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Archive for March, 2012

As a marriage and family therapist in San Diego, I practice couples therapy and individual therapy using an intergenerational perspective. I specialize in helping couples and individuals live more meaningfully in their most important relationships. Relationship counseling and individual counseling is better to seek sooner rather than later when one experiences chronic challenges in relational functioning. Research has shown that couples typically wait 6 years before seeking couples counseling. It is wiser to get help earlier and before problems fester, causing resentments to harden and become more resistant to treatment.

Dr. Murray Bowen was a pioneer of marriage and family therapy.   He believed that human beings live in interdependent emotional systems. His insights are profound. I am guided, in large part, by his ideas. James Framo, another early MFT leader, observed that clinically, Bowen’s ideas address the basic question of how one can deal with one’s family’s nuttiness without cutting off from the family. Just as Socrates urged people, “Know thyself,” Dr. Bowen encouraged people to “Know your family.”  Such an effort can enhance one’s ability to live in a more fulfilled way in one’s current relationships. In an early post I listed five of my favorite quotes from Murray Bowen. Below are *more quotes that typify Bowen’s deep and unique  level of understanding of the human condition:

“Family systems theory is based on the assumptions that the human is a product of evolution and that human behavior is significantly regulated by the same natural processes that regulate the behavior of all other living things….Homo sapiens are far more like other life forms than different from them.”

“One of the most important aspects of family dysfunction is an equal degree of overfunction in another part of the family system. It is factual that dysfunctioning and overfunctioning exist together. ..An example would be the dominating (overfunctioning) mother and passive father.”

“The more a therapist learns about a family, the more the family learns about itself; and the more the family learns, the more the therapist learns, in a cycle which continues.”

“The overall [clinical] goal [is] to help family members become ‘system experts’ who could know [their family system] so well that the family could readjust itself without the help of an outside expert, if and when the family system was again stressed.”

“Relationships are cyclical. There is one phase of calm, comfortable closeness. This can shift to anxious, uncomfortable overcloseness with the incorporation of the ‘self” of one by the ‘self ‘ of the other. There there is the phase of distant rejection in which the two can literally repel each other. In some families, the relationship can cycle through the phases at frequent intervals. In oher families, the cycle can stay relatively fixed for long periods.”

“The basic building block of any emotional system is the triangle. ”

“Important changes [between the couple] accompany the birth of children.”

“The problem of the ‘triangled’ child presents one of the most difficult problems in family psychotherapy.

Dr. Murray Bowen was one of the important pioneers in marriage and family therapy. As a clinician who specializes in relationship counseling, I am guided, in large part, by his ideas. To learn more about my model of practice, visit me at http://www.Cunninghamtherapy.com or call 619 9906203 for a complimentary telephone consultation.

* Quotes are cited from FAMILY THERAPY IN CLINICAL PRACTICE by Murray Bowen (1978)

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At times, the pain of separation seems more than we can bear; but love and understanding can help us pass through the darkness toward the light. And in truth, grief is a great teacher, when it sends us back to serve and bless the living. . . . Thus, even when they are gone, the departed are with us, moving us to live as, in their higher moments, they themselves wished to live. We remember them now; they live in our hearts; they are an abiding blessing. ~Jewish mourners’ Kaddish (Central Conference of Rabbis, 1992)

Dr. Barbara Cunningham offers insightful counseling to survivors of homicide, specializing in helping sibling survivors move through their grief and their loss (read about her model of practice at http://www.Cunninghamtherapy.com).

According to the U. S. Department of Commerce (1991), almost 2 million children from birth through 18 years of age become bereaved siblings each year. Although homicide is the least frequent form of violent dying, it may have the most profound and lasting impact on surviving family members (Rynearson, 2001). Since the mid-1980s, the rate of murder committed by youth has doubled, increasing by 102% (State Legislative Responses to Violent Juvenile Crime, 1996-1997). Homicide survivors are defined as significant others who are left behind to mourn victims of homicide. While society recognizes that the violent loss of a child is one of the most devastating experiences a parent can confront, there is little societal recognition of the impact of such a loss upon surviving siblings (Fanos, 1996). Despite the large number of adolescents and young adults who are faced with this catastrophic personal and family crisis, there is a lack of theoretical constructs and systemic treatments from which to generate a theory of sibling bereavement (Walsh & McGoldrick, 2004).

The loss of a brother or sister has a lasting effect on the overall development of the surviving sibling and the family system, and it is extraordinary that so little attention has been directed at understanding the impact of loss in young adulthood upon both individual and family life cycles (Carter & McGoldrick, 1999). The role and function sibling relationships play in identity formation is becoming recognized as a powerful force in personality development (Provence & Solnit, 1983).

Complicated grief is often part of the clinical picture with sibling survivors of homicide (Rando, 1993). In this blog, complicated grief is defined as involving an intensity of symptoms that affect people over an extended length of time or as barriers to daily living caused by grief (Weiss, 2000). Green, Lindy, Grace, and Gleser (1989) found that the experience of surviving the homicide of a loved one frequently led to complicated grief reactions. Rynearson (1984) pointed out that “the manner of dying rather than the event of death determines the meaning of death, which in turn influences the form and cause of bereavement” (p. 1452).

Allen (1991) noted that surviving the homicide of a family member was detrimental to the survivors’ psychological well being because homicide is “stigmatizing, unnatural, especially burdensome, and unexpected” (p. 18). Parkes and Weiss (1983) empirically supported their belief that the mental health effects of homicide on survivors were more pronounced than those experienced by individuals who lose a loved one because of an anticipated death. Furthermore, Allen (1991) noted that “the closer the survivor and the victim were, the more difficult the bereavement” (p. 20). Raphael’s (1983) summary seems the most appropriate to conceptualize the severity of the grief experienced by relatives of a homicide victim: “First degree family members are the ones who are the most impacted by the death, and the greater a family member is involved with the deceased, the more deeply the loss is felt” (p. 67). Kubler-Ross’s (1969) stage model of grieving has not been useful in helping these forgotten grievers to feel validated in their need to remain spiritually and emotionally connected to their deceased loved ones and to surviving family members (Walsh & McGoldrick, 2004). Instead, a model of treatment that has a deeper perspective and that examines multigenerational and emotionally interdependent functioning is needed (Bowen, 1976; Walsh & McGoldrick, 2004).

In addition to therapy focused upon issues of grief and loss, especially in the context of violent crimes, Dr. Cunningham also specializes in couples counseling, marriage counseling, and individual counseling/psychotherapy. To learn more information about Dr. Cunningham and her systemic model of practice, visit her website at http://www.cunninghamtherapy.com/ or call her at 619 9906203 for a complimentary telephone consultation.

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At San Diego Relationship Counseling, Dr. Barbara Cunningham offers affordable rates and evening hours to busy professionals who are looking to address their impairment from a  systems perspective. Dr. Cunningham is the author of a chapter in an academic textbook edited by Gary W. Lawson and Ann w. Lawson entitled ALCOHOLISM AND SUBSTANCE ABUSE IN DIVERSE POPULATIONS. The chapter is entitled “A Family Systems Treatment for the Impaired Physician.” Physicians and other people in the helping professions seem to have a high risk of using coping skills that encourage escapism rather than skills that develop the capacity to “bend in” to problems, especially problems interfering with their most important relationships. The books listed below are resources for those people looking to understand the dynamics behind such escapist solutions to the exigencies of life.

Bowen, M. (1978) Family therapy in clinical practice. Northvale, NJ, Jason  Aronson.

Cunningham, B. (2006). A resiliency-based, Bowen family systems approach to treating a sibling survivor of homicide: A case study. Doctoral dissertation, Alliant International University, San Diego, CA.

Ellis, J.J. & Inbody, D.R. (1988). Psychotherapy with physician’s families: When attributes in medical practice become liabilities in family life. American Journal of Psychotherapy, 42, 380-88.

Gabbard, G.O., & Menninger, R. W. (1989). The psychology of postponement in the medical marriage. Journal of the American Medical Association, 261, 2378-2381.

Lawson, A.W., & Lawson, G.W. (1998). Alcoholism and the family: A guide to treatment and prevention. (2nd ed.). Austin, TX: PRO-ED.

Mansky, P.A. (1999). Issues in the recovery of physicians from addictive illnesses. Psychiatric Quarterly, 70, 107-122.

McGovern, M.P. Angres, D. H., & Leon, S. (1998). DIfferential therapeutics and the impaired physician: Patient-treatment matching by specificity and intensity. Journal of Addictive Diseases, 17 (2), 93-107.

Robb, N. (1998). Teaching on addiction issues lacking in medical school, specialists told. Canadian Medical Association Journal, 158, 640-642.

Sotile, W.M., & Sotile, M.O. (2000). The medical marriage: Sustaining healthy relationships for physicians and their families. Chicago: American Medical Association.

Talbott, G.D. (1987). The impaired physician: The role of the spouse in recovery. Journal of the Medical Association of Georgia, 76, 190-92.

Talbott, G.D. & Gallegos, K.V. (1990, September). Intervention with health professionals. Addiction and Recovery, pp. 13-16.

Talbott, G.D., & Martin, C.A. (1986, February). Treating impaired physicians: Fourteen keys to success. Virginia Medical, 113, 95-99.

Twerski, A.J. (1982). It happens to doctors, too. Center City, MN: Hazelden.

Vaillant, G.E., Sobowale, N.C., & McArthur, C. (1972). Some psychological vulnerabilities of physicians. New England Journal of Medicine, 287, 372-375.

To learn more about Dr.  Barbara Cunningham‘s treatment model, visit her website at http://www.Cunninghamtherapy.com or call 619 9906203 for a complimentary phone consultation.

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See full size imageAchieving a vibrant and fulfilling marriage over the longterm is one of the greatest developmental triumphs known to our species. At Affordable Relationship Counseling: Dr. Barbara Cunningham, MFT addresses marital challenges from a Bowen Family Systems Perspective (to learn more about this model, visit her website and click on model of practice at http://www.Cunninghamtherapy.com).  In this blog, you will find some introductory remarks about the model.

At a Bowen Family Systems Theory  (BFST)conference in San Diego on March 10, Dr. Dan Papero, faculty member at the Bowen Center for the Study of the family, quotes an old Mennonite woman who says, “Perfect relationships exist only in heaven, where there is no need for them.” Relationships may be thought of as open laboratories to work on regulating oneself and focusing on one’s own part in the face of relationship challenges. One learns to think systems, which is easier when calm. When one is stirred up, it is very challenging to think systems. Therapy aims to help each client achieve greater mastery in his/her ability to do so.

Many people mistakenly believe that love should be easy and that it is “not meant to be” if it takes too much work. Wrong! Couples often make the mistakes of trying to “fix” the other person. The only person you can truly change is yourself–how you perceive what is said or done and how you may consider the myriad ways you could respond to “other” and bring out a different result. In this sense, marriages are people-growing machines. To stay separate from your partner at times and know that you CAN is one facet of building the muscle to stay together over the long haul without cutting off. People cut off when they feel smothered or the threat of incorporation. Other people, often in response to the distancer, feel their partner is blocking access, putting up walls, or even planning to leave them. Providing this frightened partner emotional safety that distance is temporary and that he/she is not being abandoned helps the pursuer tolerate the occasional distancing dance in the other. It is in this tension between needs for togetherness and separateness  that people appear troubled in their relationship in my office. Getting to a the family of origin context of what each partner learned to do in their respective families-of-origin when anxious in close relationships is part and parcel of the therapeutic effort. Developing a research attitude as one looks back over one’s family legacy in the context of BFST helps people get more objective about how they came to be who they are as marital partners and as individuals.

Bowen Family Sysgtems Theory, which in many ways guides my practice, was developed by Dr. Murray Bowen. In the late 1950’s, Dr. Bowen observed that schizophrenic patients he treated relapsed soon after discharge from inpatient treatment programs (Bowen, 1978). After observing this outcome, Dr. Bowen decided to experiment by hospitalizing the entire family along with the schizophrenic patient. Obtaining more favorable results,  Bowen came to conclude that the FAMILY, not the INDIVIDUAL, was the proper unit of treatment. He viewed families as interdependent emotional systems. Where there appeared a change in one person, it was predictable that there would be compensatory changes in other members of that family system. Bowen formulated 8 interlocking concepts, all of which had to viewed in relation to one another, much like problems people bring to therapy have to be viewed within a broader context. This view is broader and is known as a systemic view: how are one’s problems embedded in the context of their multigenerational family legacy, their nuclear family and larger society?

To learn more about Dr. Cunningham’s model of practice, visit her website at http://www.Cunninghamtherapy.com or call 619 9906203 for a complimentary consultation.

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