On Wednesday 28^th and Thursday 29^th October the Family Systems Institute held its Annual Clinical Conference: Dialogue with Difference. Its aim was to explore Bowen Family Systems Theory alongside other approaches to clinical practice. Theories explored included Bowlby’s Attachment Theory, Gestalt Psychotherapy, CBT, Gottman and the Dialogical Approach.

Day 1

Day 1 introduced us to the Dialogical Approach and applied it to a clinical case example through a role play. Dr Judith Brown presented the model, prior to demonstrating how to run an initial session with Carl Gray, Senior Social Worker as guest co-therapist.

Judith Brown outlined the Dialogical therapeutic process as one in which the clinician is attuned to the client or family and the way they experience their current situation. The clinician engages in a reflective process, sitting with, recognising, and accepting the present moment for the family. The co-therapist is invited into this reflective process to comment on their own observations and responses, and thus, this dialogue between therapists is witnessed by the family. (It is reminiscent of family therapy using a one-way screen with a team of “consultants” who relay messages and questions to the family.) In this way the co-therapist appears to act much like the “Greek Chorus” in ancient plays, making comments and reflections that motivate the family to consider their reality from a different perspective as well as acknowledging their lived experience of it. Co-regulation between therapists and families is also part of the therapeutic process.

The same family role play and case presentation was utilised to demonstrate a Bowen Theory approach. Fiona Taylor presented the Bowen Theory by describing the process of the broad perspective family dance/patterns as the focus of observation. The main goal of the therapist is to stay out of the family’s dance, to stay objective and curious, inviting family members to also step out of their ‘dance’ in order for them to gain a clearer perspective of their steps in it, and so understand how they can change the steps for themselves.

Dr Jenny Brown then demonstrated the approach as a Bowen Theory Coach/Therapist in an initial session with the same family. In this way the conference participants experienced, two different theoretical and clinical approaches with the same family. The “actors” were given an opportunity to reflect on their experience of each model from a client perspective. Through break-out groups conference participants were given space for reflection, discussion, and opportunities to ask questions of presenters. In this, our thinking was stimulated by reflective comments from guest clinicians representing each of the approaches.

The afternoon sessions developed some of the outworking of these approaches.

Lily Mailler explored Bowen Theory concepts in Family of Origin work and how as a therapist this work is essential for recognising when and how a therapist’s own family programming can get in the way of the family dance in the therapeutic process. She highlighted examples from her own work on differentiating a self and its effect in her clinical work.

Dr Judith Brown described how doing work on self as a therapist is vital to the way she works with families. She described a process of working out her family diagram, interviewing a family member regarding a significant time of her life, going through a reflective process with that family member and gaining insights and an opportunity to share these in dialogue with a training group.

Veronica Pym

Day 2

At the beginning of day 2 Jenny Brown presented this slide of a way to think objectively about different approaches.

The first key note for the day was from Dr Anne McKnight from Washington DC. Her presentation title: The Developmental Lifespan of the Child: What are the differences between Bowlby’s Attachment Theory and Bowen’s Family Systems Theory?

Bowlby developed Attachment Theory which zooms in on the mother-child attachment with an emphasis on maternal deprivation which he believed led to adult psychopathology.

Bowen developed Bowen Family Systems Theory. He understood it was deficits in the capacity of the family to manage anxiety alongside the ability of individuals to think and act for themselves while staying connected to the family, that led to symptoms in individuals. Within Attachment Theory, energy is directed towards the therapist uncovering traumas and correcting the maladaptive mothering experience while Bowen’s focus of treatment was the family unit.

The 2^nd keynote was from Lauren Errington – Parenting done two ways with a side of therapy: Gottman-informed parent program Tuning into Kids/Teens compared to Dr Jenny Brown’s Bowen-informed Parent Hope Project.

The goal of the ‘Tuning into Teens’ project (as informed by Gottman) is to teach parents to tune into their child’s emotional state and to begin using situations as opportunities for connecting and teaching using emotion coaching. The focus is on the child and their struggle with their emotions. The parents’ role is to teach the child to manage their emotions helpfully.

The goal of the Parent Hope Project (informed by Bowen) is to facilitate parent awareness of their role in relationship interactions, to develop internal agency to discover their own solutions and change what is in their control based on their parenting principles.

The afternoon sessions were 3 bite size explorations of differences between key approaches with Bowen theory/therapy.

Emma Robinson: A look at dysfunctional perfectionism through a traditional CBT lens vs a Bowen Family Systems Approach

Cognitive Behavioural Theory is individualistic and involves cognitive, behavioural, and core belief and schema work considering the ways the client can change thoughts, actions and beliefs to minimise or resolve their dysfunctional perfectionism.

Bowen Family Systems Theory looks at the family as the context of the developing perfectionism. Treatment understands family patterns and history. The work takes place with the motivated member/s of the family, who may or may not be the one with symptoms. There is a focus on developing ‘differentiation of self’.

Martina Palombi: Let’s talk about the difference. Systems thinking, relational Gestalt and ‘to be or not to be’ in the therapeutic relationship.

A primary difference in the practice of Relational Gestalt Therapy vis a vis Bowen Family Systems Theory is the role of the therapist. In RGT, the focus of treatment is the therapeutic relationship. In BFST, the focus is on the client learning to study their family, their place in it and to change self.

Jane Cooper: Where is the focus in filial play therapy? What are the similarities and differences when the intervention is implemented from the perspective of attachment theory and Bowen theory?

In Filial Play Therapy, the child, who is the symptomatic one, directs the play with the parent. The parent is coached towards better interactions with the child and increased harmony in the relationship. Play therapy influenced by Bowen Family Systems Theory is more about tolerating being different. The therapist will assist the parent to consider the family as a whole.

Nicola Fortescue

Although due to Covid restrictions this year’s conference had to be online the format proved to be very interactive allowing attendees to be truly engaged and as a result more enlivened.