Therapist Differentiation and Couple Clients' Perceptions of Therapeutic Alliance

Therapeutic alliance has been acknowledged as one of the catalysts for change within a therapeutic relationship. The contributions of therapists' characteristics to alliance are not often studied. From a Bowen System's Theory perspective, the therapist's level of differentiation would be highly relevant to the development of a therapeutic alliance. The hypothesis for this study was that therapists who are able to take a more differentiated stance in therapy will build a stronger therapeutic alliance. To test this hypothesis, multilevel modeling procedures were performed, using data from nine therapists and 93 couple cases collected at a large, Midwestern university. Therapist differentiation of self was found to be weakly associated with the clients' perception of therapeutic alliance across the early sessions of therapy, but not in the expected direction. Although the results were unexpected, this study provides an example of the potential of examining therapist characteristics from within one model of therapy, that can be applied across various clients and various models of therapy.     

All in the family: a belated response to Knudson-Martin's feminist revision of Bowen theory

The first formal attempt at revising Bowen theory within the marriage and family therapy literature is represented in the work of Knudson-Martin (1994). Claiming that several of the theory's concepts are defined at odds with female development, Knudson-Martin (1994) reconceptualizes and expands Bowen theory to rectify these perceived shortcomings. In turn, we address several fundamental concerns with Knudson-Martin's critique and revision of Bowen theory. An alternative representation of Bowen Theory, as well as its relationship to feminist thought, is put forth. Suggestions for the field's future relationship to Bowen theory are also discussed.     

Interview With Michael Kerr

The following article was written by Dr Michael Kerr in response to questions put to him by Barbara Fraser; Linda Mackay and Lu Pease when he visited Australia two years ago. These three family therapists took it upon themselves to prepare this interview in recognition of Dr Kerr's unique vantage point on Bowen Theory and family therapy. Michael Kerr was trained by Murray Bowen in the 1970s and subsequently went on to work as faculty at the Georgetown Family centre. He succeeded Bowen as director of the centre where he has devoted his professional life to the understanding, application and extension of theory. He is the co‐author with Dr Bowen of Family Evaluation: An Approach Based on Bowen Theory (Kerr & Bowen, 1988), which remains the most esteemed text on this theory. He is also the editor of Family Systems: A Journal of Natural Systems Thinking in Psychiatry and The Sciences. Bowen's Family Systems Theory grew out of years of research from the 1950s‐1970s, which included observations of inpatient families with a schizophrenic member and using data from Bowen's own interactions with his family of origin (Bowen, 1978). The theory continues to be influential in family therapy with its most well‐known contributions being the process of triangling, the intergenerational transmission of family patterns and the concept of differentiation of self. (Brown, 1999). The following discussion from Dr Kerr brings a fresh perspective on the current applications and developments of this systems theory     

Expanding Bowen's legacy to family therapy: a response to Horne and Hicks

In response to Horne and Hicks's critique of my 1994 revision of Bowen Theory, I present an updated rationale for my work. I argue that the primary difference in my construction of emotional differentiation rests in the way "self" is constructed. I suggest that many women, persons from less individualistic cultures, and very spiritual persons develop a "connected self" that is significantly different than Bowen's image of separate selves engaged with each other. I hold that Bowen Theory privileges individuality and ignores many of the positive aspects of togetherness. I put forth an inclusive model for differentiation that equally prioritizes each.     

THE INFLUENCE OF RELATIONSHIP ENHANCEMENT TRAINING ON DIFFERENTIATION OF SELF

The effectiveness of the Relationship Enhancement (RE) program (Guerney, 1987a) in increasing functional and basic levels of differentiation of self (Bowen, 1987a) was examined. Participants were 20 married couples who received training in relationship enhancement skills over six 2 1/2-hour sessions. Measures of differentiation of self, quality of relationship, and anxiety were obtained before and after training and at follow-up. The data show that significant increases in the functional and basic levels of differentiation of self occurred, a significant increase in the quality of relationship occurred, and significant negative correlations were found between differentiation of self and anxiety.     

Artifact in client satisfaction assessment: experience in community mental health settings

Artifact in client satisfaction assessment is discussed and the results of a study of three factors thought to mediate client satisfaction ratings; (a) general life satisfaction, (b) mode of administration, and (c) psychological symptomatology, are reported. A standard client satisfaction questionnaire (CSQ) was modified to yield parallel forms and was administered orally and in writing to 92 clients in two mental health day treatment programs. Satisfaction ratings obtained from these clients were quite similar to out-patient ratings obtained in previous studies conducted in this setting and using the same measures. Oral administration of the CSQ produced 10% higher satisfaction ratings than written administration (p less than .05) and less missing data (p less than .01). Satisfaction ratings were also obtained using a simple graphic instrument. Graphic ratings were comparable to CSQ ratings. Satisfaction with life in general and level of psychiatric symptoms together accounted for 25% of CSQ variance. The implication of these findings for future client satisfaction research is discussed.     

Exploring Similarity and Stability of Differentiation in Relationships: A Dyadic Study of Bowen's Theory

Bowen family systems theory (BFST) identifies differentiation of self as a crucial characteristic that relates to one's individual and relational maturity. Bowen theorizes that an individual's level of differentiation typically remains static over time and that individuals select and pair in relationships with others who have similar levels of differentiation. This study aimed to test the hypotheses of BFST by using components of differentiation of self, emotional reactivity, and emotional cutoff, in dyadic structural equation modeling. Specifically, a longitudinal dyadic confirmatory factor analysis and structural equation longitudinal panel model were two analyses utilized to statistically test the dyadic nonindependence and stability of emotional reactivity and emotional cutoff across time. Results indicated mixed support for Bowen's assumptions regarding similarity (nonindependence) and stability. That is, small levels of nonindependence and significant stability paths across time were found. Theoretical implications and considerations for future research are discussed.     

Examining the Incidence and Clients’ Experiences of Single Session Therapy in Italy: A Feasibility Study

Single session therapy (SST) postulates that one session can be sufficient for a client to take charge of the process and work toward their own solutions. Research has been conducted worldwide corroborating SST assumptions with several mental health conditions, but not in Italy. For the first time in Italy, this paper aims to explore: (1) if the most frequent number of sessions in traditional psychotherapy (not SST) is one (Study 1); and (2) the satisfaction of clients who attend SST services and the number who consider one session sufficient to address their presenting problem (Study 2). In Study 1, the records of 476 voluntary clients referred to three different traditional (not SST) psychological services in the west-central region of Latium, Italy, were retrospectively screened, and the number of sessions attended by each client recorded. In Study 2, 85 consecutive clients who voluntarily asked for SST with seven mental health professionals across Italy received a link to an online ad hoc survey, 1–3 weeks after the consultation, evaluating their experience. Study 1 found that the most frequent number of traditional psychotherapeutic (not intentionally SST) sessions was one (124 out of 476 clients (26%). Study 2 found that 44 out of 85 clients (52%) considered one session to be enough, as they felt better or much better and chose not to attend further sessions. Of those who asked for a second session (41 clients), 33 clients (80.5%) indicated that the first session was not enough and 8 clients (19.5%) wanted to address a new problem. These results converge with previous international studies and provide encouragement for the use of SST in both private and public psychological services to address the demand for timely mental health services in Italy. Further research is needed to support the efficacy of SST and to evaluate its cost-effectiveness.     

Differentiation and Healthy Family Functioning of Koreans in South Korea,South Koreans in the United States,and White Americans

Inconsistent results have been found in prior research on the Bowen Family Systems Theory concept of differentiation of self and its application to individuals, couples, and families of different cultural backgrounds. In this regard, this study examined the impact of differentiation of self on healthy family functioning, family communication, and family satisfaction with 277 participants including South Koreans living in South Korea, South Korean‐born citizens living in the United States, and White Americans living in the United States. Multigroup confirmatory factor analysis identified the measurement invariance of a differentiation scale (DSI‐R) used for the three study groups. An analysis of covariance (ANCOVA) found significant differences between White Americans and South Koreans with regard to the level of differentiation. Results of multigroup structural equation modeling (SEM) analyses found a significant association between differentiation of self and healthy family functioning across the three groups with the American group having significantly higher differentiation than the two South Korean groups.” Implications for clinical practice and future research are discussed.     

Client Psychological Distress: An Important Factor in Career Counseling

The authors explored client psychological distress as a variable in career counseling. Forty‐two clients in a naturalistic setting were seen for a total of 290 sessions by 21 counselors‐in‐training. The results indicated that (a) 60% of the clients were psychologically distressed, (b) clients' scores decreased significantly from pretest to posttest on psychological distress variables, (c) significant linear growth occurred in the clients' perception of the working alliance across sessions, and (d) the psychological distress outcome variables were significantly related to both the first session level of the working alliance and its linear growth.     

Separations: A Personal Account of Bowen Family Systems Theory

This paper is a personal account of my own family of origin research. It explores the impact of separations from parents, nuclear family, and extended family through a Bowen family systems theory perspective using concepts pertaining to Bowen theory such as chronic anxiety, differentiation of self, multigenerational family process, and the emotional system. An outline of the process of doing research in ‘vivo’ with my mother as well as conversations with my supervisor are included. Theoretical differences between individual and system models are discussed. A Bowen theoretical approach to the anxiety of separations is investigated. The efficacy of engaging in family of origin work and the effects of thinking systems is examined in light of how it assisted me to view family members, family system disturbances, and clients’ emotional systems more objectively.     

Physical activity and psychological distress in older men: findings from the New South Wales 45 and up study

Physical activity is an important factor in healthy aging and has been shown to reduce depressive symptoms. This association, however, is relatively understudied in older men. This study was a cross-sectional analysis of the association between physical activity (Active Australia Survey) and psychological distress (Kessler-10). Participants were a sample of 17,689 men age ≥ 65 yr drawn from a large-scale Australian cohort study of people age 45 years and over (The 45 and Up Study). The likelihood of reporting high or very high levels of psychological distress decreased with increasing weekly sessions of physical activity. Compared with participants reporting no sessions of physical activity, the fully adjusted odds ratio for high or very high psychological distress was .66 (95% CI .51-.85) for men who undertook 1-6 sessions of physical activity per week and decreased to .57 (95% CI, .43-.79) for men who reported 16 or more weekly sessions. The cross-sectional findings show that older men who are more active are less likely to report psychological distress, regardless of their level of functional limitation. Further research, informed by these findings, is required to investigate causal pathways and the temporal sequence of events.     

THERAPISTS' PERSONALITIES AND THEIR EVALUATION OF THREE FAMILY THERAPY STYLES: AN EMPIRICAL INVESTIGATION

This study examined the relationship between beginning therapists' personalities and their evaluations of three divergent family therapy styles. Sixty clinical and counseling psychology students completed the Adjective Checklist (Gough & Heilbrun, 1983) and rated videotaped therapy sessions conducted by Bowen, Minuckin, and Whitaker. Adjective Checklist ratings of each subject were also obtained from three friends/family members. Self-rated personality factors of dominant-masculinity and, to a lesser extent, nurturant-femininity were significant predictors of subjects' ratings of the tapes. Gender was a factor in ranked ratings of the tapes. Other-rated personality traits were not significant predictors. Implications for therapy training and supervision are discussed.     

Differentiation of Self and the Process of Forgiveness: A Clinical Perspective for Couple and Family Therapy

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 empathic relational environment.     

Human Sexuality Education in Marriage and Family Therapy Graduate Programs

Given the likelihood that marriage and family therapists will encounter clients with sexual concerns, it is important to know how graduate training programs are preparing future clinicians to work with this domain of life. Sixty‐nine marriage and family therapy (MFT) program directors completed an online survey to examine how sexual health education is integrated into graduate training programs. Findings indicate that while the majority of program directors value sexuality curriculum, and most programs require at least one course in this area, there are barriers to privileging sex topics in MFT graduate programs. Barriers include few MFT faculties with expertise in human sexuality and marginalized sexual health topics. Implications for training MFT graduate students and their work with future clients are discussed.     

Psychological Distress and Counseling Duration of Career and Noncareer Clients

This study compared the presenting psychological symptom status and the counseling duration of career and noncareer clients. Although no significant differences in the psychological status of the two groups were noticed, career clients did attend significantly fewer counseling sessions than did clients with noncareer concerns. Implications of these findings for college counseling centers are offered.     

Which therapist perceptions best predict client outcomes? A naturalistic examination

Examining associations between therapists' perceptions of therapy sessions and client-reported outcomes in naturalistic settings (real-life therapy settings) can provide valuable guidance for the assessment, treatment, and monitoring of clients. This study included data of 1334 sessions from 127 clients (86 individual and 41 couple cases) and 15 therapists, collected at a therapy training center. Clients reported their personal functioning and individual symptoms before each session. Therapists rated clients' participation, receptivity, session progress, goal progress, and therapeutic alliance at the end of each therapy session. Multilevel Structural Equation Modeling analyses revealed that therapist-rated client participation and goal progress predicted better personal functioning, beyond clients' previous personal functioning scores. In contrast, none of therapist-rated session variables predicted clients' individual symptoms, beyond previous symptom scores. Power analyses suggested sufficient statistical power to detect small effect sizes. Findings of the current study have clinical implications for treatment planning and progress monitoring.     

Family Environment,Personality, and Psychological Symptoms in Adults Sexually Abused as Children

The current study examined the relationships between family environment characteristics, personality traits, and current psychological symptoms in adults with a history of child sexual abuse. Family environment characteristics, personality traits, and psychological symptoms in 18 abused and 18 nonabused college students were examined using ANOVAs and MANOVAs. Pearson product moment correlations were also performed. Results indicated significantly more dysfunctional family environment characteristics (inflexibility, poor cohesion, family dissatisfaction, and poor family communication) in the abused versus the nonabused group. There were significantly higher levels in the personality traits of neuroticism and openness to experience in the abused group; however, there were no significant differences in psychological symptoms when comparing the two groups. The implications of the results and areas of future research are discussed.     

Nothing is as Practical as a Good Theory: Bowen Theory and the Workplace — a Personal Application

Bowen Family Systems Theory is most commonly used to understand and predict family process. It is also applied to other potentially intense relationship systems, especially the workplace. It has been used by workplace consultants and by individuals to understand, and to manage, their own workplace functioning. This paper will draw from several key Bowen concepts to analyse common workplace dilemmas and to suggest responses that may assist the functioning of the individual and the system. The author's own experience as a manager in a child and adolescent mental health programme will be used as the case study to illustrate the theory's application.     

RELATING PROCESS TO OUTCOME IN MARITAL THERAPY

Although there are a growing number of outcome research studies in marital therapy, there is a complete absence of research on change processes, and how such processes relate to outcome. This study attempts to analyze the process of change in the "best" sessions of Emotionally Focused Marital Therapy (EFT) (Greenberg & Johnson, 1986). Client performance in therapy was rated on depth of experiencing and the quality of interpersonal interactions. The occurrence of particular change events arising from the theoretical principles of EFT was also noted. Results confirmed hypotheses that higher levels of experiencing and more autonomous and affiliative interactions characterized "best" sessions of couples who were successful in therapy. The implications for treatment are discussed.