This piece is an introduction to an article focussing on a clinical case that will be elaborated to illustrate the clinical use of Bowen theory in addressing a prolonged symptomatic adjustment in a person following the death of a family member. For those who know about the findings on resilience that George Bonanno produced in his research, this introduction is an effort to view those findings from the perspective of Bowen theory. If I proceed with this, it will be interesting to see if the clinical case will actually confirm this way of thinking about the impact of death – that the impact of death for an individual family member, is like other life events, mediated by the family system and their position in it. Any and all comments or questions are welcomed. If there are none, that’s okay too. Is this a valuable or useful or perspective is my main question.
As we know, symptomatic responses to the death of a family member are typically conceptualized in an individual frame of reference. The individual’s symptomatic reactions to death might be short or long term. Individuals might suffer depression, anxiety or illness of various sorts as well as prolonged and complicated grief in reaction to death in the family. When the clinical focus is the individual, resolution of the symptoms in the individual defines the goal of therapy. Research on the trajectories of loss, that is the adjustment back to the person’s baseline level of well being before the loss, has shown that most people are resilient and that while they experience sadness and other emotional feelings that accompany loss, they do not become symptomatic. A smaller group becomes symptomatic but recovers. And the smallest group becomes symptomatic and does not recover. Classic clinical approaches to prolonged reactions to death are aimed at working through and resolving the relationship to the lost one in individual or group treatment. There is a significant body of research, which suggests that this approach, especially when it addresses normal expressions of emotion in the early stages of loss, leads to more rather than less complications for the person. More current approaches, based on research, focus on fostering emotional flexibility and adaptiveness in expression of emotion and engagement with goals (George Bonanno- Columbia U) and enabling the individual to reengage with life in a way that restores identity and meaning. (Anthony Papa – U of Nevada, Reno).
In contrast, there is a different orientation to the symptomatic individual when the clinician is focused on the family system. This chapter will focus on a clinical approach to death based on the different way of looking at the impact of death on individuals when observed in the context of the family system. Widening the lens to look at the family system enables seeing the impact of death on multiple family members and shifts the focus to how the death affects the group of individuals who are bound together in an emotional system.
In a given family, the percentages of symptoms following the loss are probably like the percentages found in the research on the trajectories of loss – that is, within the family, the pattern of variation would be that most family members would be resilient, a smaller number would have short lived symptoms, and it would be very few that have prolonged symptomatic adjustments in reaction to the loss. The level of differentiation of the family may shift these percentages in one direction or another so that there are more instances of prolonged reactions in families with lower levels of self. But as it is following other life events, it is the family system that mediates this distribution of impacts so that the variation in outcomes depends on individual’s position in the family system. It is the impact of shifts in the family system that would determine whether a family member moves into a position of increased vulnerability to dysfunction and illness.
The level of differentiation of the family does mediate the intensity of the impacts of loss and the clinical approach exploits this fact in coaching a family leader towards increased differentiation. This moderates the intensity of the patterns that organize the automatic emotional functioning of the family system thereby relieving pressure on the most impinged family members with prolonged symptomatic adjustments.
This chapter aims to illustrate the clinical approach of coaching an individual towards increased differentiation in a long – term effort following the accidental death of a young adult son. Part of the family reaction to death was the increasingly symptomatic daughter who became involved in recovered memory therapy following her brother’s death, cutoff from her family, and experienced a prolonged period of being suicidal. Her mother’s effort to increase her differentiation in the nuclear family and her family of origin had a profound impact on the restored connections, stability and functioning of her daughter and the family.
I’d also like to emphasize the need for studies that carefully track family emotional process following death to test the hypotheses and to better see how the variables work.
What an excellent example of the family emotional process after death. I think the choice of subject, in this case the family of the young woman who develops symptoms, including cutoff from the family, may yield opportunities for deeper learning about the effects of one’s position in the family, especially when the family is experiencing change and stress, which is when an individual’s position may become more clear. If the daughter’s symptoms are resolved after efforts on her mother’s part to make changes in her own functioning, it demonstrates how the family functions as a unit.
One thought, Laura, is that in grieving a death one is surrounded by others who are also grieving. But each person in his/her own way, and each deeply affected by the others. I had a client whose mother died when he was a child and it was never talked about. I wondered if he and his siblings saw the father’s reaction and possibly feared losing him, too, and hid their grieving to protect him and themselves. Just speculating.
Bowen’s concept of emotional shock wave is so on target, yet I don’t think it is recognized by Bonanno or others in the field.
Your case example looks like an excellent way to demonstrate the impact on the family of one individual’s effort to focus on self.
I found Stephanie’s comment in the comments section, though still unmoderated as yet, and wish to add a thought. The research that shows that most people move on well from a death in the family may be missing what are called subclinical effects that may linger and may affect future generations. I recall my aunt telling me 20 years after my grandmother’s death that she was never happy like she was before the death. Aunt Mary had no symptoms in the conventional sense, but I wonder if the destabilizing effect of my grandmother’s death on the larger family would not be caught in the bereavement studies. In my family’s case, symptoms showed up in the next generation, and in the next. My aunt and two of her siblings, including my mother, showed no overt symptoms (one of the four siblings did resign from the NY Times to play chess in Washington Square Park, and I think that was a symptom). But symptoms showed up in the grandchildren of my grandmother, and the issues of one of Aunt Mary’s three grandchildren could be related to Aunt Mary’s difficulty adjusting to the death of her mother. I think in my own case that the deaths of my father and Lynn Margulis in 2011 have had a subclinical effect on my functioning in some areas, though not in others. Symptoms would probably not show up in a research study, but the effects are there. I am grateful for theory, guidance to address the dependency, and to ameliorate the effects on the next generation.
Solid start, Laura. Presenting theory paired with a case study is effective teaching. People ‘hear’ stories more readily, which can then help to ‘read’ the theory part.