Working with Families

Family therapy with its central idea that humans are relational rather than individual appeared simultaneously in a number of places and across a range of therapeutic disciplines, movements and research traditions in the 1950’s. The world was ready to explore the idea that human difficulties are relational and therefore their resolution is also to be found in the pattern of interaction in which they appear. Schools of practice appeared, all of which adopted this central concept but with different emphases and practices. Allan Carr in his excellent text Family Therapy (2006) categorized them according to the ‘central focus of therapeutic concern’. Some like Minuchin’s Structural approach, the MRI school, the Strategic Therapy of Jay Haley, and Chloe Madanes and Cognitive- Behavioural approach of Patterson and Jacobson all emphasized the problem maintaining role of behaviour patterns. Much of this work was done from the mid 1950’s to late 1970’s. A different group of models eschewed positivist explanations and were informed by constructivism. These schools emphasized systems of belief and narratives which distort interactional patterns and results in symptoms, this includes the Milan systemic school, constructivism, social constructivism, narrative therapy, and solution focused therapy. A third group are those which focus on historical, contextual, and constitutional factors which are represented by Transgenerational Family Therapy of Murray Bowen, Ackerman’s Psychoanalytic Family Therapy, Experiential Family Therapy of Carl Whittaker and Virginia Satir, Henggeler’s Multi-systemic approach, and Psychoeducational approaches. In recent years there has been an appreciation that many schools have much to offer and the days of becoming a disciple of any one has passed. 

Bower Place was one of the first and when the Bower Place Model was first publicly presented this was not a popular approach. However, in 2019 a paper by Jay Lebow in Family Process traced the evolution of integrative approaches which highlighted the extent to which ‘most couple and family therapy is now an integrative practice’.  

The Bower Place model which guides all work with families comprises four meta-frames through which the practitioner analyses and intervenes in families. These lenses draw on knowledge from the schools of family therapy but also more broadly from philosophy, psychology and neuropsychology, social work, anthropology, and politics. The meta–frame that must always be addressed first is that of politics which identifies the aspects of an individual or family’s life that produce inequality. Inequality may be a function of multiple differences which can be broadly categorized as justice, power, and disadvantage, which the system responds to in such a way that this person or family is treated unequally. Inequality is fueled by a split between authority, the power or capacity to act and effect change and responsibility, the willingness to do so. Until these are properly aligned; between a couple, a child and parent, family and school, family and community, family and helper system, no change is possible. 

The practitioner can then address the remaining three lenses and in any case one may appear more relevant than another. In no order these include inside/outside space, time, and development.  

Inside/outside space is the lens where thinking from family therapy is most apparent. Inside refers to the individual who presents with the symptom and the key people in their social world. It incorporates neurobiological understanding of the logical, planning ‘front’ brain and the reactive emotional ‘back’ brain which is compromised by trauma. It also addresses the surface, those things we are aware of and recall and deeper memories and beliefs that are not immediately accessible. The outside socio-relational space is the patterns of interaction which hold the system and symptom in its unique shape. It is the client’s village and includes all those in the system; family over three generations, friends, workmates, enemies, helper, professionals and even pets. We seek patterns of alliance and fracture trans generationally and in the present, which hold and shape the family. And presenting difficulty. 

A timeline is drawn in the first session which maps the unfolding of the family’s life and its expected future. This may identify clusters of events which help explain the current situation and crucial events or turning points. The practitioner identifies those current aspects of life that the family wishes to continue and those that need to stop. 

The fourth met-frame is development, and this explores individual and family life cycle evolution and features in the individual and family which may compromise the development of age-appropriate identity. This includes physical and genetic aspects, trauma, disability, and culture. An assessment is made of family member’s identity in terms of production as earning or learning, attachment to the family or clan, peers, and sexual identity. 

The protocols and practices of BowerNote guide the activity of the practitioner as they explore the meta–frames with a view to providing advice that directly addresses the client’s request in a manner that acknowledges and seeks to manage the inevitable inequality of the therapeutic relationship. These are explicated at length in Tier 4 of the site for individuals or agencies who have a license agreement with Bower Place.