Difficulties of Adulthood – An Overview

This paper will explore the process of moving the client’s perception of the difficulty from one that is inside them to one that incorporates all relevant aspects of their world. It will also describe the application of the Bower Place Method to assessment and intervention with individual adult issues. 

Adults who present to therapy often conceptualize the difficulty as skin bound and belonging to them alone. This is reinforced by referrals from GP’s and other professionals which request help for the patients’ symptom, be it anxiety, depression, anger management or similar which has been explained through a psychiatric diagnosis. The person has often struggled to change themselves using this frame of reference without success leaving them more despairing but also more open to an alternative approach. 

Bower(Note)

The conduct of the session guided by the processes and protocols of Bower(Note), introduces a different world view.  Emphasis on the ecogram which forms the basic structure through which the difficulty is explored carries the centrality of relationship as an explanatory frame. In introducing the ecogram, a three-generation family tree inclusive of other people who are influential but not biological family, the practitioner explains that they are seeking to understand the problem in its broadest context. This alone challenges the notion that the problem is ‘in’ the client and is further reinforced by the drawing of coloured lines between people to denote the quality of the relationship. As the ecogram is constructed the practitioner explores pattern; discovering who else in the family the client resembles, who has had similar problems and how have they been resolved, what is the characteristic problem-solving style of the family, how do they show and manage intimacy and connection. Simultaneously the practitioner is constructing a timeline, a visual representation of the unfolding of events in the life of the family and pin-pointing the emergence of the symptom relative to other key family events. When feedback is sought at the conclusion of the session and subsequently, it is often the ecogram which is mentioned with clients surprised by the new perspective gained on their problem. 

The Bower Place Method

In constructing the ecogram and timeline the practitioner’s exploratory activity is guided by the four meta-frames of the Bower Place model. With all matters the politics frame is primary for until questions of ownership of the problem are resolved change is not possible. This frame identifies aspects of the system that render this person’s situation more unequal than another including issues of violence, race, disability, addiction, loss, education, trauma and disaster. It draws attention to the key therapeutic issue of whether the person who has the power and capacity to effect change in the situation takes responsibility to do so. For example, a person may present with a diagnosis of anxiety and in exploring the situation it becomes apparent that they are living with a young adult child who is drug addicted, suicidal and violent but shows no desire to change, while the parent comes seeking more ways to solve their child’s problem. No-one can make another person change no matter how powerful their desire. 

The next three meta-frames, space, time and development can be explored in any order and while constructing the eco-gram and timeline there is a natural movement between all four. This is not a rigid process of focusing on one after another but rather a movement between as the natural process of the session guides the enquiry. In reviewing any case it becomes clear where information is sparse or missing and this will direct the practitioner’s attention to that frame. 

Space refers to both the inside, neurobiological world of the person and the outside socio-relational world and the fractures and alliances that characterize it. The practitioner is interested to understand how event on the outside, for example the suicidal adult child directly affects the internal experience, the anxiety. An effective way to do this is to map the recursive pattern of interaction around the problem which may highlight the ineffectiveness of current attempts to solve the problem and highlight alternative action or relationships that may be more effective. 

Time is well represented by the construction of the time-line which displays clustering of good and bad events in the life of the individual and family and may introduce a different, systemic explanation for the presenting difficulties. The timeline incorporates time past, present and the imagined future and may dramatically present the extent to which the current situation has caused time to stop still so the individual and family experience themselves living in an ever present. It also identifies key turning points, both good and bad that have shaped the life of this person and their system. The practitioner can encourage the client to think about their future and aspects of their current situation that they no longer wish to be present, what do they want to continue and what cease.  

The meta-frame of development explores the identity of the individual considering their age and stage and that of the family of which they are a part. It incorporates how this person’s genetics, physical self, experiences of trauma and the culture of which they are a part have shaped their identity. It directs the practitioners’ attention to the aspects of their identity which may be over or underdeveloped and points the way towards productive change in those areas that have been neglected. 

This process is equally relevant for a homeless or incarcerated person as one who is embedded in a large family. We ALL have a social world, even those who say they have no family and no friends and may have no interactions in current time. We are all ‘populated’ by our relationships with others, the ‘family in our heads.’ We have all had some form of relationship growing up which has taught us how to think about ourselves and the world even if this has culminated in a desire to be alone and decision that no-one is to be trusted. We are all part of our wider culture and society where inequality and injustice may be exacerbating the difficulties a person experiences. Understanding these patterns and the presenting symptom allows for effective systemic work. 

Conducting the session according to the Bower Place Method and with the protocols of Bower(Note) allows a different view of the symptom for both practitioner and client.  It’s not just in your head.