FEST Writing Group

I am working on a journal article for Family Systems about the research I did on family system shifts and weight loss and the potential for clinical science to grasp the impact of the family emotional system by tracking shifts in the family system.  I am posting here the presentation I did at the 2015 symposium last November.  Several people had asked me based on earlier presentations and writing what I mean when I talk about shift in the family system and that is the question I aimed to address here.  It should be possible to specify any shift significant enough to affect a family member’s emotional, behavioral or physiological functioning in terms of theoretical variables that describe how family relationships are organized,  function and change as a system and I tried to move this piece in that direction.  Any comments are welcome, but especially observations about the family emotional system and how shifts happen and impact family members.

Symptoms and Shifts in the Family System

Presented at the Symposium 2015

Laura Havstad

 After having spend thousands of hours sitting with families it became increasingly impossible to see a single person without “seeing” his total family sitting like phantoms alongside him.” Murray Bowen, Family Therapy in Clinical Practice, pp. 152 

Family system shifting in the background
Unobserved, its impact
Ubiquitous.      – Laura Havstad  

 

Introduction

Bowen’s observation of anxiety shifting between family members, and how the patient’s symptoms changed as the anxiety shifted off the patient onto another family member, was basic in recognizing the family as an emotional unit. The topic of shift goes back to basic early observations of the family emotional system in Bowen’s NIMH research study of families with a schizophrenic child living in the hospital for round the clock observation back in the mid1950’s. While the term shift is not anywhere indexed in Bowen’s book of collected papers, a search of the text within Kindle turns up 100 instances of the use of the term shift. The NIMH study project went on to define how anxiety shifts between family members as a function of the ways the family managed its anxiety, that is, by way of automatic relationship patterns between family members. The automatic relationship patterns relieved some family members of tension while increasing it for the patient. These observations formed the basis for family psychotherapy which was designed to see if it would be possible to produce stable shifts in the family relationship system in order to change the chronic emotional pressures on the patient stemming from the relationship patterns in the family, in order to moderate the patient’s distress and their symptoms of emotional illness

Bowen’s observations of the phenomenon of shift in an early report from the NIMH project 1956, in Jack Butler’s edited volume. Pp. 28-29 Individual Project Report, Major findings, 26 months into project

 

Here are examples Bowen noted very early in the project by hospitalizing the whole family of the young patient: He noted from family therapy sessions“ Repeated instances of the family problem shifting from one family member to another. The most constant pattern seems to be for “normal” family members to say, “We are normal. The trouble with this family is the patient,” and for the patient to respond, “I am abnormal. The trouble with my family is me.” In this state, the patient has the greatest anxiety and other family members have low anxiety. When reality distortions are pointed out in the therapy, the person making the distortion becomes more anxious and the patient’s symptoms less intense. It is a kind of mechanism, which selects the patient as the “black sheep” or “scapegoat”, or the “holder” of the family problem. (this relationship pattern became the variable – the projection process. )The mechanism first became clearly evident after individual psychotherapy was stopped and the therapy was directed to the family as a group.” (Which points to a veritable truth – that if you are not looking at the family system you will not see it operating.)

Bowen also noted repeated instances in which the family attempts to “put the family anxiety onto the staff or onto the environment.” (One presumes through triangling staff – the concept of triangles didn’t get published until about a decade later). When this occurs and the family succeeded at putting the family anxiety on the staff, Bowen observed that the family problem is less intense, and the staff becomes upset – he later calls this transfer anxiety (see FTCP).

Bowen observed situations in which the normal sibling developed rather severe emotional upsets, with almost immediate decrease in the psychotic symptoms in the patient. This kind of anxiety transfer is usually the result of changed positions in the reciprocal dominant/submissive relationship where one sibling gains and the other loses self or status.

He noted there was evidence that the core relationship around which other family relationships revolve is the mother-patient relationship but that this core relationship is more dependent on other family relationships than originally believed – later conceptualized as triangles and interlocking triangles. .

And finally that the more maturity and objectivity attained by the staff, the more calmness and objectivity the family groups are able to attain – a key observation in elaborating the concept of differentiation of self – the mature ability to regulate one’s own emotional reactivity and define a self while in contact with but not fused into the family emotional system – as a principle for therapy

–Today I’m going to talk about shifts in the family system and shifts in symptoms of all sorts. My interest came out of my study of the 28 women who successfully lost significant amounts of weight and the finding that their weight loss began following shifts in their family relationships which impacted their functioning and anxiety levels. And in looking at the data from this study I think that these shifts in the family system that affected both the subjective and objective functioning of these women are well described by the changes three variables and their interplay – changes triangles, relationship patterns and level of functioning. By relationships patterns I mean the 4 patterns described by nuclear family emotional system that Bowen defined which include

1. The adaptive relationship where one gives up self to get along with the other,
2. Conflict in which family members fight to not lose self to the other;
3. Emotional distance to protect against losing self in the fusion (becomes cutoff between generations), and
4. Projection of the problem to a child – an important instance of the triangle where usually two are close together by focusing on what’s wrong with a third in the outsider position.

These symbiotic patterns are found through the relationship system .Triangles and these relationship patterns channel tensions into specific relationships and specific family members depending on their baseline positions in the family emotional system. The third variable is the functional level of self or level of differentiation of self which impacts the ability to self-regulate and decreases the intensity of the triangles and relationship patterns. .

The family emotional system, is an actual system, not a metaphor or analogy. The well-defined, multidimensional variables that regulate levels of functioning and anxiety in and then symptoms in the emotional unit: 1. Level of functional differentiation,   2. Triangles, and 3. Relationship patterns, underlie the seemingly endless variety of how shifts actually play out in a family system and who, when, and how much any family member becomes symptomatic.

I have three examples of how shift in symptoms follows from the shift observable in these 3 interacting variables

In this example of a behavioral and physiological symptom – obesity – the reciprocal relationship in the marriage shifts following a nodal life event in which a stabilizing triangle to the marriage is lost. The obesity resolves like this: a woman loses seventy pounds after eight years, of trying to lose weight without success. Before her weight loss a shift in her relationship pattern with her husband lifted much of the pressure on her as she fought and felt she lost to the pressure to subordinate to her husband’s dominance on major issues. Her husband suffered an unexpected loss with the death of his long-term AA sponsor. This loss disrupted the husband’s emotional equilibrium eliminating a stabilizing relationship for him which as a triangle, buoyed his functioning in the marriage. This changed the pattern of the wife adapting to the husband in the marriage and reduced the conflict over it. As the husband lost his footing with the death, his wife’s confidence in relation to him increased, i.e. her functional level of differentiation of self increased and her level of chronic anxiety decreased and she lost all her extra weight.

I’d like to make note that in this case and in my study of 28 women all of whom lost all their extra weight in the context of changed anxiety levels from emotional shifts in their family relationships I think theses shifts impact at both the level of behavior and the ability to shift self regulation and at the level of shifts in physiology. There’s a lot of interesting research around the physiology of fat going on – for instance, a very recent study out of Lisbon found that there are nervous system cells that terminate in fat cells and when they are stimulated by laser this stimulates the break up a release of fat for immediate energy use mimicking the signaling role of the protein leptin to breakdown fat which obese individuals can be unresponsive. Might this impact the level gene expression I wonder?

Here’s a recent example of the shifting interplay of triangles, relationship patterns and level of functioning and anxiety that involves a mild/moderate physical symptom. In a young married couple and the wife has digestive track difficulty. She over functions for her husband in his chronically anxious family, which has been more anxious since the fathers heart transplant several months before the shift I’m going to describe. The wife sought psychotherapy because of the spike in her emotional symptoms. She notices a reduction in her own intestinal symptoms and her husband uncharacteristically having intestinal symptoms when she stepped out of the triangle with him and his mother in which she fielded his mother’s upsets while her husband continued to distance. She pulled up her functioning out of the automatic pattern (increase in functional level differentiation) and she quit adapting to her husband’s distance from his family by quitting functioning for him, and left managing the projection and conflict with his mother to him. So the emotional load/ anxiety shifted from the young wife to her husband along with the symptom.

Here is one more example of the changed interplay of triangles, patterns absorbing undifferentiation, and level of differentiation following a nodal event and preceding a shift in the symptom.   This one involves a woman nearing middle age being stuck in her life course, which in this case was her frustration at being unmarried and without children. It also demonstrates the ongoing powerful impact of of the primary triangle with parents into adulthood. A woman in her mid thirties is frustrated in that all her siblings are married with children except her and she wants that very much. She spent many of her early years in a relationship that was emotionally intense and unstable and it took breaking away from it to stabilize herself as a health care professional as she entered her thirties.   Her parents had divorced when she was a youngster and they had remarried. Her father never forgave her mother who had left him for another man. But she stayed involved with both her parents and their extended families and was emotionally involved in the emotional process of both families, often being early in picking up the tension in relationships and being involved. When her fathers mother was dying, she came to her mother and step father saying that her father’s brother was keeping her very drugged and was influencing her to change the will in his favor. Her stepfather, a physician, went to the dying grandmother and told her that she might want to get into a different situation. Her father was grateful to her stepfather for addressing the situation and he was willing finally to be together with his ex-wife and their children for family events. With the reconciliation resolution of the tension and lack of contact between her parents, enabled by the actions of her stepfather, she met someone solid, married and got pregnant.

Discussion and Conclusion

When there is change in a symptom it is highly likely that there has been a shift – a change or moderation of relationship patterns in the patient’s most important family relationships The family system distributes anxiety or the emotional load between family members, which is more or less fixed or dynamic in different families.   Encumbered individuals are vulnerable to symptoms but that can change when their position in the emotional system shifts or tensions are resolved together with with functional changes in self. Changes that are sufficiently stable and significant are required for change in clinical symptoms.

 Bowen family systems theory predicts that symptomatic course in the individual, including symptom development, symptom exacerbations and remissions follows the in the wake of family emotional process but the family system variable is not understood to be causal. The family system variable is part of the interaction of multiple systems including physiological, psychological, behavioral and contextual variables that operate in concert to produce and regulate the course of clinical symptoms. While the family system variable is not sufficient in itself to produce symptoms, theory postulates that family emotional process is a nearly universal background variable in symptom development making it a necessary variable to account for the course of a wide range of clinical and psychological symptoms. There is significant experience observing this clinically by those who use theory to keep their view of the patient in context as part of the family system. If the family system variable and its impact can be reliably observed and documented, it should have powerful predictive and explanatory utility for a wide range of disorders and symptoms in clinical research as well.

 Clinical psychological science has not yet systematically tested the potential of family systems theory to understand and ultimately predict the course of a wide range of clinical disorders in individual family members. Neither has clinical science thought to systematically control for ubiquitous – always present – family system effects in evaluating treatment outcomes.. (Bowen, M, 1978, Kerr, M & Bowen, M, 1989, Papero, D, 19..) Among the good reasons for this is the lack of a replicable research method to assess the family system as an emotional unit or system rather than as a collection of individuals and isolated relationship variables. I’ve been using the data set with my sample of women who resolved their weight, to work toward a reliable qualitative method adapted for the purpose of documenting the impact of the family system as a unit on the clinical subject and the course of their clinical symptoms over time focusing on the variable of shift. I’ve proved to my satisfaction that this can be accomplished having found that observations of shift in the family system and change in functioning and anxiety levels with change can be made and agreed on by independent observers but there’s more data needed to go to prove at the level that is publishable in the context of a high level journal of psychological science.

 

 

 

 

 

 

 

 

 

 

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