Withers, R. (2012). A comparative study of Bowenian system theory and cognitive-behavioral family therapy. [Website article]. Retrieved from http://www.counselinginsite.com.
Bowen’s theories provided the blueprints for the first widely accepted form of family therapy, drawing heavily from the psychodynamic and individual therapies that dominated the first half of the twentieth century (Rabstejnek, 2012). Cognitive-behavioral family therapy was developed later, in the 1960’s, as more or less a reaction to Freud’s work, which many of its architects saw as being limited in scope. Names like Pavlov, Beck, Ellis, Bandura, and Skinner are associated with its development. As its name implies, the theory focuses less on emotion and more on cognition, and how, for example, irrational thinking creates faulty emotions which lead to maladaptive patterns of behavior (Becvar, 2009).
Despite the notable differences, both are well-researched and widely accepted throughout the professional mental health community, as well as being diverse in application. Both theories are used across the globe. A recent article by MacKay (2012) examines the application of Bowen theory to trauma victims in Australia, New Zealand, and New South Wales; McLachlan & Friedberg (2012) make the case for cognitive behavioral therapy in the United Kingdom. One can hypothesize that both theories are popular in many countries because they are effective.
While it would be a matter of opinion to say that one is subjectively better than the other, cognitive-behavioral family therapy does seem more suited to 21st century application, given the demands and constraints of managed care and LME’s, which tend to cap the number of sessions for which a therapist can bill. With its brief, goal-driven nature, cognitive-behavioral family therapy seems better equipped to deal with the realities of healthcare in the United States of America. This does not mean to suggest that Bowenian therapy is outdated. Rather, therapists who use his techniques simply need to be aware of the realities of managed care.
The following paper examines both theories in great detail, not in order to contrast them, though the differences are indeed apparent. Rather, the objective is to provide a comparative analysis of the two, which includes a discussion about each theory’s goals, assumptions about change, the role of the therapists, significant concepts, interventions, and the strengths and limitations of each. The discussion proceeds chronologically in terms of development, with family systems theory first, and cognitive-behavioral family therapy second.
Bowen Family Systems Theory
Family systems theory is heavily influenced by psychodynamic theory, and as such, it shares some of the same tenets. As with the psychodynamic paradigm, family system theory recognizes the past as a major force in the present. Therapy is thus guided by theory, with the understanding that change is both difficult and slow. Furthermore, to understand the individual, one must understand their environment and history (Becvar, 2009). It is perhaps because of these beliefs that Bowen was one of the only family theorists who believed in treating the individual, as opposed to the family.
Murray Bowen (1913-1990) provided one of the first comprehensive theories on family systems, which has been widely used in the U.S. for over fifty years. Most theories before it focused on the internal anxieties of the individual. Bowen, however, began to see anxiety as a function of family dysfunction (Brown, 1999). According to family systems theory, anxiety results from a perception that there is either too much distance or too much closeness to the family unit. This distance is not necessarily physical, though that may be part of it. It’s more relational in nature, and it can be influenced by previous generations as well as current stressors. Individuals react to perceived emotional demands, and relationship dilemmas ensue (Becvar, 2009; Brown, 1999). If one were to graph a functional family, one would see a straight line, with distance on one side, closeness on the other, and a symbol of anxiety at the center. If the line was to tilt and the anxiety was to shift either to the right or to the left, the symbol would grow the closer it moved to either extreme. If individuals are not emotionally equipped to deal with these shifts, a state of chronic anxiety results (Brown, 1999).
Bowen’s theories are a combination of eight overlapping concepts. Rabstejnek (2012) lists the concepts as Bowen saw them in terms of developmental sequence. They are noted in Table 1, along with their key aspects:
Table 1: Bowen's 8 Key Concepts
1. Triangles (fusion and distancing, adequate and inadequate spouses)
2. Differentiation of Self (Emotional fusion, intellectual and emotional functioning)
3. Nuclear Family Emotional Process (maternal conflict, inadequate, over- adequate spouses, emotional divorce)
4. Family Projection Process (child focus, identified or designated patient)
5. Multi-Generational Transmission Processes (compounding articles, schizophrenia)
6. Sibling Position (The Family Constellation)
7. Emotional Cutoff (Family of origin)
8. Emotional Processes in Society (Regression)
This section addresses two of these eight concepts – differentiation of self, and triangles.
In family systems theory, dysfunction is the result of “undifferentiation” from others within the family group (Becvar, 2009). An undifferentiated person is one who is too emotionally involved with his or her own family. Bowen termed this “emotional fusion,” and saw undifferentiated individuals in a state of chronic anxiety (Brown, 1999). They are unduly influenced by other people’s thoughts, judgments, and emotions, have difficulty seeing their own role in an objective light, and in many ways feel trapped within their own family. A differentiated family, by extension, is a functional family, with each family member their own unique self. This does not always mean that undifferentiated families are too close and that differentiated families maintain their distance. Rather, it has more to do with the way the family members see themselves within the context of the family unit.
Differentiation is thus a primary goal of family systems theory. Bowen called it “differentiation of self,” which is a person’s ability to separate themselves, both emotionally and intellectually, from their family (Brown, 1999). An undifferentiated person is overly concerned with acceptance and approval from other family members, and is likely held captive by trans-generational influences. For example, a mother might still be overly concerned about winning her own father’s approval, or a father might be too rigid in his interpretation of family tradition or beliefs about child rearing, or the value of education or religion. The process of differentiation can take a considerable amount of time, and it is difficult to measure. Nevertheless, Bowen saw it is crucial for change (Comella, 1996).
Brown (1999) sees the goal of family systems theory, the reduction of chronic anxiety, as having two components. First, the individuals in the family must each become aware of how emotional systems function. Second, increase differentiation, where individuals focus on making changes internally, rather than trying to change others.
If differentiation is the goal of family systems theory, an analysis of triangulation must be conducted, as triangles form the basis of Bowen’s multi-generational theory (Rabstejnek, 2012). In simple terms, triangulation results when a third person inserts themselves into a two person relationship. A mother and son, for example, may have a two person relationship, or dyad. However, if a grandmother becomes part of that relationship, the dynamics can radically change, either with a lessening of anxiety or an increase. A therapist, for example, can become part of a triangle, and hopefully their involvement allows for an increase in anxiety. Sometimes, however, the addition of a third person causes anxiety to increase and thus contributes to the overall dysfunction of the family (Becvar, 2009). In The Family Crucible, Napier and Whitaker (1978) explore triangulation in a family of five, in order to demonstrate to the family members how triangulation, while often unconscious, can seriously undermine the two-person relationship. In their book, Napier and Whitaker identify a pattern of triangulation within the family, and exposing it helps the family see its negative effects. This particular example includes a discussion about the triangulation between the husband, wife, and their eldest daughter. The daughter has unconsciously allied herself with the father, which has in turn caused a rift between the mother and the father.
The Concept of Change
Even though Bowen theory is designed for families, family systems theory operates under the assumption that individuals must change so that the family unit can as well (Becvar, 2009). As a result, effective communication is vital if change is to occur (Rabstejnek, 2012). This is particularly true in the therapeutic setting, where the counselor must establish a level of rapport and trust that facilitates effective communication, not only among family members, but with the therapist as well (Brown,1999). If families are to change, they must take personal responsibility, quit blaming one another, and learn to listen. This move toward differentiation and away from emotional fusion cannot be accomplished if communication is not present.
The Therapist’s Role
Jenny Brown, one of the more vocal international proponents of family systems theory, explains the nature of case conceptualization and assessment by describing the role of the therapist, which is:
to connect with a family without becoming emotionally reactive. Emphasis is given to the therapist maintaining a 'differentiated' stance. This means that the therapist is not drawn into an over responsible/under responsible reciprocity in attempts to be helpful. A therapist position of calm and interested investigation is important, so that the family begins to learn about itself as an emotional system. Bowen instructs therapists to move out of a healing or helping position, where families passively wait for a cure, to getting the family into position to accept responsibility for its own change. (1999, p. 98).
Murray Bowen encouraged his therapists to better understand their own family of origin. He wanted them to look at their families analytically, to check for patterns of triangulation and differentiation and other maladaptive behaviors, as this was crucial to the development of their own self-awareness (Rabstejnek, 2012). Thus, the role of the therapist is both personal and professional in nature.
Techniques and Interventions
As previously noted, one of the techniques characteristic of family systems theory is the focus of the individual over the family in clinical sessions. Bowenian therapists act as teachers and coaches as they teach their clients the art of differentiation. While family systems theory does promote individual therapy, sessions can and often do include other family members as well. In these sessions, the goal of the therapist is to remain as emotionally detached as possible, and to help the client(s) see where differentiation exists, if triangulation has occurred, and if communication is effective (Brown, 1999). Achieving differentiation, the ultimate goal of family systems therapy, can be long and hard. The following four techniques, including brief descriptions, are often used with this type of therapy, according to Brown (1999):
Family Evaluation: this usually occurs in the first few sessions. The therapist gathers family history and other pertinent data, as a researcher might when conducting an experiment. It is during this phase that a Bowenian therapist might employ a Genogram, a visual tool used to map a family across generations. According to Butler (2008):
Family diagrams visually record the facts of functioning across at least three generations of the multigenerational family. The facts of functioning are factual information about such things as physical problems, emotional symptoms, and educational achievement placed on family diagrams. The facts of functioning of the multigenerational family are assumed to reflect emotional processes within the family (p. 171).
Depending on the family, Genograms might also show signs of substance abuse, educational achievement, divorce, or a myriad of other issues which can prove useful when helping the client or family see patterns of behavior that could be causing dysfunction. Ultimately, the evaluation helps the client see current problems in a much larger systemic context.
Coaching: this technique is used with individuals who are seeking to obtain a greater level of differentiation within the family. As the name suggests, coaching I a way to instruct and support a family member learning to stand on their own two feet. It is designed with the family in mind, but usually performed on one client at a time.
Creating a multigenerational lens: Family systems theory would argue that not only does the past influence the present, but that it is still actively doing so within the family system. The so-called multigenerational lens is an exercise where the therapist uses a series of questions to stimulate discussion about the ways in which previous generations continue to influence current decision-making and beliefs. The therapist might help an individual or family see how a previous generation’s views on religion, finances, child rearing, or a host of other issues continues to influence the current family system.
Detriangling: Brown (1999) notes that this technique is central to Bowenian therapy. As previously discussed, triangles emerge when a third person enters a relationship dyad. While this can be positive, triangulation can be deleterious to relationships. If communication is essential in relationships, then the addition of an extra voice in a relationship may only confuse the message being sent. Often, family members will unwittingly form alliances, leaving a third person isolated and resentful. To combat this phenomenon, the therapist seeks to identify triangles where they exist, and assist family members with their deconstruction (p. 98-100).
Bowen’s theories have been well researched and studied over the last sixty years. For example, Bowen’s theories on differentiation, triangulation, and fusion have been shown again and again to be valid tools for assessing dysfunction (Charles, 2001 Jankowski & Hooper, 2012; Glade, 2005). Research by Comella (1996), Cook (2007) and Brown (2008) also provide useful discussions about the efficacy of Bowen’s theories in a variety of situations.
In addition to proving useful in family therapy, research also suggests that its interventions and techniques are useful in marital therapy as well (Glade, 2005). Other studies show that Bowenian theory has broad applications, including chemical dependence and trauma counseling for victims of sexual abuse (Cook, 2007; Mackay, 2012).
Strengths and Limitations for Future Use
Bowen’s theories are solid, well-researched, and most are widely accepted throughout the counseling profession (Glade, 2005; Brown, 1999). Bowen’s beliefs about the need for communication and differentiation are beyond reproach. Other concepts, such as sibling position, are perhaps less useful for future application. In a comprehensive review of research on the subject, Miller, Anderson, & Keala (2004) found that there was a substantial amount of research that provided empirical support for Bowen’s beliefs about differentiation and chronic anxiety. However, that same study also noted that concepts such as sibling position did not enjoy the same support. As Corey (2009) suggests, perhaps an integrative approach is most appropriate for a future counselor such as me. Key concepts in Bowen’s theories seem easily transferable to other approaches, while others perhaps lack the validity that they may have once had.
Finally, if there is one drawback to Bowenian therapy, it is time. In an age of managed care and a limited numbers of sessions, a therapy which seems to work best over a long period of time is perhaps not the most practical theory from which to choose. However, as several authors have noted, Bowen’s theories have served as inspiration for so many others, that it would be difficult to avoid their use in a contemporary family therapy setting.
Cognitive-Behavioral Family Therapy
Cognitive-behavioral family therapy (CBFT) is incredibly popular with contemporary family therapists. A recent survey conducted by the American Association for Marriage and Family Therapy showed that CBFT was identified as the most widely used of 27 different treatment modalities. Another survey from Columbia University noted that 68% of respondents stated that they used cognitive behavioral therapies, usually in concert with other modalities (Dattilio, 2007). Friedberg (2006) makes the following case for its continued use:
The frontier for cognitive behavioral family therapy is broad and offers tremendous opportunities. In its brief history, cognitive behavioral therapy has transcended many
initial boundaries and expanded its applications. This extension of applications is associated with many clinical breakthroughs with individuals and groups from varying
diagnoses heretofore thought to be inappropriate for cognitive behavioral therapy (e.g. bipolar disorder, schizophrenia, etc.). Directing attention to treating the cognitive, emotional, and interpersonal processes that plague distressed families continues the forward thinking style, which characterizes cognitive behavioral approaches (p. 165).
While it is one of the more recent innovations in family therapy, its roots have sprung from the research-driven and empirically proven theories associated with Behaviorism. From the early work of Ivan Pavlov and classical conditioning, to B.F. Skinner’s operant conditioning, to Robert Liberman and Richard Stuart, who took Skinner’s findings and applied them to family therapy, CBFT has evolved over the last forty years into one of the most popular and pervasive forms of therapy the world has ever seen (Rasheed, Rasheed, & Marley, 2011).
During the 1950’s and 1960’s, Albert Ellis, a psychologist, and Aaron Beck, a psychiatrist, established what would become the basis of Cognitive-behavior family therapy (Becvar, 2009). Ellis, who is perhaps best known as the father of Rational Emotive Behavior Therapy (REBT), developed his theories as a reaction to psychoanalytic models, which he saw as inefficient and unfocused. His A-B-C model of emotions and subsequent interventions target irrational thoughts, which Ellis believed were at the core of all dysfunction (Corey, 2009). Beck, the father of Cognitive Therapy, was also using cognitive interventions to treat depression, which Beck believed was caused by faulty thinking (Martin, 2007). The therapies developed by these two men would combine the behavioral with the cognitive, and allow for its eventual integration into family therapy.
CBFT is a brief, practical, hands-on approach to family therapy that research shows is effective in treating a host of problems, including depression, anxiety, drug abuse, anger, PTSD, sexual disorders, bad habits, and mood swings (Martin, 2007). As any of these issues could present within a family, it is easy to see why it is so popular. That it is brief, solution-focused, and offers measurable goals, one can see why, in an age of managed care, it is the preferred method of treatment.
In addition to expediency, CBFT is also timely. Research shows that CBFT is an effective treatment for high-conflict divorce families (Spillane-Grieco, 2000). With the divorce rate at roughly 50% in the United States, it is likely that counselors will encounter a family caught in the middle of nasty legal proceedings and child custody battles. The study shows how CBFT is used to teach spouses to trade negative thoughts about one another in favor of positive thoughts for their children. As the author of the study notes: “the family therapy sessions that focused on effective communication, empathetic understanding and negotiation had a demonstrable effect on the level of functioning of the family members” (p. 118).
The Concept of Change
Cognitive-behavioral family therapy focuses on the relationship between thoughts, emotions, and actions. Cognitive behavioral therapists reject the idea that external events, like other people or even difficult situations like a job loss cause us to think or behave in a certain way. Rather, it is one’s thinking that determines behaviors and emotions (Corey, 2009). Accordingly, change occurs in CBFT when clients change the way they think, which changes the way they feel, which changes the way they react. Ellis’ famous A-B-C model, which can be used to help clients see how their thoughts influence their emotions, continues to be a vital part of CBFT (Martin, 2007).
CBFT has broad applications, both with individual clients and whole families. Research shows that it is effective in behavioral parent training, marital therapy, couples therapy, functional family therapy, and sex therapy (Becvar, 2009; Rasheed, et al., 2011).
The Therapist’s Role
The CBFT therapist conceptualizes a case by taking a thorough inventory of a client’s or family’s presenting problems and using techniques such as Socratic questioning to assess patterns of faulty thinking and subsequent behaviors (Martin, 2007). Perhaps because of its brief, goal-driven nature, the CBFT therapist is more directive in nature, as they must assume the role of both expert and teacher as they instruct clients on how to identify and correct faulty thinking (Rasheed, et al., 2011). Ralph Ellis, whose REBT interventions are central to CBFT, was known for both his insistence on psycho-education, homework, and empowering clients to use what they had learned in therapy and to apply it to their daily lives, without the aid of a counselor (Corey, 2009). This mentality continues to shape and influence the manner in which CBFT is conducted. Friedberg (2006) notes by way of example that a session structure can employ six different parts, which give the impression that the session is part therapy and part classroom instruction. The six parts he notes are: mood check-in, review of homework, setting an agenda, processing of session content, assigning of homework, and feedback/summary (p. 161). In summary, the role of the therapist is a mixture of therapy, teaching, and analysis. One can infer from this information that rapport between therapist and clients is crucial, given its directive nature and the amount of work involved, both in the session and beyond.
Techniques and Interventions
When applying cognitive-behavioral theory to families, the literature notes a number of different concepts. Of particular interest are Automatic Thoughts, Cognitive Restructuring, and Schemas, the latter of which Aaron Beck researched extensively (Martin, 2007).
An automatic thought is a perception that a person has that they tend to accept without question (Becvar, 2009). These thoughts tend to be negative, and as thoughts precede emotion, a cognitive-behavioral family therapist would want to address these faulty thoughts, as they tend to have a deleterious effect on the family unit.
Schemas, according to Becvar (2009) are “fundamental assumptions an individual has about the world that tend to be resistant to change and all encompassing” (p. 233). Therapists assume that these schemas exist in various forms among every family member, and that they heavily influence how family members perceive, interact with, and relate to one another. As schemas tend to be faulty as well, it is vital that they be addressed, as change only occurs once thinking has been changed.
As Becvar (2009) explains, “cognitive restructuring is a therapeutic process designed to help individuals develop skills to monitor and test the validity of their beliefs, as well as to modify thoughts and perceptions (p. 233). In dysfunctional families, people tend to have unrealistic perceptions of and interpretations about others, and cognitive restructuring is an intervention designed to challenge these irrational beliefs. Becvar (2009) notes that Socratic questioning methods can be used in therapy sessions to achieve cognitive restructuring.
As previously noted, CBFT has been extensively researched. In many ways a reaction to psychoanalytic theory, it started with John Watson, who in the early 1900’s established Behaviorism, which B.F. Skinner and Ivan Pavlov expanded upon over the next several decades (Becvar, 2009). Bandura’s Social Learning Theory, Beck’s Cognitive Therapy, and Ellis’s Rational Emotive Therapy would also contribute to what is now called cognitive-behavioral family therapy (Corey, 2009; Becvar, 2009; Martin, 2007).
In addition to having solid historical roots, research shows that CBFT strategies and interventions can be used in concert with other modalities, such as contextual, strategic family therapy, solution-focused, IMAGO relationship therapy, and integrative couples therapy (Dattilio, 2007). Furthermore, research shows that cognitive-behavioral therapies have proven effective in dealing with a myriad of presenting issues, such as anxiety, depression, bi-polar disorder, eating disorders, sexual dysfunction, PTSD, substance abuse, and of course, relationship problems, which include problems found within the family unit (Martin, 2007).
Strengths and Limitations for Future Use
Despite its wide application and supporting research, cognitive-behavioral therapies do have some limitations. Roes (2011) addresses one of these issues, as it relates to substance abuse counseling. On the issue of client matching, Roes states:
CBT works best with voluntary, motivated clients. It is really not very useful in resolving the ambivalence that most of our clients bring to treatment. If mandated clients chose treatment only to avoid prison, they often are not ready to share this with their assigned counselor. So a lot of time might be wasted as the counselor tries to help clients change thoughts that they don't really have in the first place (p. 48).
Roes also suggests that unwilling clients can perceive certain cognitive approaches as being judgmental, which can provoke a defensive and close-minded attitude toward treatment. In situations such as these, Roes argues for the inclusion of motivational interviewing to assess the client’s readiness.
Dattilio (2007) addresses some of the myths surrounding cognitive therapies. For example, despite the modalities focus on the here and now, it does not ignore the client’s past. Nor does CBT discount the importance of the therapeutic relationship; in reality, a strong therapeutic relationship is essential. Finally, cognitive therapy does not simply promote positive or clear thinking. Rather, it promotes “rational” thinking, emotions, and rational behaviors (p. 8).
As a future counselor, I am certain that my sessions will be conducted with cognitive behavioral interventions. As a case manager working with therapeutic foster children, I frequently use REBT interventions when I work with both children and the foster parents themselves. I have personally experienced success with these interventions, and see no reason to ignore their use in other situations, such as marriage and family therapy. While purists seem to be few and far between, I think that CBT, perhaps augmented with other modalities, serves as an excellent cornerstone for therapy sessions. It also happens to match my personality. I am fairly directive in nature, though more so with children and less with adults. Also, with over ten years of teaching experience, the psychoeducation component of CBT is quite appealing. I do, however, acknowledge Roes’ (2011) warning about unwilling clients, though my suspicion is that most treatments will not work on a patient who is not ready to change. From both research and practical experience, I believe that cognitive behavioral therapy will continue to play a large role in my professional life.
This paper has attempted to objectively compare and contrast two different treatment modalities commonly used by family therapists in modern settings. Each has its own unique assumptions about change, its own distinct techniques and interventions, and its own way of encouraging change and even defining dysfunction. It is not a question of whether one mode is better or worse than the other. Both modalities have been in use for decades and have a body of empirical research that supports their continued use. Rather, it is a question of which modality should be used to address the needs of the client or clients. As is the case with so many issues in life, the answer to that question really depends on the situation. Corey (2009), however, suggests that counselors choose modalities that reflect their own personal belief systems and their own unique personalities. While my preference is cognitive-behavioral, because it is more in line with my own belief systems and personality, I agree with many aspects of Bowenian systems theory. Communication is the key to a functional family, and undifferentiated family members most certainly need to learn how to be their own person, without their thoughts and actions being dictated by the covert and overt forces of a family dynamic. Fortunately, both theories can be used in tandem (Dattilio, 2007). An integrative approach seems the most logical course of action. As Corey (2009) argues, there is not a single modality that exists that is far reaching enough to encapsulate all of humanity. Fortunately, the research cited in this paper suggests that there does not have to be. The only necessities are solid, well-researched theories that counselors can put to use, depending on the dynamics of the situation.
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