Family Therapy

Bowen family therapy, or Bowen family systems theory, was developed by US psychiatrist Dr. Murray Bowen. It is a type of structural family therapy used by marriage and family therapists that focuses on the complex relationships and dynamics within family systems.

The theory suggests that individuals may be best understood as part of a family unit rather than a separate, isolated entity. In addition, it suggests that when an individual is experiencing a challenge, whether a personal issue or one related to the family, the family's involvement in the solution may benefit the client and yield a more favorable result. Learning more about what this type of therapy is may help you make an informed decision on the family therapy techniques and modality that may be best for you or your family.

According to the American Association of Marriage and Family Therapy (AAMFT), family therapy is intended to be "brief; solution-focused; specific, with attainable goals; and designed with an end in mind." AAMFT notes that after receiving treatment, 90% of clients notice an improvement in their overall physical health and emotional health. In cases when a child is the client, parents report their child's behavior improved by 73% after undergoing therapy. 

While 12 is the average amount of sessions, exactly how many sessions a client is in need of depends on the family's concerns. However, not all membersof the family need to be present at the therapist's office every time, as who is to be present in each session and what gets discussed varies during the treatment process.  

Research studies indicate that family-focused interventions can be an effective form of treatment for many mental health challenges and behavioral problems, including adolescence substance use. One study looked at structural and strategic family therapy within the context of adolescents experiencing mental health challenges and their families. Interviewed before and after undergoing this approach, parents indicate "higher family cohesion" at the conclusion of treatment, and adolescents showed fewer "internalizing and externalizing problems."

A family therapist is especially trained to address mental health conditions within the context of what families may identify as issues. They can also see family members individually. As a type of talk therapy, family therapy work entails looking at the family as a whole with a view of fostering positive changes while addressing concerns. 

A licensed mental health provider can use family therapy as part of the treatment plan for an individual with a specific mental health condition or concern, such as substance use disorder. Sometimes, a primary care doctor may recommend this type of therapy or employ medical family therapy themselves. According to the APA, medical family therapy is an approach that uses biopsychosocial and family therapy principles in the treatment of individuals and families impacted by physical health challenges. 

Family therapist approach

A marriage and family therapist may use different approaches, often stemming from what is considered family systems theory. This theory holds that the "family is a single emotional, interdependent unit" of interconnecting parts, and each influences the whole. It may draw on cognitive, behavioral, and interpersonal interventions when looking at family interactions. 

For example, a licensed marriage therapist seeking to address adolescent substance use may employ structural family therapy (SFT) to identify the dynamics of the family as a unit and establishing appropriate boundaries. They may use techniques such as mapping to understand behavioral patterns and concerns within the context of the family's ways of interacting. As defined by the American Psychological Association, SFT is a type of therapy that focuses on looking for "the explanation of problems in relational networks, rather than individual psychodynamics."

Another mental health professional may focus on functional family therapy (FFT). FFT has a notable history of addressing youth and adolescent behavioral concerns and mental health challenges.

Other approaches could include Brief Strategic Family Therapy, Family Behavior Therapy, or Strengths Oriented Family Therapy, and Ecologically Based Family Therapy.

Key principles

Triangles

Triangles are considered a minor stable emotional system within a family and are a relationship in which three people are involved. In this system, the tension shifts around, and impacts, all three individuals. When the tension in the group becomes too high, it may start to affect "interlocking" triangles and, in this way, distributes the tension to others. This process may provide stability at the moment but does not necessarily solve the root cause of the problem. Clinical problems can stem from triangles; for example, pushing one person out may act as a catalyst for mental health concerns or stress. 

Differentiation of self

This concept centers on the idea that families can affect how individuals think, feel, and act; the level to which an individual depends upon others to find meaning and approval in their lives may depend on how developed the person's "self" is. For example, people with a poorly differentiated self may go out of their way to please others to gain acceptance, regardless of their feelings or beliefs. Developing a stronger sense of self through therapy may be able to help family members thrive regardless of how other family members behave.

Nuclear family emotional system

This concept involves four relationship patterns, which can cause problems within a family unit. These patterns are:

• Problems in a marriage
• Problems with a spouse
• Emotionally distant behavior
• Impairment of a child or children

Family projection process

This principle examines how parents transmit emotional problems, anxiety, and concerns they feel to their children, and how this may affect their emotional and physical development. For instance, a child may inherit a need for attention through their relationship with their parents. Mental health professionals can help provide parents with education and resources to address specific issues that may be transmitted from parent to child.

Multigenerational transmission process

This principle looks at how differences and patterns in families (in parents and their children) can be found to repeat over numerous generations, and how minor differences in differentiation between parents and children in one generation may lead, over additional generations, to more pronounced differences in differentiation among an extended family.

Emotional cutoff

This principle refers to how individuals may cut ties with family and friends to manage unresolved emotional issues. Cutting ties may be done physically by never being around each other, or emotionally by refusing to converse. Instead of resolving conflicts with a loved one, some people may avoid the situation completely.

Sibling position

The sibling position concept involves how a sibling's position in the family, whether oldest, middle, or youngest, can impact development and behavior. For example, it suggests that individuals in one sibling position, such as the oldest children, may experience a unique dynamic with parents or families compared to other siblings. 

Societal emotional process

This principle examines how emotions impact broader social behavior and can contribute to progressive and regressive societal periods. This concept draws connections between family emotional functioning and societal emotional functioning.

What is Bowen therapy used for?

During Bowen family therapy sessions, the therapist will help family members understand how their family dynamic impacts mental health and behavior. The therapist will recommend strategies to prevent and resolve conflicts. People may reach out for professional family psychotherapy to help their loved ones overcome substance use challenges, treat mental illness, or get through a divorce. The Cleveland Clinic recommends family therapy as a resource for adjusting to big changes in life such as divorce, moving, aging, or the death of a family member. 

Family therapy may resolve problems within a family, or help individuals within the family unit understand each other better. It can also be used for individuals who want to explore how their family dynamics have affected their lives. In some cases, Bowen family systems therapy can be utilized as a preventative step to address and resolve a conflict before it happens. The focus of Bowen Family Therapy goes beyond just finding short term relief from familial problems through conflict resolution and addresses the core thoughts, beliefs, and behaviors that are negatively impacting the family unit.

A family therapist can also work with the family to understand and deal with behavioral concerns and various other challenges, such as schizophrenia, bipolar disorder, substance use, depression, and marital problems. You do not have to be experiencing symptoms of a mental health condition or family conflict to benefit from family therapy; systemic family therapy is one method that can help you gain personal insight into how your family dynamic impacts how you see yourself and function in the world.

Counseling options

If you or someone you love is experiencing behaviors, symptoms, or relational concerns that are negatively affecting you or your broader family dynamic, family therapy counseling online may be beneficial. You can partake in many common family therapy modalities online. Mental health professionals offer strategic family therapy, Bowen family therapy, and many other methods. There are many methods of seeking therapy, as well. Some individuals may find it beneficial to discuss family concerns, or the impact of family dynamics, in the same setting where those dynamics play out. For example, at-home therapy online may benefit some individuals. With online therapy through a platform like BetterHelp, you can speak with a therapist from your home or wherever you have an internet connection.

Research has demonstrated the effectiveness of family counseling services and the overall benefits of family counseling delivered online. For instance, one study explored the efficacy of using telehealth for family therapy. It found that telehealth and face-to-face therapy delivered equivalent outcomes for child behavioral problems and parental depression. When signing up for telehealth treatment, you can choose between phone, video, and live chat sessions with your licensed therapist, making it a flexible treatment option.