Module 6: Learning Activity

University of Rochester School of Nursing

NUR454 Group and Family Psychotherapy

October 10, 2023

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Study Questions

1. Define the following fundamental key concepts in general systems theory which can

apply to mechanical systems or living systems like families and groups. Give applied

examples of living systems (Nichols, Ch 3):

The following concepts from general systems theory provide valuable insights into

understanding and working with complex living systems like families in the context of

family therapy.

 Feedback loop: A feedback loop is a process in which the output or result of a

system's action is fed back into the system as input, often influencing subsequent

actions (Nichols, 2017). An applied example in family therapy might be when a child's

disruptive behavior at home (output) leads to parents modifying their disciplinary

approach (input) to manage the behavior more effectively.

 Cybernetics: Cybernetics is the study of control and communication in systems. In

family therapy, it can be applied to understand how information and communication

patterns within a family system influence its functioning (Nichols, 2017). For

example, a family therapist might use cybernetic principles to explore how conflicts

are perpetuated or resolved through communication dynamics.

 Open system/closed system: An open system is one that interacts with its

environment, exchanging matter, energy, or information. A family can be considered

an open system as it interacts with the community, school, and other external factors.

A closed system, on the other hand, is isolated and does not exchange with its

environment (Nichols, 2017). An example of a closed system might be a cult that

isolates itself from the outside world.

 Negative feedback: Negative feedback is a regulatory mechanism in which a system's

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response opposes a change in the system, thereby maintaining stability (Nichols,

2017). In a family context, negative feedback could be seen when a family adapts to

external stressors like financial difficulties by cutting back on expenses to restore

financial stability.

 Positive feedback: Positive feedback amplifies or reinforces a change in a system,

potentially leading to instability (Nichols, 2017). In a family, positive feedback might

occur when escalating conflicts between family members intensify, leading to more

intense arguments or emotional outbursts.

 Homeostasis: Homeostasis refers to a system's ability to maintain stability and

balance in the face of changing external conditions (Nichols, 2017). In family therapy,

homeostasis can be observed when a family resists change and returns to familiar

patterns of behavior even when those patterns are dysfunctional, as it provides a sense

of stability.

 Black Box metaphor: The black box metaphor suggests that we can understand a

system by examining its inputs and outputs without necessarily knowing how the

internal processes work (Nichols, 2017). In family therapy, the black box metaphor

might be applied when focusing on observable family behaviors and communication

patterns without delving into each individual's internal thoughts and emotions as a way

to address systemic issues.

2. Background and Underlying Theories. Define and describe 6 interlocking key

concepts of Bowen Systems Theory in your own words. Give an applied example of

each concept. (Nichols Ch. 4) Acronym DEMSES

Bowen Systems Theory provides a comprehensive framework for understanding family

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dynamics and how emotional processes can impact individuals and their relationships within the

family system.

 Differentiation of self: Differentiation of self refers to an individual's ability to

maintain their own emotional and intellectual autonomy while staying emotionally

connected to others, especially in the context of family relationships. It involves being

self-aware and not overly reactive to emotional pressures from the family system

(Nichols, 2017). For example, a person with high differentiation might be able to

calmly express their opinions and set boundaries within a family conflict without

becoming overly emotional.

 Emotional triangles: Emotional triangles occur when tension or conflict between two

individuals is alleviated by involving a third person. In a family context, this might

involve a child seeking solace from one parent when having a conflict with the other

parent. The triangle serves as a way to stabilize emotional intensity (Nichols, 2017).

 Multi-generational Transmission process: The multi-generational transmission

process suggests that behavior patterns, emotional reactions, and relationship

dynamics are passed down from one generation to the next within families (Nichols,

2017). For example, a family with a history of substance abuse might see this issue

recur in different generations, with children of addicts being at risk for similar

struggles.

 Sibling position: Sibling position refers to individuals' birth order and roles within a

family. It can influence personality and behavior (Nichols, 2017). For instance, a first-

born child may develop leadership qualities and a sense of responsibility, while a

middle child might become a peacemaker and seek attention in different ways.

 Emotional Cut-off: Emotional cut-off occurs when individuals distance themselves

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emotionally from their families of origin as a way to reduce anxiety or unresolved

conflicts (Nichols, 2017). For example, an individual might move to a different city

and limit contact with their family to avoid dealing with unresolved family issues.

 Societal Emotional Process: The societal emotional process explores how broader

societal issues and emotional patterns can affect families (Nichols, 2017). For

instance, during economic recessions, families may experience increased stress,

conflict, and financial pressures, which can influence their emotional dynamics and

coping mechanisms.

3. Describe what would be considered normal family development as understood when using

Bowen Family Systems approach. Give applied examples. (Nichols Ch. 4)

According to the Bowen Family Systems approach, normal family development is

characterized by several key principles and patterns. These principles emphasize the importance

of differentiation, emotional regulation, and maintaining healthy family relationships. Here's a

description of what is considered normal family development in the Bowen Family Systems

approach, along with applied examples:

 Differentiation of self: Normal family development involves members striving to

increase their differentiation of self. This means they work on maintaining their

individuality and autonomy while staying connected emotionally to family members.

They can express their thoughts and feelings without becoming emotionally reactive. For

instance, in a healthy family, parents encourage their children to develop their own

identities and make independent decisions while remaining emotionally supportive.

Children grow up with a strong sense of self and can handle conflicts without intense

emotional reactions.
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 Emotional triangles: In normal family development, individuals understand the concept

of emotional triangles and actively work to minimize their involvement. Triangles are

seen as a way to reduce emotional intensity in a family, but they should not become a

primary means of conflict resolution. For example, in a well-functioning family, when

conflicts arise between two members, they address the issues directly with each other

rather than pulling in a third person to mediate or diffuse the tension.

 Open communication: Normal family development emphasizes open and honest

communication within the family. Family members feel safe expressing their thoughts and

emotions without fear of rejection or criticism. In a healthy family, parents create an

environment where children feel comfortable discussing their feelings and concerns.

Family meetings are held to discuss important matters, and everyone has a voice in the

decision-making process.

 Emotional support: In normal family development, emotional support is readily

available among family members. They are there for one another during stress or crisis,

providing comfort and understanding. In a supportive family, when a family member faces

a personal challenge, such as job loss or illness, the rest of the family rallies around them,

offering emotional support, practical help, and encouragement.

 Adaptability: Normal family development includes adaptability to changes and

challenges in life. Families are resilient and can adjust their roles and routines as needed.

A family experiences normal development when they handle transitions like a child

leaving for college or a parent retiring by discussing and planning for these changes

together, recognizing that roles and dynamics may shift.

 Self-awareness: In normal family development, members continually strive to increase

their self-awareness. They understand their family of origin's impact on their behavior and
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work on self-improvement. A family member who recognizes how their childhood

experiences have influenced their communication style seeks therapy to develop better

communication skills and contribute positively to the family's growth.

Normal family development in the Bowen Family Systems approach involves fostering

individuality, maintaining open communication, providing emotional support, and adapting to

life's challenges. It is a dynamic process where family members continually work on improving

themselves and their relationships within the family system.

4. Describe behavior disorders as understood when using this approach. Please give examples

(use the Langdon case study, pp. 75-76).

In the context of the Bowen Family Systems approach, the case study of Martin Langdon

illustrates several behavior disorders or maladaptive patterns of behavior within a family system.

These behaviors are often viewed as a reflection of underlying family dynamics. Here are

examples of behavior disorders as understood within this approach:

Emotional Cut-off:

o Martin's inability to establish healthy emotional boundaries with his mother, Janet,

is a crucial aspect of the emotional cut-off. He remains overly attached to his

mother even into adolescence, resulting in chronic conflicts and difficulties in

separating from her.

o Example: Martin's resistance to developing independent interests outside the home

during adolescence and his ongoing battles with his mother reflect an emotional

cut-off. He struggles to assert his individuality and establish independence.

Triangulation:
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o Triangulation occurs when a third person is drawn into a conflict between two

individuals, often to alleviate tension or reduce emotional intensity. In Martin's

case, he becomes triangulated between his mother and father.

o Example: Martin's parents, Janet and Warren, involve him in their own unresolved

emotional issues. For instance, Janet's attempts to maintain closeness with Martin

by preventing his father from being involved in their son's care create conflict and

triangulation within the family.

Over-functioning and Under-functioning:

o In this family, we see a pattern where Janet over-functions as a mother, becoming

overly involved and protective of Martin. Conversely, Warren under-functions as a

father, becoming distant and detached from their son.

o Example: Janet's over-involvement in caring for Martin and her reluctance to let

him explore and make mistakes lead to his dependency on her. Warren's emotional

distance exacerbates the imbalance in the family dynamics.

Failure to Set Boundaries:

o Martin's inability to accept limits and set boundaries is evident in his behavior at

school and with peers. His mother, Janet, reinforces this by siding with him against

teachers and peers.

o Example: When Martin's teachers express concerns about his behavior, Janet's

defense of her son's actions prevents him from learning appropriate boundaries and

social skills.

Family Projection Process:

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o The family projection process occurs when parental anxieties and unresolved

issues are projected onto one or more children. Martin becomes the focus of his

parents' unresolved conflicts and emotional needs in this case.

o Example: Martin becomes the "center of the universe" for Janet, filling the

emotional void she experiences due to her strained relationship with her husband,

Warren. Her intense focus on him prevents Martin from developing healthy

independence.

In summary, the Bowen Family Systems approach helps us understand how the behavior

disorders observed in Martin are interconnected with the family's dynamics, particularly the

emotional cut-off, triangulation, over-functioning, under-functioning, failure to set boundaries,

and family projection process. These dynamics contribute to Martin's difficulties establishing

healthy relationships and achieving emotional maturity.

5 A. What are goals of psychotherapy when using this approach? You can use the

Langdon case study to discuss the goals (There is a genogram of the Langdon

family on p. 79)

Improve Differentiation of Self:

o Goal: Encourage each family member, including Martin, Janet, and Warren, to

work on increasing their differentiation of self. This involves becoming more self-

aware, reducing emotional reactivity, and establishing a healthy balance between

autonomy and emotional connectedness.

o Application: The therapist would work with Martin, Janet, and Warren

individually to help them understand their emotional reactions and patterns of

behavior within the family context. They would aim to help each member develop

the capacity to remain calm and objective in the face of family conflicts.
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Address Triangulation and Emotional Cut-off:

o Goal: Assist the family in recognizing and reducing emotional triangulation and

emotional cut-off. This involves helping them communicate directly with one

another and develop healthier ways to manage conflicts.

o Application: The therapist may facilitate family sessions to help the Langdons

engage in open and honest communication. They might encourage Martin to

express his needs and feelings directly to his parents and vice versa.

Promote Individual and Family Functioning:

o Goal: Support Martin's development of independence and emotional regulation.

Also, work with Janet and Warren to improve their individual functioning and

their ability to co-parent effectively.

o Application: The therapist could provide guidance to Martin on setting appropriate

boundaries and building healthier relationships outside the family. Additionally,

they would work with Janet and Warren to help them co-parent in a way that

fosters their son's autonomy.

Explore Family of Origin Issues:

o Goal: Help each family member understand the impact of their family of origin

experiences on their current dynamics and behavior. Encourage them to work

through unresolved issues.

o Application: The therapist may ask questions to explore Janet and Warren's family

of origin experiences and how they contribute to their current struggles in the

Langdon family. This exploration can help individuals gain insight into their

behavior and decision-making patterns.

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B. What are questions the therapist uses to assess the family when using this approach?

The following questions help the therapist assess the family's dynamics, individual

challenges, and patterns of interaction, allowing for a more comprehensive understanding of the

family system and guiding the therapeutic process in the Bowen Family Systems approach.

Family History and Dynamics:

 What is the family's history and structure, including any significant events or transitions?

 How do family members typically interact with each other, and what roles do they play

within the family?

Emotional Reactivity and Patterns:

 Can you describe instances when conflicts or emotional reactivity have occurred within

the family?

 How do family members typically respond to emotional tension or disagreements?

Differentiation of Self:

 How do you perceive your level of differentiation? Are there situations in which you feel

more or less differentiated?

 Can you identify moments when you have been able to remain calm and objective in the

face of family conflicts?

Triangulation and Emotional Cut-off:

 Are there recurring patterns of triangulation or emotional cut-off within the family?

 Can you recall specific situations where you felt caught in emotional triangles or

disconnected from one another?

Family of Origin Influences:

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 What were your experiences and relationships with your own parents and siblings growing

up?

 How do you believe your family of origin experiences influence your behavior and

relationships within the Langdon family?

6. The genogram is used clinically to track family patterns through time and space. Using the

Kennedy genogram in McGoldrick et al readings, name 3 patterns that are noticeable to you. Or

Scott Joplin’s family.

Genograms are visual representations of family relationships and histories used by

clinicians to track patterns and gain insights into family dynamics. Here are three common

patterns that clinicians often look for when analyzing genograms:

Generational Patterns:

 Clinicians may look for patterns of behavior, traits, or medical conditions that span across

multiple generations. These can include tendencies for certain mental health issues,

substance abuse, or chronic illnesses to recur within the family.

Relationship Patterns:

 Genograms can reveal patterns of closeness or distance between family members. This

may involve identifying enmeshed relationships, where individuals are overly involved in

each other's lives, or patterns of emotional cut-off, where family members maintain

emotional distance.

Roles and Hierarchies:

 Genograms often show how roles and hierarchies within the family are established and

maintained. Clinicians look for patterns such as the oldest child being a caregiver or the

youngest child being the "problem child."

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To identify specific patterns in a genogram, it is essential to examine the interconnections,

symbols, and relationships within the family depicted in the genogram. Each family's genogram

will be unique, and patterns may vary widely based on the family's history and dynamics.

7. How are roles handled in alcoholic and caretaking families. Use Monica McGoldrick’s

genogram on p. 162 and in color chart 19 as examples.

Monica McGoldrick's genogram or any genogram of a family with alcoholic or caretaking

dynamics can help illustrate how these roles are distributed among family members.

Understanding these roles can be crucial in therapy to address dysfunctional patterns and promote

healthier family dynamics. Therapy may involve helping family members recognize and change

their roles, set boundaries, and develop healthier ways of relating to one another.

Alcoholic Family Roles:

 The Enabler or Caretaker: This role is often taken on by one family member, such as a

spouse or adult child, who tries to manage and minimize the consequences of the

alcoholic's behavior. They may make excuses for the alcoholic, cover up problems, and

protect the family's image.

 The Scapegoat: This family member tends to act out and draw attention away from the

alcoholic's behavior. They may become rebellious, engage in risky behaviors, or exhibit

emotional and behavioral problems as a way of coping.

 The Hero: The hero role is often assumed by an overachieving family member who

strives for perfection and success to counterbalance the dysfunction in the family. They

may excel academically or professionally as a way to cope with the chaos at home.

 The Lost Child: The lost child role involves a family member who withdraws and

becomes emotionally invisible within the family. They may avoid conflict and attention,

often retreating into solitary activities or isolating themselves from family dynamics.
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 The Mascot or Clown: This role is taken on by a family member who uses humor and

charm to diffuse tension and distract from the alcoholic's behavior. They may use laughter

as a way to cope with the family's struggles.

Caretaking Family Roles:

 The Caretaker or Enabler: Similar to the role in alcoholic families, the caretaker often

assumes responsibility for others' needs and well-being. They may prioritize others' needs

over their own and have difficulty setting boundaries.

 The Dependent: This family member relies on the caretaker for support and may struggle

with self-sufficiency. They may have a pattern of dependency and difficulty making

decisions independently.

 The Manipulator: The manipulator in a caretaking family often uses passive-aggressive

behavior to get their needs met. They may indirectly communicate their desires or use

guilt to manipulate the caretaker.

 The Rebel: The rebel may resist or challenge the caretaker's attempts to control or care for

them. They may engage in oppositional behavior to assert their independence.

 The Martyr: The martyr's role involves sacrificing personal needs and desires for the

sake of others. They may engage in self-sacrificing behaviors and feel resentful for not

receiving recognition or appreciation.

8. Describe two or three therapeutic techniques used in treatment of the Bowen Systems Theory.

Give applied examples (you can use the Kennedy case study in McGoldrick et al).

Genogram Analysis: Genogram analysis involves the creation of a visual representation of the

family's multigenerational history, including relationships, roles, and significant life events.

Therapists use genograms to identify patterns, intergenerational influences, and emotional

triangles within the family. In the Kennedy case study, the therapist may create a genogram to
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map out the family's history, including the dynamics between the parents, children, and extended

family. The genogram can reveal patterns such as the intergenerational transmission of emotional

reactivity or the influence of family-of-origin experiences on the current family dynamics. By

examining the genogram, the therapist can help the family gain insights into their relational

patterns and make connections between past and present behaviors.

Differentiation of Self: Bowen's concept of differentiation of self is central to his therapy

approach. Therapists work with family members to help them increase their self-awareness,

emotional regulation, and the ability to maintain their individuality while staying connected to

others. This involves reducing emotional reactivity and improving self-control. In the Kennedy

case study, the therapist may work with individual family members, such as the parents or

children, to help them enhance their differentiation of self. For instance, if one family member

tends to react strongly to conflict or criticism, the therapist may guide them in exploring their

emotional triggers and developing strategies to respond more calmly and rationally. This can lead

to improved communication and reduced emotional intensity within the family.

Detriangling: Detriangling is a therapeutic technique used to address emotional triangles within

the family system. Therapists help family members communicate directly with each other,

reducing the need for a third person to mediate or absorb emotional tension. This technique

promotes open and honest communication. In the Kennedy case study, the therapist may observe

that conflicts often arise between the parents, and one of the children becomes involved as a

mediator or buffer. To detriangle the family, the therapist may encourage the parents to engage in

direct, calm, and respectful communication with each other, addressing their issues without

involving the child. This can lead to a more balanced distribution of emotional tension and greater

autonomy for the child.

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These therapeutic techniques in Bowen Family Systems Therapy aim to increase family

members' self-awareness, improve their ability to manage emotions, and address dysfunctional

patterns within the family system. By applying these techniques in the context of the Kennedy

case study, the therapist can help the family develop healthier ways of relating and resolving

conflicts.

9. What are the strengths and weakness of Bowen Family System theory approach?

How is this theory evaluated in Research? Briefly describe one study that presents

evidence in support of this theory and describe its strengths and limitations.

Strengths of Bowen Family Systems Theory:

 Comprehensive Understanding: Bowen's theory provides a comprehensive framework

for understanding the complexities of family dynamics and how they influence individual

behavior.

 Multigenerational Perspective: The theory emphasizes the importance of considering

multigenerational influences on family functioning, leading to a deeper understanding of

recurring patterns.

 Focus on Differentiation: Bowen's concept of differentiation of self encourages

individuals to develop emotional maturity and autonomy, which can lead to healthier

relationships.

 Practical Application: The theory offers practical techniques, such as genogram analysis

and detriangling, that can be applied in therapy to address dysfunctional patterns.

 Long-Term Perspective: Bowen's approach is often viewed as a long-term therapy,

which can be beneficial for families looking to make lasting changes.

Weaknesses of Bowen Family Systems Theory:

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 Complexity: The theory's complexity can be challenging for both therapists and clients to

grasp fully, and it may require extensive training and practice.

 Limited Emphasis on Emotion: Some critics argue that Bowen's approach places too

little emphasis on emotional expression and processing, which can be essential in therapy.

 Lack of Empirical Evidence: The theory has been criticized for its limited empirical

support, as it is difficult to test many of its concepts rigorously through traditional

research methods.

 Incompatibility with Certain Issues: Bowen's approach may not be suitable for

addressing acute mental health crises or severe psychiatric disorders, which may require

different therapeutic interventions.

Evaluation in Research:

Bowen Family Systems Theory is challenging to evaluate empirically due to its emphasis on

qualitative and long-term therapeutic processes. However, researchers have attempted to study

aspects of the theory. One example is the study by Kerr and Bowen (1988), which explored the

relationship between differentiation of self and relationship satisfaction.

Study Description:

 Title: "Family Evaluation: An Approach Based on Bowen Theory."

 Authors: Michael Kerr and Murray Bowen.

 Findings: The study found a positive correlation between an individual's level of

differentiation of self and their marital satisfaction. Higher levels of differentiation were

associated with greater marital satisfaction.

 Strengths: This study provides some empirical support for one of the central concepts of

Bowen's theory. It highlights the potential benefits of improving differentiation in family

therapy.
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 Limitations: The study is limited by its small sample size and reliance on self-report

measures, which may introduce biases. Additionally, it focuses on a specific aspect of the

theory and does not address the theory's entirety.

While this study offers valuable insights, the limited empirical research on Bowen Family

Systems Theory suggests a need for further research to explore its effectiveness and applicability

in various clinical settings.

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References

Kerr, M. E., & Bowen, M. (1988). Family evaluation: An approach based on Bowen theory.

Norton.

McGoldrick, M., Gerson, R. & Petry, S. (2008). Genograms: Assessment and

Intervention (3rd Ed.). NY, NY: W.N. Norton & Company, Inc.

Nichols, M.P. (2017). Family Therapy: Concepts and Methods (11th Ed.) Boston:

Pearson Education.