I am thinking about a possible piece of research. It is built on Bowen’s simple assertion that lower differentiation families will have more physical, social, and emotional symptoms than better differentiated families. I have always believed that this is a brilliant example of systems thinking, and one that every clinician should keep in mind as a way of schooling oneself away from overfocusing on individuals.
My idea is to turn this assertion on its head. That is, family systems with more symptoms would be more likely to be lower in level of differentiation. In that assumption I am sort of following in the footsteps of Phil Klever and Katherine Baker. They both developed measures of functioning and then showed that functioning effectiveness is related to variables thought to be associated with level of differentiation. Elizabeth Skowron did the converse, developed a measure of individual differentiation, which she found is associated with several different areas of functioning.
My idea is more narrow than what either Klever or Baker did, or what Kerr presented in Family Evaluation. All three of these are much more fine-grained assessments than what I am proposing. I propose to develop a count of only the most serious chronic symptoms in a family system. That count, I think, should identify the least differentiated systems but not discriminate so well among the different levels of differentiation of families which are not at the lowest levels.
My variation on Bowen’s assertion would be that families with more severe and chronic symptoms will tend to be the lowest in level of differentiation. And would also be associated with other phenomena, like more life events, more child maltreatment, poor handling of life events and child maltreatment, prospectively predicting new serious symptoms, more cost to society, more high risk behaviors, measures of metabolic risk, biological age.
It has been my impression that good Bowen clinicians already count these serious symptoms. In getting to know a new client, when you hear of a serious chronic symptom in the family, you think, “This family is in the direction of lower differentiation.” Then when you hear of several of these serious symptoms in the family, your certainty about lower level of differentiation progressively becomes more confident.
I propose to formalize that process. The research method I am proposing is directly lifted from a big study at the San Diego Kaiser system, the Adverse Childhood Experiences(ACE) study. They showed that you can get extraordinarily meaningful results from asking a person simple yes-no questions on a paper-and-pencil inventory. “Growing up, were you sexually abused?” “Growing up, was a household member ever imprisoned?” “Growing up, did you ever see your mother being beaten?” The questions covered 10 areas of childhood experiences. Your ACE score is the number of yes answers to these ten areas.
They get massively consistent results with the ACE score being associated with all sorts of adult difficulties. I believe they misinterpret their results, by overly ascribing them to trauma causation, but that’s another conversation. I however am interested in their research method. Notice how simple the method is. Ask an individual a series of simply stated yes-no questions, where the critical thing is that the yes-no questions are only about very serious extreme behaviors.
I propose to do the same thing for serious chronic physical, social, and emotional symptoms in the person’s family. Your score would be the number of yes answers. The more yes answers, the more likely the family is to be lower differentiation.
If the count of serious symptoms in a family does prove to be associated with various aspects of differentiation and with Skowron’s DSI-R scores, then the family count of symptoms could be used as one of the 10-12 partial indicators of differentiation level making up a composite measure of level of differentiation.
References
Baker, K. and Gippenreiter, J.(1996). The effects of Stalin’s purge on three generations of Russian families. Family Systems, 3(1), 5-35.
Felitti,V., Anda, R., Nordenberg, D., Williamson, D., Spitz, A., Edwards, V., Koss, M., and Marks, J.(1998). The relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258.
Felitti,V. and Anda, R.(2010). The relationship of adverse childhood experiences to adult medical disease, psychiatric disorders and sexual behavior: Implications for healthcare. In The impact of early life trauma on health and disease: The hidden epidemic(pp. 77-87). Lanius, R. A., Vermetten, E., & Pain, C(Editors). Cambridge, UK: Cambridge University Press.
Klever, P. (2001). The Nuclear Family Functioning Scale: Initial development and preliminary validation. Families, Systems, & Health, 19(4), 397-410. doi:10.1037/h0089468
Skowron, E. A., & Friedlander, M. L. (1998). The Differentiation of Self Inventory: Development and initial validation. Journal of Counseling Psychology, 45(3), 235-246. doi:10.1037/0022-0167.45.3.235
Jim Edd,
As always, I appreciate your introducing interesting research from social sciences into the discussion. The ACE study seems to be an efficient way to collect large amounts of data. You see a way to take their method and apply it more broadly to physical and emotional symptoms as well at social symptoms. If I understand you, this would be a more formal and streamlined way of getting the data that we routinely collect in doing family histories and family evaluation.
How would Bowen theory lead you to interpret this data differently than the ACE researchers?
That low differentiation family systems is the broader phenomenon that explains the ACE results. Low differentiation families, I suspect, produce most of the adverse childhood experiences and at the same time severely complicate the family’s handling of those experiences. So I suspect that the proper interpretation is that low differentiation family systems produce these adult high health risk behaviors cited in the ACE study.
Jim Edd,
Over the past few days, I have been casually applying your idea to my own family and other families I know. I think it is a useful contribution to determining low levels of differentiation of self. One way I can see its value is that people often appear to function well, yet have these significant and severe symptoms in the family. Fluid functioning levels, the borrowing and trading that Bowen observed, clouds the picture. I think it adds to efforts like Klever’s and Baker’s and Frosts’s and others–to try to pin down evidence for different levels and see the phenomenon of DoS more clearly.
Thanks Laurie. And other factors can influence symptom development, as you suggest.
Jim:
I like your idea for research. It would be a useful way of tracking the multigenerational process if there were questions regarding the evidence of chronic and significant symptoms over three or more generations, depending how far back people can go. I look forward to hearing more about this. ann
Ann, go for it on the three generations. I’m trying to figure out wording in order to get the extended families of both spouses in a marriage.
“If the count of serious symptoms in a family does prove to be associated with various aspects of differentiation and with Skowron’s DSI-R scores, then the family count of symptoms could be used as one of the 10-12 partial indicators of differentiation level making up a composite measure of level of differentiation.” Jim Edd, so you will use Skowron’s instrument to validate the hypothesis that the family count of symptoms is an indicator of (low) differentiation level?
Curious, at various times in the training seminar I lead we have identified variables in differentiation of self. I can’t remember but we came out with more than the 10-12 you mention. I remember hearing someone say Bowen said there were 19 variables in dos but he decided it was counterproductive for him to put them out there and it was better for people to figure it out for themselves. Would you be willing to say what the 10-12 variables are that you are thinking about?
I would use the Skowron inventory as a partial validater. You would need several partial validaters, since we have no measure of differentiation.
I don’t know the 10-12 variables. The number is a guess. I’d only accept variables that are measurable and are probably partial measures of differentiation. So far, I’d mention Klever’s measure of level of active connection with family of origin and his measure of internally defined goals for a person. And I’d like some measure of reality orientation. I want to find measures that are practical and don’t require 5 psychotherapy interviews in order to make a rating.