Clinical applications of Bowen family systems theory
Larson, Jeffry H
Titelman, P (Ed.). (1998). Clinical applications of Bowen family systems theory. New York: Haworth, 423 pp., $ 49.95.
The purpose of this book is twofold: First, to describe Bowen Family Systems Theory, assessment, and therapy; and second, to provide examples of clinical applications of Bowen’s approach to a wide variety of individual and relationship disorders. Three perspectives from Bowen theory are presented: Theory in clinical practice, the therapist’s own family and its relation to doing therapy, and natural systems theory (i.e., biology). The 13 authors in this book each had significant contact with Murray Bowen over 20-plus-year careers.
I found the three introductory chapters in part one of the book to be good synopses of Bowen’s theoretical writings. In part two of the book, Bowen theory and clinical applications come alive with detailed case studies that demonstrate the use of his theory in individual, couple, and family therapy settings with many clinical diagnoses, including marital dysfunction, children’s disorders (such as anxiety and depression), and medical problems. In each case, therapy focuses primarily on lowering the multigenerational transmission of emotionality (e.g., anxiety) from parents to children, which Bowen theory explains as the cause of emotional problems in children. Interesting descriptions are provided of how parents transfer anxiety and behaviors from their own families of origin to their own children.
The next two chapters extend Bowen theory to the treatment of college students and the elderly. Bowen theory has a natural appeal to young adults in college as they are facing the developmental conflict of autonomy versus dependence. Treating chronic anxiety that feeds symptoms and raising differentiation of self through family of origin work are described. Four case studies describe depression and academic failure, suicide, bulimia, where the student’s symptoms become part of the emotional triangle, and an adult child of an alcoholic struggling with feelings of isolation and rejection. In the chapter on the elderly, the focus is on helping them deal with their own pending death and the anxiety that is associated with it.
The next three chapters focus on treatment for three common adult disorders: Depression, obsessive-compulsive disorder, and alcoholism. The depression chapter highlights the generally accepted view that the family plays a significant role in the origin of members’ emotional problems. The chapter on alcoholism is one of the longer chapters in the book, and it does an excellent job of describing how alcoholism and other addictions are related to Bowen family systems concepts of differentiation of self, coping with anxiety in the family system, and over- and underfunctioning roles typical in families struggling with alcoholism.
The next chapters focus on a Family Systems Theory conceptualization of incest, including sociobiological and anthropological explanations of incest, child-focused divorce adjustment therapy dealing with triangles formed between attorneys, the court, affairs, and extended family members in which the therapist must take the role of coach.
The next-to-last chapter is on remarriage. Triangles are frequently found in remarried families, and so Bowen theory is especially helpful with these families. Assessing the multigenerational nature of the family can be a sizable task in remarried families because of the number of people involved. The last chapter describes how to help divorced persons bridge emotional cutoff from a former spouse.
The greatest strength of the book is its application of Bowen theory to a wide variety of clinical problems. A second is that several authors describe their own differentiation-of-self process that allowed them to become Bowen family systems therapists.
The wide application of Bowen’s theoretical concepts to multiple clinical situations is most impressive. Edited books are usually uneven in chapter quality, but this book had no weak links. I found something useful in every chapter. My only complaint is that even after describing Bowen theory in more than 118 pages of text, some authors still reviewed his basic principles again for the reader, which seemed unnecessary.
I have done research and clinical work in eight of the clinical areas described in the book, and the eight chapters have added to my understanding of intergenerational emotional processes in the family that contribute to each of these clinical entities. However, this book is best read after a more basic primer on Bowen theory in an introductory family therapy text. Graduate students and practicing clinicians alike will find it useful and thought provoking for treating a wide variety of clinical disorders.
Jeffry H. Larson, PhD MFT-Program Director
Brigham Young University
Copyright American Association for Marriage and Family Therapy Jul 2001
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