Blog post by Jenny Brown

What a satisfying experience to read: The Origins of Family Psychotherapy, This book contains the key research papers from the NIMH* project led by Dr Murray Bowen in the latter 1950s. (Edited by Jack Butler PhD)

Why, you may well ask, was this high on my summer reading list? Don’t I know how to switch off with some good beachside appropriate fiction? Well I did manage to also enjoy a satisfying piece of fiction but I found Bowen and his team’s research papers totally engrossing.  They took me on an excursion into how a new paradigm emerged from carefully constructed observational data. It was such a unique vantage point to see how Bowen and his collaborators, over a 5 year period of observing 18 families who were in hospital (averaging a year) with their highly symptomatic young adult member, began to see and document clear evidence of how the family is an interdependent unit. (additionally data was gathered from a number of outpatient families)

I have written copious notes from this book but thought I would try, for this blog, to pick some highlights. It’s not easy to edit out any of my standout quotes but I have chosen some that I think best express the key themes that stood out for me:

Focussing on the family as a unit – more than a group of individuals and beyond the “sick” one:

The observations reveal how the symptomatic individual is wired to the responses of all family members.  In the same way each family member, whether responding with distance or with intense helping efforts, is continually shaped by each other. While this research involved people with severe forms of psychosis, the term schizophrenia could be replaced with the term “symptoms in offspring”.

There was “A shift from seeing schizophrenia as a process between mother and patient or as an illness with the patient influenced by the mother to an orientation of seeing schizophrenia as the manifestation of a distraught family that becomes focussed in one individual.” P25

“It was possible to see the broad patterns of form and movement that had been obscured by the close up view of the individual. ….The family view in no way detracts from the importance of the familiar individual orientation. …..the individual orientation can be more meaningful after it has been possible to see the family patterns.” P 158

“On one level each family member is an individual. But on a deeper level the central family group is as one. Our study was directed to the undifferentiated ego mass beneath the individuals.” P 109

Seeing how helpers can become part of the family’s helplessness or alternatively, facilitators of family’s problem solving efforts:

There are valuable insights in these papers about the way the workers can be inducted into being rescuers or experts and the effect of such postures. The worker’s self-awareness comes to be seen as of equal importance of the family’s problem solving efforts.

The therapist aims “to be helpful while staying detached from the other person’s immaturities…It is helping with a problem without becoming responsible for the problem….Our greatest philosophy I would say that our greatest help is in helping people to define their dilemmas. Our greatest energy goes into preventing staff from trying to solve dilemmas.” P 54

“When I feel myself inwardly cheering the hero, of hating the villain in the family drama, or pulling for the family victim to assert him/herself, I consider it time to work on my own functioning.” P 116

The senior social worker/case worker on the research project Ms B Basamania writes:

Anxious family members “didn’t deal with each other but turned to therapist as ‘expert’. The higher the anxiety and tension, the greater they turn to the outside as though the tension decreased with distance.” P141

“The philosophy on the project was based upon a regard for the family and its capacity to nurture human growth…. Therapeutically a guiding principle was to respond to the families in a way that would promote growth.” P143

Seeing how growth comes about from within the family:

The research papers describe the detail of the ‘action dialogue’ of the family member’s reactions to each other (both psychologically and physiologically). The emerging theory is seen in descriptions of repeating patterns such as “the interdependent triad” of parents and “patient” (it was a number of years before Bowen clarified his concept of the triangle), the circuitry of the “over adequate/ strong one and under adequate/helpless one”.  There are some clear descriptions of how growth occurs “in-situ” of the family and not in the restorative (healing) relationship with the therapist. This paradigm shift in therapy approach was a direct outworking of the paradigm shift from individual thinking to seeing the family as an interdependent unit.

“The families present a group picture of helplessness and inadequacy. They deal with many life problems as burdens to be endured rather than problems to be solved. Therapeutic emphasis is directed at this helplessness. When either parent is able to become active in solving such a problem, the emotional adjustment of the entire family changes.”P39

“Families are not really helpless. They are functionally helpless. When the family is able to become a contained unit, and there is a family leader with motivation to define the problem and to back his(her) own convictions in taking appropriate action, the family can change from a directionless, anxiety-ridden floundering unit, to a more resourceful organism with a problem to be solved.” P118-9

“The parent’s sureness of themselves may be almost more important than what they do. If they are filled with doubts and apologies, the patient resets adversely; whereas, if they feel sure of themselves, they can behave in bizarre ways without alarming or disturbing the patient, or without upsetting the patient.” pP97

At the heart of systems change is finding a way to tolerate anxiety: If I had to summarise this important research project and its findings it would be:Managing self in relationships in the midst of arousal. (The concept of Differentiation of Self) Or : How families and workers strive to find a way to operate thoughtfully  in the presence of the inevitable anxiety generated in close proximity to other human beings; especially when some are reacting out of helplessness (and equally out of anxious helpfulness). This finishing quote I have selected from Bowen is a valuable encouragement in this effort:

“Anxiety is inevitable if you solve the problem. When anxiety increases, one has to decide whether to give in and retreat or carry on in spite of it. Anxiety does not harm people. It only makes them uncomfortable. It can cause you to shake, or lose sleep, or become confused or develop physical symptoms, but it will not kill you and it will subside. People can even grow and become more mature by having to face and deal with anxiety situations. Do you have to go on treating each other as fragile people who are about to fall apart?” p119

Reference

The Origins of Family Psychotherapy: The NIMH Family Study Project.  Murray Bowen, MD. Ed Jack Butler PhD. With contributions by Michael Kerr, MD, and Joanne Bowen, PhD. New York,: Jason Aronson, 2013.

http://www.amazon.com/The-Origins-Family-Psychotherapy-Project/dp/0765709740

Note: the proceeds of this fine book are being donated to the work of the Bowen Archives.

*National Institute of Mental Health