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Discussion 2: Family Theory

Discussion 2: Family Theory

Murray Bowen is one of the most respected family theorists in the field of family therapy. Bowen views the family unit as complex and believes it is important to understand the interactions among the members in order to solve problems. Satir and Minuchin also advanced family therapy with their concepts and models. As a clinical social worker, using these models (along with having an ecological perspective) can be very effective in helping clients.
For this Discussion, review the Petrakis Family case history and video session.
By Day 4
Post (using two concepts of Bowens family theory) a discussion and analysis of the events that occurred after Alec moved in with his grandmother up until Helen went to the hospital. If you used the concepts of structural family therapy, how would your analysis of the situation be different? Which family theory did you find to be most helpful in your analysis? Finally, indicate whether Satirs or Minuchins model is the more strength-based model. Why?
 The Petrakis Family  Helen Petrakis is a 52-year-old heterosexual married female of Greek descent who says that she feels overwhelmed and blue. She came to our agency at the suggestion of a close friend who thought Helen would benefit from having a person who could listen. Although she is uncomfortable talking about her life with a stranger, Helen said that she decided to come for therapy because she worries about burdening friends with her troubles. Helen and I have met four times, twice per month, for individual therapy in 50-minute sessions. Helen consistently appears well-groomed. She speaks clearly and in moderate tones and seems to have linear thought progression; her memory seems intact. She claims no history of drug or alcohol abuse, and she does not identify a history of trauma. Helen says that other than chronic back pain from an old injury, which she manages with acetaminophen as needed, she is in good health. Helen has worked full time at a hospital in the billing department since graduating from high school. Her husband, John (60), works full time managing a grocery store and earns the larger portion of the family income. She and John live with their three adult children in a 4-bedroom house. Helen voices a great deal of pride in the children. Alec, 27, is currently unemployed, which Helen attributes to the poor economy. Dmitra, 23, whom Helen describes as smart, beautiful, and hardworking, works as a sales consultant for a local department store. Athina, 18, is an honors student at a local college and earns spending money as a hostess in a family friends restaurant; Helen describes her as adorable and reliable. In our first session, I explained to Helen that I was an advanced year intern completing my second field placement at the agency. I told her I worked closely with my field supervisor to provide the best care possible. She said that was fine, congratulated me on advancing my career, and then began talking. I listened for the reasons Helen came to speak with me. I asked Helen about her community, which, she explained, centered on the activities of the Greek Orthodox Church. She and John were married in that church and attend services weekly. She expects that her children will also eventually wed there. Her children, she explained, are religious but do not regularly go to church because they are very busy. She believes that the children are too busy to be expected to help around the house. Helen shops, cooks, and cleans for the family, and John sees to yard care and maintains the familys cars. When I asked whether the children contributed to the finances of the home, Helen looked shocked and said that John would find it deeply insulting to take money from his children. As Helen described her life, I surmised that the Petrakis family holds strong family bonds within a large and supportive community. Helen is responsible for the care of Johns 81-year-old widowed mother, Magda, who lives in an apartment 30 minutes away. Until recently, Magda was self-sufficient, coming for weekly family dinners and driving herself shopping and to church. But 6 months ago, she fell and broke her hip and was also recently diagnosed with early signs of dementia. Through their church, Helen and John hired a reliable and trusted woman to check in on Magda a couple of days each week. Helen goes to see Magda on the other days, sometimes twice in one day, depending on Magdas needs. She buys her food, cleans her home, pays her bills, and keeps track of her medications. Helen says she would like to have the helper come in more often, but she cannot afford it. The money to pay for help is coming out of the couples vacations savings. Caring for Magda makes Helen feel as if she is failing as a wife and mother because she no longer has time to spend with her husband and children. Helen sounded angry as she described the amount of time she gave toward Magdas care. She has stopped going shopping and out to eat with friends because she can no longer find the time. Lately, John has expressed displeasure with meals at home, as Helen has been cooking less often and brings home takeout. She sounded defeated when she described an incident in which her son, Alec, expressed disappointment in her because she could not provide him with clean laundry. When she cried in response, he offered to help care for his grandmother. Alec proposed moving in with Magda. Helen wondered if asking Alec to stay with his grandmother might be good for all of them. John and Alec had been arguing lately, and Alec and his grandmother had always been very fond of each other. Helen thought she could offer Alec the money she gave Magdas helper. I responded that I thought Helen and Alec were using creative problem solving and utilizing their resources well in crafting a plan. I said that Helen seemed to find good solutions within her family and culture. Helen appeared concerned as I said this, and I surmised that she was reluctant to impose on her son because she and her husband 20 SESSIONS: CASE HISTORIES ¢ THE PETRAKIS FAMILY seemed to value providing for their childrens needs rather than expecting them to contribute resources. Helen ended the session agreeing to consider the solution we discussed to ease the stress of caring for Magda. The Petrakis Family Magda Petrakis: mother of John Petrakis, 81 John Petrakis: father, 60 Helen Petrakis: mother, 52 Alec Petrakis: son, 27 Dmitra Petrakis: daughter, 23 Athina Petrakis: daughter, 18 In our second session, Helen said that her son again mentioned that he saw how overwhelmed she was and wanted to help care for Magda. While Helen was not sure this was the best idea, she saw how it might be helpful for a short time. Nonetheless, her instincts were still telling her that this could be a bad plan. Helen worried about changing the arrangements as they were and seemed reluctant to step away from her integral role in Magdas care, despite the pain it was causing her. In this session, I helped Helen begin to explore her feelings and assumptions about her role as a caretaker in the family. Helen did not seem able to identify her expectations of herself as a caretaker. She did, however, resolve her ambivalence about Alecs offer to care for Magda. By the end of the session, Helen agreed to have Alec live with his grandmother. In our third session, Helen briskly walked into the room and announced that Alec had moved in with Magda and it was a disaster. Since the move, Helen had had to be at the apartment at least once daily to intervene with emergencies. Magda called Helen at work the day after Alec moved in to ask Helen to pick up a refill of her medications at the pharmacy. Helen asked to speak to Alec, and Magda said he had gone out with two friends the night before and had not come home yet. Helen left work immediately and drove to Magdas home. Helen angrily told me that she assumed that Magda misplaced the medications, but then she began to cry and said that the medications were not misplaced, they were really gone. When she searched the apartment, Helen noticed that the cash box was empty and that Magdas checkbook was missing two checks. Helen determined that Magda was robbed, but because she did not want to frighten her, she decided not to report the crime. Instead, Helen phoned the pharmacy and explained that her mother-in-law, suffering from dementia, had accidently destroyed her medication and would need refills. She called Magdas bank and learned that the checks had been cashed. Helen cooked lunch for her motherin-law and ate it with her. When a tired and disheveled Alec arrived back in the apartment, Helen quietly told her son about the robbery and reinforced the importance of remaining in the building with Magda at night. Helen said that the events in Magdas apartment were repeated 2 days later. By this time in the session Helen was furious. With her face red with rage and her hands shaking, she told me that all this was my fault for suggesting that Alecs presence in the apartment would benefit the family. Jewelry from Greece, which had been in the family for generations, was now gone. Alec would never be in this trouble if I had not told Helen he should be permitted to live with his grandmother. Helen said she should know better than to talk to a stranger about private matters. Helen cried, and as I sat and listened to her sobs, I was not sure whether to let her cry, give her a tissue, or interrupt her. As the session was nearing the end, Helen quickly told me that Alec has struggled with maintaining sobriety since he was a teen. He is currently on 2 years probation for possession and had recently completed a rehabilitation program. Helen said she now realized Alec was stealing from his grandmother to support his drug habit. She could not possibly tell her husband because he would hurt and humiliate Alec, and she would not consider telling the police. Helens solution was to remove the valuables and medications from the apartment and to visit twice a day to bring supplies and medicine and check on Alec and Magda. After this session, it was unclear how to proceed with Helen. I asked my field instructor for help. I explained that I had offered support for a possible solution to Helens difficulties and stress. In rereading the progress notes in Helens chart, I realized I had misinterpreted Helens reluctance to ask Alec to move in with his grandmother. I felt terrible about pushing Helen into acting outside of her own instincts. My field instructor reminded me that I had not forced Helen to act as she had and that no one was responsible for the actions of another person. She told me that beginning social workers do make mistakes and that my errors were part of a learning process and were not irreparable. I was reminded that advising Helen, or any client, is ill-advised. My field instructor expressed concern about my ethical and legal obligations to protect Magda. She suggested that I call the county office on aging and adult services to research my duty to report, and to speak to the agency director about my ethical and legal obligations in this case. In our fourth session, Helen apologized for missing a previous appointment with me. She said she awoke the morning of the appointment with tightness in her chest and a feeling that her heart was racing. John drove Helen to the emergency room at the hospital in which she works. By the time Helen got to the hospital, she could not 21 SESSIONS: CASE HISTORIES ¢ THE PETRAKIS FAMILY catch her breath and thought she might pass out. The hospital ran tests but found no conclusive organic reason to explain Helens symptoms. I asked Helen how she felt now. She said that since her visit to the hospital, she continues to experience shortness of breath, usually in the morning when she is getting ready to begin her day. She said she has trouble staying asleep, waking two to four times each night, and she feels tired during the day. Working is hard because she is more forgetful than she has ever been. Her back is giving her trouble, too. Helen said that she feels like her body is one big tired knot. I suggested that her symptoms could indicate anxiety and she might want to consider seeing a psychiatrist for an evaluation. I told Helen it would make sense, given the pressures in her life, that she felt anxiety. I said that she and I could develop a treatment plan to help her address the anxiety. Helens therapy goals include removing Alec from Magdas apartment and speaking to John about a safe and supported living arrangement for Magda.  

 Bowen Family Systems Theory and Practice: Illustration and Critique By Jenny Brown This paper will give an overview of Murray Bowens theory of family systems. It will describe the models development and outline its core clinical components. The practice of therapy will be described as well as recent developments within the model. Some key criticisms will be raised, followed by a case example which highlights the therapeutic focus of Bowens approach. This is the authors version of the work. It is posted here by permission of Australian Academic Press for personal use, not for redistribution. The definitive version was published in Australian and New Zealand Journal of Family Therapy (ANZJFT) Vol.20 No.2 1999 pp 94-103). Introduction Murray Bowen’s family systems theory (shortened to ‘Bowen theory’ from 1974) was one of the first comprehensive theories of family systems functioning (Bowen, 1966, 1978, Kerr and Bowen, 1988). While it has received sporadic attention in Australia and New Zealand, it continues to be a central influence in the practice of family therapy in North America. It is possible that some local family therapists have been influenced by many of Bowen’s ideas without the connection being articulated. For example, the writing of Guerin (1976, 1987), Carter and McGoldrick (1980, 1988), Lerner (1986, 1988, 1990, 1993) and Schnarch (1991, 1997) all have Bowenian Theory at the heart of their conceptualisations. There is a pervasive view amongst many proponents of Bowen’s work that his theory needs to be experienced rather than taught (Kerr, 1991). While this may be applicable if one can be immersed in the milieu of a Bowenian training institute, such an option, to my knowledge, is not available in this country. Bowen’s own writings have also been charged with being tedious and difficult to read (Carter, 1991). Hence it seems pertinent to present this influential theory in an accessible format. Development Of The Model Murray Bowen was born in 1913 in Tennessee and died in 1990. He trained as a psychiatrist and originally practised within the psychoanalytic model. At the Menninger Clinic in the late 1940s, he had started to involve mothers in the investigation and treatment of schizophrenic patients. His devotion to his own psychoanalytic training was set aside after his move to the National Institute of Mental Health (NIMH) in 1954, as he began to shift from an individual focus to an appreciation of the dimensions of families as systems. At the NIMH, Bowen began to include more family members in his research and psychotherapy with schizophrenic patients. In 1959 he moved to Georgetown University and established the Georgetown Family Centre (where he was director until his death). It was here that his developing theory was extended to less severe emotional problems. Between 1959 and 1962 he undertook detailed research into families across several  generations. Rather than developing a theory about pathology, Bowen focused on what he saw as the common patterns of all ‘human emotional systems’. With such a focus on the qualitative similarities of all families, Bowen was known to say frequently, ‘There is a little schizophrenia in all of us’ (Kerr and Bowen, 1988). In 1966, Bowen published the first ‘orderly presentation’ of his developing ideas (Bowen, 1978: xiii). Around the same time he used his concepts to guide his intervention in a minor emotional crisis in his own extended family, an intervention which he describes as a spectacular breakthrough for him in theory and practice (Bowen, 1972 in Bowen, 1978). In 1967, he surprised a national family therapy conference by talking about his own family experience, rather than presenting the anticipated formal paper. Bowen proceeded to encourage students to work on triangles and intergenerational patterns in their own families of origin rather than undertaking individual psychotherapy. From this generation of trainees have come the current leaders of Bowenian Therapy, such as Michael Kerr at the Georgetown Family Center, Philip Guerin at the Center for Family Learning, Betty Carter at the Family Institute of Westchester, and Monica McGoldrick at the [Multicultural] Family Institute of New Jersey. While the core concepts of Bowen’s theory have changed little over two decades, there have been significant expansions: the focus on life cycle stages (Carter and McGoldrick, 1980, 1988) and the incorporation of a feminist lens (Carter, Walters, Papp, Silverstein, 1988; Lerner, 1983; Bograd, 1987). The Theory Bowen’s focus was on patterns that develop in families in order to defuse anxiety. A key generator of anxiety in families is the perception of either too much closeness or too great a distance in a relationship. The degree of anxiety in any one family will be determined by the current levels of external stress and the sensitivities to particular themes that have been transmitted down the generations. If family members do not have the capacity to think through their responses to relationship dilemmas, but rather react anxiously to perceived emotional demands, a state of chronic anxiety or reactivity may be set in place. The main goal of Bowenian therapy is to reduce chronic anxiety by 1. facilitating awareness of how the emotional system functions; and 2. increasing levels of differentiation, where the focus is on making changes for the self rather than on trying to change others. Eight interlocking concepts make up Bowen’s theory. This paper will give an overview of seven of these. The eighth attempts to link his theory to the evolution of society, and has little relevance to the practice of his therapy. [However, Wylie (1991) points out in her biographical piece following Bowen’s death that this interest in evolutionary process distinguishes Bowen from other family therapy pioneers. Bowen viewed himself as a scientist, with the lofty aim of developing a theory that accounted for the entire range of human behaviour and its origins.] 1 – Emotional Fusion and Differentiation of Self 2 – Triangles 3 – Nuclear Family Emotional System 3a. Couple Conflict 3b. Symptoms in a Spouse 3c. Symptoms in a Child 4 – Family Projection Process 5 – Emotional Cutoff 6 – Multi-generational Transmission Process 7 – Sibling Positions 1 – Emotional Fusion and Differentiation of Self ‘Fusion’ or ‘lack of differentiation’ is where individual choices are set aside in the service of achieving harmony within the system. Fusion can be expressed either as: * a sense of intense responsibility for another’s reactions, or * by emotional ‘cutoff’ from the tension within a relationship (Kerr and Bowen, 1988; Herz Brown, 1991). Bowen’s research led him to suggest that varying degrees of fusion are discernible in all families. ‘Differentiation’, by contrast, is described as the capacity of the individual to function autonomously by making self directed choices, while remaining emotionally connected to the intensity of a significant relationship system (Kerr and Bowen, 1988). Bowen’s notion of fusion has a different focus to Minuchin’s concept of enmeshment, which is based on a lack of boundary between sub-systems (Minuchin, 1974). The structural terms ‘enmeshment’ and ‘disengagement’ are in fact the twin polarities of Bowen’s ‘fusion’. Fusion describes each person’s reactions within a relationship, rather than the overall structure of family relationships. Hence, anxiously cutting off the relationship is as much a sign of fusion as intense submissiveness. A person in a fused relationship reacts immediately (as if with a reflex, knee jerk response) to the perceived demands of another person, without being able to think through the choices or talk over relationship matters directly with the other person. Energy is invested in taking things personally (ensuring the emotional comfort of another), or in distancing oneself (ensuring one’s own). The greater a family’s tendency to fuse, the less flexibility it will have in adapting to stress. Bowen developed the idea of a ‘differentiation of self scale’ to assist in teaching this concept. He points out that this was not designed as an actual instrument for assigning people to particular levels (Kerr and Bowen, 1988: 97-98). Bowen maintains that the speculative nature of estimating a level of differentiation is compounded by factors such as stress levels, individual differences in reactivity to different stressors, and the degree of contact individuals have with their extended family. At one end of the scale, hypothetical ‘complete differentiation’ is said to exist in a person who has resolved their emotional attachment to their family (ie. shifted out of their roles in relationship triangles) and can therefore function as an individual within the family group. Bowen did acknowledge that this was a lifelong process and that ‘total’ differentiation is not possible to attain. 2 – Triangles Bowen described triangles as the smallest stable relationship unit (Kerr and Bowen, 1988: 135). The process of triangling is central to his theory. (Some people use the term ‘triangulation’, deriving from Minuchin (1974: 102), but Bowen always spoke of ‘triangling’.) Triangling is said to occur when the inevitable anxiety in a dyad is relieved by involving a vulnerable third party who either takes sides or provides a detour for the anxiety (Lerner, 1988; James, 1989; Guerin, Fogarty, Fay and Kautto, 1996). An example of this pattern would be when Person A in a marriage begins feeling uncomfortable with too much closeness to Person B. S/he may begin withdrawing, perhaps to another activity such as work (the third point of the triangle). Person B then pursues Person A, which results in increased withdrawal to the initial triangled-in person or activity. Person B then feels neglected and seeks out an ally who will sympathise with his/her sense of exclusion. This in turn leads to Person A feeling like the odd one out and moving anxiously closer to Person B. Under stress, the triangling process feeds on itself and interlocking triangles are formed throughout the system. This can spill over into the wider community, when family members find allies, or enemies to unite against, such as doctors, teachers and therapists. Under calm conditions it is difficult to identify triangles but they emerge clearly under stress. Triangles are linked closely with Bowen’s concept of differentiation, in that the greater the degree of fusion in a relationship, the more heightened is the pull to preserve emotional stability by forming a triangle. Bowen did not suggest that the process of triangling was necessarily dysfunctional, but the concept is a useful way of grasping the notion that the original tension gets acted out elsewhere. Triangling can become problematic when a third party’s involvement distracts the members of a dyad from resolving their relationship impasse. If a third party is drawn in, the focus shifts to criticising or worrying about the new outsider, which in turn prevents the original complainants from  resolving their tension. According to Bowen, triangles tend to repeat themselves across generations. When one member of a relationship triangle departs or dies, another person can be drawn into the same role (eg. ‘villain’, ‘rescuer’, ‘victim’, ‘black sheep’, ‘martyr’). For example, in my own family of origin I found myself moving into the role of peacemaker after the death of my mother, who had mediated the tension between my father and brother. This ongoing triangle served to detour the anxiety that had been played out between fathers and sons in the family over the generations. 3 – Nuclear Family Emotional System In positing the ‘nuclear family emotional system’, Bowen focuses on the impact of ‘undifferentiation’ on the emotional functioning of a single generation family. He asserts that relationship fusion, which leads to triangling, is the fuel for symptom formation which is manifested in one of three categories. These are: a. couple conflict; b. illness in a spouse; c. projection of a problem onto one or more children. Each of these is expanded below. 3A. COUPLE CONFLICT The single generation unit usually starts with a dyad – a couple who, according to Bowen, will be at approximately equal levels of differentiation (ie. both have the same degree of need to be validated through the relationship). Bowen believed that permission to disagree is one of the most important contracts between individuals in an intimate relationship (Kerr and Bowen, 1988: 188). In a fused relationship, partners interpret the emotional state of the other as their responsibility, and the other’s stated disagreement as a personal affront to them. A typical pattern in such emotionally intense relationships is a cycle of closeness followed by conflict to create distance, which in turn is followed by the couple making up and resuming the intense closeness. This pattern is a ‘conflictual cocoon’ (Kerr and Bowen, 1988: 192), where anxiety is bound within the conflict cycle without spilling over to involve children. Bowen suggested the following three ways in which couple conflict can be functional for a fused relationship, in which ‘each person is attempting to become more whole through the other’ (Lederer and Lewis, 1991). 1. Conflict can provide a strong sense of emotional contact with the important other. 2. Conflict can justify people’s maintaining a comfortable distance from each other without feeling guilty about it. 3. Conflict can allow one person to project anxieties they have about themselves onto the other, thereby preserving their positive view of self (Kerr and Bowen, 1988: 192). 3B. SYMPTOMS IN A SPOUSE In a fused relationship, where each partner looks to the other’s qualities to fit his / her learned manner of relating to significant others, a pattern of reciprocity can be set in motion that pushes each spouse’s role to opposite extremes. Drawing from his analytic background, Bowen described this fusion as ‘the reciprocal side of each spouse’s transference’ (Kerr and Bowen, 1988: 170). For example, what may start as an overly responsible spouse feeling compatible with a more dependent partner, can escalate to an increasingly controlling spouse with the other giving up any sense of contributing to the relationship. Both are equally undifferentiated in that they are defining themselves according to the reactions of the other; however the spouse who makes the most adjustments in the self in order to preserve relationship harmony is said by Bowen to be prone to developing symptoms. The person who gets polarised in the under functioning position is most vulnerable to symptoms of helplessness such as depression, substance abuse and chronic pain. The over functioning person might also be the one to develop symptoms, as s/he becomes overburdened by attempts to make things ‘right’ for others. 3C. SYMPTOMS IN A CHILD The third symptom of fusion in a family is when a child develops behavioural or emotional problems. This comes under Bowen’s fourth theoretical concept, the Family Projection Process. 4 – Family Projection Process In the previous two categories the couple relationship is the focus of anxiety without it significantly impacting on the functioning of the next generation. By contrast, the family projection process describes how children develop symptoms when they get caught up in the previous generation’s anxiety about relationships. The child with the least emotional separation from his/her parents is said to be the most vulnerable to developing symptoms. Bowen describes this as occurring when a child responds anxiously to the tension in the parents’ relationship, which in turn is mistaken for a problem in the child. A detouring triangle is thus set in motion, as attention and protectiveness are shifted to the child. Within this cycle of reciprocal anxiety, a child becomes more demanding or more impaired. An example would be when an illness in a child distracts one parent from the pursuit of closeness in the marriage. As tension in the marriage is relieved, both spouses become invested in treating their child’s condition, which may in turn become chronic or psychosomatic. As in all of Bowen’s constructs, ‘intergenerational projection’ is said to occur in all families in varying degrees. Many intergenerational influences may determine which child becomes the focus of family anxiety and at what stage of the life cycle this occurs. The impact of crises and their timing also influences the vulnerability of certain children. Bowen viewed traumatic events as significant in highlighting the family processes rather than as actually ‘causing’ them. 5 – Emotional Cutoff Bowen describes ’emotional cutoff’ as the way people manage the intensity of fusion between the generations. A ‘cutoff’ can be achieved through physical distance or through forms of emotional withdrawal. Bowen distinguishes between ‘breaking away’ from the family and ‘growing away’ from the family. ‘Growing away’ is viewed as part of differentiation – adult family members follow independent goals while also recognising that they are part of their family system. A ‘cutoff’ is more like an escape; people ‘decide’ to be completely different to their family of origin. While immediate pressure might be relieved by cutoff, patterns of reactivity in intense relationships remain unchanged and versions of the past, or its mirror image, are repeated. Bowen proposes that: If one does not see himself as part of the system, his only options are either to get others to change or to withdraw. If one sees himself as part of the system, he has a new option: to stay in contact with others and change self (Kerr and Bowen, 1988: 272-273). ‘Cutoffs’ are not always dramatic rifts. An example of a covert emotional cutoff would be one family member maintaining an anxious silence in the face of another’s anger. The pull to restore harmony overwhelms the ability to stay in contact with the issue that has been raised. A central hypothesis of Bowen’s theory is that the more people maintain emotional contact with the previous generation, the less reactive they will be in current relationships. Conversely, when there are emotional cutoffs, the current family group can experience intense emotional pressure without effective escape valves. This family tension is like ‘walking on eggshells’, as issues which remain unresolved from the cutoff are carefully avoided. Triangling provides a detour, as family members enlist the support of others for their own position in relation to the cutoff. 6 – Multi-generational Transmission Process This concept of Bowen’s theory describes how patterns, themes and positions (roles) in a triangle are passed down from generation to generation through the projection from parent to child which was described earlier. The impact will be different for each child depending on the degree of triangling they have with their parents. Bowen’s focus on at least three generations of a family when dealing with a presenting symptom is certainly a trademark of his theory. The attention to family patterns over time is not just an evaluative tool, but an intervention that helps family members get sufficient distance from their current struggle with symptoms to see  how they might change their own part in the transmission of anxiety over the generations. As Monica McGoldrick (1995: 20) writes in applying Bowenian concepts: By learning about your family and its history and getting to know what made family members tick, how they related, and where they got stuck, you can consider your own role, not simply as victim or reactor to your experiences but as an active player in interactions that repeat themselves. 7 – Sibling Positions Employing Walter Toman’s (1976) sibling profiles, Bowen considered that sibling position could provide useful information in understanding the roles individuals tend to take in relationships. For example, Toman’s profiles describe eldest children as more likely to take on responsibility and leaders

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