Role of the Therapist (Typical Intervention Techniques and Process Used in Sessions)
Bowen family systems theory is unique in its emphasis upon the self-development of the therapist. Thus, I continually work on an increasingly healthy separation from my own family of origin in a way that I still remain connected.
Friedman (1991) points out that “Bowen has consistently maintained that it is hard for the patient to mature beyond the maturity level of the therapist, no matter how good his or her technique” (p. 138). In fact, Friedman explains that “In Bowen theory, the differentiation of the therapist is the technique” (p. 138). One cannot possibly be a Bowen therapist merely by reading about it or taking workshops (Kerr, 1981). The therapist must go through an emotional transformation, which happens experientially after continued exposure to revisiting one’s family of origin while applying the complex ideas of the theory. Work with one’s family of origin and work with a supervisor is a central part of the therapist’s development. Similarly, psychoanalysts must first complete their own psychoanalysis with a supervising analyst, before they are deemed competent to analyze clients.
It is important to maintain a non-anxious presence. To be objective and to promote differentiation in others is directly related to the being of the therapist, not to his/her technical skills (Friedman, 1991). To be able to think in terms of the system and not the emotionality or content requires a high level of differentiation. I push myself to work continually at separating my thoughts from feelings and knowing where I stop and my client begins.
I am warm, respectful, engaging, and matter of fact in asking questions. I maintain a collaborative atmosphere in all stages of treatment. The process of gathering family facts is, in itself, collaborative and inherently conducive to reducing anxiety. Additionally, the types of questions asked move the client toward a deepening appreciation for pattern and process. In a sense, I assume the role of researcher and am always curious. One question leads to another, and the calmer I am, the more I can call on my best thinking to expand the line of questioning into broadening perspectives. Eventually, clients begin to see replicating patterns from past to present and connections between events in their nuclear families and family of origin legacies.
I encourage family members to speak through me rather than to each other. By remaining a non-anxious presence in a triangle, I can induce a change in the relationship of the other two that would not occur if the same things were said in the absence of the therapist.
In my work with couples, I work to identify and reflect back repetitive, dysfunctional cycles of interaction early in treatment. For example, I want to identify patterns such as distancer/pursuer, overfunction/underfunction, or withdrawer/blamer. Initial progress is facilitated if the couple becomes aware of their pattern early in treatment and works toward interrupting it.
There are times when I depart from The Bowen method of having a couple talk through me. For example, in the early phases of marital therapy, I believe that it is important to assess a couple’s ability to talk to one another about sensitive material. To assess their ability to connect with one another, I may ask them to turn to one another and repeat important things to the other that they have just said to me. I watch their verbal and nonverbal styles of communication carefully. As treatment continues, I use the same method to heighten important material. I encourage communication in which one assumes responsibility for oneself, whether it is about expressing wishes for space or connection.
I am a coach, in that I teach differentiation moves, or ways that the client can increase his/her neutrality, especially in hot triangles. I also act as an educator in teaching the family about family systems dynamics. Often, I diagram or illustrate BFST concepts on a white board to increase clients’ ability to think about their processes in a systemic way. Homework may include relevant readings and letter writing assignments, which may or may not be mailed. Clients may be asked to journal and/or generate questions to ask their extended family members. Photograph albums and videos brought to session touch the past, adding a rich layer of experience to the treatment and also enhancing the joining effort of the therapist. This material may also aid in the effort to bridge cutoff, resolve attachment, or make contact with the deceased. Socratic questions that highlight process over content challenge the client to engage his/her cognitive process.
Kerr and Bowen (1988) encourage therapists to use humor and playfulness where appropriate, but warn that the maturity and differentiation of the therapist is critical to communicating that what is taken so seriously by the family can be seen in a humorous light. The client is honored as the expert on his/her own family and is often asked questions that lead him/her to take responsibility for his/her part in a family problem. A helpful guideline is that within the session, I work on making myself “small.” Such an effort means that I have succeeded in being a non-anxious presence who does not overfunction for the client.
To learn more about this model of therapy practice, visit Dr. Cunningham’s web site at http://www.Cunninghamtherapy.com. Dr. Cunningham, whose practice is conveniently located in the heart of San Diego, specializes in treating individuals and couples.