Case of Sharon and Her Family: Family Structure and Family Supports Barbara Thomlison and Karen Blasé
“If I know anything about raising my family, it’s that no one is going to pay attention unless it’s really bad. So I’ve learned to holler real loud until somebody listens.” Those are Sharon’s perceptions as a single parent raising three children, holding down two jobs, and facing the challenges presented by her oldest son. Sharon is 33 years old and is the sole provider for herself and her three children: Brian, who is 15, Cindy, age 14, and Mark, who is 11. The family lives in a transitional neighborhood and would be characterized as “working poor.” Sharon holds down a job as a bus driver and cleans offices and homes in the evening and on weekends. She is determined to avoid welfare but is increasingly frustrated as she tries to make ends meet. The family typically accesses the food bank at least once a month. There is no financial or emotional support from either of the two men who fathered the chil- dren. Brian and Cindy’s father abandoned his common-law relationship with Sharon shortly after Cindy was born and has not contacted the family since. Mark’s father was very physically and emo- tionally abusive to Sharon, and she ran to a women’s shelter when Mark was three. All three children witnessed the abuse of Sharon.
During the last few years, Sharon, who is very committed to her children, has struggled to get help for her oldest son, Brian, and to keep her family together. Brian maintained a 70 average in grade seven. Then he began to be withdrawn and depressed, and he periodically left suicide notes and notes referring to his mother’s violent death. He also was caught exposing himself several times at school activities. His physical aggression towards his mother and his siblings became a weekly if not daily occurrence. During an agonizing two-year period of escalating problems, Sharon frequently called Social Services and discussed the issues with her family physician, and she repeatedly accessed the emer- gency room at the hospital in efforts to get help for her family. While Brian was placed on a waiting list for counseling as a result of a physician referral, other services recommended that the police be called to deal with Brian’s aggression and property destruction. Social Services did not see the issues as related to child welfare mandates, and the hospital had no services to offer. Before Brian could receive counseling, he was caught sexually molesting a younger girl at his school, was expelled from school, and was subsequently arrested, resulting in three months in an open-custody setting.
Transgenerational approaches offer a psychoanalytically influenced historical perspective to current family problems by attending to family relational patterns over decades. Advocates of this view believe current family patterns are embedded in unresolved issues in the families of origin. That is not to say that earlier generations cause the problems of current families but rather that when problems remain unset- tled, they persist and repeat across generations. How today’s family members form attachments, manage intimacy, deal with power, resolve conflict, and so on may mirror earlier family patterns. Unresolved issues in families of origin may show up in symptomatic behavior patterns in later generations. A number of pioneering family therapists—Murray Bowen, Ivan Boszormenyi-Nagy, James Framo, Carl Whitaker—incorporated generational issues in their work with families. As we noted earlier, Framo typically brought each partner’s family members in for family-of-origin sessions in which current differences were discussed, and Whitaker invited extended family members such as grandparents as “consultants” to ongoing family sessions. However, we have chosen to place both Framo and Whitaker elsewhere in the text—Framo with the object relations therapies and Whitaker with the experiential therapies—because their efforts are also strongly influenced by these other outlooks and procedures. The remainder of this chapter focuses on the multigenerational views of Murray Bowen and Ivan Boszormenyi-Nagy. owen’s Family theory
A key figure in the development of family therapy was Murray Bowen, who remained, until his death in 1990, its major theoretician. By turning first to Bowen’s work, we present a theory that represents the intellectual scaffolding upon which much of mainstream family therapy is built. Bowen, the developer of family systems theory, conceptualized the family as an emotional unit, a network of interlocking relationships, best understood when analyzed within a multigenerational or historical framework.
Bowen’s theoretical and therapeutic contributions bridge psychodynamically oriented approaches that emphasize the significance of past family relationships on an individual on the one hand and systems approaches that focus on the family unit as it is presently constituted and currently interacting on the other. His therapeutic stance with couples was disciplined and unruffled but engaged. He was careful not to become triangulated within the couple’s emotional interaction (see his ideas on triangulation later in the chapter). By attending to the processes of their interactions and not the content, Bowen hoped to help the partners hear each other out without deafening passions, accusations, or blame and to learn what each must do to reduce anxiety and build their relationship.
Unlike many of his fellow pioneers in family therapy who struggled at first to stretch classical psychoanalytic theory to fit family life, Bowen recognized early on that most psychoanalytic concepts were too individually derived and not readily translatable into the language of the family. Rather than attempt to adapt such concepts as unconscious motivations to family inter- active patterns, Bowen offered another view. He believed that the driving force underlying all human behavior came from the submerged ebb and flow of family life, the simultaneous push and pull between family members for both distance and togetherness (Wylie, 1990b). This at- tempt to balance two life forces—family togetherness and individual autonomy—was for Bowen the core issue for all humans. Successfully balanced, such persons are able to maintain intimacy with loved ones while differentiating themselves sufficiently as individuals.
Since his early clinical work with schizophrenics and their families at the Menninger Clinic as well as at the National Institute for Mental Health (NIMH), Bowen stressed the importance of theory for research, teaching, and psychotherapy. He was concerned with the field’s lack of a coherent and comprehensive theory of either family development or therapeutic intervention and its all-too-tenuous connections between theory and practice. In particular, Bowen (1978) decried efforts to dismiss theory in favor of an intuitive “seat-of-the-pants” approach, which he considered especially stressful for a novice therapist coping with an intensely emotional, problem-laden family.
Bowen’s professional interest in the family began early in his career when he trained as a psychiatrist and remained on the staff at the Menninger Clinic. Under the leadership of Karl Menninger, innovative psychoanalytic approaches were being tried in treating hospital- ized persons suffering from severe psychiatric illnesses. Intrigued by the family relationships of inpatients, especially schizophrenics, Bowen became particularly interested in researching the possible transgenerational impact of a mother–child symbiosis, or intense enmeshment, in the development and maintenance of schizophrenia. Extrapolating from the psychoana- lytic concept that schizophrenia might result from an unresolved symbiotic attachment to the mother, herself immature and in need of the child to fulfill her own emotional needs, Bowen began studying the emotional fusion between schizophrenic patients and their mothers. In 1951, in order to view their relationship close up, he organized a research project in which mothers and their schizophrenic children resided together in cottages on the Menninger grounds for several months at a time.
In 1954, Bowen was eager to put his new ideas regarding family dynamics into clinical practice. However, stifled by what he saw as the prevailing emphasis on conventional individual psychiatry at the Menninger Clinic, he moved his professional research activities to the NIMH in Bethesda, Maryland. Soon, in what was a radical idea for its time, Bowen had entire families with schizophrenic members living for months at a time in the hospital research wards, where he and his associates were able to observe ongoing family interaction. Here Bowen discovered that the emotional intensity of the mother–child interaction was even more powerful than he had suspected (Kerr, 2003). More important, the emotional intensity seemed to character- ize relationships throughout the family,1 not merely those between mother and child. Fathers and siblings also were found to play key roles in fostering and perpetuating family problems (Hargrove, 2009). Bowen recognized that these additional relations took the form of triangular alliances that were continually formed and dissolved among differing sets of family members.
The reciprocal functioning of all the individual members within the family became so apparent that Bowen expanded his earlier mother–child symbiosis concepts to viewing the entire family as an unbalanced emotional unit made up of members unable to separate or successfully differentiate themselves from one another. Although he did not adopt a cybernetic epistemology per se, nor was he interested especially in directly changing a family’s ongoing interactive pat- terns, Bowen had moved from concentrating on the separate parts of the
family (the patient with the “disease”) to a focus on the whole family. Then he began to direct his attention to what he called the family emotional system—a kind of family guidance system shaped by evolution that governs its behavior. The conceptual shift proved to be a turning point in his thinking, as Bowen increasingly viewed human emotional functioning as part of a natural system that followed the same laws that govern other systems in nature, such as the laws of gravity. Bowen began to study human emotional functioning in a more rigorously scientific way. In so doing, Bowen was beginning to formulate nothing less than a new
theory of human behavior. Family systems theory (sometimes referred to as natural systems theory to differentiate it
Murray Bowen, M.D.
from cybernetically based family systems theories) is derived from the biological view of the human family as one type of living system. As Friedman (1991) points out, the theory is
not fundamentally about families but about life (or what Bowen referred to as the “human phenomenon”), and it attempts to account for humanity’s relationship to other natural sys- tems. As Wylie (1990b, p. 26) explains, Bowen “considered family therapy a by-product of the vast theory of human behavior that he believed it was his real mission to develop.” According to the theory, the human family is seen as appearing due to an evolutionary process in nature. Thus, like all living systems (ant colonies, the tides, the solar system), humans and the human family are guided by processes common in nature. In particular, the theory concerns itself with a special kind of natural system—the family’s emotional system (Kerr, 2003). When the NIMH project ended in 1959, Bowen moved to the Department of Psychiatry at Georgetown University in Washington, DC, because the university was a place more con- ducive to his theoretical bent. He remained there for 31 years, until the end of his career. Working in an outpatient setting, and with families many of whom had less severe prob- lems than schizophrenia, Bowen continued to formulate a comprehensive family systems theory that could be applied to processes occurring in all families, functional as well as dys- functional. At the same time, he proposed a method of therapy based on a solid theoretical foundation. Developing a training program in family therapy while continually refining the concepts he first developed in the 1960s, he published Family Therapy in Clinical Practice in 1978, detailing his theoretical formulations and offering therapeutic techniques consistent with that theory. In 1977, Bowen became the first president of the newly formed American Family Therapy Association, an organization he helped found to pursue interests in research and theory. LO 2 eight interlocking theoretical concepts Bowen’s theory of the family as an emotional relationship system consists of eight interlocking concepts. Six address emotional processes taking place in the nuclear and extended families; two concepts—emotional cutoff and societal regression—speak to the emotional processes across generations in a family and in society. All eight constructs are interlocking, so none is fully understandable apart from the others (Kerr, 2003). The eight concepts are tied together by the underlying premise that chronic anxiety is om- nipresent in life. While it may manifest itself differently, and with different degrees of intensity depending on specific family situations and differing cultural considerations, chronic anxiety is an inevitable part of nature. Bowen viewed chronic anxiety as a biological phenomenon that humans have in common with all forms of life (Friedman, 1991). From this natural systems perspective, past generations transmit chronic anxiety, which impacts family members as they balance togetherness and individual self-differentiation. Anxiety is the sense of arousal in an organism when it perceives a real or imagined threat. In humans, anxiety stimulates the emotional system, overriding the cognitive system and lead- ing to behavior that is automatic or uncontrolled (Kerr, 2003). Anxiety is inevitably aroused as families struggle to balance the pressures toward togetherness as well as toward individ- uation. If greater togetherness prevails, imbalance results and the family moves toward in- creased emotional functioning and less individual autonomy, leading the person to experience increased chronic anxiety.
Consider the case of a high school senior who comes from a working-class family in which a sense of togetherness prevails over an appreciation of the individuality of its members. She has just been accepted to a college in another state and has been offered a scholarship. As the family has only limited financial means, the scholarship represents a major opportunity. In a family such as this, the other members might subtly or explicitly pressure the young woman not to take this chance. Let’s say that part of her wants to go while a part of her understands (because of the submerged ebb and flow of family dynamics) that she shouldn’t go. The chance exists that the family demands for togetherness could keep this young woman feeling anxious, from finding herself as an individual and achieving important life goals. Chronic anxiety, then, represents the underlying basis of all symptomatology; its only antidote is resolution through differentiation (see next section), the process by which an individual learns to chart his or her own direction rather than perpetually following the guidelines of family and others.
LO 3 According to Family Systems Theory, Eight Forces Shape Family Functioning:
1. Differentiation of self 2. Triangles 3. Nuclear family emotional system 4. Family projection process 5. Emotional cutoff 6. Multigenerational transmission process 7. Sibling position 8. Societal regression
LO 4 Differentiation of Self
The cornerstone of the Bowen family systems theory is the notion of forces within the family that lead to individuality and the opposing forces that make for togetherness. Both intrapsy- chic and interpersonal issues are involved here. In the former, the person must, in the face of anxiety, develop the ability to separate feelings from thinking and to choose whether to be guided in a particular instant by intellect or emotion. In the latter, he or she must be able to experience intimacy with others but separate as an autonomous individual from being caught up in any emotional upheaval sweeping the family. The well-differentiated person is able to balance thinking and feeling (adhering to personal convictions while expressing individual emotions) and at the same time retain objectivity and flexibility (remaining independent of the family’s emotional pressures).
Differentiation of self, says Bowen, reflects the extent to which a person is able to distinguish between the intellectual process and the feeling process of what he or she is expe- riencing. Differentiation of self is demonstrated by the degree to which a person can think, plan, and follow his or her own values or convictions, particularly around anxiety-provoking issues, without having behavior automatically driven by the emotional cues from others.
One way people can demonstrate (especially to therapists) their degree of relative differenti- ation is through speaking in I-statements (reflective of I-positions), that is, statements that verbalize the degree of separation an individual feels vis-à-vis others. The degree to which one separates emotionally from parents in growing up is key to differentiation. In extreme cases, the attachment becomes a symbiosis in which parents and child cannot survive without one another. Such unresolved emotional attachment is equiv- alent to a high degree of undifferentiation in a person and in a family (Papero, 1995). (In other cultures, particularly those that focus on family togetherness, individuality and differentiation may be expressed differently.) The ideal here is not to be emotionally detached or fiercely objective or without feelings, but rather to strive for balance, achieving self-definition but not at the expense of losing the capacity for spontaneous emotional expression. Individuals should not be driven by feelings they do not understand. As Hargrove (2009) notes, “The person who balances emotional reactivity and thinking without regard to the family’s emotional process is thought to be func- tioning at a higher level of differentiation of self ” (p. 290). As Papero (1990, p. 48) summarizes, “To the degree that one can thoughtfully guide personal behavior in accordance with well-defined principles in spite of intense anxiety in the family, he or she displays a level or degree of differentiation.” For example, suppose our high school student mentioned previously chooses to go to college. After living away, she goes home at midyear to attend her sister’s wedding. Amid the tensions that typically occur around such an event, to what degree is she drawn into family feuds, conflicts, coalitions, or emo- tional turmoil? Her differentiation can be gauged by the degree to which she is able to remain sufficiently involved to enjoy the pleasures of this family event while sufficiently separated so as not to be drawn into the family emotional system. Individuals with the greatest fusion between their thoughts and feelings (e.g., schizophrenics dealing with their families) function most poorly; they are likely to be at the mercy of automatic or involuntary emotional reactions and tend to become dysfunctional even under low levels of anxiety. Unable to differentiate thought from feeling, such persons have trouble differentiating themselves from others and merge easily with whatever emotions dominate or sweep through the family. Highly fused persons, with few firmly held positions
of their own, are apt to remain emotionally “stuck” throughout their lives in the position they occupied in their families of origin (Bowen, 1978). Bowen (1966) early on introduced the concept of undifferentiated family ego mass, a term derived from psychoanalysis. The term conveys the idea of a family emotionally “stuck together,” one in which “a conglomerate emotional oneness . . . exists in all levels of intensity” (p. 171). The classic example of the symbiotic relationship between mother and child may represent the most intense version of this concept (in such families, a father’s detachment may be the least intense). The degree to which any one member is involved in the family from moment to moment depends on that person’s basic level of involvement in the fam- ily ego mass. Sometimes the emotional closeness can be so intense that family members feel they know each other’s feelings, thoughts, fantasies, and dreams. This intimacy may lead to uncomfortable “overcloseness” and ultimately to a phase of mutual rejection between mem- bers. So emotional tensions in a family system shift over time (sometimes slowly, sometimes rapidly) in a series of alliances and splits. Bowen later recast the term undifferentiated family ego mass into systems language as fusion-differentiation. Both terms underscore the transgenerational view that maturity and self-actualization demand that an individual become free of unresolved emotional attach- ments to his or her family of origin. To illustrate his point, Bowen (1966) proposed a theoret- ical scale (not an actual psychometric instrument) for evaluating an individual’s differentiation level. As noted in Figure 8.1, the greater the degree of undifferentiation (no sense of self or a weak or unstable personal identity), the greater the emotional fusion into a common self with others (the undifferentiated family ego mass).
A person with a strong sense of self (“These are my opinions . . . This is who I am . . . This is what I will do, but not this”) expresses convic- tions and clearly defined beliefs. Such a person is said to be expressing a solid self. He or she does not compromise that self for the sake of marital bliss, to please parents, or to achieve family harmony. People at the low end of the scale are those whose emotions and intellect are so fused that their lives are dominated by the feelings of those around them. As a consequence, they feel anxious and are easily stressed into dysfunction. Fearful and emotionally needy, they sacrifice their individuality in order to ensure acceptance from others. They are expressing an undif- ferentiated pseudo self, which they may deceive themselves into thinking is real but which is composed of the opinions and values of others. Those far fewer individuals at the high end are emotionally mature. They can think, feel, and take actions on their own despite exter- nal pressures to fall in line. Because their intellectual or rational functioning remains rela- tively (although not completely) dominant during stressful periods, they are more certain of who they are and what they believe, freer to make judgments independent of any emotional turmoil around them. In the midrange are persons with relative degrees of fusion or differ- entiation. Note that the scale eliminates the need for the concept of normality. It is possible for people at the low end of the scale to keep their lives in emotional equilibrium and stay free of symptoms, thus appearing “normal.” However, they are more vulnerable to stress and, under stress, may develop symptoms from which they recover far more slowly than those at the high end of the scale.
bowen’s theoretical differentiation-of-self scale distinguishes people according to the degree of fusion or differentiation between their emotional and intellectual functioning
• those at the lower level (0–25) are emotionally fused to the family and others, and lead lives in which their thinking is submerged and their feelings dominate.
• those in the 25–50 range are still guided by their emotional system and the reactions of others; goal-directed behavior is present but carried out in order to seek the approval of others.
• in the 50–75 range, thinking is sufficiently developed so as not to be dominated by feeling when stress occurs, and there is a reasonably developed sense of self.
• those rare people functioning between 75 and 100 routinely separate their thinking from their feelings; they base decisions on the former but are free to lose themselves in the intimacy of a close relationship. bowen (1978) considers someone at 75 to have a very high level of differentiation.
• those over 60 constitute a small percentage of society. To summarize:
• Below 50 (low differentiation): tries to please others; supports others and seeks support; dependent; lacks capacity for autonomy; primary need for security; avoids conflict; little ability to independently reach decisions or solve problems.
• 51–75 (midrange differentiation): definite beliefs and values but tends to be overcon- cerned with the opinions of others; may make decisions based on emotional reactivity, especially whether significant others will disapprove.
• 76–100 (high differentiation): clear values and beliefs; goal directed; flexible; secure; autonomous; can tolerate conflict and stress; well-defined sense of solid self and less pseudo self (Roberto, 1992).
A person’s level of differentiation also relates to the person’s relative independence from others outside the family group. A moderate to high level of differentiation permits interac- tion with others without fear of fusion (losing one’s sense of self in the relationship). While all relationships ranging from poorly to well-differentiated ones are in a state of dynamic equilib- rium, the flexibility in that balance decreases as differentiation decreases. Figure 8.2 illustrates the varying degrees to which a person’s functioning can be influenced by the relationship process. Bowen family systems theory assumes that an instinctively rooted life force in every human propels the developing child to grow up to be an emotionally separate person, able to think, feel, and act as an individual. At the same time, a corresponding life force propels the child and family to remain emotionally connected. Because of these counterbalancing forces, no one ever achieves complete emotional separation from the family of origin. There are considerable differences in the amount of separation each of us accomplishes, including differences between siblings in the degree to which they emotionally separate from the family.
relationship a is one where the functioning of each person is almost completely determined by the relationship process. The degree to which individual functioning is either enhanced or undermined by the relationship is indicated by the shaded area. The clear area indicates the capacity for self-determined functioning while in a relationship. relationships b and c are progressively better differentiated. Individual functioning, therefore, is less likely to be enhanced or undermined by the relationship process. relationship d is theoretical for the human. It represents two people who can be actively involved in a relationship yet remain self-determined Source: Kerr and Bowen (1988), p. 71.
The latter is due to characteristics of the different parental relationships established with each child, which we elaborate on later in this section. LO 5 Triangles Bowen family systems theory also emphasizes the emotional tension within an individual or in that person’s relationships. For example, the greater the fusion in a couple, the more difficult it is to find a stable balance