Family Systems Issue 13.2

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Table of Contents: 13.2

FROM THE EDITOR
Robert J. Noone, PhD

ARTICLES: Journal articles reflect natural systems thinking or are relevant to it. These may include concept papers as well as research studies.

STUDY OF WEIGHT LOSS AS A MODEL FOR CLINICAL RESEARCH: SHIFTS IN THE FAMILY SYSTEM, THE SUBJECT'S FUNCTIONING, AND THE COURSE OF CLINICAL SYMPTOMS
Laura Havstad, PhD and Kathleen J. Sheffield, MS, MA, RD
Clinical sciences have not yet systematically tested the potential of Bowen family systems theory to understand and predict the course of a wide range of clinical symptoms. This is a progress report on the development and application of a reliable method to document the emotional impact of the family system on clinical subjects and the course of their symptoms over time. A systematic method of analyzing data from family evaluation interviews has been developed to track shifts in the family emotional system associated with weight loss in overweight and obese individuals. The method produces a timeline of shifts in the family system, shifts in the functioning and anxiety levels of subjects, and changes in subjects’ weight. Four studies are described that illustrate and support the development and use of the method. It is hoped that this framework will encourage the practice of tracking the family system as a variable in mainstream clinical research, especially in studies of the course of symptoms and treatment outcomes over time and across a broad range of clinical disorders.

DEVELOPING A SYSTEMS MODEL FOR FAMILY ASSESSMENT
Daniel V. Papero, PhD, MSSW
In personal conversations, Murray Bowen often floated the idea of a system of family diagnosis or assessment. He believed that it would be possible to create a family diagnostic system that could be used alongside or even in place of the DSM. In the book Family Evaluation, Michael Kerr proposed a general schema for such an assessment. Although several attempts have been made to informally follow the Kerr proposal, none has been extensively tested and validated.

In 2011-2012, the NIMH began development of the Research Domain Criteria (RDoC), “…a research framework designed for studying the full range of human behavior from normal to abnormal based on biology, behavior, and context.” (NIMH RDoC Publications accessed September 28, 2017) The RDoC moves away from the categorical classification model of the DStM to a dimensional or continuum model. It currently comprises five domains, or areas of functional continua, and proposes two additional ones. The current domains are: (1) negative valence systems, (2) positive valence systems, (3) cognitive systems, (4) systems for social processes and, (5) arousal/modulatory systems. Two proposed additional domains include neurodevelopment and environment.

The RDoC use of dimensions led the author to consider a new approach to family assessment that differs from the Kerr model. Beginning with Bowen’s conceptualization of the family as a system and his focus on the functioning of that system as it faces adaptive challenges and the accompanying anxiety and stress, it becomes possible to develop a dimensional model of family system functioning. That model includes five dimensions ranging from optimal to dysfunctional: resourcefulness, tension management, connectedness and integration, systems thinking, and goal structure. At this point, a systems model for assessing family functioning remains a preliminary proposed schema. Further development will require the creation of a working group to develop, refine, and test the sub-dimensions within each domain, a process not yet begun.

FROM THE ARCHIVES: A special feature of Family Systems is a previously unpublished manuscript by Murray Bowen and other researchers in the family field..

FAMILY PSYCHOTHERAPY IN OFFICE PRACTICE
Murray Bowen, MD
Introduction by Ruth Riley Sagar, MA
Dr. Bowen presented this paper at a conference on Psychotherapy and the Family at Temple University on March 30, 1961. It was also published in the American Journal of Orthopsychiatry in 1961. At the conclusion of his research project at the NIMH (1954-1959), Dr. Bowen was appointed as a Clinical Associate Professor of Psychiatry at Georgetown University School of Medicine and had begun a clinical practice in Chevy Chase, Maryland.

This presentation describes ninety-four families with a wide range of family problems. Sixteen families had an overtly psychotic offspring, nine families had delinquent problems in teenage children, twenty-one families had behavior and learning problems in adolescent children, and forty-eight were husband-wife families where the children were not the main focus of the family problem. The treatment course ranged from brief family psychotherapy from ten to twenty hours to long-term therapy of 200 to 300 hours extending up to two to three years. In these ninety-four office practice families, the principal problem was in the child in 49% and between the parents in 51%.

FACULTY CASE CONFERENCE: Presentation of a faculty clinical case, followed by a discussion with faculty members of the Bowen Center.

THE DIFFERENCE BOWEN THEORY MAKES IN CLINICAL PRACTICE: CHALLENGES AND CHOICES
Victoria Harrison, MA
This clinical case was presented at a faculty case conference in October 2017 after two months of family systems psychotherapy with a couple. It is an example of the difference it makes for a therapist to draw upon Bowen family systems theory to define for herself decisions and directions involved in the challenges of therapy practice.

This presentation illustrates ways that family history and a family diagram help to understand and interrupt a common e motional process that persists in individual therapy—focus on the other as the problem. Defining the focus of therapy as “working on self” offers an alternative perspective that facilitates a shift from blaming each other toward understanding patterns of reacting that each brings to problems in the marriage. It is a responsibility of the therapist to raise questions in the sessions that direct thinking toward differentiation of self in all family relationships, rather than continue to support the emotional process of focus on the other. This is one of the biggest differences between therapy based in Bowen theory and the more common relationship therapy approaches.

It is possible in the early months of therapy to hypothesize the difference it can make if either spouse is able to recognize his or her own reactions and their impact. Both husband and wife in this example show some ability to begin to make changes, based initially upon the clarity of the theoretical focus of the therapist.

BOOK REVIEW: Reviews on books relevant to Bowen theory and its many applications.

THE ISLAND OF KNOWLEDGE
Marcelo Gleiser
Reviewed by Anne S. McKnight, EdD, MSW