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ANZJFT Volume 29 Number 2 2008 pp. 6169

A Bowen Family Systems therapist employs concepts of triangles and the family projection process to view a childs symptoms as embedded in the broader family patterns. This article will examine the dynamics of two family therapy cases where parents anxiously asked for their childrens symptoms to be fixed. These cases will be used to explore the common presentation in child and adolescent mental health, where the parents are concerned for their children but are also keen not to open their own can of worms. The presenting problem in the first case was violent hostility between adolescent sisters and in the second case was an adolescents anorexia. Drawing on client feedback, I reflect on the therapy process behind the divergent outcomes. In case one, the parents were willing to address their own troubled relationship and family of origin, while in case two, the parents discontinued therapy when family of origin dynamics began to be explored. The article suggests how the therapist can evoke parents curiosity about their role in anxious family patterns, without them feeling blamed. Keywords: Bowen Family Systems, therapeutic relationship, triangles In the current Australian climate of child and adolescent mental health, where individual diagnoses are matched with specific treatment protocols, the focus is often on treating the child, with only secondary attention to his/her context. For example, the Australian National Outcomes and Casemix Collection (NOCC, 2003) has seen the introduction of a suite of standard measures into routine clinical practice in child and adolescent services, in order to assist assessment and treatment planning ( Coombs, Burgess & Pirkis , 2006). For clinicians this may be onerous, while at the same time containing in its prescriptive certainty. For anxious parents, who may understandably be concerned about being blamed for their childs difficulties, this manualised child-focused trend may be less threatening than approaches which involve them. When parenting deficits are seen as primary contributors to a child symptoms, the tendency is to offer children individual treatment to assist them in building more resilience, and to use psycho-education to improve

parent effectiveness. When biological deficits are seen as causing a childs symptoms, the parents are viewed as requiring education about the nature and treatment of the illness. Family systems therapists believe that the childs symptoms are embedded in the familys patterns of reactivity, and in societal process (Bowen, 1974, 1975; Smith, 2001). Bowen theory proposes that even symptoms with a biological basis are affected by the degree to which the caregiver anxiously focuses on the child, and how the child responds in the reciprocal pattern that emerges (Kerr, 1988). An intense child focus, which can be positive or negative, presents significant developmental challenges to young people as they react to others. Being under the intense scrutiny of caregivers leaves them with little emotional breathing space to grow in thinking, feeling and acting for themselves (Donley, 2003; Maloni, 1998; Gilbert, 1999). This article will draw from parents feedback in two cases, in an effort to shed some light on the conditions that may facilitate a parents willingness to consider their own contribution to the circular relationship patterns in which symptoms have emerged. The clients comments also provide insight into how the therapist can maintain a respectful engagement with parents who are distressed about their childs symptoms, while opening up a broader systems exploration. Even when parents and other family members agree to attend the family therapy sessions, it is often difficult to shift the focus from discussing how to fix the problems of one child or the problems in a sibling relationship. From a Bowen Family Systems perspective, it is good therapy practice to ask how family members are responding to the We Dont Need Your Help, But Will You Please Fix Our Children Jenny Brown Articles Jenny Brown, Director, the Family Systems Institute, Neutral Bay. www.thefsi.com.au. Address for correspondence: jbrown@thefsi. com.au. 30 Grosvenor St Neutral Bay NSW 2089. Page 2 symptoms as opposed to What might be causing the problem? Asking the family to give personal reactions invites family members to develop more awareness of themselves (differentiation) and their impact on others, as well as their reactions to others in the system. Learning to identify ones own actions and reactions in the web of relationships is better than inviting other family members to

focus on the person with the problem through expressing their views about how to change or blame that person (Papero, 2000). The tightrope the therapist walks in this approach is to ask questions that help people to think about the impact of their own behaviours on the symptom-bearer and others, without taking on a blame the parents tone. It is quite understandable that parents who are asking for help are generally trying their best and would feel vulnerable to anything suggesting a shift in blame away from external factors or factors inherent in the child. For example if a therapist asks the parents to describe their own relationship, without clearly connecting the question to the presenting problem, this can readily lead to a battle over what constitutes the real problem there may not be any readiness to address marital issues and the family may withdraw from therapy (Nicholson, 1993: 76). The therapist confronts the common dilemma of whether to stay with the parents request to fix the child, or to expand their view to consider their possible part in the childs symptoms, which runs the risk that they drop out of therapy. On one side of the dilemma, the parents may feel relieved that a professional is willing to join them in their efforts to fix their child. On the flip side, paying attention to the childs difficulties may lay the responsibility for change on the child. It may also leave untouched the underlying relational process that maintains the problems, so that symptom relief is either short-lived or the problem focus shifts to another member of the family. A good deal of attention has been given to the trend in family therapy to exclude children, with therapists preferring to work with adults and couples. Therapists may be more anxious about managing the complexity of whole family interactions where children are renowned for spilling the beans and may lay bare a familys troubles much more rapidly and frankly than any of the adults (including the therapist) are prepared for (Sanders, 2003: 179). Other authors, including Cox, have echoed Sanders, and have made a healthy critique of exclusionary practices in family therapy, where it has become a trend for therapists to exclude children from their sessions and concentrate on the marital relationship (Cox, 1997). Little has been written however, about how to help parents to see their own part in the family system in which their childs problems have emerged. The following case discussions offer two different outcomes to my attempts to work with fix our children but leave us out of it parents. Names and identifying data have been changed in both cases. The Larsen Family

Broadening the Focus from the Childrens Symptoms The Larson family came to therapy because of intense rivalry between the two eldest daughters in a family of four. Sarah aged 19 and Cait aged 17 frequently fought over territorial issues (phone, computer and TV usage), and Caits borrowing and not returning Sarahs clothes and makeup. The fights had escalated to breaking things and hitting each other. The parents (Mark and Julie) persuaded their reluctant daughters to agree to one session of therapy. Therapy continued over a 14-month period. Seven of these meetings were family sessions with the parents and elder daughters, and two sessions involved the younger two siblings. Sarah and Cait came to three sessions on their own and one session together. Mark and Julie attended 11 sessions together and were each seen individually twice. Towards the end of therapy Julie came to five individual sessions to focus on family of origin issues. Mark and Julie wrote about their experiences of therapy at my request six months after finishing their work. The following are verbatim extracts from their feedback. Marks Initial View Almost everyone I know would look at us and say Oh, they are OK. They have a wonderful marriage and model children. Facades are a wonderful thing. To be frank, I did not go to family therapy with a view to solving my marriage problems (the burning resentment I felt for my wife). I went because of the kids. They seemed to hate each other and indulged in never-ending verbal and physical fights at every opportunity. Somewhere deep in my subconscious I probably recognised there was a link between my marriage and our kids behaviour but I did not want to think that the process would move towards the two of us I was frightened about the possibility of discussing such personal matters with my wife and a stranger. Julies Initial View I had thought that the difficulties in my marriage could be kept separate from the children and that they would not be affected if we remained civil to each other. I also thought that my husbands sexual difficulties were his problems that he needed to sort out. Equally my own problems were for me to sort out. Mark Focuses on the Presenting Problem Perhaps I felt safe behind the barrier of my kids and solving their problems. The therapist seemed realistic in tackling our problems. After getting background information we moved on to a pretty quick fix for the kids. The first step was for me to accept that I got angry which was not easy for me. The second required me to step back and identify my flash points. Next we had to notice the triangle pattern of

dealing with the kids that we were locked into. The fourth was to deliberately change this pattern. Next each child and the two of us agreed to a code of conduct based on Jenny Brown 62 ANZJFT June 2008 Page 3 reasonable behaviour on our part as adults as well as the children. What I liked about family therapy was it was very directed, focused on the presenting issues and required us to think about changing unhelpful or destructive behaviours. Our therapist said the process would not solve all our problems but would allow us to do things differently and give us a chance to understand what was going on. Julie Focuses on the Presenting Problem The therapist had the right balance between being approachable and warm and yet business-like and determined to get on with the task without being cold and detached. My children, all adolescents, liked her which shocked me They said that she treated them with respect, listened to what they said, was not condescending and seemed to understand what was going on for each of them. She was real and honest. She said things like I dont expect that you will like or even get on with your sister, some people dont but dont they think that there needs to be reasonable behaviour while you are living together. Shifting the Focus from the Presenting Problem Julie and Marks reflections emphasise the degree of anxiety that any client brings to therapy, and the importance of feeling that the therapist is listening to each person without taking sides. When the client looks at patterns in the fights rather than the content of arguments, or who was right or wrong in the disputes, s/he avoids blame and gains some hope that things could improve. In a Bowen Family Systems approach, the first goal in any therapy is to calm the escalating anxiety through a combination of engaging with each person and conveying a sense of thoughtful investigation. The therapist aims to reduce clients anxiety about the symptom by encouraging them to learn how the symptom is part of their pattern of relating (Brown, 1999: 97). As the therapist asks questions about family patterns in a neutral manner, her goal is that one or more family members are able to think more objectively about intense emotional processes, that is, for family members to reflect as well as feel (Kerr & Bowen, 1988: 284). With every effort made to be a relatively non-anxious

presence, the therapist works to avoid taking sides in the clients problems and becoming automatically and inadvertently triangled into the process (Herz Brown, 1991: 23). While the therapist endeavours not to respond either negatively or positively to the emotional reactions of clients, they do ask questions that draw out the detail of the familys concerns (Meyer, 1998: 76). Mark and Julies feedback shows how vital it is that the therapist connected with their presenting concerns in the beginning of therapy. Digging prematurely into family history or the marital relationship would most likely have intensified their tension and potentially sabotaged their engagement in therapy. (This may be different in couple therapy where a move away from marital conflict to family of origin relationships can be quite calming.) The father commented that it had been helpful to focus on behaviour as opposed to explanations and feelings. My decision was guided by Bowens approach to lowering reactive anxiety in the therapy room by focusing on what all the clients can observe and describe, rather than the therapist inviting individual subjective viewpoints. We externalise feelings by asking the client to think and talk about the feeling, rather than expressing it (Titelman, 1998: 37). This is to assist clients in becoming aware of the stimulusresponse system of feeling reactions in their relationship, including mannerisms, facial expressions and tones of voice. For example the therapist asks the client: What are the main issues that trigger your tears? rather than, Can you describe how you are feeling right now? When clients learn to observe the negative stimuli in their relationship by defining them in as much detail as possible they may be able to diffuse their responses without any instructions from the therapist (Bowen, 1978: 250). Julie and Marks feedback is a reminder of some of family therapys basics, which are often left out of academic writing. Such fundamentals of engaging a family as not expending emotional energy in trying to be liked or helpful: giving every one equal say; inviting everyones input in problem solving: and suggesting concrete tasks, such as to define a reasonable code of conduct for family arguments. It is also interesting to hear from these clients that they valued the therapists toning down of their expectations for harmonious outcomes. This intervention is guided by the Bowen Family Systems perspective that the higher the stress in families, the more heightened the pull for harmony and fusion becomes. As anxiety increases, people experience a greater need for emotional contact and closeness and, in reaction to similar pressure from others, a greater need for distance and emotional insulation (Kerr & Bowen, 1988: 121). When a parents urgent need to create idealised connection is defused, it often follows that family members (particularly

adolescents) are more able to hold their sense of autonomy without needing to deploy reactive individuating responses such as rebellion and cut-off. The Transition to Parent and Couple Issues Mark We spoke about the families we came from but did not dwell on our personal tragedies. Rather we looked for triangle patterns of communication that went around the three corners of the triangle rather than one-on-one communication. The question was: who were the oppressor, the oppressed and the rescuer in this triangle? Where did this occur in our family of origin? How did it occur that my father never spoke to his brothers or his father despite the fact that they lived close together, and does that pattern repeat in my 63 We Dont Need Your Help, But Will You Please Fix Our Children ANZJFT June 2008 Page 4 generation? What does that say about my own behaviour and how I deal with conflict or loss? The process took several weeks but it was a satisfying process because I was learning and progressing as the weeks passed. More importantly there were signs of progress, signs of co-operation, fewer arguments, signs of co-operation, less bad language. Finally the children were done and the moment of truth arrived. I had to deal with my marriage. We had already touched on major aspects of our relationship that affected the kids. There was a gentle but urgent inevitability about moving to the darker recesses of our marriage. Julie I learned to see the pattern we kept repeating with the girls. When the two of them fought, Mark would get angry, especially with Cait. I would then try and appease and smooth over the conflict, which ended up increasing the tension between Mark and me. Dealing with the issue of warring children was less threatening than beginning with our marriage. However very quickly we were helped to see that there were serious unresolved issues that we as a couple had never addressed. Over the years we had developed some very negative habits of not communicating directly (I was especially not good at this), of blaming, scapegoating and feeling entitled to our bad behaviour because of the others bad behaviour. The most helpful thing for me was to understand that

tension and difficulties anywhere in the system affected the whole family. It is clear from the parents comments that staying with the presenting problem of their daughters fights was productive in helping them to see how they were inadvertently involved in maintaining the destructive patterns. Exploring sequences of who does what during the violent incidents was helpful in opening up a systems view for the family (Breunlin, Schwartz & MacKune-Karrer, 2001). This avoids subjective explanations of the conflict, which potentially take the therapy into a debate about who is most to blame. A focus on the patterns or process of the fights helped the parents to reflect differently on their part in the dynamics. Their feedback reveals that both parents began to see that Marks rapid, angry intervention, followed by Julies attempts at mediation and damage control, left both of them feeling unsupported with bottled up resentments surfacing. It also left both daughters caught in a cycle of negative affect that was larger than their own territorial battles. When family members can stand back and view their reciprocal patterns of reactions, little room is left for blaming individuals. Rather, all relationships [are] seen as the product of the participation of all its family members all families are composed of people struggling to survive in a sea of anxiety (Kelly, 2003: 143). If the focus had been on the content of the fights, or an effort to find a solution to disagreements, this would have continued previous unsuccessful attempts to change the daughters behaviour. The therapist generalises principles of healthy disagreement and codes of conduct to all family members, rather than holding any family member more responsible for change than the others. If the adolescents had been dismissed prematurely from the sessions, their dismissal might have constituted a form of ecology chopping in which the therapist misses the rich feedback offered by multiple perspectives. As family therapists ... having as many family members as possible participate in therapy makes it easier to identify constraints (Breunlin, Schwartz & MacKune-Karrer, 2001: 366). If the therapist had worked only with the parents at this early stage, it is likely that their defensiveness about their own relationship could have escalated. Without the useful descriptions from the daughters about what they observed to be the behaviour of other family members, it would have been easy for the parents and therapist to align in an effort to focus on fixing the sibling relationship. Such a narrow child focus threatens to intensify the very patterns of reactivity which can keep the problems from being resolved. An over-focus on the childs symptomatic behaviour may assist in maintaining the child in a triangled

position that functions to divert anxiety from what is not being addressed in the parents relationship. This predictable detouring of parental anxiety is now receiving research attention in the therapy field (Fivaz-Depeursinge & Favez, 2006). Bowen described how this occurs, using his concept of the family projection process where over a period of time a child/children responds anxiously to the tension in the parents relationship, which in turn is mistaken for a problem in the child. A detouring triangle is thus set in motion, as attention and protectiveness are shifted to the child (Brown, 1999: 96). When symptoms are present in one or more children, it may be that anxiety from other subsystems gets bound in one particular subsystem through an intense positive or negative focus on a child. Anxiety in the marriage can be diffused by this focus, but when tension is high, the projection process intensifies, creating an emotional crowding effect for the child, which ultimately gives the child less emotional room to develop (Donnelly, 2003: 148). It was interesting to hear how readily the parents came to see the pattern of triangles where they stepped into predictable roles of the mediating peacemaker and the outside oppressor. Julie could see how her stepping in to smooth things over undermined Mark and aligned her with her daughters. Mark was beginning to see that the sisters arguments gave him an indirect way of expressing how angry he felt at being excluded by her protective and confiding relationships with the children. Triangles provide an expression for predictable patterns in families, Jenny Brown 64 ANZJFT June 2008 Page 5 when the inevitable anxiety in a dyad is relieved by involving a vulnerable third party who either takes sides or provides a detour for anxiety (Brown, 1999: 95). The therapist uses her knowledge of triangles to ask questions that reveal the presence of alliances, such as: Who gets involved in the argument? When do they step in? What do they say and do? How is it responded to? Who would be perceived as Caits supporter? The mediator? Who is invited to help Julie in this effort? How does this happen? This is done as a form of joint research with family members, where they are invited to look for clues to the repetitive patterns in which they are involved. A collaborative approach that enlists the clients curiosity and problem-solving resources means that the therapist is not

working too hard in a solo effort to address the familys problem. It seems from Julie and Marks reflections that they found this time of joint exploration an important ingredient in increasing their commitment to the therapy process. Readiness to Work on the Couple Relationship Mark Early on we had to hear each others pain and empathise with it without being defensive or accepting the blame (our typical pattern). Hearing, really hearing your own part in someones pain is a very sobering experience. I saw the pain I had inflicted on my wife for being a workaholic being emotionally absent from my family and there was the revenge I had inflicted on my wife by withdrawing from sex because she had inflicted pain on me. We had to choose whether or not our marriage was worth saving Did we want to continue to live with the patterns that had brought us to where we were? For me, this meant resuming sex and not behaving in a revengeful way For my wife it meant less complaining, trusting me to change and helping me back into the family. Julie I needed to acknowledge my own anxiety and overfunctioning concerning the children. I needed to be more honest with my husband and with myself and focus more on what I needed and wanted and ask for it rather than trying to have those needs satisfied in a more manipulative and less honest way. I found it extremely difficult and confronting to discuss the intimate details of our sexual relationship It had become such a huge unspoken secret, just talking about it diffused a lot of the anxiety. It is clear in these excerpts that Julie and Marks anxiety about the pain in their marriage was high. The therapist does not respond anxiously to what is being said by taking sides or by trying to relieve the pain. This increases the likelihood of each spouse being able to hear the other with some objectivity. The therapist guides the shift in the session from anxiously reactive behaviour to thoughtful reflective discussion; she asks attentive questions that invite the clients to think about their relationship patterns. It is not easy for a therapist to maintain a sense of calm in the face of anxious defensive parents/spouses. However, this is likely to be the most significant contribution a therapist can make to the parents willingness to risk exploring their relationship. Therapists, standing on the sidelines of the natural system and serving as consultants, try to keep themselves from entering or being pulled into the family emotional field, while developing a reality-oriented, open and hopefully warm and respectful relationship with the individual who

is consulting them (McGoldrick & Carter, 2001: 283). The Outcome of Therapy Mark We have continued over weeks and months now maintaining our changed behaviour I am sure there will be times when we fall back into bad habits but the emotional bank account between us is filling up. Julie We are more able to talk honestly about what we want and discuss our way when there are differences. We are not the Brady Bunch, but there is an honesty and calm in our family now. Our kids can just be themselves we know there will be difficult times but I feel as a family and as individuals we are better equipped to know how to deal with them. The outcome of this case reflects a work in progress as opposed to a neat fix of the problems. Symptoms did abate in this instance. The number of violent incidents decreased; the eldest child ceased to display depressed mood and suicidal ideation. The parents report that they went beyond symptom relief to acquiring some new resources and awareness for dealing with the inevitable stressful situations that must be negotiated in future. The parents feedback highlights how helpful it was for them to stay with identifying patterns, without blaming any one person in the family. In interactional patterns there is no clear starting point or cause, just predictable cyclical responses to a stressful situation in which the distancers make just as much contribution as the central active players. When, in response to what was discussed in the session, the therapist invited the clients to think clearly about choices, she also appears to have facilitated a helpful engagement for both parents and their daughters in the early phase of the work. The work for change is not left in the hands of the therapist when she encourages the parents to focus their main effort of observing, clarifying, discussing and experimenting during the period in between sessions. It is clear from the parents reports that the therapist had an important role in validating the courage it took to risk doing things differently. I helped the parents to sustain efforts by preparing them for change back reactions. This is when members of the system react in a manner that increases anxiety and seems to pressure the individual to return to their predictable role. The systems-oriented therapist cautions clients not to 65 We Dont Need Your Help, But Will You Please Fix Our Children ANZJFT June 2008 Page 6

underestimate family members reactions to any change, efforts which are likely to be intense, and will take you off guard if you are not prepared (McGoldrick & Carter, 2001: 296). The Peters Family Failure to Broaden the Focus Prior to beginning family therapy with me, five professionals had treated Tricia Peters anorexia. While Gary and Susan Peters demonstrated great commitment to being involved in their daughters therapy, for over a year and a half they appeared to stay locked into the view that therapy was about helping the therapist to fix their anorexic daughter. Their defensiveness intensified when they were invited to consider whether or not family dynamics might be contributing to their daughters intransigent symptoms. Over a 20-month period there were 32 sessions with the identified patient Tricia and her parents Susan and Gary, four sessions with the whole family (including two older siblings who had left home), five sessions with the siblings, four sessions just with the parents, three motherdaughter sessions, four individual sessions with the mother and four individual sessions with the daughter Tricia. While Tricia enjoyed periods of improved weight and self-directed activity (such as a part time job), these improvements seemed to be followed by an increase in Susans anxiety symptoms and distancing. In response Tricia became distressed by her mothers condition, blaming herself for causing her mother so much trouble. Gary would then be drawn into a more active role in supporting Tricia to relieve the burden on Susan. In turn, Tricia would intensify her restrictive food regime and act more helpless. In therapy, I made a conscious effort to explore these patterns without any blame, however Susans sensitivity to judgment remained high throughout the work. The following are her comments about her experience six months after she terminated family therapy in favour of sending Tricia to another individual therapist. A professional we had earlier consulted told me to stop sticking my nose into things. He told me I had a lot to answer for. He wanted to be Tricias best friend. In most of Tricias treatment I felt very judged as a parent. I was shocked that anyone could question me as a bad mother and I had been exactly the same parent to both my daughters. My husband Gary didnt feel judged. I think because he has such a calm personality, therapists thought he was very together, but he has a lot of eating disorder problems in his family. I felt biases from you at times, but because you were very professional I always felt I could feed this back to you. I dont think you understood enough how much stress I

carried into starting therapy, from nearly having my daughter die and from feeling shut out of her treatment. The way I let it all out in therapy is not a true indication of how I am most of the time. I know you thought that our extended family problems were important in the end but we didnt find it helpful. We had already addressed everything and it probably should not have been talked about in front of Tricia. The most helpful thing about family therapy was that it helped us all to understand the pain and torture Tricia was going through. And I never would have understood how to help her around food. The least helpful thing was feeling judged by what I did in an hour session. Sometimes I was scared to say anything. Susans comments are certainly salutary reminders to me, and to any family therapist. Clearly her experience of feeling like an outsider in therapy triangles was not conducive to her being able to consider alternate perspectives on the patterns of her daughters symptomatic behaviour. In line with a Bowen Family Systems view that at least 50% of the work of therapy is the therapists effort to stay out of the clients emotional system (McGoldrick & Carter, 2001: 283), it is vital that I examine my own contribution to the context in which one family member continued to react defensively. I did at times get drawn into trying to get Susan to see that her own anxious reactions were closely linked to Tricias symptom levels. While descriptions of behavioural sequences did seem to provide evidence for this, it is important that members of the family are the ones that speak this view rather than the therapist becoming anyones mouthpiece. Had I been able to patiently persist with exploring process in the family, asking each person to comment on what they were seeing and learning, I would not have needed to instruct anyone, even in the mild or indirect ways that I occasionally found myself doing. The family system would then have decided when it was ready to expand its view of the problem. Bowen theory constantly reminds the therapist to pull back from over-functioning for family members: One of the most constructive attitudes a therapist can have when he/she approaches a clinical family is to regard the family as a tremendous resource for the therapists learning If a therapist can ask questions that do not express an opinion or assume an answer, then she/he can learn about the family and in the process the family can learn about itself (Kerr & Bowen, 1988: 292). It is possible to theorise that Susan may have been particularly sensitised to perceiving blame based on previous experiences and/or feelings of denied guilt. A psychoanalytic perspective could understand Susans experience of

being blamed as her projecting self-blame onto the therapist (projective identification) (Flaskas, 2005). From a Bowen theory perspective, these client sensitivities or intrapsychic defenses would not be discounted, but the therapist chooses to make adjustments to her own part in contributing to the clients one down position. The focus is on the therapists self-awareness in the therapeutic relationship, rather than on working in the transference with a client (Brown, 2007). Jenny Brown 66 ANZJFT June 2008 Page 7 My choice to focus on my own contribution to the impasse in this case is in keeping with Bowens emphasis on the therapists effort to work on her own differentiation. If I were to focus on the pathology of a family member, I could easily be replicating what the parents are doing in focusing on their childs problems rather than being willing to look at what they themselves can change in their reactions to the child. According to Bowen, a goal in therapy is to help the client to discover the part the self plays in the system and to modify the system by controlling the part self plays (Bowen 1971: 237). To facilitate the clients self awareness, the family therapist makes this a personal goal: In order to achieve this a good deal of work on the self of the therapist is required in learning how to stay engaged with a client without getting drawn into alliances, over responsibility or withdrawing (Brown, 2007: 14). The invitation for the therapist to subtly take sides is ever-present. For me to stay de-triangled, my feedback to the family would have needed to draw on the reports and comments of family members and not on my own opinions. It would then have opened up the space for each family member to speak directly to each other about what they needed in their relationship, rather than me unwittingly becoming anybodys advocate. When Gary adopted the mediator position between his wife and daughter instead of speaking on his own behalf, I can now see that his conflict-avoidant stance was as much a contribution to family intensity as was Susans anxious focus on Tricia. This awareness of triangles would also have helped me to avoid placing undue responsibility on Susan to tone down her anxious focus on Tricia. Without a view of triangles involving both parents, therapists can too easily blame the mother for simply doing what she has been socialised to do: That she (mother) complies to the extent that she does is

then often seen as her pathological need to serve or control or to remain central (Carter, 1988: 28). Gary as the distancing silent male is as much a part of the repeated patterns of tension in the family as is overinvolved Susan. Susans feedback also reminds me of the importance of keeping in mind the history of the familys relationship with other professionals. If a family member reports that other professionals have taken sides, it is useful information to the therapist about how they themselves may lose neutrality. An Adequate Level of Symptom Relief Susans feedback also reminds me that the first task of family therapy is to calm down the anxiety in the system in order to achieve a reasonable degree of symptom relief (Brown, 1999). Because of the serious and chronic nature of anorexia, the therapist would do well to remember that a parents heightened anxiety is completely understandable, and that this arousal is likely to undermine cognitive awareness until there is a reasonable period of symptom stability (i.e. until the condition is no longer life-threatening). This is consistent with the assumption that when symptoms are severe and longstanding, the arousal level of the anxious individual tends to override the cognitive system and behaviour becomes increasingly automatic (Papero, 1990: 42). Whenever symptoms remain severe, anxiety will most likely be too high to permit expanding the familys view to broader system or family of origin issues. Bowen did caution us about the difficulties of shifting the anxious focus on a child when the intensity of anxiety is high. In such cases he preferred to dismiss the child as quickly as the parents could tolerate it and to give priority to the relationship between the parents. The usual approach in family therapy is to soften the intensity of the focus on the child and to gradually shift the focus to the parents, or between the parents and families of origin. This might be relatively easy if the process is not intense, or it can be so intense that little is accomplished beyond symptomatic relief and easing the pressure for the child (Bowen 1975: 298). Susan did remark on the unhelpfulness of exploring family of origin cut-offs. I had begun to explore the parents cut-off from the husbands extended family on the hypothesis that a cut-off with the parent generation can fuel the anxiety in the parentchild relationship primarily because the blame and sensitivity to others that contributed to the cut-off in the previous generation can now slip into blame and sensitivity between parent and child in the new generation (Donley, 2003:151). While the cut-off between the generations may significantly feed anxiety in the nuclear family, the therapist needs to ask questions that make this connection relevant

to the client, such as What do you think has been the impact of lack of family support on your relationship with your daughter? Susan also reminds me how important it is for the parent with the most proximity to the symptombearer to be able to vent her distress and to know that the therapist has heard this without judgement. At the same time, the therapist remembers that the most important validation needs to come from within the family rather than from the therapist. Conclusion The therapist walks a fine line in any case where parents insist that their child be fixed without addressing broader family issues. The balance between respecting the parents view, and the potential unhelpfulness of increasing the burden of responsibility on the child, is a core dilemma for the therapist. Parent feedback from these two cases provides useful insights into a therapeutic process that can lead to reduced defensiveness and consequent willingness to focus on the self in relationship with others, rather than on the child. 67 We Dont Need Your Help, But Will You Please Fix Our Children ANZJFT June 2008 Page 8 The twin concepts of family projection process and triangling in of a symptomatic child or children provide useful theoretical guides to the conduct of family therapy when the family ask me to fix the child. While these assumptions do provide such guidelines, the presence of intense parental anxiety can still result in the therapist being subtly drawn into trying to impose these ideas on the parents prematurely in an attempt to shift their view of the problem. As Kerr and Bowen state: If a therapist reacts to a familys anxiety by telling people what to do, the resources of the family will quickly become submerged. If a therapist does not react, but just helps a family define the nature of the problem with which it is confronted (especially the relationship process that create and reinforce it), the resources of the family will resurface (Kerr & Bowen, 1988: 283). Parents will undoubtedly continue to present in therapy saying that We dont need your help, but will you please fix our child? In the current climate of mental health, individual diagnoses and treatment are privileged, which reinforces the parents expectation. A Family Systems approach helps us respond to the fix our child request because we take the view that parents are not the cause of their childrens symptoms, but rather, have the ability to provide some leadership and can therefore initiate some

change in their own behaviour that has a ripple effect through the family. Less anxious parents who are willing to take responsibility for their own difficulties may not automatically resolve the childs problems, but may set the stage for a childs behaviour to be less of an automatic reaction to their parents and more an expression of their individuality. Postscript Three years after the Peters family completed therapy, Gary (father) initiated his own therapy to deal with the cut-offs in his extended family and to learn how to relate to Tricia in the face of her continuing anorexic symptoms. The following year Susan returned with Gary and they are now addressing their part in the anxious escalations that are occurring in their daughters treatment system. Four years after the finish of therapy with the Larson family, the eldest daughter Sarah (aged 23) started individual therapy to assist her when one of her parents was diagnosed with a serious illness. References Bowen, M., 1971. Family Therapy and Family Group Therapy. In M. Bowen, 1978, Family Therapy in Clinical Practice, NY, Aronson. Bowen, M., 1974. Societal Regression as Viewed Through Family Systems Theory. In M. Bowen, 1978, Family Therapy in Clinical Practice, NY, Aronson. Bowen, M. 1975. Family Therapy After Twenty Years. In M. Bowen, 1978, Family Therapy in Clinical Practice, NY, Aronson. Bowen, M., 1978. Family Therapy in Clinical Practice, NY, Aronson. Breunlin, D., Schwartz, R. C. & MacKune-Karrer, B., 2001. Metaframeworks. Transcending the Models of Family Therapy, San Francisco, Jossey Bass. Brown, J., 1999 . Bowen Family Systems Theory and Practice: Illustration and Critique, ANZJFT, 20, 2: 94103. Brown, J., 2007. Going Home Again: A Family of Origin Approach to Individual Therapy, Psychotherapy in Australia, 14, 1: 1218. Carter, E., with Walters, M., Papp, P. & Silverstein, O., 1988. The Invisible Web, Gender Patterns in Family Relationships, NY, Guilford. Coombs , T., Burgess, P. & Pirkis, J., 2006. Routine Outcome Measurement in Australian Child and Adolescent Mental Health Services: The Lessons of Implementation. Paper presented at the17th World Congress of the International Association for Child and Adolescent Psychiatry and Allied Professions

Melbourne , September 2006. Cox, N., 1997. Treating Parents and Children Together: A Feminist Look at Exclusionary Practices in Family Therapy and in Child Psychotherapy, Women in Therapy, 20, 20: 89100. Department of Health and Ageing, Canberra, 2003. Mental Health National Outcomes and Casemix Collection: Technical Specification of State and Territory Reporting Requirements for the Outcomes and Casemix Components of Agreed Data, Version 1.5. http://www.mhnocc.org/ resources/national_outcomes_and_casemix_collection. Donley, M., 2003. Unravelling the Complexity of Child Focus, Family Systems, 6, 2: 147160. Fivaz-Depeursinge, E. & Favez, N., 2006. Exploring Triangulation in Infancy: Two Contrasted Cases, Family Process, 45, 1: 318. Flaskas, C., 2005. Psychoanalytic Ideas and Systemic Family Therapy, ANZJFT, 26, 3: 125134. Gilbert, R., 1999. Connecting with Our Children: Guiding Principles for Parents in a Troubled World, NY, Wiley. Herz Brown, F. (Ed.), 1991. Reweaving the Family Tapestry, NY, Norton. Kelly, B., 2003. Toward Undoing Cutoff: A Twenty-Five-Year Perspective. In P. Titelman (Ed.), Emotional Cutoff: Bowen Family Systems Theory Perspectives , NY, Haworth Clinical Practice Press. Kerr, M., 1988. Chronic Anxiety and Defining a Self, The Atlantic Monthly (September): 3558. Kerr, M. & Bowen, M., 1988. Family Evaluation: An Approach Based on Bowen Theory, NY, Norton. McGoldrick, M. & Carter, B., 2001. Advances in Coaching: Family Therapy with One Person, Journal of Marital and Family Therapy, 27, 3: 281300. Jenny Brown 68 ANZJFT June 2008 Page 9 Maloni, J., 1998. Emotional Dysfunction in Children. In P. Titelman (Ed.), Clinical Applications of Bowen Family Systems Theory, NY, London , Haworth. Meyer, P. H., 1998. Bowen Theory as a Basis for Therapy. In P. Titelman (Ed.), Clinical Applications of Bowen Family Systems Theory, NY, London, Haworth.

Nicholson, S., 1993. Troubled Children, Troubled Marriages Whose Problem Is It? ANZJFT, 14, 2: 7580. Papero, D., 1990. Bowen Family Systems Theory, Needham Heights, MA, Allyn & Bacon. Papero, D., 2000. Bowen Systems Theory. In F. Dattilio, F. & L. Bevilacqua, (Eds), Comparative Treatments for Relationship Dysfunction, NY, Springer. Sanders, C., 2003. Living up to our Theory: Inviting Children to Family Sessions, ANZJFT, 24, 4:177181. Smith, W. H., 2001. Child Abuse in Family Emotional Process, Family Systems, 5, 2: 101126. Titelman, P., 1998. Overview of the Bowen TheoreticalTherapeutic System. In P. Titelman (Ed.), Clinical Applications of Bowen Family Systems Theory, NY, London , Haworth. 69 We Dont Need Your Help, But Will You Please Fix Our Children ANZJFT June 2008

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Differentiation of Self and the Process of Forgiveness: A Clinical Perspectivefor Couple and Family Therapy
Wayne E. Hill,' Cathy Hasty^ and Carol J. Moore' ' East Carolina University, United States of America ' Presbyterian Hospital, Charlotte, United States of America In this article we explore the role of differentiation of self in facilitating forgiveness in the context of couple and family relationships. Differentiation is defined from the Bowen perspective as the ability to connect with others without being excessively emotionally reactive to the ebb and flow inherent in all significant relationships (being able to connect to others yet also being able to self-regulate). Forgiveness is described as the releasing of an emotional injury via a complex psychological and relational process that is less an act of will than a discovery or possibility through understanding and empathy. Differentiation of self is related to emotional intelligence and empathy. The developmental and relational benefits of such are illustrated and discussed. A rationale for viewing differentiation and forgiveness in a contextual, historical, and relational attachment paradigm is suggested. Relevant clinical cases illustrate the dynamics of differentiation and forgiveness as discovery in the context of an understanding and empathie relational environment Keywords: differentiation, forgiveness, empathy, emotional intelligence, attachment theory, couple and family therapy

In an Esquire magazine interview with Michelle Obama's brother, college basketball coach Craig Robinson shared this story. Twenty years ago his sister asked Robinson to play a game of pickup basketball with Barack Obama. Michelle Robinson had recently begun to date Obama and wanted her brother's assessment of him. Robinson reported that he learned a great deal about Obama from their first game together. He stated that Obama was a quietly confident team player. He passed the Address for correspondence: E. Wayne Hill, Department of Child Development and Family Relations, College of Human Ecology, Rivers 266, East Carolina University, Greenville, NC, 27858. E-mail: hillea@ecu.edu THE AUSTRALIAN AND NEW ZEALANDJOURNAL OF FAMILY THERAPY
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ball when he should have passed, and he took the shot when he shotild have taken it. Obama did not try to impress Robinson by constantly passing the ball to him just because he was dating his sister. Robinson reported that he gave his sister a favorable review of Obama's character (Klosterman, 2009). Robinson's impressions of Obama from that pickup basketball game provide a constructive and practical illustration for understanding the concept of differentiation of self. Differentiation involves managing anxiety and retaining one's individuality while remaining in a significant and effectual relationship with others. The role of differentiation in understanding system dynamics and family relationships has been well documented by the seminal work of Murray Bowen (1978). The concept of differentiation was a cornerstone of his theory. Bowen advocated that the degree of anxiety along with the degree of integration of the self were crucial aspects in understanding family relationships. The essence of differentiation is the ability to connect with others without being excessively emotionally reactive to the ebb and flow inherent in all significant relationships. The more highly differentiated person stays connected without overly accommodating significant others or abandoning them when relational tensions arise. The more differentiated person does not deny authentic dependency needs, but does not depend excessively on others for acceptance and approval or solicit dependency from others. The less differentiated person seeks either to please or unduly accommodate significant others or to distance from them emotionally. The more highly differentiated individual can be both autonomous and relationally connected without being overwhelmed by emotion when relationships become strained. Feminists have critiqued the split between autonomy and dependency that is often fostered via gender bias in our culture. Lerner (1988), for example, states: Dependency needs are a universal aspect of human experience. The struggle to achieve a healthy integration of passive-dependency longings and active autonomous strivings constitutes a life-long developmental task for hoth men and women. Yet despite such universality, the very word dependency is more frequently associated with the female sex. Indeed, dependency, like passivity, has heen considered the very hallmarkof femininity (p. 156). Lerner implies that differentiation shotild not be identified solely with autonomy for either sex, but with a balanced view of self that allows for a context of appropriate expression of dependency and autonomy without undue anxiety. Kerr and Bowen (1988) suggest that individuality and togetherness are biologically rooted counterbalancing life forces. There is a clear equilibrium between autonomy and connectedness analogous to what Angyal (1965) referred to as autonomy (self-regulation, governing and expansion) interacting with homonomy (being connected to and perceived as significant to others). The individuated autonomous person still needs 'to mean something to someone else' (Angyal, 1965,

p. 18). In other words, the more highly differentiated person maintains his or her autonomy while also being appreciably connected to others. According to Bowen (1978), the more highly differentiated person has the ability to separate emotion from cognition feelings from thinking. This allows the person to stay connected without being reactive. Friedman (1985) suggests that
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Differentiation of Self and the Process of Forgiveness such separation is about being able to remain playful versus being overly serious or anxiously helpful. Schnarch (1991) contends that it is about remaining in emotional contact with significant others while retaining the ability to function autonomously. Highly differentiated individuals possess what has been called emotional intelligence, which involves inner knowledge and appreciation of one's own emotions, while simultaneously recognising and empathising with the emotions of others. (Goleman, 1995). Highly differentiated individuals understand that human behaviour is complex and results from many variables rather than one single cause. They have learned not to take human frailty and inappropriate human behaviour personally. This helps to insulate them from emotional reactivity and to avoid detrimental conformity, upheaval, control struggles, or emotional estrangement (Beavers, 1985). Empirical findings demonstrate support for Bowen's theoretical concept differentiation of self For example, Skowron & Friedlander (1998) reported that 609 adults participated in a series of three studies, in which higher levels of differentiation reflecting less emotional reactivity, emotional cut-off, and fusion with others predicted lower chronic anxiety, better psychological adjustment, and greater marital satisfaction. In addition, Skowron, Wester and Azen (2004) found that for college students differentiation of self partially mediated the effects of academic and financial stress and exerted a direct influence on their adjustment. Using qualitative and quantitative methods a 5-year longitudinal study conducted by Klever (2003) found that higher levels of intergenerational fusion correlated with higher levels of nuclear family symptomology. Congruent with Klever's findings a study reported by Murray, Daniels, and Murray (2006) found that more severe symptoms of fibromyalgia were significantly associated with higher levels of perceived stress, lower levels of differentiation of self and higher levels of emotional cut-off. According to a review by Solomon, Dekel, Zerach, and Horesh (2009), empirical findings also indicated that more highly differentiated individuals experience lower levels of avoidant and intrusive thoughts, general psychiatric distress, behavioural dysfunctions, trait anxiety, and depression than are experienced by those who are not highly differentiated. They suggest that these findings support Bowen's claim of an inverse relationship between chronic anxiety and differentiation. Elevated levels of anxiety inhibit poorly differentiated persons from effectively coping with stressful events and render them more at risk for psychological and relational problems. It appears that less differentiated individuals have difficulty tolerating the anxiety of ambivalence, which is inherent in all significant relationships. This would inevitably impede the forgiveness process. Beavers (1985) suggests that because human beings are limited and finite, a social role of either absolute power or helplessness prohibits many of the needed satisfactions to be found in human encounters. Highly differentiated persons do not take a one up or one down position with those with whom they interact. They recognise that human perception and discernment are subjective and that no person possesses the unchallengeable truth. Such individuals, according to Beavers (1985), possess an 'abiding uncertainty' that allows them to doubt, pose questions, and seek

solutions rather than cast blame. Higher levels of differentiation, therefore, involve
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the ability to tolerate ambivalence with an understanding that human differences, frailty, weakness and imperfection need not be viewed as evil or perversity. Given such an understanding of differentiation, it is plausible that the forgiveness process would be enhanced in significant relationships where a higher degree of differentiation is evident and impeded when differentiation is weaker. We view differentiation of self as a fluid concept that has plasticity, much as the brain possesses plasticity and is thus pliable, variable or adaptable. We believe that differentiation of self is not stagnant, inert or static but open to growth, maturation and further development when growth conditions are prevalent, which is a divergence from Bowen who saw that functional differentiation is plastic and can shift temporarily in response to the emotional climate while basic differentiation is more embedded in intergenerational biological patterns and is thus more difficult to shift. We concur with Bowen that differentiation of self can never be fully or completely achieved for any individual, however higher levels of differentiation clearly allow more self and other acceptance, which encompasses the heart of a forgiveness process. We hold the view that forgiveness can be enhanced when differentiation is ameliorated via a therapeutic clinical context of corrective emotional/relational experiences. In the following we introduce clinical cases in which forgiveness was enhanced by therapeutically augmenting weaker levels of differentiation and clearly impeded when differentiation was not improved.

The Significance of Forgiveness

Forgiveness is the act of releasing a perceived wrongdoing, mistake or oversight. It overcomes hostilities and resentments through a process of personal and relational healing that enhances differentiation and intimacy. Walrond-Skinner (1998) suggested that forgiveness enables conflicted intimate relationships to be renewed because the process itself has a restorative and salutary impact. Archbishop Desmond Tutu (1998) declared that 'forgiveness is an absolute necessity for continued human existence' (p. xiii). Martin Luther King Jr. (2010) echoed this sentiment when he declared, 'He who is devoid of the power to forgive is devoid of the power to love ... Forgiveness is a catalyst creating the atmosphere necessary for a fresh start and a new beginning' (pp.4445). Hargrave and Sells (1997) and Sells and Hargrave (1998), as well as McCullough, Pargament, andThoresen (2000), found evidence for the salutary effects of forgiveness for difficulties that originate from anger, anxiety, depression, family-of-origin issues, sexual abuse and compulsions, personality disorders, guilt, drug abuse, broken marital relationships, and mental health in general. Some earlier studies cited by McCullough et al. (2000) linked forgiveness and moral development. More recent studies have found significant positive effects of forgiveness training for a variety of psychosocial factors. These effects include less anger, fewer feelings of hurt, malice, and estrangement, reduced hypertension, and reduced physical symptoms of stress. These studies suggest that skills-based forgiveness training may prove effective in reducing anger as a coping style and in reducing perceived stress and physical symptoms. This benefit would assist immune and cardiovascular functioning in daily living and reinforce the bodymind connection.
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(Harris, Luskin, Benisovich, Standard, Bruning, Evans & Thoresen, 2006; Luskin, Cinzburg, & Thoresen, 2005; Tibbits, Ellis, Piramelli, Luskin, & Lukman, 2006). In a recent review of the forgiveness literature, Legaree, Turner and LoUis (2007) propose three primary dimensions through which therapists might understand forgiveness. The first dimension considers whether forgiveness is essential, and thus helpful. The second dimension asks whether forgiveness is an intentional (willed) decision, and the third dimension examines the benefits of forgiveness. In their concluding comments they raise an important ethical question: How can the therapist be responsible (differentiated) to his or her own position on forgiveness, yet also be sensitive to the client's values, ideals and ethics regarding forgiveness? Even well differentiated persons are imperfect human beings. The reality is that every individual faces the need to be forgiven and to forgive. Thus therapists and clients alike must determine their own position on forgiveness. We believe and propose that when individuals can respond to the inevitable ups and downs of relationship with a greater degree of differentiation between thoughts and feelings, between self and other, and are able to manage anxiety and retain their individuality, they will in essence be better able to forgive and accept forgiveness.
Differentiation and Forgiveness as Process

Hargrave (1994) referenced the work of Boszormenyi-Nagy in conceptualising forgiveness from a relational/contextual perspective. From such a perspective, issues of trust and justice are believed to be critical concepts of a 'relational ethic' that allows family members to experience relationships as reciprocal, balanced, and trustworthy. When justice and trust issues are violated in families, the victims are left with the painful realisation that the persons on whom they are most dependent cannot be fully trusted. Such experiences lead to feelings of rage and shame, which in turn lead to behaviours of over-control or chaos. The work of forgiveness offers an opportunity to restore balance, release blame, and promote reconciliation. An injury that stimulates a high reaction often has reference points in the person's history. As therapists we seek to uncover and reveal the real and imagined injuries, as well as the key reference points for those injuries in the injured person's history. The process of forgiveness includes a willingness to explore and embrace the negative emotions that invariably are involved in our relational wounds and wounding, particularly the emotion of shame. Karen (2001) described this process poignantly in the context of a parentchild relationship: The child does something that irks the parent. He may be fussing or tantrummy or just extremely annoying, as children can be; often it's the child's anger that the parent cannot tolerate. But whatever the cause, the parent loses his temper, goes into a rage, perhaps becomes physically violent. Now the parent feels guilty. He wants to erase what's just happened. He wants to be forgiven. But he cannot accept responsibility or blame. It will make him too ashamed, too terrible about himself. So he doesn't fully soften; he doesn't relocate his love. He doesn't say to himself, 'Oh my God, I've been a monster to this little person I love, and now 1 want to do everything I can own up, apologise, soothe to nurse this sobbing child back to repair. This avenue feels closed to him. (pp. 8485)
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Such shame and guilt may prompt parents towards less differentiation with their children, thus revealing the fusion in their relationship, where they struggle to separate their emotional distress from their values as a parent. A cycle can occur in which the parent attempts to repair the relationship by giving into demands until the parent is pushed to breaking point and repeats the original injury. This is an example of fusion or the lack of differentiation.

Hill (2010) references the clinical scenario of a male client who struggled for years with alcoholism and reported how difficult it was for him to ask for his wife's forgiveness, even when he wanted to do so and strongly believed that forgiveness would be granted. When the client spoke of the detrimental consequences of his drinking and his guilt for disappointing and hurting his wife, he reported strong feelings of shame. It became increasingly clear that his difficulty was not in asking for forgiveness per se, but in reawakening and re-experiencing the shame that the request for forgiveness invariably triggered. Relational healing came when he became able to acknowledge his shame via increased functional differentiation (an enhanced ability to separate the emotion of shame from his thinking/being and subsequent behaviour). With the help of his therapist he discovered that he did not have to be ontologically defined or controlled by the emotion of shame. The therapist sought to ask him critical existential questions to help him separate his emotions from his principles and thus think about what he truly wished to do about the different messages of each. This realisation allowed him to ask directly for his wife's forgiveness. This uncomfortable yet necessary process allowed him to rediscover and reestablish relational trust and reciprocity with his wife. The move toward asking for forgiveness requires the courage to re-experience the shame, in a context where the process is healing and beneficial rather than toxic. The inability to acknowledge shame or to differentiate the emotion from the person is what makes the shame toxic. Shame that is openly expressed facilitates the discovery of wholeness and relational healing, which is the embodiment of forgiveness. Transparent vulnerability enhanced by differentiation frees people to share more deeply. This is true not only for intimate partners, but also for parents who have said or done hurtful things to their children. Acknowledging the wrong and facing the shame may be agonising, but the benefits are life giving. Those who are courageous enough to engage deeply in the process of forgiveness discover the agony and the ecstasy of more intimate relationships. Appropriate vulnerability is an asset to establishing intimacy, not a liability. Writing from a sociological perspective, Tavuchis (1991) advanced this observation. He suggested that apology is always laborious and painful, yet when accomplished it becomes a transforming miraculous gift and 'the more so because the gesture itself reiterates the reality of the offense while superseding it' (p. 8). This is a wonderfial example of the well differentiated, forgiving and forgiven individual.
Forgiveness/Differentiation as Discovery via Empathy

Regardless of how forgiveness is defined, it is a concept that conveys complex cognitive, emotional, and relational processes. Karen (2001) suggests that one critical element is that of agency. Does an individual possess authority over his or her actions
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related to the ability to forgive? One's capacity or ability to forgive may reveal one's willingness or ability to recognise and accept one's own broken humanity and the broken humanity of another. The better differentiated individual embraces his or her own vulnerabilities as well as those of others. However, to suggest that one can simply will oneself to forgive another does not do justice to the complexities of human beings and to the relationships or differentiation of self Karen (2001) declares, 'WTien forgiveness becomes the battle cry of moral and emotional health, we are no longer respectful of people's wounds and people's struggles' (p. 14). Patton (1985) embraces the complexity of forgiveness by suggesting that forgiveness is not an act but a process of discovery. Patton declared, 'human forgiveness is not doing something but discovering something that I am more like those who have hurt me than different from them' (p. 16). The process of forgiveness, as

Worthington (1998) suggests, requires the humility to see oneself as equally as fallible and needy as one's offender. Such cognitive and affective empathy, which were central to differentiation, form the core wisdom needed to embrace and discover both our shared humanity and forgiveness. A male client reported being angry when his wife got a speeding ticket as she raced to get a babysitter less than a mile from their home. They had been hanging wallpaper and their toddler needed attention while they were trying to finish what had become a frustrating project. When the therapist confirmed the hypothesis that her rush to get back was an effort to assist him, he became much more empathie and understanding. She became more empathie of his anger when she realised that he became anxious because her late return ignited a fear that she had been in an accident. Understanding the origin and context of each other's distress, which Bowen theory stresses through seeing one's own part in the emotional upset via cognitive and affective empathy (differentiation) thus fostered relational healing (Hill, 2010). An underlying understanding and affirmation of differentiation is echoed in Kurtz and Ketcham (1992) when they declared: Uniting these experiences is the discovery of commonality the sense of having rejoined the human community for both revelations involve finding a new relationship with 'other'. Our need for forgiveness is thus profound, for it is the experience of being forgiven that pulls us out of the stagnating mire of self-centered focus on our own pain and pushes us back into the not-necessarily-pure but at least circulating stream of community and commonality (pp. 218-219). A powerful connection appears to exist between the experience of being forgiven and one's capacity to forgive. Patton (1985) embraced this view when he proposed: ... forgiveness is discovered not in trying to forgive, or in being instructed ahout the process of forgiveness, but in the larger process of reconciliation which is concretely expressed in human life through overcoming one's shame and discovering who one is heyond the experience of injury and brokenness. The person who concentrates on whether he or she can forgive is unlikely to do so (p. 148). Without the ability to comprehend or recognise emotional needs in others, which is the essence of empathy and differentiation, caring and compassion become thwarted or stalled. Indeed, Goleman (1995) asserted that the root of emotional intelligence lies in one's empathie ability. Empathy involves the ability to read
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another's feelings via non-verbal cues: tone of voice, gestures, facial expressions, posture, and the like. Goleman cites research that reported the benefits of being able to read accurately the feelings of others via non-verbal channels. These benefits included better emotional adjustment and stability, more popularity, more sociability, and more sensitivity. Empathy requires and develops self-awareness and lies at the heart of higher levels of differentiation. The more aware and discerning one is toward his or her personal emotions, the more skilled one is in reading and responding to the emotions of another. Goleman (1995) declared that 'failure to register another's feelings is a major deficit in emotional intelligence, and a tragic failing in what it means to be human. For all rapport, the root of caring, stems from emotional attunement, from the capacity for empathy' (p. 96). This perspective is also supported by the work of Gottman and DeClaire (1998), who assert that emotional intelligence is important to a child's overall development. Indeed, they suggest that emotional intelligence is a better predictor of how children will do in life than almost anything else. They found evidence that emotionally intelligent children can soothe and calm themselves more effectively,

have higher academic achievement scores in math and reading, have fewer behaviour problems, and have better physical health and more meaningfiil relationships with people in general. They also report that emotional intelligence appears to be a buffer against certain types of stress. Parental empathy and attunement (emotional synchronicity/differentiation) play an essential role in a child's learning to monitor his or her emotions and to recognise and respond to the emotions of others. From a therapeutic standpoint, empathie attachment processes can help to facilitate healing in adult relationships. For example, Kohut (1984) spoke of the need for 'corrective emotional experiences' in the therapy context where empathie mirroring is experienced, barriers of shame are diminished, self-soothing is increased, and healing begins to occur. A more accurate description would be 'corrective relational experiences' that have emotional, cognitive, and relational consequences. Healing in each dimension would thus promote increased differentiation and the corresponding empathie capacity to discover forgiveness as given and received. Empathy increases differentiation thus providing the catalyst for experiencing forgiveness as discovery. Worthington (1998) references an incident in the life of Corrie Ten Boom that aptly illustrates this dynamic. Ten Boom and her family experienced the horrors of the Nazi concentration camps during World War II. She was the sole survivor from her family, and following the war toured the world sharing a message of forgiveness. On one occasion, following her lecture on forgiveness, she encountered an old man who confessed to being a guard in one of the prison camps. He extended his hand and asked Ten Boom for forgiveness on behalf of those he had harmed. She recognised the man as one of the guards where she had been a prisoner. Ten Boom's first reaction was rage and resentment. She thought of her sister who had died in the camp. How cotild she dismiss Betsie's slow horrible death with a mere handshake? Ten Boom then had a different reaction, prompted by a reflective and empathie internal dialogue. This differentiation process prompted her to recognise and acknowledge her own humanity and need for forgiveness, which she had refer50 THE AUSTRALIAN AND NEW ZEALANDJOURNAL OF FAMILY THERAPY

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enced in her lecture. She reported that she could not in good conscience withhold her forgiveness. She took his extended hand and said in complete sincerity, 'I forgive you, brother, with all my heart' (Ten Boom & Buckingham, 1974, p. 57). Via empathy and humility, which is at the heart of differentiation. Ten Boom was able to extend forgiveness to the former prison guard. Karen (2001) reminds us that the need to forgive is an authentic aspect of being human, but we are not always willing to forgive because doing so requires feeling painful emotions or uncovering painful memories. There may be complicated connections with other painful emotions and events. In the previous example. Ten Boom had to separate (differentiate) forgiveness from the fear of betraying her sister by forgiving. We may need to be reminded of the importance and benefits of forgiveness. To provide corrective relational and emotional experiences would likely provide the renewed relational and empathie context for anxiety reduction and the unfolding discovery of forgiveness for self and other. However, from a clinical perspective, to focus on forgiveness as the most critical issue or to push family members to adopt an intentional or immediate forgiveness stance would meet with resistance at their initial level of emotional functioning/differentiation. This is congruent with Bowen's idea of differentiation of self, which he suggested was related to emotional functioning and maturity. In fact, Bowen (1978) believed that parents can project their emotional immaturity onto their children

and that 'the child who is the object of the projection is the one most emotionally attached to the parent, and the one who ends up with a lower level of differentiation' (p. 477). Thus, the issue is not emotional attachment per se but the nature or quality ofthat attachment. As Ainsworth, Blehar, Waters, and Wall (1978) have advocated, healthy or secure parent/child attachment does not promote dependency, but autonomy, which is also critical for increased differentiation of self
Ambivalence and Empathy in Relationship to Forgiveness and Differentiation

For persons who have become estranged, forgiveness is one of the most critical processes for facilitating restored relational and emotional well-being. Yet forgiveness is not a simple issue of 'will power' or merely 'letting go' but a complex process that can usher in a deep healing process within and among persons. Bringing awareness of the forgiveness process into the therapeutic environment is part of the therapeutic process in general. Forgiveness is an essential element in human relationships regardless of context. In addressing the attributes of healthy couples. Beavers (1985) suggested that when relational mistakes are inevitably made, healthy couples do not translate obvious human frailty and imperfections into evil and perversity. This allows couples to disagree and blunder without fear of isolation or abandonment. More highly differentiated individuals understand that human beings make mistakes. The truly important issue is not whether errors will be made, but how families cope with them when they occur. The issue of emotional intelligence and the ability to bring an empathie understanding are critical and, as Beavers (1985) suggested, a tolerance for ambivalence is essential. He asserted that respect for
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ambivalence in family members is foundational for understanding and resolving intimate relationship conflicts. Beavers (1985) declared: It is both useful and reassuring to know that people are indeed ambivalent about anything that is finite and yet needed such as loved ones, jobs, support systems. Ambivalence can be resolved but not eliminated. Healthy couples know this and tolerate outbursts of bad feelings from spouse and children without using such negative experiences to 'prove' evil intent, (p. 71) Since human imperfection is a given, the experience of ambivalence is normal and expected in intimate relationships. With this understanding, empathy and differentiation become essential for facilitating a process of forgiveness. Thus, therapists who work with family members to facilitate a more well differentiated and empathie relational environment in which ambivalence is openly acknowledged and respected will more likely enhance the discovery of forgiveness (Hill, 2001).

Empathy, Differentiation and Forgiveness as Process

In addressing the issue of forgiveness as process in marital and family therapy, Coleman (1998) and Gordon, Baucom, & Snyder (2000) suggested two different yet similar models for facilitating forgiveness. The importance of attending to and enhancing differentiation and empathie relational experiences and understandings were implied in both models. Coleman (1998) declared that all hurts involve loss and described three types of loss: (1) loss of love by death or breakup, (2) loss of self-esteem, and (3) loss of control or influence. The forgiveness process begins when the person is able to identify the specific loss that has occurred. The second phase of this process of forgiveness involves confronting the one who injured you in order 'to confirm that you were deeply hurt and to make clear that the offense cannot be ignored' (p. 89). Thus, the process of forgiveness will be different for each person all starting from a different place on the differentiation-of-self continuum.

Colman (1998) described the third phase as wrestling with the question 'why' in order to make sense of the suffering. This often encompasses a dialogue between the offending party and the injured party. It is in this dialogue that critical differentiated empathie experiences can be facilitated to augment the forgiveness as discovery process. Note the implications for differentiation of self in Coleman's comments: The dialogue to understanding sometimes reveals to the injured person that he or she too was hurtful and played a role in the relationship problem that led to his or her being deeply hurt by the other family member. Such a discovery does not excuse the behaviour of the injurer, however. But it might make the injured party a bit more understanding and lead to a better idea of what changes each party needs to make to heal the relationship, (p. 91) The fourth phase in Coleman's (1998) model was forgiving, which he described as renewing trust in the relationship. The final phase, letting go of the pain of resentment, he described as an arduous process that will eventually lead to discovering new possibilities for the relationship as a direct result of the suffering.
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In a similar vein, Gordon et al. (2000) conceptualised forgiveness as a response to interpersonal trauma. They viewed forgiveness as emerging in stages in the context of dealing with the trauma. Stage one concerned the impact or consequences of the trauma. Stage two encompassed the search for meaning and new understanding of self and other in relationship. Stage three involved progressing with one's life with a renewed set of relationship beliefs. Embedded in both of these models is an implicit understanding and appreciation of the necessity for the grief and loss created by injury or trauma to be confronted if forgiveness is to be discovered. In addition, a corrective and more differentiated empathie relational experience between the injured parties is crucial for facilitating relational healing and forgiveness. This process can only be facilitated in a therapeutic context where the parties feel safe and secure enough to explore their relationship amid the grief and loss created by the violation (Hill, 2010).
Enhancing Foi^iveness via Differentiation

Providing a therapeutic environment where personal histories can be explored, injuries and wounds shared, and differentiation and empathy enhanced can usher in a resolution process that facilitates forgiveness. Hearing the experience of the offending person is as important as hearing the story of the offended person. Hurts and injuries on both sides need to be shared and heard in an empathie context that focuses on the themes of common humanity that emerge in the sharing. Only in this way ean reeiproeal emotional attunement and enhaneed differentiation be fostered and experieneed. The therapist provides a holding environment for the intensity of the injury, assisting the person who is injured to reformulate that experienee within a more differentiated internal dialogue, thus ushering in a greater ehanee of justly hearing the other as well as being heard. For example. Hill (2001) referenees a female elient who forgot to feed the dogs one morning and ealled her husband during his rather rushed luneh hour for his assistanee in feeding them. When her husband responded to her request with obvious irritation, she was hurt. The therapist, seeking to enhance differentiation, suggested that perhaps the husband examine his irritation in the context of the overall situation, which led the husband to aeknowledge that his irritation was more about his unexpeeted ineonvenienee than frustration with her. In the context of recognising her husband's individuality and empathising with his inconvenience, she was able to further differentiate, and thus let it go and forgive. Her husband was also assisted with his own empathie response when he was able to acknowledge

directly to her that he understood how his comments made in frustration were deemed hurtful by his wife, who already felt annoyed with herself for forgetting to feed the dogs and disliked having to call her husband. WTien each spouse had an opportunity to touch the other's common humanity (via enhanced differentiation), both were more open to relational healing and forgiveness. An additional clinical ease further illustrates how enhaneed differentiation ean foster the forgiveness process. A middle-aged man came home stressed by workrelated issues and sought comfort in a eold glass of milk. He diseovered that only about an ounce of milk was left in the milk container. He became angry and threw
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the container across the kitchen, spilling the milk onto the floor. His wife walked into the kitchen, curious about the upheaval. He promptly scolded her for not purchasing an adequate supply of milk. Normally this interaction would have escalated into an all-out uproar. She would have been incensed by his behaviour and accusation and defended herself However, their previous work in therapy yielded a much more differentiated alternative response on her part, which enabled them to discover a deeper understanding and respect for self and other. Rather than defend herself, his wife responded with an observation/inquiry, 'It seems to me that there is something else going on that doesn't have to do with "Got milk"? What's bothering you? Did something happen at work?' He was startled by her clearly differentiated and caring response and began to share with her about his day. An unpleasant encounter with his supervisor had left him feeling frustrated, devalued, and angry. His misplaced projection and indignation regarding the milk was the proverbial straw breaking the camel's back. He subsequently acknowledged and apologised for his tantrum and asked for her forgiveness while cleaning up the spilled milk. As a result, they had a helpful and meaningful conversation that was mutually and relationally beneficial. She felt satisfaction in her differentiated response by staying calm under attack, thus separating thinking and feeling. As she came to understand his day and to empathise with his distress, she became more amenable to forgiving his tantrum. He found her clearly differentiated empathy and understanding inviting, allowing him to be more authentic and open in sharing his feelings created by the distressing work experience. Thus, they discovered in each other's differentiated responses a genuinely human connection that strengthened their bond and enhanced their level of intimacy (Hill, 2010). Part of the work of differentiation requires identifying the driving forces in one's behaviour through reflection, rather than acting out the emotional residue from other events. The wife's differentiation may invite the husband to engage his 'observing ego' to modulate his emotional reactivity before he acts out in another sequence of events. Of course, facilitating forgiveness is much easier when the hurts are not overwhelming or deep. The scenario of a husband who has an affair with his wife's best friend is more problematic. Some hurts run so deep that healing and forgiveness take much more time, effort, and patience. The process may have some similarities, but the intensity and the outcome may be radically different. Hill (2010) reported consulting on a case in which a middle-aged husband, when confronted by his wife about an unexplained hotel charge on their credit card, acknowledged that he had been having an affair. He had never had an affair in the 20 years of their marriage. His father had died six months prior to the affair. He felt noxious shame and expressed deep regret. Her pain, loss, and sense of betrayal were acute and understandable. He asked her to forgive him, but it was not an easy

process for either of them. It was only when she heard the context of her husband's grief in light of his family history that she was able to move toward the forgiveness process. She learned that when his father died unexpectedly (his first major family loss), he felt emotionally abandoned. He sought comfort for his grief outside his marriage, as he had
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Differentiation of Self and the Process of Forgiveness often done when he felt hurt or abandoned as a child. In the context of his family of origin, he had learned that comfort is not found within the family. When his wife saw his sense of shame and his pain related to his unresolved grief in this context, she was able to empathise with him in a new way. Subsequently, she was comforted by understanding that what had happened was more about him and his history than about her failure as a wife. Thus, she was able to embrace his humanity and move toward forgiveness. Her insight and forgiving stance reflected an enhanced/higher level of differentiation of self. He was able to acknowledge his shame and empathise with her pain. He came to understand how she had experienced the hurt as a statement about her worth and value as a person and as a wife. Consequently, they touched each other's shared humanity (via increased differentiation) in ways that enhanced their empathy as well as intimacy, facilitating forgiveness. Common sense humanity is at the heart of differentiation of self where mutual respect seems warranted. The word 'respect' implies a re-visioning process to see someone in a different (more differentiated) light and gain a new perspective. This occurred for a client who discovered forgiveness by taking such a differentiated view, awakening empathy even though the offending party was not available for reconciliation. In this case, a woman in her late thirties was distraught by the sudden death of her mother. She had been alienated from her mother for many years and had always hoped there would be reconciliation in their future. The woman's mother had been an alcoholic who neglected and eventually abandoned her 8-year-old daughter. The daughter grew up believing that her abandonment was because she was not lovable. Now, the hope of any measure of reconciliation had died with her mother. Upon the suggestion of her therapist, the daughter began to investigate the details of her mother's life from childhood. Her grief was ameliorated afiier discovering from relatives the hardships that her mother had endured during her childhood and early adult years. Slowly, through empathy with her mother's life circumstances, the young woman began to respect (the re-visioning of improved differentiation), to understand and to accept her mother. She came to realise that her mother had probably done the best she could, given her own horrific history of abuse and neglect. Her mother had not fully understood the depth of her own pain or the pain she had caused her daughter. The daughter realised that her mother had not neglected or abandoned her because of some innate flaw or inadequacy in her. Through increased differentiation, understanding, and empathy, she was able to embrace their common humanity and begin the forgiveness/healing process. The authors of this article suggest that the concept of differentiation of self implies that relational healing and forgiveness emerge on the common ground of shared and flawed human experiences. One cannot rationalise behaviours that violate important intimate boundaries or intentionally injure with harsh words or hurtful deeds. However, family therapists and mental health providers who stress an empathie and more differentiated understanding of the historical context of persons can enhance a shared human connection within relationship systems. From this humane and enhanced differentiated perspective, forgiveness can be more readily

discovered within and between persons.

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