FEST Writing Group

 

The Symptom and the System: As modelled in the Family Diagram app by Patrick Stinson

With the Applied variables of the Havstad Model, A Framework for Clinical research Based on Bowen Theory

 Hello Festwg,

The link above is to a 30 minute video I just recorded, demonstrating the use of Patrick Stinson’s Family Diagram App with the Framework for Clinical Research based on Bowen Theory. That framework  is a template of  few specific variables anyone can apply to family data they put in the app and Patrick called it the Havstad Model.[1]  Below are the notes I used for the narration but I hope you can take a look at the video.  It may stand as it is or I may redo it to get a version where I don’t have to clear my throat so much – post nasal drip/allergy as the glorious spring proceeds here.  If I re record it I will include improvements from feedback.

I don’t say this in the video but the demo makes it clear how the family system manages the multigenerational chronic anxiety by the triangling that puts everyone together and one out. I hadn’t seen this in the case before doing this demonstration, but the main purpose is to demonstrate the app and the research model. 

I’m Dr. Laura Havstad. I’m going to use a case example from my clinical research on weight loss with the Family Diagram app developed by Patrick Stinson of Vedana Media. The family diagram app can be used  to track shifts in family relationships  and change in a symptom as shifts in family patterns impact the anxiety and functioning levels of a symptomatic family member. I am showing you the family diagram on the app from a subject from that study.

With the family diagram app you can  build a family diagram that represents family relationships across generations with basic data like births and deaths. More uniquely, the app can also track events, large and small,  alongside family patterns  as they shift dynamically over time. The patterns of the family relationship system can be graphically represented in the app with conventional symbols of the family diagram and include  conflict, distance, reciprocal functioning and projection to a child, along with cutoff between generations, moving toward and away from another which can help tracking triangles and there is even a symbol for defining oneself to others in the family.

You can see the emotional system symbols shift on the diagram as you move through time scrolling the graphical timeline.

The family diagram app also allows you to add variables to study alongside shifting family patterns.  I added variables that emerged as the important ones to track in my study. These are the variables that constitute the basic clinical hypothesis from Bowen Theory which is that changes in relationship patterns in the family can produce changes in the level of anxiety and functioning levels of family members and change in the functioning and anxiety level of a family member can result in changes in their symptoms.  By adding these variables to be tracked, the family diagram app, with reliable and complete enough data, makes it possible to systematically test  the clinical hypothesis from Bowen theory in different families with different symptoms while making a detailed study of how shifting family patterns and individual functioning interact  in any given case.

The variables I added, as a framework for research based in Bowen theory[2] are included in the Havstad Model Template that anyone can find and apply to their inputted family data. When applied to family data in the app, the variables appear on the diagram as they appear and change over time when scrolling the graphical timeline which I’m showing you now
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I’m  showing on the app in the 6.3.2020 video titled HAVSTAD DEMOS APP, a family diagram of Subject #7 (aka #7 or 7) ,who was interviewed in 1978 for the research study. She had dieted to goal weight like others in the study and the question was had something changed in the family system that enabled her to succeed in dieting to goal weight?

The data entered into the diagram is from the family evaluation interview done for the research project.  The interview covered subject 7’s weight history and the concurrent history  of the family system. Having a systematic way to capture data that others can evaluate is important.

The transcript of the interview with 7 was combed line by line to capture all the events subject #7  described along  with all the evidence for the Havstad model variables –   shifts in family relationships and changes in  7’s anxiety and functioning levels, and in her weight, which is the symptom being tracked here.

Entering the  carefully curated  produces the  timeline for all data entries that is  visible in the spreadsheet timeline in the app.The spreadsheet shows the basic variables being tracked by the app – plus the variables one puts in and I put in the variables of the Havstad Model template in the app settings – having separated acute from chronic anxiety as a separate variable.

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Using the features of the family diagram app with the available data, I’m going to demonstrate the change in 7’s symptom of overweight following shifts in the family system and her anxiety level as they occur step by step in 7’s active family relationships.

Subject #7 was 28 years old when she was interviewed for the research study in July of 1978. She had lost 24 lbs. several months before the interview and had met her goal of getting rid of 15 lbs gained gradually over the previous 4 years, and an additional 5 or 6 lbs. gained in December of the prior holiday season. She was continuing to lose an additional few lbs. at the time of the interview when she was at her lowest weight.

We begin with a basic family diagram of the subject and her active family relationships. It is shifts in these relationships that are being tracked from 1971 to 1978.  Baseline patterns that precede the events from 1971 on are that  #7 is more positive to her father than her mother, and her mother has had emotional illness and has been dependent and adaptive to others, in a tense relationship with her mother. I represented this with the projection symbol.

Shockwave of 1971-1973

In about October of 1971, is the death of #7’s maternal grandfather. Death certainly changes relationships but I only have a little  data from the interview on exactly how .  But the death of 7’s maternal grandfather seems to be the start of a little shock wave.

After the death of 7’s maternal grandpa in October 1971, the next event in June of 1972  is 7’s marriage, 6 months after her grandfather’s death. Her weight at the time of her marriage is 150 lbs, which is her baseline weight and is the major symptom I’m tracking here.

7’s mother’s suicide in October of 1972, 4 months after 7’s marriage and a year after her father’s death.

• Interestingly the suicide of her mother didn’t really upset 7 until later, and so it did not seem her chronic anxiety went up after this event.
• The relationship shift that occurred was that 7’s father took on the role of helping his wife’s mother on a regular basis, with chores and errands. I’ve represented the father’s helping relationship with his mother- in law .with emotional process symbol of reciprocity.
• 7’s father complained about his wife’s mother and her negative behavior towards him to 7, who did not experience negativity with her grandmother like that. I’ve represented this negative tension with the away emotional process symbol between the father and 7’s maternal grandmother.
• This is 1972

Meanwhile, in 1975 #7s acute anxiety decreases as she helps her older sister who is developmentally disabled get moved to a facility that supports higher functioning in her sister.

And, gradually gaining 15 lbs, by June of 1976,  Subject # 7 weighs 165 lbs.

That same June of 1976, 7 is very bothered and her acute anxiety goes up as one of her best friends cancer is diagnosed with cancer.

• A note about acute and chronic anxiety. Anxiety is defined in Bowen theory as a reaction to a real or imagined threat. Acute anxiety goes up and down in response to events against the background of chronic anxiety which changes much less often as it has been conditioned by the most important relationships in the family system.
• Sustained shifts in the chronic anxiety level that comes from shifts in family relationships presumably has more significance for sustained change in a symptom than acute anxiety that goes up and down more often.

Increasing chronic anxiety for #7 in 1976-1977 as the relationship system shifts after a nodal event – 7’s father has a stroke

And then in July of 1976, a nodal event, her father suffer’s a stroke at a graveside remembrance service for #7’s mother.  When her father passes out, #7 is told she screamed but she doesn’t remember.

• After his stroke, 7’s father distances from his mother in law and he completely stops helping her or seeing her. Thereciprocal relationship ceases,  and his anxiety goes down with no contact.
• Then 7 takes on helping her grandmother and gets the reciprocity symbol.
• Following her father’s stroke 7’s chronic anxiety goes way up. She is seriously bothered by her mother’s suicide for the first time. Shedreams about it and she develops ongoing obsessive behaviors around checking the stove and locking up.
• The father’s stroke was in July of 1976, and in December of 1976 his new girlfriend moves in. 7’s anxiety goes down. She’s glad someone is there in case her father has another stroke.
• April 1977, Her father’s second stroke does not increase 7’s anxiety.

A Nodal event – In August of 1977, 7 and her husband move closer to her husband’s work to cut down his commute.

• A side note. I did not realize move had any significance in the emotional system until I saw it in the context of the timeline of events and shifts having entered what followed into the app.
• This is a good example of how the app pushes one to see the system more completely and not miss important events and shifts and their impacts in the family process. Practicing entering family information in the app forces one to sharpen perceptions about the family system and to conceptualize family process more comprehensively and precisely.

The move created a relationship change and 7 is not able to see her grandmother as often.

And by about September 1977 7’s grandmother is getting snotty with her and the away symbol signifies the relationship tension.

• 7’s anxiety goes up and she gets headaches.
• 7 moves towards her husband complaining about her grandmother.
• She moves towards her father complaining about her grandmother.
• 7’s father tells her to stop seeing her grandmother.
• 7’s husband tells her to stop seeing her grandmother.

7’s chronic anxiety goes down before she diets to goal weight

In November 1977, #7 stops seeing her grandmother.

Her headaches go away, she’s feeling much better, she’s feeling much better about herself.

• 7’s chronic anxiety goes down.
• Her husband is positive about her feeling better and moves toward her
• 7 really lives it up and puts on 5 or 6 lbs over the holidays in December of 1977.

At her highest weight ever of 170.5 lbs at the end of December 1977, 7’s acute anxiety goes up because of her weight and her husband teases her affectionately about her hippo hips.

• Two months later on March 6, 1978 , 7 starts a gym and begins her diet to goal weight. Her functioning is up in the context of reduced chronic anxiety and an uptic in acute anxiety, bothered by her weight.
• 7 loses 10 lbs in the next 11 days. This motivates her to keep functioning up.
• March 15, 7’s acute anxiety goes up as she gets notice of possible layoff coming in the fall.
• Her husband is positive about her weight loss. This motivates her to keep her functioning up and dieting and exercising 5 times a week.

In May of 1978, 7 is 147.5 lbs and she had achieved her goal weight which was the criterion for being in the weight loss study.

• The drop in chronic anxiety level when 7 distanced from her grandmother appears to be the critical family system shift preceding her diet to goal weight. I would not have seen this except for seeing anxiety shift down after family shifts in 25/27 other subjects in the study, about 6-12 weeks before starting the diet to goal weight.
• Ultimately, one of the most exciting potentials of the family diagram app is as a data base for systematic data collection for family systems.

Between reaching goal weight and the research interview in July of 1978 when her weight was a pound lower than her goal weight

• 7’s acute anxiety went up because she did not get to teach summer school
• 7’s acute anxiety went down because she learned she would not be laid off in the fall.
• 7 was considering visiting her grandmother with her husband or more likely bringing a friend so as not to feel guilty.

Conclusion:

To conclude, I hope I’ve demonstrated the potential of the family diagram app has along with using the Havstad Model as a framework for clinical research, to examine the clinical hypothesis of Bowen theory that changes in symptoms follow changes in the family system.  And that others will use the app to further data collection for clinical research with family systems as they study their own families and the families they coach.

[1] Havstad, L & Sheffield, KJ. Study of Weight Loss as a Model for Clinical Research: Shifts in the Family System and the Course of Clinical Symptoms.  Family Systems. Volume 13, Number 2, 2018. 105-128.

[2] Ibid.