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Integration of Bowen's Family System Theory
I come from a culture where family is considered the core of everyone’s existence. In the religious terms, it is the domestic church. In the social terms, it is the origin of society. In the political sense, it is considered the root of all politics, and in the global aspect, it is referred to as the reflection of the world we live in. My mother (God bless her soul) used to insist that if we want to make a difference in the community, we had to start from home, and indeed, she kept reminding us that charity begins from home.




Teresa Ngigi, PhD
Universidad Central de Nicaragua
Universidad Azteca
August, 10, 2015




I took this advice very seriously, and ventured into the long journey of self-discovery which would eventually lead me to my strong desire of making a difference in the society where I find myself. Were it not for the nurture I received from the family, I believe I would not be where I am today.
My conviction is that when the family is healthy, then society at large will be healthy. I therefore believe that Bowen’s systemic family theory can be the foundation stone of my work as a psychologist/counselor/psychiatric educator and lecturer. My experience is that a sound family offers the support needed to grow and extend into society. This article will therefore expound on this concept and demonstrate how applying Bowen’s principles has helped me in my work.
Beginning at the Menninger Foundation in Topeka, Kansas, in 1946, and subsequently at the National Institute of Mental Health and Georgetown University Medical Center, Murray Bowen, MD conducted a series of research investigations from which he developed a new way of thinking about human interactions, and a new theory of the family emotional system. According to Bowen, functional disabilities develop from poorly differentiated relationship patterns in one’s family of origin, which are characterized by high anxiety and emotional reactivity. This anxiety commonly results in triangulation and/or cutoffs of highly charged relationships.
What distinguishes a family systems orientation from other orientations is its view of the family as a social system, with assessment and treatment of problems of an individual member in the context of the family as an interactive unit. Individual psychopathology and health cannot be adequately understood, and perhaps more importantly, cannot be optimally and most effectively treated, apart from their psychosocial context, particularly the family. The family systems orientation is not a method, but an all-encompassing theoretical orientation. The practice of family systems therapy is dependent not on conjoint treatment of multiple individuals, but rather by how the clinician attends to the relationship system in problem formulation and treatment planning. A systems viewpoint can be utilized regardless of how many people are in the room. Therapeutic interventions are aimed at modifying dysfunctional family patterns in which symptomatic behavior is embedded (Cohen, 2013).
Family systems theory concentrates on the interactions of family members and views the entire family as a unit or system (Sharf, 2012). In family systems theory, treatment is designed to understand and bring about change within the family structure, and consequently within the society.
Improved functioning is believed to result when emotional reactivity no longer blocks intellectual process.
The family is a central system that significantly impacts a person’s psychological development and sense of personal well-being. Families often take on the function of protecting other family members in response to what occurs in the broader social environment (Ivey, et. al. 2002). It is not uncommon to see people identifying themselves with their families so much so that their own identity becomes ambiguous. In my culture, we say that “I am because we are”, meaning that an individual assumes an identity only through the family or the society. This can be argued and debated, but it holds a lot of wisdom which helps people to be each other’s keepers. In my culture, if I have children, I would not say “my children”, but “our children”, not necessarily referring to my husband and I, but to the entire community which takes an active role in educating a child. If I see any child misbehaving, I have the duty to correct that child, irrespective of who their parents are. I would be held responsible if I ignored misbehavior by children as long as I am the adult around. If a family member is healthy, their family is considered healthy, and vice versa.
Family systems theory views the family as a unit, a network of interlocking relationships, which have a remarkable influence in the thinking, feelings, and behavior of each member. The psychology of the individual is not ignored in family theory; it is only put into a larger context (Kerr & Bowen, 1988). Bowen focused on patterns that develop in families in order to diffuse anxiety. A main generator of anxiety in families lies in the perception of either too much closeness or too great a distance in relationships (Brown, 1999). The family involved in this work reflects significant levels of anxiety springing from the way each member experiences distance from the other. Brown further posits that the degree of anxiety in any family will be determined by the current levels of external stress and the sensitivities to particular themes that have been transmitted down the generations. If families do not have the capacity to think through their responses to relationship dilemmas, but rather react anxiously to perceived emotional demands, a state of chronic anxiety or reactivity may be set in place (Brown, 1999).
The family that I currently work with reflects an anxious togetherness in which people have lost individual direction and are functioning in reaction to one another. In this case, responsibility is uprooted from where it belongs, and blaming becomes everyone’s defense and coping mechanisms.
Family systems theory is based on the assumptions that the human being is a product of evolution and that human behavior is significantly regulated by the same natural processes that regulate the behavior of all other living things (Kerr & Bowen, 1988). Emphasis in family systems theory is on process rather than content: focus is in what is happening in the present rather than what happened in the past or the sequence of events that led up to an event (Sharf, 2012).
Family therapy is concerned with the resolution of problems, what is going on right now and how we can change things for the better, not with the why of the past. The process engages distressed families with compassion and respect to enhance their best qualities and reparative potential thereby helping families emerge strengthened, more resourceful, and able to love fully and raise their children well.
The focus is on direct assessment of “the facts of functioning”, the existing patterns in real relationships, and the active problem solving skills necessary to change them.
Working through the dynamics of the whole family to optimize resilience, support family strengths and resources, and promote healthy adaptation, provides a practical and constructive approach for individuals to explore and understand the rules of their family of origin, their role in it, the influence of these experiences, and how they impact their current relationships. This approach creates a nurturing atmosphere, which is both healing and protective. The broad systemic impact reduces stress and vulnerability, fosters healing and growth, and empowers families to overcome persistent adversity. The goal is to solve problems in current relationships so as not to leave a damaging legacy for future generations (Cohen, 2013).
The traditional Italian society in which I live is also known to value closeness of family members, and therefore people identify with their family members in a significant way. My job is to address the needs of each particular client as well as of other family members. Coming from an African background, I am attuned with this particular approach and my work becomes easier. Each family member influences the other in very noteworthy ways, and therefore working only with an individual, to my experience, has not been as effective as working with the entire family. This approach usually requires structure and time. A treatment plan is created by the clinical team which directly deals with the client in conjunction with significant family members. Both short term and long term goals and objectives are set, and a specific number of hours allocated to this intervention. In this intervention, several clinical professions are involved namely case managers, psychologists, psychiatrists, social workers, and educators, among others. Bi monthly meetings are held with all the team members involved and the progress of the patient evaluated. Monthly meetings are held with all the family members involved, or when there is a pressing need that calls for attention.
The value of a systems approach far exceeds the artificial categories of family, couples, or multifamily group treatment modalities. As a basic worldview, what distinguishes a systems perspective from others includes:
Attention to individuals or problems in context
Interactions between individuals, subsystems, or whole systems
Circular versus linear processes
Patterns that connect over time.
In my interventions, I look at “the family as the unit of illness” and then the psychotherapeutic approach is “the family as the unit of treatment”. The concept of the family as a system includes attention to circular, reciprocal processes rather than linear ones such that a change in one part of the system is followed by compensatory change in other parts of the system.  The family is a combination of “emotional” systems, which refers to the force that motivates the system and “relationship” systems which refer to the ways in which it is expressed.  All emotional symptoms are viewed as evidence of family dysfunction rather than as intrapsychic phenomena.
In an effort to focus on the family, emphasis on the “sickness” of the patient is defocused. The concept of the “family projection process” is defined by how a family problem is transmitted to one family member and then fixed there with a diagnosis. As the intervention progresses, individuals in the family go through a process of “differentiation of self” from other family members. Important change needs to happen in the parental relationship. This method of psychotherapy is directed to the family ego mass rather than to the individual problems of a group of family members. The explicit goal is to help the parents separate themselves from the child and the child from the parents. This process is not easy, as many patients see this as a threat, since many of the family relationships are symbiotic ones.  The basic dynamics include the husband-wife “emotional divorce” and triadic involvement of the child. There is often a dramatic decrease in the child’s symptoms within a few weeks after the parents have been successful in keeping the focus on themselves. The problem in the child would almost completely disappear by the time parents were seriously occupied with each other. When the patient is a child, the best one can hope for is to reach a stage when the two parents can work together on their part of the family problem without involving the child. The child will automatically improve without participation in the family psychotherapy (Cohen, 2013).
This family is composed of four members. Pseudo-names are used in order to protect their anonymity: two siblings Odey (15), and Meg (12), the mother Claude, and the maternal grandmother Abby. Claude is divorced since 2001, and has been living with her two children ever since. Since the divorce, the siblings have gradually developed survival mechanisms, especially in the absence of a father figure, as well as the presence of a mother who acts impulsively. The grandmother has been very instrumental in the running of the family, playing a significantly active role in the lives of her grandchildren as well as her daughter. The current situation is that a few months ago, Meg ended up in hospital after an episode of acting out which involved physical violence towards her brother and the destruction of household items. That particular day, she and her brother had been left by themselves in the house. The mother was at work, while the grandmother had gone to run some errands. A quarrel ensued, and Meg reacted in an out of control way, attempting to stab her brother. The neighbors heard the commotion and called the police, who in turn called the ambulance which took Meg to hospital. She was admitted to the neuropsychiatric ward, and after a couple of weeks, I was called to intervene as Meg was about to be discharged from the hospital.
Going home was a delicate task because the situation in the home front had not changed, and in order to avoid a future replica of what had happened, everyone needed therapy. My task involved going to the family home, which made it easier for me to observe the family dynamics closely and understand what makes each family member tick, and the way each member influences the other both positively and negatively. My first observation was based on the relationships and family dynamics of each member.
Bowen’s Intergenerational Therapy.
Bowen’s theory holds that a family becomes conceptualized as an emotional unit because the emotional functioning of each family member is so interdependent. The functioning of an individual family member would not be adequately understood out of context and in isolation from the people around them. Each person becomes an emotional prisoner of the way the other family member functions, and none of them is able to change their functioning enough to change the process (Kerr & Bowen, 1988). This dynamic creates as many problems for young Meg as for the rest of the family members. However, other family members often view Meg as the cause of their problems, without considering how their reactions accelerate Meg’s issues, and how Meg’s situation is a reflection of their own anxiety-determined function. Meg then considers herself the cause of the family malfunction, and as well, blames the family for her problems.
Bowen also notes:
The reciprocal functioning is so precise that whenever a significant personality characteristic is found in one family member, it is predictable that its mirror opposite characteristic will be found in another family member. The two opposite characteristics so reinforce each other that it is impossible to understand adequately the intensity of a particular trait in one person out of the context of the intensity of the mirror opposite trait in another person. The activeness of one person is reflected in the passiveness of another, and vice versa (Kerr & Bowen, 1988).
In the case of Meg and her family, each member reacts to her mood. If she comes home from school angry, everyone else tends to be edgy. If she is joyful, there is a different atmosphere in the home. Meg has learned that her mood influences the reactions of the others towards her, and at times she uses this to her advantage. She is aware that she controls the other family members, and at times takes subtle pride in it. When Meg wants something, she starts yelling, and her tone of voice changes – becoming like that of a younger child. She then starts crying and throwing temper tantrums, and everyone either reacts through attempting to calm her down, or they get angrier than her. Many times Meg obtains what she wants when she behaves in this manner. She has learned to pull the right strings and manipulate everyone with her behavior.
Fusion is where individual choices are set aside in the service of achieving harmony within the system (Brown, 1999). Fusion occurs when thoughts and feelings are not distinguished. Fusions can be expressed in two ways, namely, as a sense of intense responsibility for another’s reactions, or by emotional cut-off from the tension within a relationship (Kerr & Bowen, 1988). In Denim’s family case, it is often quite difficult to tell whose anger is being manifested by individual family members. Meg’s anger triggers everyone’s reactions, and there is a steady escalation which leads to an out of control situation, enhanced by blaming.
Fusion does not reflect the overall structure of family relationships; rather, it describes each person’s reactions within a relationship. A person in a fused relationship reacts to the perceived demands of another person immediately, without thinking over the choices or discussing them over with the other person (Brown, 1999). Meg’s mother is the main family member who manifests this fusion. The mother uses remarkable amounts of energy in taking things too personally in ensuring the emotional comfort of the daughter. This reaction, however, does not guarantee Meg’s emotional comfort. If anything, it soothes her and gives her the message that the mother can be manipulated by her behavior.
Family projection process describes how children develop symptoms when caught up in the previous generation’s anxiety about relationships. The child with the least emotional separation from their parents is said to be the most vulnerable to developing symptoms. The child responds anxiously to the tension in the parents’ relationship, which gets mistaken for a problem in the child (Brown, 1999). This is what happened in the case of Meg. She did not know how to deal with the strained relationship between her mother and her father. She at one point demanded to move to her father’s home, and last summer, she spent two months with her father and step-mother. Those two months changed Meg’s attitude so much so that she returned home loathing her mother and blaming her for the divorce and all the problems the family experiences. She also loathed her dad for marrying another woman and even having children with her. Her anger was welling up and manifesting in aggressive behavior. Both parents believed that she had a serious pathology, thus they resorted to the social services.
Despite the separate lives of the parents, a detouring triangle was set in motion, and attention and protection were turned to Meg. This led to more demands by Meg on her parents. Focus therefore shifted from the problems between the estranged couple to Meg. Intergenerational projection took over, and Meg became the focus of the family anxiety. Bowen views traumatic events as significant in highlighting the family processes rather than actually causing them (Brown, 1999). The child who is emotionally attached to the parents may have the least differentiation between feelings and intellect and the most difficulty in separating from the family (Papero, 1983). In the case quoted above, Meg experienced trauma when she learned that her father was living with another woman, and that she had step-brothers. She reacted aggressively, demanding to go and live with her father and step mother. Her experience with this family was traumatizing, because her step mom, an active alcoholic, could come home drunk and behave erratically. Her father appeared helpless in this situation, albeit wanting to keep the situation under control. Her father therefore gave her the responsibility of checking out every time her step mom was drunk and reporting it to the father. She resented this responsibility but could do nothing about it. When she returned to her mom after summer, she was extremely angry, manifesting her frustration through violent behavior. Her aggressivity was directed to no one in particular, but she used to explode at any real or imagined incitement or provocation. It appears her experiences with her dad’s new family were traumatic, and she did not know how to deal with the trauma.
An emotional cut-off is more like an escape where people decide to be completely different from their family of origin. Meg experiences a remarkable cut-off from the family. The mother continuously seeks to get closer to her emotionally but Meg will not let her. As things stand now, the emotional distance created is wide, and it appears that no one is close enough to the other in this family. Sometimes the behavior of the family members is calm and pleasant, with the aim of avoiding outbursts and violence. One feels remarkable tension in the house. Tempers flare at the least provocation, and the only way people seem to be relating with one another is by being reactive. There is a chain of endless reactions and counter-reactions, and everyone seems to constantly be on edge.
While some temporary relief may be experienced after a cut-off, patterns of reactivity in intense relationships remain unchanged and past versions are repeated. Through cut-off, several issues are avoided and the family tension becomes elevated. Triangling provides a detour, as family members enlist the support of others for their own position in relation to the cut-off (Brown, 1999), as has been happening with the grandmother. The higher the level of anxiety and emotional dependence, the more likely children are to experience an emotional cut-off in a family (Sharf, 2012). This cut-off is a powerful issue in Denim’s family.
My intergenerational therapy sessions are aimed at gathering information in order to attempt to understand the family’s emotional processes, which, at the same time, provides information to family members about the presenting problem in its systemic context. This presenting problem is tracked through the history of the nuclear family and the extended family (Brown, 1999). The family evaluation interviews can take place with any combination of family members. Sometimes a single family member can be sufficient if that person is willing to work on differentiating their own feelings and intellectual processes rather than blaming other family members (Sharf, 2012). In Denim’s case above, first, observation was used which gave me a general picture of the family situation. Then interviews with individual members of the family have been held, as well as weekly meetings with all the members of the family in order to understand the dynamics involved, everyone’s role in every situation in the family, and to map out small strategies that are carried out by everyone in order to make life in the family bearable, given the circumstances. Weekly evaluation is done in order to assess the commitment of each member, to ensure that everyone is working from the same wave length. Affirmation is used to reinforce the good will of all the members. Continuous positive reinforcement is used every time some achievement, no matter how minute, is made. During these meetings, everyone is given a chance to express themselves and suggest some action that will be carried out in order to empower each member to be responsible for their own choices. This helps ease tension and avoid blaming. Little successes are recognized and rewarded with affirmation. The family is also encouraged to celebrate its successes with a meal taken together, or going to a movie together as a family. This has created some basic trust among the members, and everyone is starting to feel responsible for the welfare of the family. The main problem remains that members of this family are all discouraged, and it appears that they do not have hope in each other. Each one, in their turn, claims that things will never work because the situation is so desperate and people are so used to blaming that shaking the system will require a miracle. I however see a good margin for change and growth, albeit small and painful.
My task is to look for clues about the emotional process of this particular family including patterns of regulating closeness and distance, how anxiety is dealt with in the system, what triangles get activated, the degree of adaptability to changes and stressful situations, and any signs of emotional ‘cut-off’ (Brown, 1999). Loosening the central triangle that has formed around and maintains the problem is essential. Family members learn about systems concepts as they operate in their own family. This does not mean an attempt to convince people to do things differently but to encourage family members to see beyond their biases so that they can consider each person’s part in the family patterns (Brown, 1999).
Differentiation is seen as the capacity of the individual to function autonomously by making self-directed choices, while remaining emotionally connected to the intensity of a significant relationship system (Kerr & Bowen, 1988). This is the goal towards which we are working in Denim’s family. Complete differentiation is said to exist in a person who has resolved their emotional attachment to their family – thus shifting out of their roles in relationship triangles – and can therefore function as an individual within the family group. A person who is highly differentiated is well aware of their opinions and has a sense of self, is able to stand up for themselves, and is not dominated by the feelings of others (Sharf, 2012).
Self-Differentiation is a progressive, internal interplay between autonomy (separation) and connection (togetherness) while progressing toward developing and known goals. Being an authentic adult is hard work and a never completed task. The pathway is paved with difficulty and challenge.
Differentiation is described in many ways in the following points:
Growing in the ability to see where and how one fits into one’s family, the position one holds and the power that is and is not given to that position.
Growing in the ability to be fully responsible for one’s own life while being committed to growing closer to those one loves.
Intentionally developing, at the same time, autonomy and intimacy. In developing autonomy, one sets themselves towards achieving their dreams and ambitions. In developing intimacy, one allows those close to them to see and know them as they really are.
Being willing to say clearly who one is and who they want to be while others are trying to tell them who they are and who they should be.
Staying in touch with others while, and even though, there is tension and disagreement.
Being able to declare clearly what one needs and requesting help from others without imposing one’s needs upon them.
Being able to understand what needs one can and cannot meet in their own life and in the lives of others.
Understanding that one is called to be distinct (separate) from others, without being distant from others.
Understanding that one is responsible to others but not responsible for others.
Growing in the ability to live from the sane, thinking and creative person one is, who can perceive possibilities and chase dreams and ambitions without hurting people in the process.
Growing in the ability to detect where controlling emotions and highly reactive behavior have directed one’s life, then, opting for better and more purposeful growth born of creative thinking.
Deciding never to use another person for one’s own ends and to be honest with oneself about this when they see themselves falling into such patterns.
Seeing one’s life as a whole, a complete unit, and not as compartmentalized, unrelated segments.
Making no heroes; taking no victims.
Giving up the search for the arrival of a Knight in Shining Armor who will save one from the beautiful struggles and possibilities presented in everyday living.
Paying the price for building, and living within a community, thus, the differentiated person finds a place with others while also being separate from others.
Moving beyond “instant” to process when it comes to love, miracles, the future, healing and all the important and beautiful things in life.
Enjoying the water (rather than praying for it to be wine), learning to swim (rather than trying to walk on water).
The process of differentiating focuses on developing personal, authentic relationships with each member of the family, and changing one’s part in old, repetitive, dysfunctional emotional patterns so that one is able to speak one’s personal views calmly and non-reactively regardless of who is for or against them (Cohen, 2013).
Bowen reckons that differentiation is a lifelong process, and that it is impossible to attain total differentiation. Differentiation of self is a process that can reduce anxiety and symptoms in one person without symptoms resurfacing in another. When one family member becomes more aware of their own part in whatever problems exist, becomes more willing to assume responsibility over that part, and becomes more able to act on that basis, improvements in their functioning will not be contingent on someone else’s absorbing their share of the family’s immaturity and undifferentiation (Kerr & Bowen, 1988). Therefore, when one family member is able to work towards a higher level of differentiation, they will not only reduce their own level of chronic anxiety but the overall level of chronic anxiety in the entire family. So far, the situation in Denim’s family is gradually improving, because each member is grasping the fact that they can make personal choices, and that no one is responsible for the emotional welfare or lack of it of the other. This understanding is helping the members realize their own power to control their own behavior and not anyone else’s.
Results attained so far in Denim’s family
The main goal of Bowen family therapy is to reduce chronic anxiety by facilitating awareness of how the emotional system functions, and increasing levels of differentiation, where the focus is on making changes for the self rather than attempting to change others (Brown, 1999). This leads to reduction of blaming, decreased reactivity, and increased responsibility for the self in the emotional system. Denim’s family has started experiencing some changes in the way they interact and relate with each other. There is less tension in the home, but still there remains noteworthy work to be done, seeing as these family dynamics are deeply rooted and the process of awareness and acceptance is slow and demanding. There is also some degree of resistance because the status quo is much more familiar than the new life being experienced by each member. Periodic relapses are experienced by the members, but we seek to acknowledge them and not dwell on them, and choose to move on without getting stuck and discouraged. Sometimes this resistance is also due to the fact that now everyone has to take responsibility over their own behavior instead of blaming Meg for all the problems being experienced in the family, and this is far from the comfort zone.
Bowen views therapy taking effect through reducing the client’s anxiety over the symptom by encouraging them to learn how the symptom is part of their pattern of relating. This has been a hard task in that no one in Denim’s family originally saw their problems from this view point. Everyone thought that the problem was external, outside of each member; therefore family members had a certain degree of “holier than thou” attitude. However, the family atmosphere created remarkable anxiety. After several sessions, the family members are beginning to see the symptom as part of their relating, and this is gradually reinforcing them positively.
Focusing on the ‘self’ increases each member’s level of differentiation. Denim’s family members are resisting the pull Bowen named ‘togetherness force’ in the family. This is a result of working on avoiding blame and identifying each one’s role in the family situation. Each family member is unique, and brings something different to the family dynamics, despite belonging in the same family.
In all this, the family should be able to support both the cognitive and emotional development of each member in a way that does not trap that member into only one way of thinking or behaving (Ivey, et. al. 2002). This is the goal we are aiming at.
My Role
My role is to be able to connect with the family without becoming emotionally reactive. I work towards maintaining a ‘differentiated’ stance, hence, not being drawn into an over- or under-responsible reciprocity in my attempt to be useful. Being calm and interested in the family system is essential, and this leads to the family learning about itself as an emotional system (Brown, 1999), as well as feeling appreciated and not judged. This is not an easy task because the family is used to blaming, so I also become the object of blame when things do not go as expected. Sometimes the family has considered me as their messiah – and often, the question directed to me is “What should I do?” Bowen (1978) instructs therapists to move out of a healing or helping position, where families passively wait for a cure, to ‘getting the family into a position to accept responsibility for its own change’. I am not doing any work for the family, instead, I am leading each family member to understand their role and not to expect me to solve their problems for them. I offer them my expertise, I am a facilitator. This attitude ensures long lasting results because the family learns to and works through their problems themselves, which provides a strong foundation for change, for the present and for the future.
Bowen is wary of therapists losing sight of their part in the system of interactions, where they may be inducted into a mediating role in a triangle with the family; hence, high priority is given to understanding and making changes within the therapist’s own family of origin (Brown, 1999). I need to be wary of my own issues and address them. Thankfully, I do so with my supervisor, my own space which helps me to maintain healthy boundaries while offering empathy to the family. I need to practice differentiation as opposed to offering techniques in dealing with the family dynamics. Bowen notes that the therapist’s resolution in their family of origin is reflected in the ability of emotional contact with a difficult, emotionally charged problem, while not feeling compelled to preach about what others should do, not rushing in to fix the problem, and not pretending to be detached by emotionally insulating oneself (Kerr & Bowen, 1988). My approach is of motivating family members to create their own strategies in dealing with their problems. The weekly meetings serve to evaluate what is working and what is not. Flexibility is encouraged here in order to address each situation according to need, and to be ready to change direction if one strategy is not working.
I seek to be active in directing the therapeutic conversation, halting enactments in order to prevent the escalation of the family members’ anxiety. Everyone talks directly to me so that other family members may listen well and hear what their members are saying without reacting impulsively. Bowen avoided asking emotional response questions to clients, since he considered this less likely to lead to differentiation of self, but preferred asking for thoughts, reactions, and impressions. He called this activity ‘externalizing the thinking of each client in the presence of the other’ (Bowen, 1978).
In this particular family, members were used to talking “at” and “to” each other as opposed to talking “with” each other. The atmosphere was ever charged with anxiety and tension, and whatever small provocation caused an escalation of reactions, leading to aggressive behavior and sometimes violence.
Setting boundaries has been effective. Boundaries lead to responsible behavior within therapy and outside it. These boundaries are verbalized and accepted by the members. Boundaries refer to how a family is organized and follows the rules; they do not address the issue of how family members work together or fail to work together (Sharf, 2012). When the family’s rules become inoperative, the family becomes dysfunctional. When boundaries become either too rigid or too permeable, families have difficulty operating as a system (Sharf, 2012).
Family members are empowered to make choices and be responsible for them.
The way family members work together indicates the degree of flexibility or rigidity within the family structure. Family members need to work together in order for the family to function. Each person needs to understand their role and carry it out effectively.
Sometimes the siblings (Odey and Meg) have ganged up with each other against the mother through alliance. This sometimes shifts from the siblings among themselves to incorporation of the grandmother against the mother. This exacerbates the situation in that the mother gets extremely charged when she realizes what the other members are doing.
Family members are learning to utilize new resources and to enhance their ability to cope with stress and conflict.
Communication between one person and the other is an act that defines a relationship. This is being enhanced by learning how to express oneself with respect, using “I” statements and owning one’s reactions and feelings.
The goals set are concrete and practical. The aim of setting these goals is to reduce anxiety. Through interacting with the family members, I am able to know which family member is experiencing anxiety, in what ways, and in which situations. Sufficient information is required in order to plan strategies to accomplish goals.
Through these interactions, family members as well as I grow and change in therapy. Since we affect each other in therapy, growth is essential and inevitable for both.
Bowen’s systemic family theory has been very useful in my work with this family, and not only with this particular one, but with all my patients.
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