TEMA 4: CUM AM DE LUCRU CU TERAPIA MEA?

Terapia transgenerationala
Terapia sistemica de familia a lui Murray Bowen

Recomandare Elena: I. II. III. IV. V. VI. VII. Model folosit impreuna Model recapitulative curs avansat II Enumerare teze si concept care stau la baza psihoyh mele Obiective generale ale th mele Cand e considerate terapia terminata de catre p th Care este procesul th de baza? Enumerare tehn din repertoriu

I.

Model folosit impreuna este pentru aborcarea experentiala

I sedinta: evalueaza si intervine PT evalueaza interactiuni, stiluri de comunicare, defense, concomitent promoveaza schimbarea. Ex: indeamna la comunicare directa si congruenta A II-a sedinta si a n-a PT continua evaluarea si mai ales lucreaza cu comunicarea Ghidare client : sa-si insuseasca comunicarea congruenta (subliniere intentie pozitiva, fara reprosuri, si invinuiri, alegere alternative) PT experimenteaza si creaza noi ocazii pentru a avea experiente noi. Membrii system au experiente noi, inedite. Tehnica sculpturii Joc de rol 1|Page

Alegere alternative Coregrafia Desen Identif si reviz convingeri limitative Umor Expresivitate O alta sarcina impo a PT in sed a II-a este sa acompanieze familia pentru a depasi recaderile si pentru a descoperi solutii noi, mai potrivite. Apoi: consolidare si inchidere Diferente Autoapreciere Stima de sine Unicitate si asemanari. Problem de rezolvat prin dezvoltare Retea de sustinere Orice problema se rezolva prin dezvoltare Defensa aparte atunci cand se doreste evitarea

II.

Cursul avansat II, 23-26.10.2008, Elena

Bagajul therapeutic: 2|Page

1. Teorii 2. Tehnici 3. Atitudini

4. 5. 6.

7.

8. 9.

egalitate (terapeutul nu este expert in problema client!) - Empatie, 5 niveluri - Curiozitate - ? binevoitoare - Cel care ghideaza - Asertivitate - Reflecting team - co-constructie terapeut-client obiectiv terapie, ales pe baza ipoteze: O principal etapele process therapeutic: inceput, mijloc, final/sfarsit Inceput: crearea climat de incredere , siguranta, speranta Confidentialitate process Adaptare limbaj Clarificari Metacomunicare Reasigurari Te arati dsponibil , intrebari despre nevoi Informatii clare, siguranta Focalizare pe resurse Rabdare Marcel: culegere de info, personae implicate in problema client, motivare celorlalte personae, nuante Combatere rezistente, lasat timp Respect pentru ceea ce spune clientul CADRU PRIMA SEDINTA: obiective: Climat, inceput la telefon Ipotezele Definire problema Stabilire obiective Contract therapeutic - Joining:relativizare granite pentru client - Prezentare, adaptare la client - Regulile 3|Page

Definire problema Definire asteptari, asteparile se discuta Negocierea motivatii Obiective: prin alianta terapeutica, operationale Contract therapeutic: durata sedinte, interval de timp intre sedinte, actliber consimtit, o Enumerare teze si concept care stau la baza psihoyh mele 10. MIJLOCUL TERAPIE: obiective: ajutarea membri families a se exprime Ajutarea membrii families a se inteleaga reciproc Incurajare 11. SFASIT TERAPIE: terapeutul observa indeplinirea O iar familia/ clientul nu mai ofera material nou Clientii considera ca au atins obiectivele propuse Th obserrva ca are limitary ce duc la final th Modalittai de a inheia th ce v-a ajutat cel mai mult? Daca ar fi sa continuati ce ati schimba? Discutare motive intrerupere Atentie la dependent

III.

Enumerare teze si concept care stau la baza psihoyh mele Bowen:

Murray Bowen

Among the pioneers of family therapy, Murray Bowen's emphasis on theory and insight as opposed to action and technique distinguish his work from the more behaviorally oriented family therapists (Nichols & Schwartz, 1998. Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon). Bowen's therapy is an outgrowth of psychoanalytic theory and offers the most
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comprehensive view of human behavior and problems of any approach to family therapy. The core goal underlying the Bowenian model is differentiation of self, namely, the ability to remain oneself in the face of group influences, especially the intense influence of family life. The Bowenian model also considers the thoughts and feelings of each family member as well as the larger contextual network of family relationships that shapes the lie of the family. Bowen grew up in Waverly, Tennessee, the oldest child of a large cohesive family. After graduating from medical school and serving five years in the military, Bowen pursued a career in psychiatry. He began studying schizophrenia and his strong background in psychoanalytic training led him to expand his studies from individual patients to the relationship patterns between mother and child. From 1946 to 1954, Bowen studied the symbiotic relationships of mothers and their schizophrenic children at the Menninger Clinic in Topeka, Kansas. Here he developed the concepts of anxious and functional attachment to describe interactional patterns in the mother-child relationship. In 1954, Bowen became the first director of the Family Division at the National Institute of Mental Health (NIMH). He further broadened his attachment research to include fathers and developed the concept o triangulation as the central building block o relationship systems (Nichols & Schwartz, 1998. Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon). In his first year at NIMH, Bowen provided separate therapists for each individual member of a family, but soon discovered that this approach fractionated families instead of bringing them together. As a result, Bowen decided to treat the entire family as a unit, and became one of the founders of family therapy. In 1959, Bowen began a thirty-one year career at Georgetown University's Department of Psychiatry where he refined his model
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of family therapy and trained numerous students, including Phil Guerin, Michael Kerr, Betty Carter, and Monica McGoldrick, and gained international recognition for his leadership in the field of family therapy. He died in October 1990 following a lengthy illness.
teoria sistemica, ca modalitate de gandire mai putina autonomie emotionala in vietile noastre decat credem cei mai multi sunt reactivi si dependent unul fata de celalalt familia, ca o retea de relatii multigenerationala, formeaza interjocul individ-a fi impreuna , conform unor 6 conceote intreconectate (1966) plus alte doua adaugate in 1976: sep emotionala si process emotional societal. Moniva MGoldrick: etnicitatea: terapie de familie pe baze de diferente de etnie, norme si valori culturale de diferenta, nun sunt familii disfct ci diferite in mod legitimate.

Monica McGoldrick, LCSW, PhD (h.c.)

Director, Multicultural Family Institute Teacher, author and family therapist. Books include: The Genogram Journey: Reconnecting with Your Family (2nd ed, 2011), Re-Visioning Family Therapy (2nd Ed. 2008), The Expanded Family Life Cycle (4th Ed., 2011), Ethnicity & Family Therapy (3rd Ed., 2005), Genograms Assessment and Intervention (3rd Ed., 2008), Women in Families, and Living Beyond Loss, (2nd Ed, 2004). Faculty, Psychiatry Dept., RWJ Medical School, Visiting Professor, Fordham University School of Social Service (19912001). Honorary Doctorate, Smith College School for Social Work(1991). American Family Therapy Academy Award (1988) for Distinguished Contribution to Family Therapy Theory & Practice. Formerly: Co-Director, Cultural Competence Training Center for Central NJ.

Betty Carter

An ardent and articulate feminist, Betty Carter was instrumental in enriching and popularizing the concept of the family life cycle
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and its value in assessing families. Carter entered the field of family therapy after being trained as a social worker, and emphasized the importance of historical antecedents of family problems and the multigenerational aspects of the life cycle that extended beyond the nuclear family. Carter further expanded on the family life cycle concept by considering the stages of divorce and remarriage (Nichols & Schwartz, 1998. Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon). Carter's interest in family therapy was stimulated by taking part in a family therapy field placement at the Ackerman Institute as part of her M.S.W. requirements at Hunter College. She quickly became an avid student of the Bowenian model, and served on the staff of the Family Studies Section at Albert Einstein College of Medicine and Bronx State Hospital with Phil Guerin and Monica McGoldrick. Carter left the Center for Family Learning to become the founding director of the Family Institute of Westchester in 1977. Carter served as Codirector of the Women's Project in Family Therapy with Peggy Papp, Olga Silverstein, and Marianne Walters, and has been an outspoken leader about the gender and ethnic inequalities that serve to keep women in inflexible family roles. Currently, Carter is an active clinician and specializes in marital therapy and therapy with remarried couples (Nichols & Schwartz, 1998.Family Therapy: Concepts and Methods. 4th ed. Allyn & Bacon). Her work with couples focuses on helping her clients to understand their situation and to address unresolved family issues. Carter incorporates tasks, such as letter writing, which serve to intensify and speed up the communication process and help couples move out of rigid patterns of behavior.
doua boweniene feministe Micheal Kerr 7|Page

Michael E. Kerr, MD Michael E. Kerr, MD succeeded Murray Bowen as Director of the Georgetown Family Center in 1990, following a close twenty-year association with him. Dr. Kerr is the co-author with Murray Bowen of Family Evaluation: An Approach Based on Bowen Theory which was published by W.W. Norton & Company in 1988. He has also written many articles and book chapters related to Bowen theory and its applications. He is the editor of Family Systems: A Journal of Natural Systems Thinking in Psychiatry and the Sciences published by the Georgetown Family Center. Dr. Kerrs primary research interests have been the relationship of Bowen theory to evolutionary theory, the relationship of physical, emotional, and social symptoms to family emotional process, and the process of differentiation in clinical work. At an Annual Family Symposium, he proposed a new concept in Bowen theory called, "the unidisease." He is developing an article on the unidisease concept for publication. He speaks frequently around the country at medical schools, universities, meetings of national organizations, and regional conferences on these and other topics related to Bowen theory. He has produced a videotape lecture series on Bowen family systems theory and its applications, a lecture tape entitled, Why Do Siblings Turn Out So Differently? and a lecture tape called, Towards A Systems Concept of Supernatural Phenomena: A Status Report. Contact Information: mekerr@thebowencenter.org

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Philip Guerin
Student a lui Murray Bowen , ideile sale inovatve au dus la dezviltarea unei sophisticate abordari clinice in terapia /tratamentul problemelor copiilor, adolescentilor, cuplurilor si indivizilor adulti. Tinte therapeutice: contextual multigenerational, calmarea zestrii emotionale a mb familiei si definirea unor tipare specific de relationare in familie. Abordarea sistemelor familiale este desinata sa masoare severitatea conflictelor si identificarea zonelor specific care au nevoie de imbunattaire. 1970: director al studiilor de antrenare a familiei la colegiul medical A Einstein si spitalul de stat Bronx. Clinician desavarsit, este si autorul unor carti si articole valoroase in domeniul terapiei de familie: Evaluarea si tratamentul conflictelor maritale. O aborcare in 4 stadii, 1987 si Lucrul cu triunghiurile din relatii: unul-doi-trei sau abc-ul din psihoterapie , 1996. 1. Diferentierea sinelui

Context emotional DS un grad relative de autonomie Persoanele diferentiater sunt mai flexibile, mai adaptabile mai autonome. Au spirit critic. Mentin un grad de obiectivitate si distanta emotionala. Persoanele differentiate au un eu mai solid, mai integrat Deciziile sunt rationale, nu emotionale. Nediferentiatii sunt mai rigizi, mai dependent emotional de altii, cmpt directionat pe emotii. Decizii pe baza de emotii nu pe ratiune Pseudo-eu (self): deciziile luate la perioade diferite de timp sunt incosistente unele cu altele Bowen (1976) ps-eu = eu pretins, persoana il poate sinti ca fiind real dar nu este.

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Intreventie th: crestere grad de autonomie, unii fata de altii. Fuziunea si diferentierea sunt concept f importante in ceea ce priveste ipotezele trangenerationale si intergenerationale. Doua personae nediferentiate tind sa se gaseasca sis a fuzioneze. Separarea de famikia de origine si fuziunea sotilor.
2. Process emotional al familiei nucleare

Gama de pattern-uri relationale emotionale din sisteme, dintre parinti si copii. 4 mecanime - Distanta emotionala - Conflict marital - Transmiterea sau proicetarea problemei catre copil: problemele dintre soti si anxietatea generate tind sa fie evitate prin concentrarea lor pe unul sau mai multi copii. (mama fuzioneaza symbiotic cu unul dintre copii), concomitant cu distantarea tatalui care este si evitat in acest timp. Copilul fuzionat este cel mai vulnerabil la dezvoltarea unor smpt. - Disfunctia intr-un sot: poate devein solid cand sotul disf dezvolta o maladie fizica sau mentala.
3. Triunghiuri si triangularea; proiecti asupta unui sau mai ulti copii.

Triunghiul este unitatete de baza a intredependentei in sistemul emotional familial. Bowen spune ca o diada (un system format din doua personae) este stabile atat timp cat este calma. Apar f stresori care cresc anx si atunci cand atinge un nivel ridicat o a treia persoana va fi atrasa in campul emotional al celor doi. Ex; un cvonflict intre soti sotia isi va atrage mama in conflict cu scopul de a-si reduce anxietatea. Pot fi latent si sa nu se manifeste decshis, ele fiind cativate in pewr de stress.
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Nivelul de stress sau anx pentru destabilizare diada este in stransa legatura cu gradul de diferentiere al celor doi.
4. Procesul proiectiv al familiei: nivel de dif parental trece mai departe la unul

sau mai multi copii. Obi, un copil va avea o implicare emotionala crescuta cu unul dintre parinti.=supraimplicare. Variatii: parinte ingrijorat excesiv pana la parinte ostil act copilului. Dinamica deterioreaza caoac copil de a fct efic in context sociale. Gradul de dif parental si nivelul de stress in familie detemina intensitatea process proicetiv al fam.
5. Intreruperea sau distantarea emotionala, = fuz dintre generatii

Scadee anx asociata cu contactul familial si creaza o probl: izoleaza indivizii care ar putea beneficia de contact. Disfunctia se poate asocial cu relatii superficiale, boli fizice, drpresie, cmpt impulsive. 6. Process de transmitere multigenerationala. Tendinta de a repeat pattern-uri disfct ale conduitei emotionale in generatii successive culmineaza cu niveluri scazute de dif e eu-lui pentru anumiti mb ai gen ai tinere. (Hall, 1981) 7. Pozitia de frate sau sora Varsta mai mare si distributia pe sexe intre fratii ac generate au o puternica infl asupra cmpt. (Hall, 1981)
8. Procesul emotional al societatii (regresia sociala).

Concept cheie Bowen-procesele (pattern-urile) familiei sunt observabile social si in modul de intreactiun e social.
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Societatea esueaza cand f stress sunt cronici si face fata la f acuti: Bowen. Din pricina stressului cronic, atat societatea cat si familia pierd contactul cu pricipiile sistemului lor intellectual si vor actiona in virtutea sistemului emotional, cand isi pierd obiectivitatea. Daca react emotional iti piersi obiectivitatea

Murray Bowens Insights into Family Dynamics*

1. Diferentierea sinelui sau cum sa ai propria ta viata si sa nu te lasi coplesit de propria familie. Fortele familiei pentru imoreuna si fortele opuse de a fi separate. Gradul in care apare dif selfului la un individ reflecta posibilitaeate acestuia de a distinge intre proceul intelectula sic el emotional. In acste mod dif s este legata de gradul in care individual este in masura ca actiunile, relatiile si viata sa sunt ghidate de emotii sau ganduri. (ce parte din mine imi conduce viata mea, emotiile sau creierul , cne este seful emotiile sua gandurile, ratiunea? Indivizi cu o mare fuziune intre cele doua fct cel mai prost. Sunt la mila reactiilor emotionale involuntare si tind sa devina disfunct la cle mai mic stress. In acelasi mod in care nu pot dif emotiile de ratiune acedte persoane au greutate de a se dif de altii si fuz usor cu emotia dominant in familie. Acesta este codependenta, efectiv nu poate spune care este dif dintre gandurile si emotiile proprii si cerle ale latei persoane. Bowen a introdus conceptual de masa de ago familial nedif , derivate din psihoanaliza pentru a transmite ideea de familie blocata emotuional impreuna, locul unde conglomeratul de unuicitate exista la divefire niveluri cde intensiatte. (gradina de variate grade de codepende in familie) Ex: gradul de relatie de simbioza intre mama si fiu poate reprez cea mai intense vresiune a acestui concept. Tatal se detaseaza mai putin intens. Gradul in care un mb al fam la un miment dat este dire prop cu gradul de impl in are masa de ego emotional. Tensiunile emot variza in diverse grade.

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Bowen a definit psihoanalitic variabila masa de ego emotional mai traziu ajunge sa sa def in fuziune dif (codependenta septaresanatosa. Penrtu ca cineva sa devina individ independent tb sa devina liber de proble emotion ale familieimde origine sis a expire un self solid. Gradul in care oricare mb al fam este implicat in familie la un moment dat depinde de nivelulbazal de implicare in masa de ego familial. Ctaeodata aceasta apropiere emotionala poate fi atat de intense cam b fm pot sti totul despre restul mb fam: vise, ganduri, emotii, fantezii etc. Aceasta intinmiktate poate duce la supra apropiere inconfortabila si in final la respingere mutuala intre doi memebri: certuri, usi trantite, telefoane trantite etc) . In cocl in sistemult familiei tensiunile emotionala vraiza cu timpul (cateodata rara alteori rapid) intr-o serie de aliante si respingeri. Ccea ce Bowen a caracterizat intiail in termini psihoanalititci masa de ego nediferentiata- a recadrat mai tarziu in termini de fuziune-diferentire (codependenta-separarae sanatoasa). Ambii tremeni dovedesc ca maturizarea si self actualizarea necesita cere ca individual sa-si rezlve atasamewnetle emotiomale din fa de orig . O persoana cu un sine puternic ( astea sunt opinile mele, asta cred eu, asta sunt ru, asta am sa fac, si asta nu am sa fac exprima convingeri clasre si bine definite. O asedmenea persoan nu isi va comptomite self-ul de dragul fericirii maritale, sau sa fie pe placul parintilor, sau sa-si obt dorintele prn coercitie. Un lat exemplu este un parinte care nu va enable an addict to continue to use drugs or alcohol.

0 25 50 75 100 Undifferentiated Differentiated Codependent Codependent in recovery Alcoholic/Addict Alcoholic/addict in recovery Dysfunctional Functional Fused/ Enmeshed Self actualized Unhealthy Healthy Triggered, evoked, freaking out Rational under stress Emotionally immature Emotionally Mature Parent/Child relationships Adult/Adult relationships False Emancipation Emancipation CGAS* 80 or less CGAS 81 or higher 13 | P a g e

GAF* 80 or less GAF 81 or higher (* See page 9 for information on CGAS) PersoaNLE CU7 UN SCOR SCAZUT SUNT CELE AL CARORO EMOTII SI INTYELECT SUNT DOMINATE de emotiile celor din jurul lor: ex: copilul meu experimenteaza dificultati tre sa ma grabexsc sa-l salvez) Ca o consecinta sunt disfct. Bowen considera ca au un pseudoself, pe care-l poti crede a fi rela dar este format din opinii si va,lori ale celollaltyi (codependenta). Cei care ua un scor la nivel mare sunt mature emotional, deoarece inn periaode de trse intellect si rationalul fct bune.si pot lua decizii bune independent de emotioanlitaea din jur. Cele mai multe perssoane sunt la mijlocul scalie cu diferite grade de dif si fuziune. Scasla elimina nevoia de concept de normalaitate. Confrom lui Bowen orice nivel de dif reflecta niv de dif din familia sa . Un nivel moderat catre inalt de dif permite intractiune a cu altii fara teama de fuziune (pierdere a sinelui intr-o relatie sau sa devii codependentma enervezi e un semn de pierdere a self-ului. Flexibilitatea scade proport cu scadrea difernt. Teoria lui Bowen spune ca este in instinctual finite umane de a propulsa sau genera copii capabili sa dezv. O persoana separate emotionala, capabila sa gandeasca, sa simta si sa actioneze ca un individ. In acelasi timp tot insntinctyul face ca persoana sa ramana concetgata emotuional. Va rezultata al acestor soua forte nimeni nu poate ajunge la separararea emotinala complete de familia de origine. Totusi sunt diferente considerabile in modul cum ne separam de familie cat si diferente dintre gradele de separarea ale copiilor in aceeasi familie. Aceste lucru din urma se datoreaza relatiilor diferite stabilite de parinti cu ficeare copil in parte. 2. Triunghiuri sau cum in loc sa ne maturizam noi insne sa incercam sa sa arasnjam pe altcineva.

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Cu cat gradul de fuziune intre soti este mai mare cu ata este mai dificil a gaseasca o cale de a-I staosface pe ambii. Bowen, 1978, spun ca in acset mom intrevine triangularea, e dificil sa discutam in doi atunci vom dicuta depsre altcineva. Triunghiul dilueaza anxietatea. Cata vreme este situati calma SOTII POT FACE SCHIMBURI INTRE EI. Cand nivelul stabilitatii este ameninttdin cauza supararii sau anxietatii datorate unui stress intren sau din cauza unui stress extern (abuzul de droguri sau de alcoole creaza un stress major). Cand un anumit nivelul de stress va fi ajuns unul sau ambii parteneri va implica o persoana vulnerabila. (o persoana cu un eu sanatos nu va fi interesata in drama altei persoane). Acets triunghi va dilua anxietatea. Daca ea va crets se va triagula o lata p[esdoana de catre triungh deja existent. Cu cat familia edste mai fuzionata cu atat eforturile de tr vor fi mai mari. De ex famililiile cu probl de alcool pierd multa vreme sa discute in loc sa treaca la ctiune. Adica sa se maturizeze si sis a devina fct. Bowen refers to the triangle as the smallest stable relationship system. By definition, a two-person system is unstable and forms itself into a three-person system or triad under stress, as each partner attempts to create a triangle in order to reduce the increasing tension of his or her relationship (even partners in healthy marriages seek outside counsel at times). As more people become involved, the system may become a series of interlocking triangles, in some cases heightening the very problem the multiple triangulations sought to resolve. For example, a distraught mothers request for help from her husband in dealing with their son is met with withdrawal from the father. As the mother-son conflict escalates, she communicates her distress to another son, who proceeds to get into a conflict with his brother for upsetting their mother. What began as a mother-son conflict has now erupted into interlocking conflicts between mother and son, brother and brother, and mother and father. The alcoholic and drug addicted family often has dozens of involved individuals. Thus triangulation does not always reduce tension. Bowen points out that triangulation has at least four possible outcomes: (1) a stable twosome can be destabilized by the addition of a third person (for example, alcoholism, drug addiction); (2) a stable twosome can be destabilized by the removal of a third person (marital conflict follows after 15 | P a g e

an alcoholic, addict or codependent seeks treatment, and thus is no longer available to be triangulated into their conflict); (3) an unstable twosome can be stabilized by the addition of a third person (seeing a therapist, recovery); and (4) an unstable twosome can be stabilized by the removal of a third person (conflict is reduced by setting a boundary and eliminating an addict/alcoholic from ones life). To give another familiar example, note that conflict between siblings quickly attracts a parents attention. Let us assume that the parent has positive feelings toward both children who, at the moment, are in conflict with each other. If the parent can control his or her emotional responsiveness and manage not to take sides while staying in contact with both children, the emotional intensity between the original twosome, the siblings, will diminish. (A parallel situation exists when parents quarrel and a child is drawn into the triangle in an attempt to dilute and thus reduce the strain between the combatants.) Generally speaking, the probability of triangulation within a family is heightened by poor differentiation of 5 family members; conversely, the reliance on triangulation to solve problems helps maintain the poor differentiation of certain family members. (Substance dependent/codependent families not in recovery always get worse.) As we discuss later in this chapter when we describe Bowens therapeutic technique, a similar situation exists when a couple visits a marital/family therapist. Following from the theory, Bowen contends that if the therapist the third person in the system can remain involved with both spouses without siding with one or the other, the spouses may learn to view themselves as individual, differentiated selves as well as marital partners. However, if the third person loses emotional contact with the spouses, the twosome will proceed to triangulate with someone else. (If all family members seek recovery then differentiation occurs. Those who do not seek recovery will find other addicts or codependents to hook up with.) 3. sistemul emotional al famliei nucleare sau suntem toti captive in ou Nuclear Family Emotional System or We Are All Stuck Inside The Egg Bowen spune ca oamenii isi aleg parteneri cu grade echivalente de dif. Un cuplu va produce copii asemanatori lor. Sisatemul emotional al familie nucleare resultat va fi instabil si va cauta variate forme de a reduce anx/tensiune si de a mentine stabilitatea. (alcoolul, drogurilr si codpenedenta merg f bine impreuna) Cu cat este mai mare fuziunea in familia nucl cu atat mai mare va fi anx si 16 | P a g e

potyentialul de instabil su cu atat mai are predilectia familieimsa caute rezolvare prin cearat , distantare, sau un partener cu defcinete la vdere sau cu fct compromisa sau preocupatyi de un copil. Caest lucru fac cam b sa scada stress prin abuz de subst. Bowen vede trei pattern posibile la partenerii smpt. In fdam nucleara. Ca fiind produsul fuz intense (niveluri crescute de codependenta) intre parteneri. Fiece patt se intensifica de anx si can dintens ajunge un parg sufic se dezv diverse forme de smpt. Persoana sau relatia care manif smpt este detrem de patt emotionale predom in acel sisitem fam. Cele trei patt sunt urmatoarele: 4. Disfct, fizca sau emotionala a unuia dintre parteneri, cateodata devenita cronica, ca o altrnatriva la a infrunta direct conflictul din familie;anx generata de fct. Nedif a fiecarui mb al familie este absorbita disproportional de un parinte smpt. 5. Semnificatia clinica , cronica, nu rezolva conflictul marital, in care cicluri de apropiere departare emotinala apar.; ambele sentiemetele negative in timpul conflictului si cele positive unul pentru altul din perioada de apropiere sunt n modelul roller coaster; anxietatea familieieste absorbita de catresoti. 6. Handicapul fiziologic al unu copil, activeaza focalizarea parentala asupra disfct coplilului si ignira sau naega propriul lord if scazuta ( e copilul, prostule!) ;cum copilul devine centru atentiei al familiei, intensity relatiei parentale este diminuata si anx famn este absrbita de problema copilui; gradul de dif alcopli cu cat este mai scazut cu atat mai mare va fi vulenrab lui de a creste in fam anx si deci de a creste disct. VIII. . relationship is diminished, thus the family anxiety is being absorbed in the childs

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Disfunctia unui sot poate lua forma de reciprocitate supra sau sub adecvata, in care un mb al famlie preia toate rtesponsabilitatile pe cand celalat subfct. Codeoendentilor permit dependentilor sa sub fct.

Dysfunction in one spouse may take the form of an overadequate-underadequate reciprocity, in which one partner takes on most or even all family responsibilities (earning a living, caring for the children, cooking, shopping, and so on) while the other plays the counterpart role of being underresponsible. Codependents enable dependents to under function. Fused together, the two-pseudo selves develop an arrangement in which one partner increasingly underfunctions while the other takes up the slack by assuming responsibility for them both codependency! When the tilt gets too great the one giving up more pseudo self for the sake of family harmony becomes vulnerable to physical or emotional dysfunction chemical dependency, other addictions, illness! In some cases, the pattern intertwines with marital conflict, the under adequate one (alcoholic) complaining of dominance, inconsiderateness, and so forth from the spouse. The overadequate one (codependent) is more comfortable with the arrangement until the underadequate one complains or becomes so inadequate as to cause difficulties for the overadequate one. When this occurs, the problem is likely to be seen as belonging to the unhappy underadequate spouse, rather than as a relationship problem for which both need help the alcoholic is the problem, not me! aproape fiecrae familie are un copil care este mai vulnerabil la fuziune ca celalt si care poate fi trriangulat intr-un conflict parental. Orice crest a anx parentale declanseaza un cmpt disfct la scoala, acasa sau ambele. Ducand la si o mai mare crest a anx parentale. In shimb cmpt copilului devine un handicap, tran format cateodata in un patt de fct scazuta pe viata. Sistemul emot al fam nucleare este un fnmen multigenerational. Indivizii tind sa repete ceea ce au invatat in fam de orig. sis a paseze si la copii lor.

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Pentru Bowen , singura cale reala de a rezolva problem de fam este de a schimba interactiunea in familiile de origne (semnarii de recuperera, psihoter, educatie ) Doar in acste fel poate inceapa diferentierea si indivizii implicate sa devina mai putini hiper reactivi la fortele emotionale zdrobitoare din familil sis a dea viitoarelor generatii posib de a produce fam santatoase. Individuals tend to repeat in their marital choices and other significant relationships the style of relating learned in their families of origin, and to pass along similar patterns to their children. To Bowen, the only effective way to resolve current family problems is to change the interactions with the families of origin (recovery, psychotherapy, education, workshops). Only then can differentiation proceed and the individuals involved become less overreactive to the emotional forces sweeping through the family - and give future generations a better shot at producing functional families. 4. procesul proiectiv al familiei sau hai sa fim de accord ca acest copil este bun si celalalt ester rau, acesta este destept si celalalt nu este. Asa cu am observant mai devreme patintii nu raspund n acelasi fel la fiecare dntre copii desi pretend contrariul. (rolurile tipice in familiile sunt eroul, tapul ispasitor, mascot, copilul pierdut, copilul patinte, micul ajutor) Diferenteke dintre cmpt parentale produc diferente semnificative intre cmpt copiilor si in modul cum fct acestia. Copii care sunt obiectul focalizarii parentale tind sa dezvolte o mai are fuzionare decat fratii lor si in consec raman mai vulnerabili la stressful emotional ce are loc in familie. Cei predispusi la fuziune, copii focus, sun tai sensibili la perturbariincl semnel incipiente. Bowen crese ca parintii, la randul lor imaturi, selecteaza ca obiect de atentie cel mai infantile/slab copil, indif de ordineanasterii. Asta e problema, nu este sigur alcoolismul meu, codependenta, afacerile, jocuriled enoroc etc)

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Acest process proiectiv lucreaza cu triada mama-tata-copil; trans nedif apare prin traigularea celui mai vulenrabil copil in relatia parentala. Bowen subl ca pozitia in fratrie a parintilor in familia de origine este posibila cheie prin care aleg coplilul urmatoarei generatyii. Copilul cel mai astast emotional din familie va avea cea mai mica dfer a sinelui si cea mai difcila separera de familie. Mai mult, Bowen crede ca cu cat e mai mare gradul de nedif a parintlor mai mult se bazeaza pe procesul proicetiv pentru a stabiliza sistemul si si este mai probabil ca mai multi copii vor fi fuzionati. Acset process al al proectarii sau al transterii nedif parentale cu atat mai devreme cu cat incepe legarea matrena de copilul mic. Codepend si depend se poate trans la generatii. Intensitatea procesulu de proiectie al fam este legata de doi factori: gradul de imaturitate sau nedif al parntilor, si nivrlul der stress sau anx experimentat de familie. In scenatiul trangulariii copilul raspunde anxios la anxietatea mamei, ea fiind primul ingrijitor, ; mama devine alarmata la ceea ce ea precepe a find plproblema copilului si devine hiperprotectiva. In acest fel se stabileste un ciclu in care mamma intantilizeaza copilul (chiar la maturitate, se numeste activare) care copil, in schib, devine hamdicapat si exigent (devine addict, somer, alcoholic) Tatal, care este sensibil la anxietatea sotiei, in incercarea de a o calma joaca un rol suportiv si devine al treile piscior al triunghiului. Fiind colaboratori , parintii au stabilizat acum realtia lor in jurul unui copli tulburat (tap isp) si a unui proce de perpet a tr familiei. 5. intreruoerea(distantarea emotionala Sau voi pretend ca nu suntem intr-o relatie Copii mai putin implicate in procesul p sunt apti de a rezita fuziunii si separab gandirea de sentimente sau emotia de ratiune si cunosc diferenta dintre ei si altii.cei care sunt mai mplicati inceraca varii strategii de a atinge maturittea chiar mai devreme.

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Separare geografica, bariere psihologice sau selfdeception ca sunt eloberati de legaturile de familie din cauza distantei. Drogurile si alcoolul suntf efic la sepatare , pentru moment. Bowen considera ca aceasta presupusa libertate un cut-off emotional, un zbor de la probl eotionale nerezolvate si nu o reala emancipare. Evitarea atasamentulu poate reprez negarea confl nerez sis a mascheze fuzionea neexplorata. Cutoff emo reflecta o problema (subl fuziunea dintre generatii), rezolva o problema (reduce anx asociata cand esti in contact) si creaza o problema (izolarea oamenilor care ar putea beneficia de un contact mai apropiat. Cutoff apare mai frecv la familiile in care exista un nivel mare de anx si de dependent emotionala (drog, alcool abuz si depend-codepend). Cum ambele cresc si coeziunea fam marite este asteptata conflictul intre mb familiei poate fi ascuns si deghizat. Fuziunea ar putea ajunge la un nivel de nesuportat, iar unii mb pot caut o mai mare distantare, emotionala, sociala, chimica, poate fizica pentru conservarea sinelui. Cand se impune comunicarea aceasta este superficiala, scurta si neautentica. Bowen a sugerat ca atunci cand exista cut off emot intre parinti si bunici, atunci probabilitatea unui cutoff intre parinti si copiii generatiei urmatoare creste Bowen insista ca adultii tb sa-si resolve atasam emotionale in familiile de origine. Bowen a descries propria sa lupta pentru difer din familia sa de orgine. Fara acestlucru, Bowen spune cat h de famlie poate fi traangulatvfara voie in conflictele familiilor clientilor, ca atunci cand erau copii in propr familii, probabil supraidentif cu un mb al fam sau proiectand la altii propriile probl nerezolvate. In gen, th este vulnerabl la efortul familiei clientlui sa reziste schimb s sa pastr hoemostazia fam. Th de fam tb sa fie in contact cu sis a fie liber de propria lui intrenalizare a fam in asa fel cat b nerezolvate din trecut sa nu perturbe terapia cu familia client.

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Iata un exemplu visual: imag ca suneti un purec pe un cal. Iar calul galopeaza spre sud. Tu si cu un prieten purec va intalniti si impreuna luati decizia schimb traiect cal. Esti ferm: calule ia-o spre nord. Dupa o vreme realizezi ca directia ramane nemodif. S audni mai multi mb dn familie pt un scop: sa mergi cu calul sper nord. Din pacate calul nu va lua nicicand in seam apararea unor pureci. Singura cale in care purecii si pot indeplini dorinta proprie este de a se da jods de pe cal si a o lua singuri spre nord. Calul in fiece familie este compus din: valorile const si incost, norme, reguli, asteptari. .in plus am vazut cum slaba dif in mod clar ne ia abilitatea de a lua decizii in viata nostra, pt ca desesori suntem condusi de emotiile unei late persoane . Sau in mod incost, suntem de accord sa implinim asteptarile altui mb al fam (aici este o probl sit u esti asta) Prin urmare, din puct de vedere psihologic, cu exc cazului cand ne faem traba suntem la mila trectutului nsotru si nu vom fi niciodata autorii vetii noastre. Putem continua sa fim dependenti de chimicale si nicicand mai avansati dincolo de momentul inceperi folos de subst sau sa suferim o moarte premature si tragica. Sau codependenta noastra poate sa ne fixeze pe cmpt altuia producand un parinte necrutator in adult si dincolo de si astfel ambii previn de la maturizare si noi insine de la a avea o viata implinita. Deci putem fi o victima a celor slab dif si niciodata sda nu depasim etapa sugarului sau sa decidem sa ne schimbam sau sa luam o decizie sa cautam ajutor sis a ne traim viata. Ce e sa-ti traoesrti viata? Sau sa ia viata ta? Ei, acseat este intrebarea pe care o pun cei care dortesc o viata implinita. . Or our codependency may cause us to be fixated on anothers behavior causing us to relentlessly parent them into adulthood and beyond and thereby both prevent them from ever growing up and ourselves from ever having a fulfilling life. Or we may be the victim of those poorly differentiated souls and never psychologically let go of the breast, or decide to change, or make a decision to reach out for help, suck it up, and get a life. What is the necessary work to get a life? This is the question that those who want a full, functional 22 | P a g e

cei care isi vor peterec restul vietii raspunzand la inyrebarea asta. Asta e intreb la care veti rasp fiec dntre voi mereyu mereu. Doemne da-mi linistea sa accept lucr pe care nu le pot schimba (la fel ca totti ceilalti), da-mi curajul sa schimb lucr care pot (ca mine insumi) si intelepciunea sa stiu dif dintre mine si o alta persoana (ce catedata e imposibil) life and wonderful, fun, and juicy relationships will spend the rest of their lives answering. This is the question we will be asking each of you to ask yourself over and over.

God, grant me the serenity to accept the things I cannot change (Like anyone else), The courage to change the things I can (Like myself), And the wisdom to know the difference between myself and another person ( Which is sometimes impossible).
1 - Emotional Fusion and Differentiation of Self 2 - Triangles 3 - Nuclear Family Emotional System

3 - Nuclear Family Emotional System

In positing the 'nuclear family emotional system', Bowen focuses on the impact of 'undifferentiation' on the emotional functioning of a single generation family. He asserts that relationship fusion, which leads to triangling, is the fuel for symptom formation which is manifested in one of three categories. These are: a. couple conflict; b. illness in a spouse; c. projection of a problem onto one or more children. Each of these is expanded below.

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3A. COUPLE CONFLICT The single generation unit usually starts with a dyad - a couple who, according to Bowen, will be at approximately equal levels of differentiation (ie. both have the same degree of need to be validated through the relationship). Bowen believed that permission to disagree is one of the most important contracts between individuals in an intimate relationship (Kerr and Bowen, 1988: 188). In a fused relationship, partners interpret the emotional state of the other as their responsibility, and the other's stated disagreement as a personal affront to them. A typical pattern in such emotionally intense relationships is a cycle of closeness followed by conflict to create distance, which in turn is followed by the couple making up and resuming the intense closeness. This pattern is a 'conflictual cocoon' (Kerr and Bowen, 1988: 192), where anxiety is bound within the conflict cycle without spilling over to involve children. Bowen suggested the following three ways in which couple conflict can be functional for a fused relationship, in which 'each person is attempting to become more whole through the other' (Lederer and Lewis, 1991). 1. Conflict can provide a strong sense of emotional contact with the important other. 2. Conflict can justify people's maintaining a comfortable distance from each other without feeling guilty about it. 3. Conflict can allow one person to project anxieties they have about themselves onto the other, thereby preserving their positive view of self (Kerr and Bowen, 1988: 192). 3B. SYMPTOMS IN A SPOUSE In a fused relationship, where each partner looks to the other's qualities to fit his / her learned manner of relating to significant others, a pattern of reciprocity can be set in motion that pushes each spouse's role to opposite extremes. Drawing from his analytic background, Bowen described this fusion as 'the reciprocal side of each spouse's transference' (Kerr and Bowen, 1988: 170). For example, what may start as an overly responsible spouse feeling compatible with a more dependent partner, can escalate to an increasingly controlling spouse with the other giving up any sense of contributing to the relationship. Both are equally undifferentiated in that they are defining themselves according to the reactions of the other; however the spouse who makes the most adjustments in the

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self in order to preserve relationship harmony is said by Bowen to be prone to developing symptoms. The person who gets polarised in the under functioning position is most vulnerable to symptoms of helplessness such as depression, substance abuse and chronic pain. The over functioning person might also be the one to develop symptoms, as s/he becomes overburdened by attempts to make things 'right' for others. 3C. SYMPTOMS IN A CHILD The third symptom of fusion in a family is when a child develops behavioural or emotional problems. This comes under Bowen's fourth theoretical concept, the Family Projection Process.

3a. Couple Conflict 3b. Symptoms in a Spouse 3c. Symptoms in a Child 4 - Family Projection Process 5 - Emotional Cutoff 6 - Multi-generational Transmission Process 7 - Sibling Positions

Modelul bowenian al conflictului marital n modelul bowenian al conflictului marital, ca i n problemele individuale la aduli i copii, exist o influen a sistemului sinelui, sistemul familial extins (familia de 25 | P a g e

origine) i sistemul nuclear al cuplului. I. Sistemul sinelui Problemele sinelui pot fi separate n: probleme de dezvoltare, factori de personalitate, proieciile familiei de origine. 1. Problemele de dezvoltare i pentru conflictul marital n particular, problemele de dezvoltare a adultului n conceptualizarea individual i relaional a problemelor. Termeni ca vrsta de 30 de ani, criza vrstei de mijloc, menopauza masculin, sunt bine documentate i descrise de muli cercettori. Evident, schimbrile brute de identitate, capacitate psihic, carier, poziie social sau soie n ciclul vieii plaseaz un stres sever asupra relaiilor i cer o schimbare neateptat de reguli, roluri i ateptri n cursul oricrei csnicii.
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2. Factorii de personalitate sunt, probabil, extins studiai de modelul psihodinamic al terapiei maritale, care descriu paternurile relaionale n termenii interblocarea nevrotic ca n binecunoscutul mariaj obsesiv-isteric. Terapeuii bowenieni descriu acelai tip de indivizi n termenii patternurilor relaionare interactive ca urmritori orientai emoional sau distanai orientai spre obiect (distanare emoional). Urmritorul emoional este o persoan orientat spre comunicarea sentimentelor, a crei tendin este de a-i asuma rspunderea pentru meninerea relaiilor, are un ritm intern i interpersonal care funcioneaz cu dou viteze: vitez maxim i stop. Un urmritor emoional tinde s fie mai degrab o pasre de noapte dect un matinal i s valorizeze intruziunea sa n viaa personal a celorlali, precum i a altora n viaa sa. El 26 | P a g e

este un tip entuziast, i plac provocrile i aventurile, i asum mai multe riscuri dect este necesar i are un optimism incurabil. Erorile pe care le comite sunt de domeniul faptelor, implicrii. Scuzele i faptele explicite vin rapid, n timp ce sfriturile i lurile de rmas bun sunt foarte grele. Distanatul emoional pe de alt parte este o persoan orientat spre obiect cu o tendin extrem de slab spre a transmite gnduri i emoii personale altora i a crui ritm este clar i previzibil. El este o persoan matinal, care prefer s nu i se adreseze ntrebri personale i care va rsplti acest favor adresnd extrem de rar ntrebri persoanale. Din punct de vedere temperamental se apropie cu precauie de sarcini noi i aventuri i are o doz sntoas de pesimism. Erorile pe care le face sunt de domeniul omisiunilor. Scuzele apar de obicei greu, n timp ce s abandoneze o sarcin e uor, sfriturile i separrile par s cauzeze mai puin suprare i durere emoional. Cel mai apropiat terapeut de terapia bowenian vine cu o teorie noninteracional teorie a personalitii prin scrierile existeniale despre sine n terapia sistemic ale lui Forgarty. El descrie zone sau arii de investiie n individ, care sunt: oamenii, obiectele, adncimea i timpul. Totui la o examinare mai atent, dimensiunile Oameni, Obiecte i Timp reflect tendine interactive (ex. micarea printre obiecte) n contextul unei relaii (ndeprtarea de oameni), doar n dimensiunea Adncime Forgarty descrie ceea ce poate fi considerat eveniment intrapsihic. Forgarty se ocup de dimenisiunea adncimii cel mai elocvent n lucrarea sa 27 | P a g e

Pe empatie i apropiere, aici ele descrie dificultile care emerg n relaii care decurg din lipsa de dorin a indivizilor sau incapacitatea de a simi termenii experienei sufleteti de pustiire, goliciune, pe care Forgarty l vede ca pe un aspect al existenei umane inevitabil. Oamenii ns, dect s umple cu acest gol, ncearc s-l umple cu succes, recompense materiale i n ultimul rnd prin relaii interpersonale. Cum golul este practic imposibil de umplut, cnd nu se ajunge la aceste ateptri nerealiste, distresul emoional care emerge este adesea protejat de relaiile interpersonale, ca i cum satisfacia personal (mplinirea) unuia este responsabilitatea celuilalt i nefericirea unuia este vina celuilalt.
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Forgarty pune considerabil accentul pe responsabilitatea personal, proiecii, experiene existeniale, auto-contientizare n evaluarea i terapia cuplului. Acest proces este mai evident n al su ciclu expectaii-alienare, n care progresiv, expectaiile nerealiste cu privire la so i cstorie, trec prin stadiile dezamgirii, rnirii, tristeii, furiei i n final alienare i izolare. 3. Proieciile familiei de origine sunt determinantul major al coninutului (i intensitii) acestor expectane disfuncionale, determin de asemenea multe dintre atitudini, orientri i concepii care afecteaz comportamentul individului n csnicie. Acest program este gndit spre a avea loc n mecanismul multigeneraional al procesului de proiecie familial. n procesul de proiecie familial, membrii familiei sunt investii cu anumite 28 | P a g e

caracteristici: serios, iritabil, nerealist i obligaii emoionale: ai grija de mama etc de ctre predecesorii ale cror probleme de relaionare n familie sunt nerezolvate din cauza doliului incomplet, loialitii familiale, divoruri sau despriri. Astfel aceti indivizi ies din familiile lor de origine n lume i csnicie programai s repun n scen caracteristici aparinnd oamenilor, relaiilor i evenimentelor demult ngropate. De exemplu, un brbat crescut ntr-un triunghi parental tipic, aspru, cu un tata extrem de distant i o mama supra-implicat, sufocant (care a renunat si mai ajung soul) poate ajunge la relaii intime adulte cu o alergie emoional la apropiere, care l va face s experimenteze o invazie i o pierdere a independenei i de asemenea cu o atitudine compensatorie extrem de distant, modelat de tatl su. Tatl distant Mama
distant supra-implicat (sufocant)

Fiul n mod analog, o femeie care a crescut ntr-un triunghi parental tipic, cu un tata departe, idealizat i represiv, o mama extrem, care a concurat cu fiica ei pentru doza limitat de afeciune pe care o aloca tatl, poate ajunge la maturitate cu o dependen emoional de brbai distani, pe care l urmeaz, dar pe care niciodat nu reuete s-l ajung i cu o incapacitate de a relaiona cu femei. Tata distant Mama
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distant, idealizat supra-implicat, critic

Fiica n final, brbaii i femeile cresc ntr-un sistem familial cu frai i surori, iar

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aceast experien de frate est un alt determinant puternic n comportamentul interpersonal al adultului. Toman a demonstart, de exemplu, c mariajele care sunt complementare (un frate mai mic al unei surori cstorindu-se cu o sor mai mare a unui frate mai mic) au o mai mare probabilitate de rezisten n timp i de procreare dect mariajele necomplementare. Aceste piese de afacere neterminat cu prinii, fraii i rudele mai ndeprtate sunt normale din punct de vedere statistic, dar mai puin dect optime. Cu ct aceste probleme sunt mai intense i cu ct sunt tratate prin distanare i nlturare din sistemul marital n care s-au dezvoltat, cu att mai mare este riscul ca acestea s fie reluate n relaiile maritale i s predispun la suferin. II. Sistemul familial extins Seciunea precedent a descris cum creterea ntr-un anumit tip de familie predispune indivizii, n condiii de stres la recrearea patternurilor relaionale predictibile i nsufleirea acestora n moduri disfuncionale predictibile. Oricum, un model al conflictului marital are nevoie s specifice cum aceste patternuri sunt declanate i ce menine evidenta disfuncionare i interaciunea dureroas care caracterizeaz aceste patternuri n conflictul marital. O viziunea psihodinamic asupra conflictului marital susine c sub presiunea realitii n convieuirea de zi cu zi, idealizarea figurilor reciproce ale soilor se erodeaz i se instaureaz deziluzia cu un corespondent nerealist, proiectiv i negativ nspre cellalt so. O viziune structural strategic afirm c schimbrile din ciclul vieii unei familii (ex. naterea unui copil) fac interaciunile obinuite ale familiei disfuncionale sau 30 | P a g e

regulile nvechite, iar soii se vor afla n conflict pn cnd vor elabora reguli noi, mai apropiate noului context. Viziunea sistemul familial bowenian este c nivelul neateptat de anxietate, modurile de a face fa anxietii i severitatea stersorilor receni reprezint evenimentele
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nodale (care intensific anxietatea ca emoie i proces) n sistemul familial extins din jurul mariajului sunt determinanii majori ai timpului, intensitii i persistenei conflictului marital. De exemplu ntr-un sistem familial cu un grad mare de fuziune, despre care am discutat mai sus, nivelul anxietii este extrem de ridicat din cauz c stresorii i tulpinile vieii normale nu sunt tratate n mod eficient. n plus, n astfel de sisteme, structurile disfuncionale apar spre a face fa unor nivele neobinuit de ridicate de anxietate cronic. ntre aceste structuri reciproce se afl triangulrile (descrise mai sus), distanarea reactiv (emoional) i strangulrile, n care poriuni din procesul emoional neplcut (ex: dezamgire) sau probleme sufocante (ex: suferine nerezolvate) sunt evitate ncetnd s mai conlucreze cu membrii importani ai sistemului familial care reprezint problemele toxice. Corespunztor, apropierea reactiv i situaia nclcit, n care anumii indivizi sunt mpiedicai de la o separare normal i o autonomie de funcionare, adesea compenseaz nevoile emoionale n alte relaii care sunt tratate prin distanare reactiv. Reciprocitatea acestor structuri este vizibil n observarea triangulrilor n familie, care sunt adesea compuse 31 | P a g e

din o strangulare i dou mreje individuale. n plus, pentru astfel de observaii clinice, cercetrile stresului i a bolilor arat ca interaciunile neateptate cu familia de origine joac un rol semnificativ n setul psihic de simptome. De exemplu, ct de bine se neleg indivizii cu prinii lor este un predictor important al bolilor legate de stres, iar depresia postpartum este mai comun femeilor care sunt distanate fizic i emoional de familiile lor extinse sau care au avut un deces recent n familiile de origine. Rolul decesului membrilor familiei n depresia postpartum ilustreaz al doilea factor major din familia extins n conflictul marital, numit eveniment sau stresor nodal. Evenimentele nodale pot fi recente (conflictul ngrijrii bunicii n vrst) sau ndeprtate (disputa pe marginea motenirii bunicului de acum zece ani), instantanee (atacul de cord al
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tatlui) sau de termen lung (boala Alzheimer a mamei), pozitive (naterea unui copil) sau negative (moartea unui frate), serioase (ameninarea unui rzboi nuclear) sau blnde (copilul ncepe coala cu internat). Evenimentele nodale pot de asemenea s se produc la nivel individual (pierderea slujbei), relaional (divorul surorii), al grupului social (libertatea femeilor), sau la nivelul ntregii societi (criza energetic). Astfel, evenimentele nodale sunt fie fenomene de familie (cstoria, divorul, naterea, moartea etc) producndu-se n sistem sau fenomene non-familiale (angajarea, fenomene sociale) care se strecoar spre membrii familiei din exterior. n orice caz, 32 | P a g e

evenimentele nodale pot influena suferina marital prin creterea nivelului anxietii n sistemul familial extins., astfel intensificnd paternurile disfuncionale ale familiei (triangulri, strangulri, situaii nclcite), care crete stresul individual al membrilor familiei (inclusiv soilor) i n mod simultan descrete irul opiunilor relaiei i coerena potrivit reelei familiale. Mai mult dect att, la un nivel mai mulumitor, natura evenimentelor nodale specifice poate declana probleme maritale vulnerabile i toxice care nu sunt adresate cuiva anume (ex: divorul surorii poate amenina stabilitatea altor mariaje din sistemul familial). Pe scurt, nlimea frecvenei i severitatea evenimentelor nodale n sistemul familial extins i maturitatea emoional sczut (diferenierea i apropierea) a sistemului vor va natere la anxietate ridicat si la o probabilitate mai mare de apariie a simptomelor individuale n relaie, incluznd conflictul marital. III. Cuplul/ sistemul familial nuclear n final, surse ale conflictului marital apar din afara relaiei de cuplu i a altor probleme ale familiei nucleare. Unii dintre aceti factori incluznd incompatibilitatea n poziia dintre frai, ateptri nerealiste i triangulri reciproce reactive (distana-urmrie, peste i sub-funcionare) sunt dificil de izolat decontextele interconectate ale sinelui i ale familiei extinse. Astfel de factori sunt reluai n relaia marital i predispun la disfuncii n context stresant. Desigur, chiar dac aceste moteniri complicate i limitri nu sunt prezente, multe compromisuri, negocieri, adaptri i nvturi noi care trebuie s apar ntre dou persoane pentru a putea tri mpreun i probabil s aib copii sunt formidabile. Mc Goldrick 33 | P a g e

nota: Cstoria cere ca un cuplu s renegocieze mpreun un numr vast de probleme personale pe care mai nainte le-au definit pentru ei nii sau au fost definite de ctre prini lor, incluznd deciziile zilnice, cum ar fi cnd i cum s mnnce, doram,
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vorbeasc, fac sex, lupte, reduc tensiunea. Ei trebuie s decid n ceea ce privete vacanele, amenajarea spaiului, timp i bani. Apoi sunt deciziile de familie despre ce tradiii i ritualuri trebuie s rein din familia de origine a fiecruia i care sunt partenerii pe care i vor dezvolta pentru ei. Acestea i mii de alte decizii similare nu mai pot fideterminate individual. Ei trebuie s lucreze la compatibilitate pentru ca cei doi s se potrivesc. Cuplu s+ar putea gsi de asemenea n situaia de a renegocia relaiile lor cu prinii, fraii, prietenii i alte rude din perspectiva mariajului lor. Odat ce aceste greuti trec, timpul i noile stadii ale ciclului familial al vieii lovesc cuplul, numeroi parametri ai relaiei maritale pot trece prin stres. Guerin menioneaz funcionarea relaional de ntreinere care poate ceda la stres: comunicarea, schimbul de informaii, auto-dezvluirea, credibilitatea, i timpul de activitate al relaiei. La modul general, aceste funcii sunt manifestarea climatului emoional al cuplului, patternuruile de micare (urmrire-distanare, supra i sub- funcionare) i triangulrile centrale. n general, cnd stresul atinge mariajul (din oricare dintre sistemele descrise mai sus), patternurile tranzacionale care ar putea fi adaptative sau cel puin benigne, devin 34 | P a g e

mai reactive i mai exacerbate, iar disfunciile pot aprea n unele arii ale sistemului familial. n sistemul cuplului n care reaciprocitatea reactiv primar este pe axa orizontal de urmrire-distanare, progresia este n general de la urmrire activ la distan spre distanare reactiv a urmritorului i urmrire reactiv a distanatorului i a chin reciproc sfrit prin distana fix ntrerupt de ntmpltoare btlii furtunoase. n astfel de cupluri , relaiile extramaritale i triangulrile cu copii sunt comune, conducnd la conflict marital care nu duce nicieri i formeaz copilul simptomatic de mai trziu. Distan Urmrire Reciprocitatea distan-urmrire Distan Distan Distanarea reactiv din partea urmritorului Urmrire Respingere
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Urmrire reactiv din partea distanatorului, respingere din partea urmritorului Tensiune Distana fix Munc Aventur etc Apropiere Distanare Distanare conflictual Triangulare marital Distanare tcut Distan apropiere Copil simptomatic Triangularea copilului 35 | P a g e

Cuplurile n care tranzacia reactiv primar s-a realizat pe axa vertical a supra i subfuncionrii dezvolt adesea simptome la unul dintre soi sau tranzacii ritualizate n jurul abuzului de substane cnd stresul lovete sistemul. Subfunc distan suprafunc IV. SCOP/OBIECTIVE TERAPIE

The main goal of Bowenian therapy is to reduce chronic anxiety by 1. facilitating awareness of how the emotional system functions; and 2. increasing levels of differentiation, where the focus is on making changes for the self rather than on trying to change others.

Bowenienii nu incearca sa schimbee oamenii si nici nu sunt interesati de rezolvarea problemelor. Terapia este o ovazie de a invata mai mult despre ei insisisi despre relatiile lor, in asa fel inact sasi poata asum aresponsabilitatea propriilor problem. Terapeutul ajuta mb fam sa reninte la ideea de vinovatie sis a gasesca greseala pentru a se confrunta si explora propriilor lor roluri din problema familiei. Paternul inseamna atentie la process ( pattern de reactivitate emotionala) si la structura (reteaua intreconectata a triunghiurilor). Procesul therapeutic: Bowen: depinde de abilitatea de a se raporta la familie, fara a se implica emotional. Terapeutul are 5 fct principale in tratament: 1. Sa defineasca sis a clrifice realtia dintre soti prin utilizarea genogramei. 2. Sa pastreze eu-l in afara triunghiului sistemului emotional al familiei. 3. Sa invete fct sistemului emotional utilizand pricipiile modelului. 4. Sa demo dif prin conducerea eu-lui in cursul terapiei. 5. Sa resolve separarile. Kerr si Bowen sugereaza utilizarea urmatoarelor intrebari in process: 1. Cine a initiat terapia? 36 | P a g e

2. Care este simptomul si care este pacientul identificat? 3. Care este familia nucleara al pacientului identficat? 4. Pattern-uti de fct emotionala in fam nucl? 5. Ce infl: o incarcatura excesiva de evenimente sau un nivel redus de adaptabilitate? 6. Care este gradul de dif al sinelui din sistemele familiale? 7. Care sunt directiile pentru terapie? Th face un triunghi nou, unul terapautic. Procesul detriangularii si dif care va schimab profund si permanent sist fam. Creste capacitatea par de a-si gestiona prorpia anx si de aici vor devein capabili sa se ocupe de cmpt. Scopul th maritale este crestere autofocus, scaderea reactivitatii emorionale, modif pattern disf. Terapia de cuplu se baz pe premiza ca tens in diada se va disipa daca ei raman in contact cu a o treia persoana (intr-un tr stabil) daca caea persoana ramane neutral si obiectiva ma degraba decat angajata emotional. Tr th poate rasturna proceul insidious al probl de ment a triangularii. Mai mult schimb in tr va schimba inyregul system familial. Terapia cu o persoana se baz pe premiza ca daca o pers din familie realiz un nivel inalt de dif aceasta va permite celorlalti mb din families a faca acelasi lucru.

1.Imbunatatirea diferentierii eu-lui (Bowen, 1978) 2.Cu o diferentierea crescuta, mb individuali ai familiei sun tai capabili sa tolereze anxietatea sis a-si acceseze functiile intelectuale. 3.Reactivitateae emotionala crescuta si fct intellectual sporita sunt late scopuri atinse de terapia lui Murray Bowen. 4. comunicarea deschisa in cadrul familiei. 5. reducerea comnuicarii iresponsabile, subterana a secretelor si barfelor cu altii. 6. rezolvarea treburilor neterminate cu familia de origine.scop personal al terapeutului: Anxietate redusa in campul emotional pentru imbunatirea nivelului fct al dif eului si pentru reducerea simptomelor. 37 | P a g e

Imbunatirea nivelului de baza al dif pentru a creste adaptabilitatea persoanei la campurile emotionale intense. Iolanda Mitrofan Conditii pentru schimbare cmpt Crest capac de a distinge dif dintre gandire si simtirre Mics anxietate si marind focusul pe sine. Intelegerea si nu actiunea este vehicul schimbare. Atmosfera siedintelor si pozitia th sunt ambele desemnate sa micsoreze emotionalitatea. Cheia este neuttralitatea. Terapia nu cere prezenta intregii familii ci doar a constiintei sale. Parte a procesului de dif a sinelui este dezv rel pers cu orice mb al familiei. Puterea acesto r legaturimde famlie poate parea misterioasa in s[ecila pentru cei care nu se gandesc ca bun a lor stare ar fi dependent cu realatiile din familie. Freud avea o notiune similara privind nivelul intrapsihic. In modelul neurolologic al mintii, din Proiect pentru psihologie stiiitifica, Freud spune ca mintea imatura are putine iesiri ( catehxis) pentru canalizarea energiei psihice si de aici are capacitate sau flexibilitate scazuta pentru amanare raspuns. Mintea matura , pe de alta parte, are multe canele de raspuns, care permit flexibilitate mai mare. Notiunea lui Bowen de crest a retelei emotionale familiale este asemeni model lui Freud, f clara.

VII. Tehnici
Chiar 7 tehnici mai importante ale terapiei sistemice Bowen. 1. Genograma(Guerin, 1972) sau diagrama familiei (Bowen) Organizare date, in timpul fazei de evaluare, scoate la lumen in timpul process th. Procesele relationale si triunghiurile cheie.

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2.

Triunghirile terapiei procesele relationale conflictuale ale familiei au tr actvate legate de smpt. Cheie in incercarea de a restabili echil. Familia va incerca sa train th. Este nevoie cat h sa fie liber de reactivitatea emot familia va icepe sa gas solutii la probl lor. La lucrul cu cupl se pun intre fiecarui sot pt atenuarea emotiei si a creste obs ai gand obiectiva, a dif emotia de ratiune. Se va face effort pt a incetin suprafct in diada Ir cel subfct sa se implice Experimente relationale - alterare strc din tr cheie : sa ajute mb fam sa constde procesele sist sis a invete sa rec propr rol in ele. Fograty, experim pe urmarit urmariti emotionali. Clientii nu se vindeca miraculous emotional c vad ce e cu ei insisi si in rel. Antrenarea: este o latrenativa boweniana penrtu roul de implicare in mai personal si mai emotional comun celor mai multe forme de terapie.pui intrebari de process pentru a ajuta oamenii sa vada procesel emotionale ale fam si rol lor.scop: crest intelegerii, crest autoconcentr si legatur mai fct intre mb cheie ai fam. Pozitia eu- pozitie personala, spui ce simti in loc ce fac altii, una dintre cele mai directe cai de a rupe cercurile de reactivitate emotionala. Terapia de famlie multipla James Framo Povesti de inlocuire - tehnica lui Guerin, care arata filame, casete video si spune povesti penrtru a invata mb fct sist intr-un mod care minimizeaza defensvitatea acestora.

3.

4.

5. 6. 7.

MODELUL IN PRACTICA CLINICA Tehnica Nu este focalizata pe un model ce are descireri specific depsre cum sa structurezi sesiunea th. Scopul este cat h sa asistemb fam sa obtina niveluri mai mari de dif, niveluri cu mai putina vinovatie, reactvitate scazuta, si crestere a responsabilitatii pentru sine in sistemult emotional. Un aspect important este propriul lucru cu sine al terapeutului cu familia de origine, , roul central al th in a directiona conversatia, siminima lui focalizare pe copii in procesul th. Bowen vede trei stadia ale th:

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1. Reducerea anxietatii clientilor despre symptom incurajand-I sa afle cum smpt este parte dn pattern-ul lor de relatie. 2. Focalizarea asupra clientilor ca problema de self , pentru a creste gradul de dif. Clientii sunt ajutati sa reziste atractiei fortei impreuna din familie. 3. Clientii adulti de acum, dupa cele doua faze, sunt antrenat sa se dif fata de fam de origine, asumarea dif care scade automat anx sdi marierea responsabil in familia nucleara.

Clinical Practice : The Role of the Therapist

The role of the therapist 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' (Bowen, 1971 in Bowen, 1978: 246). Bowen warns of the problems of therapists losing sight of their part in the system of interactions, where they may be inducted into a mediating role in a triangle with the family. Hence there is a high priority given to understanding and making changes within the therapist's own family of origin. In training, the emphasis is on the trainees' level of differentiation, and not on therapeutic technique. The therapist's resolution of family of origin issues is reflected in the:

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...ability to be in emotional contact with a difficult, emotionally charged problem and not feel compelled to preach about what others should do, not rush in to fix the problem and not pretend to be detached by emotionally insulating oneself (Kerr and Bowen, 1988: 108).

Clinical Practice : Therapist Activity

The therapist is active in directing the therapeutic conversation. Enactments are halted so as to prevent the escalation of clients' anxiety. Clients are asked to talk directly to the therapist so that other family members can "listen and 'really hear' without reacting emotionally, for the first time in their lives together" (Bowen, 1971 in Bowen, 1978: 248). Bowen himself would avoid couple interaction in the room and concentrate on interviewing one spouse in the presence of the other. Bowen clearly avoided asking for emotional responses, which he saw as less likely to lead to differentiation of self, preferring mostly to ask for 'thoughts', 'reactions' and 'impressions' (Bowen, 1971, in Bowen, 1978: 226). He called this activity 'externalizing the thinking of each client in the presence of the other' (Bowen, 1975 in Bowen, 1978: 314).

Clinical Practice : Children in Bowen's Therapy

A surprising feature of Bowen's family therapy is his tendency to minimise the involvement of children. While Bowen might include children in the beginning stage of therapy, he would soon dismiss them, focusing on the adults as the most influential members of a family system (Bowen, 1975 in Bowen, 1978: 298). Excluding a child from therapy responsibility is viewed as a detriangling manoeuvre. When parents cannot use the child as a 'triangle person' for issues between them, and the therapist resists taking the replacement role in the triangle, parents can begin differentiating their respective selves from one other.

Clinical Practice : Family Evaluation

The beginning sessions in Bowenian therapy focus on information gathering in order to form ideas about the family's emotional processes, which concurrently provides information to family members about the presenting problem in its systemic context. The presenting problem is tracked through the history of the nuclear family and into the extended family system. A multigenerational genogram is a useful tool for recording this information (McGoldrick and Gerson, 1985; Kerr and Bowen, 1988: 306-

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313). The therapist looks for clues about the emotional process of the particular family, including: patterns of regulating closeness and distance, how anxiety is dealt with in the system, what triangles get activated, the degree of adaptivity to changes and stressful events, and any signs of emotional 'cutoff'. Information collected is acknowledged to be extremely subjective, especially when extended family are discussed; but stories about past generations are viewed as useful clues to the roles people occupy in triangles and the tensions that remain unresolved from their families of origin. If for example, a member of the extended family is described as 'the rebel', the therapist explores what events gave rise to this label, who else has occupied this role across the generations and how triangles formed around family crises involving 'rebellion'. Calming family members' anxiety in the early stages of therapy might involve helping them to make connections between the development of symptoms and potent themes in a family's history. Another aim will be to loosen the central triangle that has formed around, and maintains, the presenting problem. Teaching clients about systems concepts as they operate in their own family is part of therapy at this stage. This does not mean attempting to convince people to do things differently but to encourage family members to see beyond their biases so that it is possible for them to consider each person's part in the family patterns.

Clinical Practice : Questions that Encourage Differentiation

The therapist asks questions that assume that the adult client can be responsible for his / her reactiveness to the other. An example would be, "How do you understand the way you seem to take your child's acting out so personally?" In response to such questions, family members are encouraged to take an 'I' position where they speak about how they view the problem, without attacking, or defending against, another family member (Bowen, 1971a in Bowen, 1978: 252; Goodnow and Lim, 1997). Clients are taught to make personal statements about their thoughts and feelings in order to facilitate a greater sense of responsibility in a relationship. For example, an accusatory statement such as, 'You are so selfish to cause this much worry for your parents!', is shifted to, 'I am really concerned that this might affect your school grades'. The parent is encouraged to 'own' their worries, rather than to project their anxieties through blaming statements. Developing such a 'self-focus' is said to be crucial in lowering anxiety and enabling 'person to person' relationships where each family member can think about the part they play in problematic interactions.

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Clinical Practice : Creating a Multigenerational Lens

Bowen's multigenerational model goes beyond the view that the past influences the present, to the view that patterns of relating in the past continue in the present family system (Herz Brown, 1991). Hence the therapist uses questions to encourage clients to think about the connection between their present problem and the ways previous generations have dealt with similar relationship issues. For example, if the onset of a symptom followed a death in the family, the therapist asks about how grief has been dealt with in previous generations. Questions seek to uncover family belief systems as well as the way relationships have shifted in response to loss. Tracking symptoms and exploring related themes over at least three generations makes it more difficult for individuals to blame one another for individual deficiencies. As therapist and family members see how patterns repeat over generations, it is possible to identify the 'automatic' reactions of family members towards each other: The ability to act on the basis of more awareness of relationship process (not blaming self or others, but seeing the part each plays) can, if done repeatedly in important relationships, lead to some reduction in emotional reactivity and chronic anxiety (Kerr and Bowen, 1988: 132).

Clinical Practice : Detriangling

This is probably the central technique in Bowenian therapy. The client is first helped to recognise both the subtle and the more obvious ways that they are 'triangled' by others, and the ways in which they attempt to triangle others in their turn. The therapist uses questions to facilitate the family members' awareness of their roles in family triangles. Simple open ended tracking questions, using what Herz Brown (1991) terms the four 'Ws' (who, what, when and where) help clients to become 'detectives' in their own interpersonal systems. It is often very difficult for family members to identify the triangles they participate in, and the sometimes covert ways in which they detour anxiety. An example would be a client who was struggling to understand her negativity towards her father. When questioning included her mother's role in these emotions, the client began to see that her view of her father was influenced by her position in a triangle. As her mother's ally in this triangle, she viewed her father as the inadequate husband who left her mother feeling needy. Once triangles have been identified, family members are helped to plan ways of communicating a neutral position to others, leaving the dyad to communicate directly with each other. The goal is for a

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family member to find a less reactive position in the face of the other's anxiety. This will require different stances in different systems, ranging from refusing to discuss the deficiencies of another behind his/her back, to reversing one's usual reaction in a triangle. For example, when the predictable pattern in the family system is to keep distance between those who haven't been able to work out their problems, the therapist helps a family member to plan strategies that shift their usual role in maintaining the avoidance. The family member might encourage more involvement between the conflictual twosome, or change the subject when invited to discuss the conflict. Reversal is a key detriangling technique. When for example a family member A complains about how uncaring another person is, person C reverses the predictable sympathetic response, substituting a casual comment about how considerate person B seems for not putting demands on A's time and energy. Unlike a strategic intervention, the goal of any detriangling stance is not to change the other's relationship but to express one's neutrality about it. A calm and thoughtful neutral stance prevents one from anxiously reacting to the tension of another relationship by 'taking sides'.

Clinical Practice : Coaching: Family Therapy with an Individual

Another distinguishing feature of Bowen's model is its validity in working with a single adult. The term 'coaching' describes the work of the therapist giving input and support for adult clients who are attempting to develop greater differentiation in their families of origin. Clients should feel in charge of their own change efforts, with the therapist acting as a consultant. Bowen thought that a person's efforts to be more differentiated would be more productive when the focus shifted away from the intensity of the nuclear family to the previous generation. The emphasis is on self-directed efforts to detriangle from family of origin patterns. An individual's efforts can modify a triangle, which in turn ripples through to change in the whole extended family. Bowen described 'coaching' as 'family psychotherapy with one family member' (Bowen, 1971 in Bowen, 1978: 233). This therapy takes on the flavour of teaching, as clients learn about the predicable patterns of triangles. The therapist supports their efforts in returning to their families to observe and learn about these patterns. Clients practise controlling their emotional reactivity in their family and report their struggles and progress in following sessions. During family of origin coaching, clients use letters, telephone calls, visits and research about previous generations to gain a systemic

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perspective on their family's emotional processes and a sense of their own inheritance of these patterns. The therapist prepares clients for the anxiety they will encounter if they shift from their customary roles in their families of origin. Any such changes will inevitably disturb the predictable balance of family patterns and therefore heighten anxiety and resistance. Change is viewed as a three step process where: a. one takes a new position, b. family members react and c. the new stance is maintained in the face of pressure to revert to the original position (Herz Brown, 1991). Bowen (1978) emphasised that it is what happens in step 'c' that really determines whether change occurs.

Current Developments
Bowen's model has been adopted and developed by many prominent therapists. Rather than attempt to summarise all of these developments, I shall focus on the applications of the model by Betty Carter and Monica McGoldrick which have influenced the practice of the Family Institute of Westchester in New York and the Family Institute of New Jersey. Since the early 1980s, the work of Carter, McGoldrick and their colleagues has expanded Bowen's framework to include attention to the family life cycle (Carter and McGoldrick, 1980, 1988.) As well as the 'vertical' flow of anxiety through the generations, Carter included an assessment of 'horizontal' stress as families move through various stages of the life cycle. Vertical and horizontal patterns converge, as multigenerational tensions impact on the ways that life cycle tasks and disruptions are negotiated. The stress of life cycle changes affects the choice of family of origin issues focused upon in the current generation. Using a life cycle perspective, symptom development is viewed in the context of an unresolved adjustment to a life cycle task.

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Acknowledging the significance of gender, race, ethnicity and class on a family's progression through life cycle stages was an important development in family assessment (eg. McGoldrick, Pearce and Giordano, 1982; Carter et al., 1988; McGoldrick, Anderson and Walsh, 1988; Herz Brown, 1991). This much broader focus provides what Carter has called a 'multi-contextual lens'. These variables are part of the context of the family's 'horizontal' story and underlie the potent themes of a family's multigenerational legacy. Patterns of gender across the generations are viewed as powerfully contributing to the roles that people occupy in the family emotional system. The inclusion of gender sensitivity in a Bowenian framework means that the therapist helps clients to look not only at patterns of relating over the generations but also to critique the roles they occupy in relationships. Such a focus is not confined to the family system's gender expectations but includes questions that look for connections to socially defined gender roles. Betty Carter, in developing her work from the women's project (Carter et al., 1988), has outlined how Bowen's key concepts (fusion, differentiation and triangles) need to be viewed differently from a feminist position. Gender roles will determine the way men and women express fusion, with women socialised to be dependent and approval seeking and men socialised to withdraw and emotionally 'cut off'. Carter asserts that the concept of fusion can easily be misused to pathologise the 'over-involved female' while overlooking the distant male. With a 'gender sensitive lens', a Bowenian therapist validates rather than pathologises the relational concerns of women and explores ways that men can take responsibilities in this sphere. The distancing of a male will be seen not only as a symptom of lack of differentiation but also as a socially prescribed reaction. Likewise, the nature of a relationship triangle is influenced by gender related behaviour. Carter illustrates the different ways a therapist might view a triangle with and without the feminist lens. The triangle of a husband in a distant position, with his wife and mother in conflict, would be viewed by a feminist Bowenian therapist as 'a case of two women bumping into each other as each tries to carry out her family responsibilities in the face of the man's withdrawal' (Carter et al., 1988). Interventions will respect the women's roles and dilemmas and focus on how the husband can choose to be more involved in both significant relationships. Without such a lens, the detriangling strategy would typically be to have the husband set more boundaries with his mother - which has the effect of preserving the gendered stereotype of the 'possessive' mother in law.

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The therapist is challenged to recognise that no intervention is free from societal constructs in regard to gender and power (including race, ethnicity, class and sexual orientation) so that 'every intervention will have a different and special meaning for each sex' (Carter et al., 1988). Thus therapists expand their questioning to ask about the relational impact of each spouse's income and ethnicity. The organisation of child care and housework is also explored. Therapists are encouraged to challenge men's excuses that work prevents family involvement and women's expectations about financial support (Carter, 1996). An awareness of the impact of therapists' own value system on their therapy is also stressed (Carter, 1992). For Bowenian therapists in the nineties, the core of Bowen's theory of symptom development and change remains unaltered. What has been added is attention to how wider socio-political issues of power and hierarchy are played out as couple or family problems. A broad range of systemic techniques such as restorying and circular questioning can readily be incorporated into the model (Carter and McGoldrick, 1988).

Critique Of Bowen's Model

Bowen's model of family therapy is perhaps most distinctive for its depth of evaluation beyond symptoms in the present. Its focus on emotional processes over the generations and on individuals' differentiation within their systemic context offers family therapists a multi-level view that has usually been reserved for psychodynamic therapies. Bowen's model pays attention to the emotional interaction of therapists and their clients and expects that the process of therapy must in some way be applied to the therapists' own lives, so that they are able to remain meta to the client family system. A number of Bowenian therapists acknowledge that the wider focus of Bowen's model can be a drawback in that many clients want only to address symptom relief in the nuclear family (Young, 1991). For the Bowenian therapist, symptom reduction is seen only as the ground work from which families can proceed less anxiously towards working on detriangling and improved levels of differentiation. Herein lies a clear danger of discrepancies in client and therapist goals. While Bowenian therapy has been embraced by some leading feminist therapists, such as Betty Carter and Harriet Goldhor Lerner, it has also received its share of criticism from a feminist

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perspective. Deborah Leupnitz (1988) points out that Bowen, along with other male family therapy pioneers, has paid rather too much attention to the mother's contribution to symptom development in the child. Some support for this can be found by scanning the index to Kerr and Bowen (1988), where 'fathers' do not warrant a category yet 'mothers' are referenced in relation to families of schizophrenics, levels of differentiation in the child, and their role in triangles (Kerr and Bowen, 1988: 395). [The index to Bowen's own collected papers, Family Therapy in Clinical Practice, however, includes one reference to 'fathers' and none to 'mothers': Eds.] A perceived over-investment by a mother in her child is seen as a sign of undifferentiation. Unlike the current feminist therapists who use the Bowenian model, Murray Bowen (along with many of his Georgetown colleagues) failed to contextualise maternal behaviour. Patriarchal assumptions about male / female roles and family organisation are not acknowledged or critiqued, which leaves women vulnerable to having their socially prescribed roles pathologised. Women are readily labelled as 'over concerned', and their active, relational role in families too easily labelled as 'fused' and 'undifferentiated'. There is no questioning of societal norms that can be seen to '[school] females into undifferentiation by teaching them always to put others' needs first' (Leupnitz, 1988: 43). The women's project in family therapy asserts that a model such as Bowen's pressures the woman to 'back off' while placating and courting the distant male (Carter et al., 1988). Carter asserts that this is not only biased against women but disrespectful of men since the model assumes men's limitations in terms of emotional engagement in therapy and family relationships. An ongoing challenge for feminist Bowenian therapists is to reconstruct a therapy language of intimacy and attachment that is not misused to imply dysfunction (Bograd, 1987; Carter et al., 1988). Another criticism that flows from the biases of Bowen's 'male defined' terminology, is that his is a therapy lacking in attention to feelings (Luepnitz, 1988). It is asserted that Bowen's therapy focuses on being rational and objective in relation to emotional processes, which relegates to a low priority the expression of emotions in therapy. My own experience of this model, with its invitation to explore the 'tapestry' of one's family across the generations, is that it is an emotionally intense therapy. While Bowen may emphasise the goal of helping the client learn about their family's emotional processes, in practice it is the experience of the emotions, embedded in family of origin relationships that is a key motivator for the client to undertake family of origin work. I recall Betty Carter, in asking a man

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about his relationship with his own father, tapping deeply into emotions that motivated him to make changes in his ways of relating.

Case Example
The Barret family were referred for family therapy by the individual therapist of the sixteen year old anorectic daughter, Tanya. Tanya had been hospitalised by her doctor the previous month when her weight levels were considered life threatening. To date the family had not been involved in her treatment but were now feeling that they could no longer remain on the sidelines when the risk levels were so high. Hospitalisation had also intensified family reactivity, with Tanya blaming her father for allowing her freedom to be taken away, both parents feeling angry that she could allow herself to fall so low, and her nineteen year old sister questioning how Tanya could put her family through so much worry.

Stage 1: Calming the system

When a family member is exhibiting life threatening symptoms, it is not realistic to expect that anxiety can be lowered to non reactive levels. In the case of the Barret family my goal was to take the focus away from Tanya's weight sufficiently to enable the family to explore each of their roles in the anxious family patterns. The other systems involved in her treatment were framed as providing her with support and monitoring the risk of her symptoms. She received individual therapy where the therapist focused on supporting her through adolescent life cycle tasks. Her doctor was responsible for monitoring her medical condition and weight gain. Family sessions could therefore concentrate on family process in dealing with Tanya's eating patterns.

Stage 2: Nuclear family issues

Locating the presenting problem in the broader family context revealed that the family was in the process of negotiating some significant changes. Around the onset of Tanya's pronounced weight loss, her older sister, Roslyn, had moved away from home to begin medical studies at university. Roslyn had previously been considered the rebel of the family but was now clearly labelled as the 'golden girl' who would make them all proud with her academic success. Family roles and the theme of economic success were identified. Mr. Barret had recently received a promotion which

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necessitated moving to another city. Mrs. Barret had left her job as a nurse and had not been working for the nine months following the family move. Gender themes were becoming evident as Tanya spoke of how personally she was identifying with her mother's loss of professional role. While there were numerous family changes that could inform hypotheses about her symptoms, my primary focus was the operation of family triangles in dealing with anxiety. Tanya expressed her triangled role in her parents' issues as she spoke about their emotional life. She described the stress of her father's work and reported passionately on her mother's loss of status since giving up her nursing job. She perceived her mother's life as empty, and she herself felt similarly empty and directionless. The fusion in nuclear family relationships was striking, with family members reacting to either comfort or criticise each other. During the sessions, the six year old daughter Liz passed tissues to those who looked upset, or distracted by using puppets from the play box to bring some humour into the room. I reflected to the family just how closely 'wired' to each other's feelings they all were and how readily they seemed to switch from their own issues to focus on the emotional intensity of others. Questions were asked that encouraged an awareness of this fusion, for example: [To Tanya]. 'I know you've become an expert at being the emotional voice for your parents but what would you say, just this once, if you could speak for your own needs?' [To Mr. Barret]. 'Do you have any sense of when you first started to take Tanya's symptoms so personally - as if they were directed at hurting you?' Mrs. Barret spoke of how their eldest daughter Roslyn had complained of feeling suffocated by being at home and how they had hardly seen her during her last few years of high school. When Roslyn was at home her relationship with her father had been highly conflictual. Now that she was at medical school Mr. Barret spoke of how proud they all were of her. He had tears in his eyes as he spoke of how Roslyn now had the chance to achieve what he had not been able to. Each of the children, to varying degrees, appeared to be triangled into their parents' emotional issues. While Roslyn and Liz were currently occupying symptom-free roles in diffusing parental anxiety, Tanya seemed stuck in a symptom-focused dance with her parents' neediness. Nuclear family triangles were tracked around family members' responses to Tanya's eating patterns. A typical sequence would be:

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Mrs. Barret watching Tanya's eating behaviour closely, with Tanya becoming increasingly withdrawn. Mrs. Barret would accuse Tanya of bingeing and purging, with the latter responding in tears, saying that nobody in the family would trust her. Mr. Barret who had been hearing a daily account of his wife's suspicions, would begin yelling at Tanya, saying what a disappointment she was to him. Mrs. Barret would feel sorry for her daughter and move closer in support. At this point, when Tanya's symptoms threatened to increase distance and tension in the marriage, Mrs. Barret would suggest ways to her husband and daughter about how they could make up.

Tanya continued to refuse to eat with the family but would set up a joint outing for herself and her Dad.

Stage 3: Expanding the view to previous generations

While seeking to draw out the repetitive patterns in the current family experience, I also look for ways to connect present tensions to multigenerational themes. Exploration of both parents' family of origin revealed potent themes that fed into the intense struggle of the nuclear family triangle between Tanya, her father and her mother. While ever Mr Barret and Mrs Barret could worry about her, they did not have to address the relationship disappointments that they had hoped would be mended through their marriage. A key task of ongoing therapy was to help the parents separate these unresolved family of origin issues from their interactions with Tanya. Both parents had been in the same middle child position as Tanya, which had intensified their identification with her. Reflecting on their own adolescence and their relationship with their parents helped Mr Barret and Mrs Barret to assume a more objective stance towards their daughter. Mrs Barret was able to stop herself encouraging Tanya to look after her father following an argument. Mrs Barret was also able to see how her striving to create a different relationship from the distant and critical one she had with her own mother was getting in the

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way of her being able to set any limits with Tanya. Mr Barret was able to start viewing Tanya as a separate person from himself or his father and was thus more able to notice her unique strengths. This shift was a particularly painful journey for Mr Barret, who recounted his memories of his alcoholic father, who had died in an emaciated state after choking on his own vomit. The parallel to Tanya's symptoms helped to make sense of his intense reactivity in their relationship. Tanya was able to hear that her parents' reactions were more about where they had come from than about what kind of a daughter she was. During therapy she struggled to cope with the shift in family patterns. She was excluded from the triangle with her parents where she had occupied a pivotal role in helping to regulate their closeness. To assist with this shift, some sessions were held with her and her older sister Roslyn, so that the sisters could establish a connection as young adults sharing similar life cycle tasks, rather than being their parents' caretakers. A couple of months down the track, she mentioned that she had been writing to Roslyn and that they were sharing information about boyfriends that their parents were not privy to. After about five months of therapy, her weight had increased to a level which put her out of the medical risk category. At this time Mr Barret and Mrs Barret felt that they wanted to focus on some of their own family of origin issues as a couple and individually. Tanya was busy rehearsing for a school play in which she had the female lead, so she asked if she could take a break from family sessions and let her parents come on their own.

Conclusion
At a time when family therapy is rediscovering its psychoanalytic roots (Quadrio, 1986; Luepnitz, 1988; Flaskas, 1993; James, 1992), it is important to be clear about the distinctions between psychodynamic and Bowenian approaches. While both models are comprehensive in accounting for many aspects of human experience, the essential difference is that Bowen's focus is not the intrapsychic experience of the individual. It focuses on the structure and workings of the system so that the individual can forge a different systemic role. While in psychoanalysis, self understanding comes through the vehicle of the therapist / client relationship, in Bowenian therapy it comes from the between-session, planned action of the 'self in the system'.

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In giving an overview of Bowen's model, this paper risks oversimplifying its in-depth formulation of family process. My aim has been to summarise Bowen's core concepts and to give a flavour of how these influence the focus of therapy. One needs to be mindful however, of potential pitfalls when using a family of origin model. Bowen's focus on the distant to solve the proximate may take families on therapeutic paths which go beyond their request for the shortest possible road to symptom relief. Without recent significant socio-political additions, Bowen's theory decontextualises relationship patterns that are powerfully informed by gender, ethnicity and class. Those who adhere to a Bowenian framework speak of the appeal of its attention to complex family patterns in both vertical and horizontal time. Perhaps what is most distinctive about Bowen's theory amongst systemic therapies, is that it directs therapists to consider their own roles in their families of origin so that they can personally experience the theory in order to appreciate its clinical application.

References
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Kerr, M., 1991. Living The Theory, The Family Therapy Networker, March-April: 39-40. Lederer, G. S., and Lewis, J., 1991. The Transition to Couplehood. In F. Herz Brown, (Ed.), Reweaving the Family Tapestry, NY, Norton. Lerner, H., 1983. Female Dependency in Context: Some Theoretical and Technical Considerations, American Journal of Orthopsychiatry, 53: 697-705. Lerner, H., 1988. The Dance of Anger, NY, Harper & Row. Lerner, H., 1990. The Dance of Intimacy, NY, Harper & Row. Lerner, H., 1993. The Dance of Deception, NY, Harper & Row. Luepnitz, D., 1988. The Family Interpreted: Psychoanalysis, Feminism and Family Therapy, NY, Basic Books. McGoldrick, M., Pearce, J. and Giordano J., (Eds), 1982. Ethnicity and Family Therapy, NY, Guilford. McGoldrick, M. and Gerson, R., 1985. Genograms in Family Assessment, NY, Norton. McGoldrick, M., Anderson, C. and Walsh, F., (Eds), 1988. Women in Families, NY, Norton. McGoldrick, M. and Walsh, F. (Eds), 1991. Living Beyond Loss, NY, Norton. McGoldrick, M., 1995. You Can Go Home Again, NY, Norton. Minuchin, S., 1974. Families & Family Therapy, Cambridge, MA, Harvard University Press. Quadrio, C., 1986. Analysis and System: A Marriage, Australian and New Zealand Journal of Psychiatry, 18: 184-187. Schnarch, D., 1991. Constructing the Sexual Crucible, NY, Norton. Schnarch, D., 1997. Passionate Marriage, NY, Norton. Toman,W., 1961. Family Constellation, NY, Springer. 3rd rev. edn, 1976.

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Acknowledgment
The author wishes to thank Kerrie James for ideas helpful in the writing of this article.

Obiective generale ale th mele http://www.familysystemstraining.com/

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