Two Concepts of Family Therapy, Term Paper Example

Abstract

In the present paper, two situations of a female patient are analyzed from the perspective of two concepts of family therapy. The first one is transgenerational therapy of Bowen with its interconnection to his other concepts included. The second one is a narrative therapy of White and Epson. Both of therapies are applied to each of the described cases and issues are analyzed in the framework of those concepts. The structure of the paper is simple. Firstly, the initial issue is analyzed in the context of two theories, then the second one.  Finally, instead of conclusion the main evaluation of those concepts and their limitations is explained.

Key words: transgenerational therapy, narration, alcoholism, distancing, dependence.

Theory Application Paper

In the field of therapy and psychology in general, analysis of family interconnections and influences is the most difficult to make mainly because the situation in each family is unique and number of members and their behavior patterns depend on case to case basis. That is why the best way to deal with the family therapy is to combine various theoretical approaches and concepts, and see which combination might be the most workable and effective in specific cases. It also depends greatly on which type of therapy is preferred by the therapist himself. This is usually conditioned by his inclinations to a specific mode of behavior and character. The most successful outcome of the therapy is when therapist and his patient’s needs correspond to each other’s ability to give and take, and when the concept applied corresponds to the actual situation. In the present paper, two situations of a female patient are analyzed from the perspective of two concepts of family therapy. The first one is transgenerational therapy of Bowen with its interconnection to his other concepts described. The second one is a narrative therapy of White and Epson. Both of therapies are applied to each of the described cases and issues are analyzed in the framework of those concepts. The structure of the paper is simple. Firstly, the initial issue is analyzed in the context of two theories, then the second one.  Finally, instead of conclusion the main evaluation of those concepts and their limitations is explained.

The first case.

The case of female is characterized by a very deep psychological traumacaused by living in an alcoholic family. Since the main mode of family behavior was denial of problems and lack of any feelings expression, the girl had grown reserved and performing in her behavior in the outer world. According to Bowen, she was not able to proceed with the differentiation of self in the process of growing up, because of her parents’ negligence to her and her younger sister; she was always trying to get their approval or any kind of attention (Bowen, 1976). In this context, irrespective of trying to be better than her parents and more expressive in her family feelings, she followed their pattern of emotional behavior. She began to deny feelings to them just as they were denying having any feelings to her. Subsequently, she ended up suppressing her real feelings and not allowing herself to develop further as an independent personality. In this context, the distinction between feelings and thoughts was   not entirely made (Bowen, 1978). Most likely in her therapy sessions, her narration would be interrupted by emotional feedbacks to irrelevant details or description of some most painful situations without any emotions. In this context, the therapist would have to be concentrate on how emotions were flowing from one state to another one (Bowen, 1978).

The example of parents’ irresponsibility and lack of a good practice to follow had influenced her perception of right and wrong, responsibility and irresponsibility. Although she wanted to be opposed to her parents by the right manner of behavior and responsibility, her desire to rebel against them and to attract their attention had pushed her out of the family environment to the social substitution of that environment (Bowen, 1976). In this context, it is crucial to outline that she could not have strong relationship and feeling of responsibility about her sister, because subconsciously, she still felt jealous that her sister was younger and that she was loved more. Even if it was not the case, she still was seeing her sister as one of the reasons why her parents did not have feelings for her (Davis & Butler, 2004). Subsequently, she was looking for another environment where feelings and relationship could be expressed and developed. In her search for intimacy and lack of knowledge of how to build any relationship, she had found a rescue in the sex, which ended up with unwanted pregnancy.

Particular feature of the teenage pregnancy and early sexual life is that she could not differentiate her own feelings from those of her parents (Metcalf, 2011). In this case, she had transformed her parents’ self-hate and self-denial into herself. In this context, her perception of the situation was that her parents acted in that way because she did not deserve anything better, just as her parents thought of themselves (McGoldrick & Carter, 2001). In this context, the main transitional emotional feature of the family is a lack of self-esteem and continuous denial of reality and family itself. From one point of view, lack of actual feelings and family ties were contributing to her differentiation from the family, but, in fact, inability to express herself in her family had resulted in her complete fusion into it. She would constantly compare her-self to her parents and follow their pattern of emotional and actual behavior (Bowen, 1976). In this context, Bowen’s nuclear family emotion process is highly influential. Her parents had passed her motional numbness, feeling of irresponsibility and desire to escape the reality. In other words, they had passed her quite a negative emotional view on the surrounding world (Davis & Butler, 2004). Since her reaction to the family situation never took form of an open conflict (she was hiding her feelings), her implications were to become either physical or emotional. In the end, they were both. Physically, she became damaged through the early sex, pregnancy and further drug abuse. Emotionally, she could not find her self-esteem and develop attachments with anyone.

From the perspective of narrative therapy, under conditions of the first case, it would be extremely difficult for the patient to externalize from the family situation and name the core problem of her case. At that point, she would be going through the process of problem’s denial. She would consider that the main problem was her parents’ alcoholism and not their psychological state which resulted in the family disorder (White, 1989). In this context, her “dominant story” would refer mainly to her parents and their influence on the family environment and herself. Through her narration, she would confirm Bowen’s suggestion that she could not differentiate herself from her family and that she had fused with it. Thus, the main story would refer rather to her parents than herself. Subsequently, a therapist would need a few sessions in order to get to her a topic of narration and even longer in order to achieve externalization and comprehension of the problem itself. Morally and mentally she was not be mature enough to face the truth right away or even express it to someone (Metcalf, 2011). Another problem might be her lack of trust, so a therapist would have to win it without shifting of his and her roles.

Concerning the narration of her values and perception of ideal life, she would either describe something opposite to her family, from a movie or anything else, or she might suggest that it just could not happen that way and she was incapable of having anything good in her life. In this respect, self-denial and deprivation of any possible positive outcomes would be dominant in her narration (White, 1989). Particular feature would be that she might not mention her sister at all or depict her in a very negative manner as a burden in her life, just as her pregnancy. Most likely she kept the child, but not because she felt compassion, mainly in order not to be like her parents. In any case, narrative therapy would take a long time for her to externalize from her family life, mainly because she had never done that before, and because she was living the life of her parents and did not know how to do it in her own way (White, 1989).Subsequently, it would be extremely painful to get to the core problem of her case – lack of power and control over her life as the main multigenerational transition. If that comprehension was achieved at the point of the first case, she would not get herself into further, more complicated family relationship.

The second case.

The structure of her new family and relationship with its members is as disorganized and misbalanced as her previous case, but this time her problems have implications on her children and her own family. From the story of the second case, it becomes clear that she could not overcome the lack of self-confidence and develop strong self-esteem. The fact that she  has two children of her own and her husband has his own adult ones suggests that she could not build a long-termed relationship with other men and that she could not develop trustworthy feelings to anyone of her age, even farther or farthers of her children (Bowen, 1976). In this context, she was following a learned pattern of behavior – sexual relationship without attachment, which she believed to be enough for a relationship to last. Another reason for such behavior might be the fact that she lacked appropriate sexual education from her parents.

The reason why she had married an older man is because she needed someone to take care of her as an archetypal farther and an older family member. Her inability to separate from her home family emotionally had resulted in her inability to built togetherness in her own family, particularly when it referred to her daughter (Bowen, 1978). The reason of this conflict is that her daughter understands the inferiority of her mother’s position in the new house, inappropriateness of her previous sexual life and of course drug abuse. Becoming exactly, what she did not want to be – a copy of her parents, she had alienated her daughter and could not provide her with an appropriate example to follow. Thus, she le=ft her daughter in the same position as she was once. In other words, she continued her parents’ process of transgenerational transition of emotional weakness and powerless behavior (Davis & Butler, 2004). The reason why she is in a better relationship with her son is because she is not really a pattern for his behavior, since he accepts her as his mother and not a farther to follow in his future family life development. Most likely he is also a younger child who had experienced fewer hardships than his sister.

The lack of power and control over her life are also the reasons why she is treated so badly by her step-children. Her inability to stand for herself and desire to please everyone, which is originated in her childhood desire to please her parents and attract their attention, is the main reason why she is exploited by her step-children (Bowen, 1978). Another crucial point is that her good relationship with the husband is due to his mild and accommodating character. She was looking for protection; that is why she had chosen an older man. She was too weak and uncertain of herself to marry someone with a strong will and self-esteem.  In other words, they were attracting each other by similarity in characters and modes of behavior. If they were not similar in their giving characters, his children would have been more respectful to his wife and he would be more active in protecting her (Metcalf, 2011). On the other hand, it is also unclear what happened to his previous wife or wives. His children might view the new wife as one more “new wife”.

The second case shows the deterioration of the first one – the disruption of the first family had resulted in girl’s inability to develop a healthy family of her own. In the end, her parents had transferred their powerlessness, denial of reality and lack of self-respect and self-esteem to their daughter and to their grandchildren as well (Metcalf, 2011). Although the influence on the third generation is a bit different, lack of a healthy family and absence of balance between togetherness and separateness would result in the distortion if their own lives and future families (McGoldrickn & Carter, 2001). In case of the daughter, a classical emotional cut-off might follow, and the son might develop imbalanced dependence on females in his life, since he had no strong male example to follow. In case of the patient, if she does not take therapy seriously, she might get into a deep depression and return to drug abuse or even worse commit a suicide (Bowen, 1976).

The narrative therapy under those conditions might be more workable than before. Since the time of her actual contact with parents and childhood trauma is a long-gone past, she would be more eager to externalize from her participation in the events and begin to analyze them more objectively. She would be finally able to narrate the “dominant story” without continues emotional breakdowns (White, 1989). The main reason why she might be able to abstract from her reality is because of her children. She would no longer see herself as that neglected child, but might be able to see her own children being neglected as a child in her story. Thus, she would be able to make a parallel of her behavior with her parents. At this point, the therapist would have to help her understand the eternal problem of her family, which was not an alcoholism, but powerlessnessand subsequent lack of emotions (White, 1989). In this context, after the assertion and comprehension of her inherited problem, it would be helpful for her to see her parents again and try to talk to them. Most likely they would not get the same clearness of thought as she expected, but this meeting would be crucial for her to understand, forgive them and finally let them go and start living the life of her own (Metcalf, 2011).

Critics instead of conclusions.

It may seem that both concepts are quite workable in their interpretation of both cases and that success of each theory is undeniable. It is so only from the first glance. Each therapy has its limits and terms of application. In case of Bowen’s therapy, the main limitation is its theoretical character and rather explanatory nature. While it can explain any aspect of human relations through the nuclear family emotional processes, it cannot resolve all aspects of their implications or even explain them to the patient (McGoldrick & Carter, 2001). The main reason is that progress of each patient is individual and therapist cannot tell his patient straightforwardly what his true problem is. That is why in the first case, the therapy would work only if all family members were involved. It would be difficult toachieve, since parents were life-long alcoholics and the teen was very unstable and reserved. On the other hand, comprehension of the transgenerational nature of the problem needs a mature mind, even if it is influenced by childhood traumas. In other words, the main limits of the concept are its theoretical direction and dependence of possible success on individual’s age.

In case of narrative therapy, unlike transgenerational one, it is more practical and is based on patients ability to tell stories of his/her life. The problem is that the corner stone of the therapy is an assumption that the patient is not entirely destroyed by his core problem and that the process of externalization is possible. In the first case, it was obvious that externalization in the young age is difficult to achieve, particularly under conditions when an individual is incapable of differentiating her feelings and frustrations from those of her parents (Roberts, 2005). It takes time and different environment for the patient to start thinking and telling the story in a different manner. Another problem of this therapy is that participation of the therapist is more limited than in Bowen’s concept (Metcalf, 2011). Thus, when an individual is not ready to face the truth he is not facing it, because the therapist is not getting involved much. Subsequently, in order to get an efficient result a combination of therapies should be applied, just as it was shown in those cases.

References

Bowen, M. (1976). Theory in the practice of psychotherapy. In. P.J. Guerin. (Ed.). Family Therapy. New York, NY: Gardner.

Bowen, M. (1978). Family therapy in clinical practice. New York, NY: Aronson.

Davis, S.D., & Butler, M.H. (2004). Enacting relationship in marriage and family therapy: A conceptual and operational definition of an enactment. Journal of Marital and Family Therapy, 30(3), 319-333.

McGoldrick, M. & Carter, C. (2001). Advances in coaching: Family therapy with one person. Journal of Marital and Family Therapy, 27(3), 281-300.

Metcalf, L. (2011). Marriage and Family Therapy: A Practice- Oriented Approach. New York, NY: Springer Publishing.

Roberts, J. (2005). Transparency and self-disclosure in family therapy: Dangers and possibilities. Family Process, 44(1), 45-63.

White, M. (1989). Selected Papers. Adelaide: Dulwick Centre Publications.