the client's life, as well as considering a very multifaceted identity in terms of biological sex, gender identity, sex, social sex role, as well as sexual orientation. And to even consider this across generations is a recommendation when working with LGBTQ clients using Bowen Therapy.

So in conclusion, I hope you have found this a useful introduction to Bowen Therapy and I encourage you to learn more.

Transcript for:Understanding Bowenian Family Therapy Concepts

Transcript for:
Understanding Bowenian Family Therapy Concepts