Lay of the Land Assignment
Lay of the Land Assignment
Although distinct from each other, Bowenian intergenerational therapy and psychoanalytic family therapy share the common roots of (a) psychoanalytic theory and (b) systemic theory. A psychoanalytically trained psychiatrist, Bowen (1985) developed a highly influential and unique approach to therapy that is called Bowen intergenerational therapy. Drawing heavily from object relations theory, psychoanalytic or psychodynamic family therapies have developed several unique approaches, including object relations family therapy (Scharff & Scharff, 1987), family-of-origin therapy (Framo, 1992), and contextual therapy (Boszormenyi-Nagy & Krasner, 1986). These therapies share several key concepts and practices:
• Examining a client’s early relationships to understand present functioning
• Tracing transgenerational and extended family dynamics to understand a client’s complaints
• Promoting insight into extended family dynamics to facilitate change
• Identifying and altering destructive beliefs and patterns of behavior that were learned early in life in one’s family of origin … Lay of the Land Assignment
Bowen Intergenerational Therapy
In a Nutshell: The Least You Need to Know
Bowen intergenerational theory is more about the nature of being human than it is about families or family therapy (Friedman, 1991). The Bowen approach requires therapists to work from a broad perspective that considers the evolution of the human species and the characteristics of all living systems. Therapists use this broad perspective to conceptualize client problems and then rely primarily on the therapist’s use of self to effect change. As part of this broad perspective, therapists routinely consider the three-generational emotional process to better understand the current presenting symptoms.
The process of therapy involves increasing clients’ awareness of how their current behavior is connected to multigenerational processes and the resulting family dynamics. The therapist’s primary tool for promoting client change is the therapist’s personal level of differentiation, the ability to distinguish self from other and manage interpersonal anxiety.
The Juice: Significant Contributions to the Field
If you remember a couple of things from this chapter, they should be:
Differentiation
Differentiation is one of the most useful concepts for understanding interpersonal relationships, although it can be difficult to grasp at first (Friedman, 1991). An emotional or affective concept, differentiation refers to a person’s ability to separate intrapersonal and interpersonal distress:
• Intrapersonal: Separate thoughts from feelings in order to respond rather than react
• Interpersonal: Know where oneself ends and another begins without loss of self
Bowen (1985) also described differentiation as the ability to balance two life forces: the need for togetherness and the need for autonomy. Differentiation is conceptualized on a continuum (Bowen, 1985): a person is more or less differentiated rather than differentiated or not differentiated. Becoming more differentiated is a lifelong journey that is colloquially referred to as “maturity” in the broadest sense. A person who is more differentiated is better able to handle the ups and downs of life and, more importantly, the vicissitudes of intimate relationships. The ability to clearly separate thoughts from feelings and self from others allows one to more successfully negotiate the tension and challenges that come with increasing levels of intimacy.
For example, when one’s partner expresses disapproval or disinterest, this does not cause a differentiated person’s world to collapse or inspire hostility. Of course, feelings may be hurt, and the person experiences that pain. However, he/she doesn’t immediately act on or act out that pain. Differentiated people are able to reflect on the pain: clearly separate out what is their part and what is their partner’s part and identify a respectful way to move forward. In contrast, less differentiated people feel compelled to immediately react and express their feelings before thinking or reflecting on what belongs to whom in the situation. Partners with greater levels of differentiation are able to tolerate difference between themselves and others, allowing for greater freedom and acceptance in all relationships.
Because differentiated people do not immediately react in emotional situations, a common misunderstanding is that differentiation implies lack of emotion or emotional expression (Friedman, 1991). In reality, highly differentiated people are actually able to engage more difficult and intense emotions because they do not overreact and instead can thoughtfully reflect on and tolerate the ambiguity of their emotional lives. Lay of the Land Assignment
It can be difficult to assess a client’s level of differentiation because it is expressed differently depending on the person’s culture, gender, age, and personality (Bowen, 1985). For example, to the untrained eye, emotionally expressive cultures and genders may look more undifferentiated, and emotionally restricted people and cultures may appear more differentiated. However, emotional coolness often is a result of emotional cutoff (see the later section on Emotional Cutoff), which is how a less differentiated person manages intense emotions. Therapists need to assess the actual functioning intrapersonally (ability to separate thought from feeling) and interpersonally (ability to separate self from other) to sift through the diverse expressions of differentiation.
Genograms
The genogram has become one of the most commonly used family assessment instruments (McGoldrick, Gerson, & Petry, 2008). At its most basic level, a genogram is a type of family tree or genealogy that specifically maps key multigenerational processes that illuminate for both therapist and client the emotional dynamics that contribute to the reported symptoms. New therapists are often reluctant to do genograms. When I ask students to do their own, most are enthusiastic. However, when I ask them to do one with a client, most are reluctant. They may say, “I don’t have time” or “I don’t think these clients are the type who would want to do a genogram.” Yet after completing their first genogram with a client, they almost always come out saying, “That was more helpful than I thought it was going to be.” Especially for newer therapists—and even for seasoned clinicians—genograms are always helpful in some way. Although originally developed for the intergenerational work in Bowen’s approach, the genogram is so universally helpful that many therapists from other schools adapt it for their approach, creating solution-focused genograms (Kuehl, 1995) or culturally focused genograms (Hardy & Laszloffy, 1995; Rubalcava & Waldman, 2004). Lay of the Land Assignment
The genogram is simultaneously (a) an assessment instrument and (b) an intervention, especially in the hands of an intergenerational therapist. As an assessment instrument, the genogram helps the therapist identify intergenerational patterns that surround the problem, such as patterns of parenting, managing conflict, and balancing autonomy with togetherness. As an intervention, genograms can help clients see their patterns more clearly and how they may be living out family patterns, rules, and legacies without conscious awareness. As a trainee, I worked with one client who had never spoken to her parents about how her grandfather had sexually abused her and had no intention of doing so because she believed it would tear the family apart. This changed the day we constructed her genogram. I had her color in each person she knew he had also abused. When she was done, the three-generation genogram had over 12 victims colored in red; she went home and spoke to her mother that night and began a multigenerational process of healing for her family.
Rumor Has It: The People and Their Stories
Murray Bowen
A psychoanalytically trained psychiatrist, Bowen (1966, 1972, 1976, 1985) began working with people diagnosed with schizophrenia at the Menninger Clinic in the 1940s and continued his research in the 1950s at the National Institute for Mental Health (NIMH), where he hospitalized entire families with schizophrenic members to study their emotional processes. He then spent the next 30 years at Georgetown University developing one of the most influential theories of family and natural systems, which has influenced generations of family therapists.
Georgetown Family Center: Michael Kerr
A longtime student of Bowen, Michael Kerr has also been one of his most influential students and has served as director of the Georgetown Family Center, where Bowen refined his clinical approach.
The Center for Family Learning: Philip Guerin and Thomas Fogarty
Guerin and Fogarty co-founded the Center for Family Learning in New York, one of the premier training centers for family therapy. Both Guerin and Fogarty have written extensively on the clinical applications of Bowen’s model.
Monica McGoldrick and Betty Carter
Betty Carter and Monica McGoldrick (1999) used Bowen’s theory to develop their highly influential model of the family life cycle, which uses the Bowenian concept of balancing the need for togetherness and independence to understand how families develop. McGoldrick’s work with genograms is the definitive work on this tool subject (McGoldrick, Gerson, & Petry, 2008).
David Schnarch
Grounded in Bowen’s intergenerational approach, Schnarch developed a unique approach to working with couples, the sexual crucible model, which is designed to increase a couple’s capacity for intimacy by increasing their level of differentiation. One of the hallmarks of this approach is harnessing the intensity in the couple’s sexual relationship to promote the differentiation process.
The Big Picture: Overview of Treatment
Much like other approaches that have psychodynamic roots, intergenerational therapy is a process-oriented therapy that relies heavily on the self-of-the-therapist, most specifically the therapist’s level of differentiation, to promote client change (Kerr & Bowen, 1988). This therapy does not emphasize techniques and interventions. Instead, therapists use genograms and assessment to promote insight and then intervene as differentiated persons. For example, when one partner tries to get the therapist to take his/her side in an argument, the therapist responds by simultaneously modeling differentiation and gently promoting it in the couple. By refusing to take sides and also helping the couple tolerate their resulting anxiety (their problem is still not fixed, and neither partner has been “validated” by the therapist), the therapist creates a situation in which the couple can increase their level of differentiation: they can use self-validation to soothe their feelings and learn how to tolerate the tension of difference between them. Change is achieved through alternately using insight and the therapeutic relationship to increase clients’ levels of differentiation and tolerance for anxiety and ambiguity. Lay of the Land Assignment