CASE Study 2 COU1201 Family therapy PDF

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CASE STUDY 2 COU1201 The proposed model I chose to approach family therapy covering concept, techniques relevant to the theory of Bowen family system. In my view, for this particular study the Bowen family system better suits the needs of the assignment as Nichols and Minuchin (1999) state that structural family therapy is an aggressive intervention because it challenges families. The Bowen Family Systems Therapy (BFST) is more focused on psycho-educational factors with low emotional reactivity. Further, BFST exposes the role of the family attachment in multigenerational family as it is in this case study. For the purpose of this paper, using the theory of M.Bowen family system I would like to analyse the key concepts of the theory, therapy goals, and present challenges and criticism for the family of Jan, Frank and two daughters – Aria and Kylie. According to the authors Nichols, M. P., & Schwartz, R. C. (1998) presented in Family therapy concepts and methods. Boston, MA: Allyn & Bacon. p.141 “Bowen family systems therapy has by far the most comprehensive view of human behaviour and human problems of any approach to family treatments. It extends the focus deeper into the hearts and minds of family members and broader into the wider family context that shaped, and continues to shape, the life of the family” The key concepts in the BFST are: differentiation, triangles, nuclear family, emotional process, family projection process, emotional cut -off, sibling position, multigenerational transmission. Differentiation Differentiation is very important concept in BFST theory. According to theory, an official patient should not be emotionally connected to the family of origin with no fusion. In the other words, a patient- person should be separate but not cut -off. Numerous studies assert that BFST see a connection between low differentiation and poor emotional, psychological, and physical health, compared with higher differentiation and better health.

Poorly differentiated persons, are more problems to handle stress and are susceptible to “greater levels of chronic anxiety (Peleg, Popko, 2002, p. 357). Differentiation is also a factor affecting an individual as well as a family system. Following this line of thought, the other members of the family might have a low level of differentiation. In order to measure differentiation a Chabot Emotional Differentiation Scale can be used. Triangles Triangulation is based on interaction of a three-unit emotional relationship system. When a two person in emotional system is going through anxiety is likely that the person who is more weak involve a third person in order to ease a tension. Easing tension in the triangle might bring temporary stability but does not resolve a conflict. Family Projection Process This is a process wherein a parent, due to lack of differentiation, conveys and imparts personal emotional struggles and problems to a child. A parent becomes intensely focused on one of the children, who becomes enmeshed with the parent and less able to differentiate. This invites the parent to further intensify the focus onto the child and the child ultimately develops the psychological need for the parent to continue the behavior, which perpetuates this circular process (Nichols & Schwartz, 1998). According to Papero (1990), this dynamic is not exclusively human, but is observed in the animal kingdom as well. Such interlocking sensitivity and reactivity between mother and child can be seen in other life-forms. Jane Goodall reports on the relationship between a chimpanzee mother, Flo, and her son Flint (Goodall, 1979). Although Flo appeared to be an excellent mother and had produced older children who become dominant animals in the chimpanzee community, her relationship to Flint was different. They were unable to accomplish weaning, with Flint clinging to his mother well past the usual age when young males join their adolescent peers When Flo died in Flint’s eighth year, Flint survived her by three and a half weeks. (p. 59)

Multigenerational Transmission Process This process describes differentiation over multiple generations. All the children in any given family will learn behaviours and emotional reactions from the parental system resulting in similar differentiation levels. However, the child who is most fused with the parental system will develop a lower level of differentiation and the child who is the least fused with the parental system will develop a higher level of differentiation than the parents. As these children mature and marry individuals with similar differentiation levels, the process repeats itself, eventually rendering remarkable differences in the differentiation levels over the next few generations (Nichols & Schwartz, 1998). Several longitudinal studies using qualitative and quantitative methods from Klever (2003, 2004, 2005) support BFST as it relates to intergenerational fusion or undifferentiation, and symptomatology impacting nuclear family functioning. Sibling Position Sibling position, or birth order, is hypothesized to predetermine an individual’s personality tendencies in terms of the nuclear family emotional process. Additionally, while individuals who grow up in the same sibling position across families may predictably have common characteristics, they can function differently according to their particular level of differentiation (Nichols & Schwartz, 1998).

Emotional cut off Emotional cut off is the result of non-differentiation from one’s family of origin. Individuals can distance, or cutoff, themselves geographically by moving away or emotionally by avoiding certain personal topics. The result is the same; the conflict remains unresolved (Nichols & Schwartz, 1998). While cut off is due to emotional and relational problems, it can affect a person in the physical realm as well Nuclear Family Emotional Process

Murry Bowen believed that lack of differentiation and unresolved attachment will result in problems with marriage relationship. Conflicts and disfunction might appear. According to the BFST, it is especially important to differentiation with parents physically, emotionally, socially and in order to positively influence one’s nuclear family. Siblings position “Interactive patterns between marital parents may be related to the position in his or her family of origin. Position determined by the birth order or functional position of the child in the family influence. Siblings also can be seen as a factor in determining personality” (except form lecture 5 (Murray Bowen Family Therapy by Karen Dare) Behavior Disorder Development According to BFST, individual and relational symptomatology is caused by stress and anxiety. “Symptoms develop when the level of anxiety exceeds the system’s ability to bind or neutralize it” (Nichols & Schwartz, 1998, p. 152). Differentiation level is directly correlated with a person’s capability to handle stress and therefore remain symptom free. The person with a higher differentiation level is better equipped to handle stress in relationship than the less well-differentiated individual. When a less than well differentiated two-person system experiences stress, the relationship will seek to triangle to relieve the stress. Multi generational transmission Murry Bowen believes that pathology in families can last through generations. “ Mul t i gener at i onal emot i onal pr ocessi sanc hor edi nt heemot i onal s y s t em andi ncl udesemot i ons ,f eel i ngs ,ands ubj ect i v el ydet er mi ned at t i t udes ,v al uesandbel i ef st atar et r ans mi t t edf r om onegener at i ont o t henex t .Thi st r ans mi ss i oni sas sumedpr i mar i l yt hr oughr el at i ons hi p. Ther el at i ons hi pex per i encesmaybegi ni nt hewomb,butt hemos teas i l y r ecogni sedcomponent soft hemul t i gener at i onal t r ansmi ss i onocc uraf t er bi r t h. I ti spr edi ct abl et hat" emot i onal pr obl em"wi l l beboundi noneormor eof t hr eepat t er nsofemot i onal f unct i oni ng:confl i ctbet weenmat es , di s pr opor t i onat eadapt at i onbyonemat et opr eser v ehar mony ,orf oc us ofpar ent al anxi et yonachi l d.Thewayt hef ami l ypr obl em i spl ay edout

i nonegener at i onhaspr edi ct abl econsequenc esf ort henextgener at i on” ( (M.E Kerry, M.Bowen , 1978)

Identifying information In this case study, Jan (42) and Frank (45) have been married for a number of years and have two daughters Aria (16) and Kylie (14). Jan is employed as marketing manager for Coles, while Frank currently works as a bank manager.

They both have grandparents. As a couple their relationship in many ways is complementary in positive sense. However, when it comes to parenting their daughters Jan and Frank relationship becomes an unhealthy complementary. Frank dominates and controls, while Jan is lenient and becomes more of a passive victim.

Differentiation Keith is comfortable with his behavior as an individual, father, and husband, and can behave differently and without influence from his family of origin. Additionally, he possesses the ability to maintain his own perspective and value system. However, “under stress he might develop neurotic problems” (M.E Kerry, M.Bowen , 1988)

Kylie is poorly differentiated child. She appears to be a rebel, with highly reactive personality. She “ operates in opposition to her parents and others. Most of her values and beliefs are formed in opposition to the beliefs of others ” (M.E Kerry, M.Bowen , 1988 p.95)

As an example she got into argument with her grandparents after they report on her smoking cigarettes. According to Bowenian theory, the rebel child acts in more immature manner to parents than to other peers. At the age of 14 Kylie has a boyfriend who is 17 and drives a car. Jan is not very well differentiated. She has low level of solid self but relatively reasonable levels of pseudo-self. She can function well in work and social situation but in the stress situation ( e.g Kylie ‘s problems) she tends to become lenient.

Triangulation One of the basic triangulations is between Jan – Frank regarding Kylies’s freedom and bad behaviour. While Jan and Kylie tend to grow closer, Frank and Kylie tend to distance themselves. In a stress situation Frank is acting “harsh”, while Jan is tend to be “lenient”. Both of them are trying to control the child’ s behavior and they fail as they do not understand the factors forming triangulation.

Emotional cut off Frank appears to be emotionally cut off from Jan over the problems with Kylie. Jan is tend to blame Frank for the situation. When Frank and Jan cut off they just freeze they problems which are going to surface later.

Family projection process The mechanism behind the conflict between Jan and Frank lies in the past. That was probably deficiency of positive feelings between Jan and

Frank which resulted in conflict and its projection onto Kylie.

Multigenerational transmission In Bowenian theory, the parent – child (Jan,Frank and Kylie) conflict have its origin in inheritance levels of differentiation from grandparents ( Susan,Alan and Hal, Sue) Siblings position In the case study, there are two sisters (Aria, Kylie). “ Aria is doing well at school, has friends, love dancing (..)” “Kylie as had a couple of friends who have dropped out of school (..), she smokes.. got a boyfriend”. They somehow fit into classification created by Walter Toman (1961) and used by Murry Bowen. The younger sister Kylie (14) is bubbly, impulsive, materialistic while Aria (16) is an responsible caretaker who has got goals in life.

Diagnosis Jan No clinical syndromes or developmental disorders) No personality disorders) No general medical conditions No medication Frank No clinical syndromes or developmental disorders) No personality disorders) No general medical conditions No medication

Aria No clinical syndromes or developmental disorders) No personality disorders)

No general medical conditions No medication Kylie No clinical syndromes or developmental disorders) No personality disorders) No general medical conditions No medication Processes and stages of therapy Hypothetical therapeutic therapy for the family described in the case study would involve a couple of sessions. (1) That would be assessment through evaluations interviews. (2) Identifying patterns of emotional reactivity According to BFST, process and structure are the main elements of therapy. “Process refers to patterns of emotional reactivity; structure refers to patterns of interlocking triangles” (Nichols & Schwartz, 1998, p. 156). Authentic adjustment and change involve revisiting previously intimately barren relationships with the hope of building emotional closeness. Deconstructing triangles is another change in the family system that will bring increased levels of differentiation for both the individual and the family system. Because family members are encouraged to view the problem as systemic in nature and are not personally labelled as the problem, they are invited to view change as systemic rather than personal (Nichols & Schwartz, 1998). (3) Interlocking triangles For genuine change to occur, the marital triangle needs to be altered. The Bowenian therapist is an integral part of this process. The therapist joins the triangle assuming an emotionally neutral position whereby enabling the couple to detriangle and differentiate, which in turn will dramatically transform the family system overall because change in one triangle will bring about systemic change (Nichols & Schwartz, 1998).

Therapeutic goals Jan and Frank have a difference of opinion in the area of discipline. Again, this difference seems to be a result of what they learned in their respective families of origin. Frank is inclined to mete out a harsher discipline than Jan. This does cause a large amount of disharmony and remains an unresolved issue, and invites triangulation with Jan. This issue needs to be addressed.

Contrary to Frank, Jan need to differentiate from family of origin, detriangulate. The couple need to work on intimacy and improve behavioural patterns. They need to be educated on Bowenian method, especially detriangulation and maintaining balance between emotions and intellectual functioning. CONCLUSION According to BFST, process and structure are the key elements of therapy. Process is connected with a change of emotional reactions of family members while structure refers more to unlocking triangles. Deconstruction of triangles leads to change of family system and influence the level of differentiation of each family member. The processes are presented by therapist as a system change not a singular unit change. However, when the particular member of the family changes the whole system transforms into desired form. The role of the therapist is more like an educator who explains emotional connections, builds closeness, instead of just fixing a problem within the family. Challenges and critique

In the 1990’s a number of studies were testing the validity of Bowen’s theory elements. Some were validated while others were not supported. The unsupported assumptions were the idea that persons with similar differentiation levels attract and marry, theories on sibling position, triangulation, and multigenerational transmission, and the consequences of differentiation on child functioning, adaptableness, and physical health issues (Miller et al., 2004). Additionally, Bowen Family Systems Theory has received critical reviews for gender bias, over-focusing on the mother’s contribution to symptom development in children thereby fostering disrespect for both the male and female parent, and while it does describe emotional processes, it does not readily allow for emotional expression (Brown, 1999, Horne & Hicks, 2002).

References

Brown, J. (1999). Bowen family systems theory and practice: Illustration and Critique. [Electronic Version] A.N.Z.J. Fam. Ther., 20(2), 94-103.

Horne, K. B., & Hicks, M. W. (2002). All in the family: A belated response to Knudson- Martin’s feminist revision of Bowen theory. Journal of Marital and Family Therapy, 28(2), 103-113. Kerr, M. E., & Bowen, M. (1988). Family Evaluation. New York, London: W. W. Norton &. Company Nichols, M. P., & Schwartz, R. C. (1998). Family therapy concepts and methods. Boston, MA: Allyn & Bacon. Miller, R. B., Anderson, S., & Keala, D. K. (2004). Is Bowen theory valid? A review of basic research. Journal of Marital and Family Therapy, 30(4), 453-466. Klever, P. (2003). Intergenerational fusion and nuclear family functioning. [Electronic Version] Contemporary Family Therapy: An International Journal, 25(4), 431.

Papero, D. V. (1990). Bowen family systems theory. Boston, MA: Allyn and Bacon. Peleg-Popko, O. (2002). Bowen theory: A study of differentiation of self, social anxiety, and physiological symptoms. [Electronic Version] Contemporary Family Therapy, 24(2), 355....