Handbook of bowen family systems theory and research methods mignonette n keller, robert j noone, routledge, 2020 scan

“One of the important contributions of Keller and Noone’s volume of collected studies from the
perspective of Bowen Theory is its focus on concepts in family systems theory and related constructs in the wider multidisciplinary research literature. The authors of these studies are deeply
conversant with Bowen theory and its potential as an integrative theory to guide research and
practice. This is a project that aims to carry forth Bowen’s most ambitious goal for his family
systems theory, that of moving towards a science of human behavior.”
Laura Havstad, Ph.D., director, Programs in Bowen Theory, Northern California.
“Diverse perspectives of empirical research are necessary to address the complexities of research
in family systems. Reciprocal influences of individuals and families, families and communities,
and communities and culture require a consistent theoretical grounding for approaching meaningful questions. Launched from Bowen family systems theory, Keller and Noone have assembled
a knowledgeable group of scholars and practitioners to address important concerns of family
research for an invaluable resource for family systems researchers. It is an important text for those
seeking to design and interpret systems research.”
David S. Hargrove, Ph.D., is professor emeritus at the University of Mississippi,
Oxford, MS, where he served as chairperson of the Department of Psychology,
interim chair of the Department of Modern Languages and interim chair of the
Department of Exercise Science.
“The Bowen family systems theory field will advance as a natural science when the ideas are
applied and systematically researched by many professionals in varying fields of study. This book
has collected the research and explorations of seasoned experts in our field, investigating ways of
advancing the theory and its applications. The effort to research families as an emotional system
is daunting and complex. This collection of works documents how many authors and researchers
have undertaken the challenge. It will be a valued resource in my library.”
Walter Howard Smith, Jr., Ph.D., is a trustee of the Casey Family Programs Foundation
based in Seattle, WA. He is the retired Deputy Director and Clinical Director at the
Allegheny County Department of Human Services in Pittsburgh, PA, where he
served as Deputy Director of the Office of Children, Youth, and Family Services.
He is a licensed psychologist in private practice.

Handbook of Bowen Family Systems
Theory and Research Methods

The Handbook of Bowen Family Systems Theory and Research Methods presents innovative approaches
on a range of issues inherent in family research and discusses the links between theory, data
collection, and data analysis based on Bowen family systems theory.
This multi-authored volume discusses core issues within family systems theory, including anxiety, stress, emotional cutoff, differentiation of self, multigenerational transmission process, and
nuclear family emotional process. Chapters also examine related constructs in the research literature such as adaptation, resilience, social support, social networks, and intergenerational family
relations. Readers will be able to view theoretical and methodological issues from the perspective
of Bowen theory and develop a clearer knowledge of ways to navigate the challenges faced when
studying individual, familial, and societal problems.
An essential resource for clinicians and researchers in the social and natural sciences, the Handbook of Bowen Family Systems Theory and Research Methods provides a comprehensive framework
for understanding the application of Bowen theory to family practice and family research.
Mignonette N. Keller, Ph.D., is faculty at the Bowen Center for the Study of the Family in
Washington, D.C., and former assistant professor in the School of Social Work at Howard
University, Washington, D.C. She received her doctorate from Howard University, Washington,
D.C., master’s from the University of Chicago, Chicago, IL, and postgraduate training at
Georgetown University School of Medicine, Washington, D.C.
Robert J. Noone, Ph.D., is faculty at the Center for Family Consultation, Evanston, IL, and
the Bowen Center for the Study of the Family in Washington, D.C. He is the editor of the
journal Family Systems and co-editor of The Family Emotional System (2015). He received his
doctorate from the University of Illinois at Chicago and postgraduate training at Georgetown
University Medical Center in Washington, D.C.



Handbook of Bowen
Family Systems Theory
and Research Methods
A Systems Model for Family Research

Edited by Mignonette N. Keller and Robert J. Noone


First published 2020
by Routledge
52 Vanderbilt Avenue, New York, NY 10017
and by Routledge
2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2020 Taylor & Francis
The right of Mignonette N. Keller and Robert J. Noone to be identified as the authors of
the editorial material, and of the authors for their individual chapters, has been asserted in
accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or utilized in any
form or by any electronic, mechanical, or other means, now known or hereafter invented,
including photocopying and recording, or in any information storage or retrieval system,
without permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or registered trademarks,
and are used only for identification and explanation without intent to infringe.
Library of Congress Cataloging-in-Publication Data
A catalog record for this title has been requested
ISBN: 978-1-138-47811-4 (hbk)
ISBN: 978-1-138-47812-1 (pbk)
ISBN: 978-1-351-10328-2 (ebk)
Typeset in Bembo
by Swales & Willis, Exeter, Devon, UK


Contents

Notes on Editors
Notes on Contributors
Foreword
Preface
Acknowledgments
Introduction
Mignonette N. Keller and Robert J. Noone

x
xi
xiv
xxi
xxviii
1

PART I

Foundations of Family Research Introduction

13

1 The Role of Theory in Family Research
Mignonette N. Keller and C. Margaret Hall

15

2 The Origins of Family Research
John F. Butler

24

3 Developing a Systems Model for Family Assessment
Daniel V. Papero

36

PART II

Bowen Theory: A Systems Model for Family Research

47

4 Bowen Theory: A Systems Model for Family Research
Mignonette N. Keller

49

5 Data Collection and Family Research
Mignonette N. Keller

62

6 Data Analysis and Family Research
Carrie E. Collier

74

vii

Contents

PART III

Mechanisms Influencing Family Functioning: Stress/Anxiety,
Differentiation of Self and Emotional Cutoff Stress/Anxiety
7 Stress, Chronic Anxiety, and Symptom Development: A Family
Systems Perspective
Robert J. Noone

91

93

8 Bowen Theory in the Study of Physiology and Family Systems
Victoria Harrison

105

9 Human Stress Genomics and Bowen Theory: Potential for Future Research
Laurie Lassiter

120

10 Use of Differentiation of Self in Family Research
Randall T. Frost

138

11 Emotional Cutoff
Anne S. McKnight

157

12 Cutoff and Self-Functioning in Three Generations of Families with
Substance Abusing Teenagers
Anne S. McKnight

174

13 Within Family Variability: Intergenerational Cutoff and Family Projection
in an Adopted Family
Laura R. Brooks

188

PART IV

Mechanisms Influencing Multigenerational Family Functioning

201

14 Nuclear Family Emotional Process
Robert J. Noone

203

15 The Primary Triangle and Variation in Family Functioning
Phillip Klever

216

16 Family Emotional System and the African American Family
Mignonette N. Keller

236

17 Multigenerational Transmission Process
Robert J. Noone

254

18 The Multigenerational Transmission of Family Unit Functioning
Phillip Klever

265

viii


Contents

19 The Multigenerational Transmission Process and Family Functioning
Mignonette N. Keller

278

PART V

Interdisciplinary Use of Bowen Family Systems Theory

299

20 Anthropological Contributions to the Study of the Human Family
Joanne Bowen

301

21 Bowen Theory Integrated into Nursing
Phyllis W. Sharps

321

22 The Family: A Public Health Approach
Yvonne Bronner, Paul Archibald, Ian Lindong, and Barbara Laymon

332

23 The Family and Academic Achievement
Clancie Mavello Wilson

347

PART VI

Implications for Future Directions in Family Research

363

24 Extension of Bowen Theory to Include Natural Systems of Human Societies
and Their Sustaining Environments
Patricia A. Comella

365

25 Future Directions of Family Research
C. Margaret Hall
Appendix A: Cutoff and Self-Functioning in Three Generations of Families and
Substance Abusing Teenagers
Anne S. McKnight

389

396

Appendix B: Standardized Questions for Annual Interviews
Laura R. Brooks

397

Appendix C: Multigenerational Family History Assessment Module
Mignonette N. Keller

398

Index

427

ix


Editors

Mignonette N. Keller, Ph.D., is faculty at the Bowen Center for the Study of the Family in
Washington, D.C., and a former assistant professor in the School of Social Work at Howard
University, Washington, D.C. Her writing and research interests include theoretical and methodological issues in family research related to factors influencing family functioning; a systems
model for family research; and the family diagram as a reliable assessment instrument for empirical
research. She received funding from the Center of Research on Minority Health at the National
Institutes of Health for her study of alcohol dependence and the family based in the Howard
University Alcohol Research Center. The Howard University Faculty Research Award Programs
provided funding for her multigenerational study of factors influencing family functioning.
Dr. Keller holds a doctorate in sociology from Howard University, Washington, D.C., a master’s
degree in social service administration from the University of Chicago, Chicago, IL, and she
completed postgraduate training at the Georgetown University School of Medicine, Washington,
D.C., in family theory, family psychotherapy, and family research.
Robert J. Noone, Ph.D., is co-founder and faculty at the Center for Family Consultation in
Evanston, IL, where he maintains a practice in psychotherapy. He is the editor of the journal
Family Systems and a faculty member at the Bowen Center for the Study of the Family in Washington, D.C. Along with Dr. Daniel V. Papero, Dr. Noone is editor and contributor to the
recently published book The Family Emotional System: An Integrative Concept for Theory, Science,
and Practice (2015) and author of published articles and book chapters on Bowen family systems
theory and psychotherapy. A practicing family therapist for more than 40 years, he received his
doctorate from the University of Illinois at Chicago and his postgraduate training in family systems therapy at Georgetown University School of Medicine in Washington, D.C.

x


Contributors

Paul Archibald, Ph.D., is an assistant professor in the Department of Social Work at the College
of Staten Island, City University of New York Staten Island, New York, and a former assistant
professor in the School of Social Work at Morgan State University. His research interests include
violence, trauma, depression, and substance abuse. He has several publications in professional
journals related to substance abuse, depression, and black males.
Joanne Bowen, Ph.D., is a research professor in the Department of Anthropology at the College
of William and Mary in Williamsburg, VA. She is also the Executive Director of the Murray
Bowen Archives Project in the History of Medicine Division of the National Library of Medicine, a nonprofit organization dedicated to the preservation and dissemination of the Murray
Bowen Archives. Dr. Bowen is the author of numerous scientific publications in professional
journals and book chapters.
Yvonne Bronner, Sc.D., R.D., is a professor in the Department of Public Health in the School of
Community Health and Policy at Morgan State University in Baltimore, MD. She has conducted
research on breast feeding, obesity, and healthy lifestyles and served as the principal investigator
of the Nutritional Assessment of the Maryland School Child Study. Dr. Bronner is the author of
numerous publications in professional journals and book chapters.
Laura R. Brooks, M.A., is a faculty member at the Bowen Center for the Study of the Family in
Washington, D.C. She coordinates the Internship Program and Research Committee and serves
on the editorial board of the Family Systems Journal. She has a family therapy practice in Ellicott
City, MD. Her research interests include adoptive families, family projection process, within
family variability, emotional cutoff, and research from a systems perspective.
John F. Butler, Ph.D., is in private practice at Rose Street Mental Health Care in Wichita Falls,
TX. He is editor of the Origins of Family Psychotherapy: The National Institute Mental Health Family
Studies Project and the author of several professional articles on family theory and psychotherapy.
Carrie E. Collier, Ph.D., is a faculty member at the Bowen Center for the Study of the Family in

Washington, D.C. She is the Director of the online program for studies in Bowen family systems
theory at the Bowen Center. She is also an adjunct faculty member in the Department of Counseling and Human Development at George Washington University, Washington, D.C. Her
research interests include research methodology that captures family systems variables and devising
and testing a family unit functioning scale to be used in clinical and research studies. She maintains a clinical practice in Washington, D.C., at the Bowen Family Center.

xi


Contributors

Patricia A. Comella, J.D., is a faculty member at the Bowen Center for the Study of the Family

in Washington, D.C. She is currently a self-employed, independent consultant. Prior to her
retirement, she was employed as a Senior Foreign Affair Officer, Office of Nuclear Energy
Affairs, at the U.S. Department of State in Washington, D.C. She has published numerous articles related to Bowen theory.
Randall T. Frost, M.Div., is Director of Training and Research at Living Systems in Vancouver,
B.C., a pastoral counseling center that uses Bowen theory as its primary approach to counseling,
training, education, and research. He is a member of the faculty of the Bowen Center for the
Study of the Family in Washington, D.C., and author of professional articles and book chapters
on family theory and psychotherapy.
C. Margaret Hall, Ph.D., is a Professor Emeritus of Sociology, Georgetown University, Washing-

ton, D.C., where she was a member of the full-time faculty from 1970 to 2018. She chaired the
department of sociology in 1976–1980 and 1983–1989 and directed Women’s Studies from 1993
to 1996. Dr. Hall specialized in theory construction in clinical sociology, with particular attention
to social intelligence and social sources of personal and social identify. Her research interviews
address primarily family, religion, or belief systems, gender, the emotional bases of social intelligence, and individual and social behavior. She used observations, life histories, and content analyses as research methodologies in her work on theory construction. Dr. Hall published
extensively including journal articles, book chapters, and books.
Victoria Harrison, M.A., is Founding Director of the Center for the Study of Natural Systems

and the Family in Houston, TX. She is also senior faculty at the Bowen Center for the Study of
the Family in Washington, D.C. She is in private practice based in Bowen theory and uses biofeedback and neurofeedback for the study of reactivity. She conducts research on physiological
reactivity in the family and its impact on health and reproduction. She is the author of several
journal articles and book chapters.
Michael Kerr, M.D., is the Director of the Bowen Academy in Islesboro, ME. He succeeded

Murray Bowen as Director of the Georgetown Family Center in 1990. He is the founding editor
of Family Systems: A Journal of Natural Systems Thinking in Psychiatry and the Sciences and served as
editor from 1994 to 2014. He is the co-author with Murray Bowen of Family Evaluation: An
Approach Based on Bowen Theory. He recently published Bowen Theory’s Secrets: Revealing the
Hidden Life of Families (2019). Dr. Kerr has written numerous journal articles and book chapters
related to Bowen theory.
Phillip Klever, M.S.W., has had a private practice in Kansas City, MO, since 1979. He has been

conducting a longitudinal, multigenerational family research study that began in 1994. This study
has explored how the following variables influence variation in nuclear family functioning: viable
emotional contact versus cutoff with the multigenerational family, stress in the multigenerational
family, symptomology in the multigenerational family, reactivity in the primary triangle, family
projection, and goal direction of the husband and wife. He has also examined nuclear family
emotional processes being passed on to the next generation. He has published numerous articles
in scientific journals and book chapters regarding his findings related to various aspects of Bowen
theory.
Laurie Lassiter, Ph.D., M.S.W., has a private practice in Leverett, MA. She presents at conferences and webcasts on Bowen theory regularly. Her past mentors are Murray Bowen and the
xii


Contributors

evolutionary biologist Lynn Margulis, with whom she associated until the latter’s death in 2011.
She has written several articles and book chapters on Bowen theory, with particular interest in
the relationship of the triangle to differentiation of self. She applied Bowen theory to social
organisms representing early life and she has emphasized the evolutionary heritage of Homo sapiens. Her current interest is in the research potential of discoveries in the social regulation of genetic expression as it relates to Bowen theory.
Barbara Laymon, Ph.D., is a faculty member at the Bowen Center for the Study of the Family in

Washington, D.C. She is also the Lead Analyst for the National Association of County and City
Health Officials, the nonprofit representing local health departments across America. Her research

background includes an interest in long-term care policy, maternal and child health, managed care
organization, population health and epidemiology, community health assessment, and social determinants of health. Dr. Laymon is interested in the ninth concept in Bowen theory, the supernatural
phenomenon, and plans to conduct research on systems thinking in religion and spirituality.
Ian Lindong, M.D., Ph.D., is an assistant professor in the School of Community Health and
Policy at Morgan State University in Baltimore, MD. He concurrently serves co-director and coinvestigator roles in federally sponsored programs in the university. His research interest include
technology in health care services delivery and program effectiveness evaluation. He has taught
biomedical courses in pathophysiology in the Nursing program, in addition to Epidemiology and
Biological Basis of Public Health in the Public Health graduate program.
Anne S. McKnight, Ed.D., is the Director of the Bowen Center for the Study of the Family in
Washington, D.C. She has been the Director since 2011 and served on the faculty since 1992.
Her clinical and research interests include death in the family, addiction, epigenetics, and ethics.
Dr. McKnight has numerous publications in professional journals and book chapters related to
Bowen theory. She maintains a clinical practice in Washington, D.C., and Arlington, VA.
Daniel V. Papero, Ph.D., is a senior faculty member at the Bowen Center for the Study of the
Family in Washington, D.C. He is the author of Bowen Family Systems Theory and the co-editor
of The Family Emotional System with Dr. Robert Noone, in addition to having written journal
articles and book chapters. He lectures both nationally and internationally on the Bowen theory
and maintains a clinical practice in Washington, D.C.
Phyllis W. Sharps, Ph.D., is a professor in the School of Nursing at Johns Hopkins University,

Baltimore, MD., where she also serves as the Associate Dean of Community and Global Programs and holds the Elsie M. Lawler Chair. As Associate Dean for community programs and
initiatives, she directs three health and wellness centers operated by the Johns Hopkins School of
Nursing. Her scholarly expertise and interests include perinatal health, domestic violence, parenting, women’s health, domestic violence, and infant mortality. Dr. Sharps has numerous scientific
publications in professional journals and has written book chapters.
Clancie Mavello Wilson, Ph.D., is the Director of the Joseph and Lauretta Freeman Foundation,
a nonprofit organization committed to addressing the needs of youth and families. Her research
interests include identifying more effective ways to educate and aggressively involve parents in
the process; better understanding of cultural differences and how these differences impact learning; as well as research to bridge the gap between home and school. Dr. Wilson is the author of
several articles in professional journals and book chapters.

xiii


Foreword

This is a book about Bowen theory and research, so I will frame current research on Bowen theory
in the context of Murray Bowen’s key discoveries. Most readers are likely aware that Bowen is the
originator of Bowen family systems theory. He and his collaborators developed the theory based on
observational research in many settings over several decades. Early in Bowen’s research in the second
half of the 1940s at the Menninger Clinic, he concluded that Freud’s psychoanalytic theory was
plagued with enough subjectivity that it would never be accepted by the sciences. This realization
motivated Bowen to read extensively in the sciences and other disciplines to determine what would
be necessary to develop a theory of human behavior that would meet the criteria of the accepted
sciences. The background research convinced Bowen that such a theory could be developed.
Bowen’s observational research settings prior to the first publication of the new theory in 1966
included eight years at Menninger’s, five years at the National Institute of Mental Health
(NIMH), and five years at the Georgetown University School of Medicine’s Department of
Psychiatry. The theory that emerged from that research was an emphatic departure from psychoanalytic theory. Its two most innovative aspects were applying systems thinking to describe
human behavior and grounding the theory in Homo sapiens being a product of evolution. Not
surprisingly, the major obstacle to applying systems thinking is cause-and-effect thinking. Causeand-effect thinking in the form of psychopathology existing within the patient causing neurotic
and psychotic disorders was at the core of Freudian theory.
Bowen was a maverick from the time he arrived in the fall of 1959 in the Georgetown Department
of Psychiatry, a psychoanalytically oriented program. Like other departments around the country, it
was easier for them to accept family therapy than it was to accept a family theory that was out of step
with psychoanalytic theory. Despite being out of step with other members of the department, Bowen
was able to establish family programs at Georgetown for the psychiatric residents and mental health
professionals in the community. The new method of therapy spawned by the new theory was built
around the process of differentiation of self. This concept both explained variation in human emotional functioning and provided a blueprint for raising one’s level of differentiation.
A key piece of research at Menninger’s was facilitated by Bowen breaking from standard psychiatric practice and meeting with members of his inpatients’ families. In doing so, he observed
how powerfully affected emotionally the patients were by their families, especially their mothers,

and vice versa. The traditional practice of insulating the doctor–patient transference relationship
from contamination by interaction with the family had allowed the intensity of family–patient
interactions to fly under the radar. This family–patient emotional intensity was evident no matter
what the patient’s diagnosis.
One particular study that Bowen conducted with a schizophrenic patient at Menninger’s
allowed an actively psychotic patient to regress. The key was allowing the patient to get worse
without nervously intervening. As expected, as the patient regressed, and his symptoms worsened,

xiv


Foreword

but, after a period of time, his psychotic symptoms unexpectedly disappeared. The patient related
to the research staff much like a normal child.
This observation challenged a psychoanalytic theory contention that schizophrenic people had never
formed an attachment to their mothers during early development. However, Bowen and his team saw
that they were indeed capable of forming an attachment, but that ability had been buried under the
psychosis. This conclusion fit with the intense reactivity Bowen was observing between adult patients
and their family members at Menninger’s. I interpret these observations to indicate a high level of anxiety that schizophrenic patients experience in their social interactions, especially with family. This can
trigger a powerful impulse to withdraw, both behaviorally and into psychotic thinking.
The term symbiosis was in the psychiatric literature at that point in the early 1950s. Bowen
adopted the term to describe what he was observing between the inpatients and their family
members. It appeared that the normal early symbiotic mother–child attachment had never
resolved. He decided to study mother–adult offspring symbiosis and chose to conduct the study
with mothers and their adult schizophrenic offspring, but he could have studied symbiosis with
any severe dysfunction. He departed Menninger’s for the NIMH to set up the symbiosis study
on an inpatient research ward in 1954.
The study began with three mothers and their young adult schizophrenic offspring. One
mother–daughter pair agreed to live on the ward full-time; the other two pairs spent most of

their waking hours there. The research ward was located in the National Institutes of Health
Clinical Center. Despite his early observations at Menninger’s, Bowen was still using psychoanalytic thinking when the study began. This was reflected in his conceptualizing the unresolved
symbiosis as being the result of “interlocking psychopathologies.” As part of the study, he provided individual psychotherapy for the mother and the schizophrenic offspring. The purpose was
to define the specific psychopathologies of both people with the expectation that this therapeutic
process might enable them to separate into two people.
Two very important research observations had occurred by the end of the first year of the
study. The first was that the unresolved symbiosis was more intense than had been recognized at
Menninger’s, and neither mother nor offspring was motivated to change it. Bowen interpreted
the obstacle to change as “loss of each other equals death.” He described it as a fusion of feeling
states between the two people. The second observation was equally if not more important:
fathers were part of the problem. Fathers visited the research ward frequently enough for research
observations to be made about them, too.
Observing fathers led to the conceptualization that the mother–adult offspring symbiosis was
a fragment of the larger family group. Families function as emotional units. Family members are
linked by a powerful emotional interdependence that is associated with exceptionally high
reactivity to each other. Other family pioneers also conceptualized the family as an “organism,”
but Bowen was the only one to anchor the emotional process in a human emotional system that
had been shaped by billions of years of evolution.
At this juncture, the study morphed from a study of symbiosis to a study of the family. Family
groups that included a father, a mother, schizophrenic offspring, and “normal” sibling were now
admitted to the project. The patient’s symptoms were viewed as part of a dynamic process
involving the entire family.
What made the Family Study Project unique was that Bowen and the research team were
observing family interactions directly. Learning what was unfolding in the families was not
dependent on just listening to the subjective reports of family members. All of the staff made
careful notes of their observations. Despite being housed on a research ward, it was a reasonably
naturalistic setting in that the staff worked not to intrude into family tensions and conflicts. This
was not an easy task because family members often tried to get staff members involved. A study
of seven outpatient families paralleled Bowen’s research ward studies.
xv

Foreword

Bowen characterized the perspective the research team gained from the Family Study Project
as equivalent to moving from watching a football game from the vantage point of the sideline to
the very top row of the stadium. This allowed previously unobserved broad patterns of movement of the players on the field to come into view. As Bowen and his team observed families
over a long period, he decided that the term “function” was preferable to “role” or even personality trait. Function is a more flexible term in that it can accommodate family members’ functioning in a variety of ways that result from the nature of their reciprocal functioning with others.
For example, a schizophrenic patient may severely under-function when interacting with his
over-functioning parents, but under-function less when relating to a sibling or someone outside
the family. Marked contrasts in functioning were frequently observed in how family members
functioned in a work setting versus in the family setting. For example, a father might function
with more sureness and decisiveness in his work setting than in the family setting. A common
family pattern was a passive father, a more active mother, and helpless and immature schizophrenic offspring. These patterns were not fixed in stone but could vary with changing
circumstances.
An extremely important observation concerned the “normal” siblings of the schizophrenic
patient. Bowen would later refer to this as varying levels of “differentiation of self” in the siblings. The child with the most intense attachment to mother since early in life, and extending
into adult life as an unresolved symbiosis, inherits more of the parents’ immaturities or weaknesses than their strengths. The less involved sibling, growing up in a different and less anxious
“parental triangle,” inherits more of the parents’ maturities or strengths.
The association Bowen made with degree of unresolved attachment to family, such as the variation between siblings and overall life functioning, challenges the still commonly held view that
various types of abuse, physical and emotional neglect, having a mentally ill or substance-abusing
parent, parental separation and divorce, and domestic violence place children at risk for later life
problems such as heart disease, strokes, diabetes, cancer, emphysema, and Alzheimer’s. Such
occurrences correlate with later life problems, but Bowen’s theory describes a “hidden” layer of
family system forces and patterns operating underneath abuse, trauma, and neglect that are more
influential on a child’s outcome. This underneath layer, which reflects a low level of family functioning (undifferentiation), affects how much “self” a child develops. It can explain why two siblings exposed to the same trauma and deprivation can turn out very differently. Trauma, abuse,
and neglect are not good things to happen to a child, but they are symptomatic of a more insidious process.
It was common in the family movement to refer to the identified patient, the most dysfunctional of a sibling group, as a “scapegoat.” This term risks conveying that the child is a victim.
The child is not a victim if you apply systems thinking to recognize that the mother–child relationship is a reciprocal interaction. For example, a child acting like a baby can calm the mother’s
anxiety. The child does it automatically because he or she is rewarded with a calmer mother.

The mother is calmed by viewing the source of her anxiety as outside herself, in the child, and
ministering to the needy child also helps her feel competent. The focus of both parents on the
child’s functional helplessness can distract the parents from potential tensions between themselves
and thus stabilize their relationship. Bowen and the research team assessed the parents’ maturity
levels to be just a little higher than those in the child. Their problems are typically hidden by
their over-functioning, making them appear more mature than they really are.
This non-victim perspective on a child does not relieve parents of their responsibility in family
therapy to take the lead in changing family process. The child is an equal participant in the
family process but is in too dependent of a position to take responsibility for leading change in
the family. Parents benefit greatly from a therapist who can discern that whatever negative

xvi


Foreword

experiences are playing out in the family, they do not result from a lack of love or involvement
but from too much anxiety-driven involvement.
Bowen viewed the family with a psychotic member as functionally helpless, an anxious organism, without a leader. Interestingly, he did not think the family members were truly helpless, but
functionally helpless in relationship to each other. A pervasive passivity exists in poorly differentiated families, although it may be punctuated with overly controlling and aggressive behaviors.
The helplessness is also accentuated by years of seeking answers outside themselves and by the
mental health professionals consulted taking responsibility for diagnosing and fixing the patient.
A brief description of change in one family at NIMH will highlight the processes just
described. Bowen developed his first method of family therapy at the NIMH, a method he
referred to as family group therapy. All family members were present for the sessions. In this case
example, the mother and adult schizophrenic daughter’s relationship was often tense and conflictual. The mother over-functioned, and the daughter under-functioned, in the reciprocity. The
father, highly reactive to his wife’s anxiety, tended to support her view that the basic problem
was in the daughter. With the help of therapy, the father began to see how anxious he was
about his wife’s anxiety and how it clouded his thinking about how things were playing out in
the family. As a result of his developing a little more objective view of the family dynamics, he

changed by no longer going along with his wife’s pleadings to support her anxiety-driven focus
on the child. In response, the wife had an emotional meltdown of her own, pleading desperately
with the husband to support her with the daughter. The mother was feeling angry, abandoned,
and especially helpless. The husband held his ground in face of her pressure. He was not angry at
his wife, just calmer and a little surer of himself. To his amazement, his stance eventually had
a calming effect on his wife, which then helped her resist her daughter’s anxious pleadings that
the mother do what was typical for her when the daughter was feeling helpless and distressed.
The mother would take over and fix the problem. Of course, this accomplished only a shortterm solution. Now, with the mother not doing her usual thing, the daughter put stronger pressure on her mother to solve her problem by acting more psychotic. The mother held the line,
and the daughter picked up her functioning. What I have just described is one of the many versions of “family emotional process” that Bowen and the research team were observing. The process flows through a family in predictable ways, with often-predictable results.
When the Family Study Project ended in 1959, Bowen moved to Georgetown University
School of Medicine, Department of Psychiatry. The inpatient studies were over, but his theoretical thinking and numerous innovations of the therapy flourished there. An important observation
from outpatient studies at Georgetown was confirmation that the same patterns in families with
schizophrenia occurred in better differentiated or more maturely functioning families, but with
less intensity. Work at Georgetown also fleshed out an idea that began at NIMH. The idea was
that the high degree of intensity of unresolved emotional attachment between a mother and adult
dysfunctional child reflected the outcome of gradually increasing degrees of unresolved emotional
attachment over many generations. The idea eventually became a concept in Bowen theory: the
multigenerational transmission process.
Bowen considered another development at Georgetown one of the most important: differentiation of self in one’s own family. As an alternative to lying on a couch for many years, with some
“coaching help,” people could apply Bowen theory to the real world of their own families to work
on whatever degrees of unresolved attachment they had with them. Bowen suggested that, for
family therapists to be effective in their work, they had a particular responsibility to do this.
Besides continuing developments in theory and therapy, family programs Bowen developed at
Georgetown enabled interested psychiatric residents and other mental health professionals in the
community to learn about Bowen theory and therapy. An annual symposium on family began in
1965, a postgraduate training program began in 1969, and the Georgetown University Family
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Center opened its doors in 1975. All those activities continue to this day. Bowen’s book of collected papers was published in 1978.
In the late 1980s, a new psychiatry department chair was especially unaccepting of Bowen’s
ideas being so out of step with the still psychoanalytic base of the department. The chair’s attitude, along with Bowen’s health having been in decline for several years, led to Georgetown
University severing ties with the Center in the summer of 1990. It could be that the department
thought the Family Center would fall apart without Bowen because it assumed the Center was
Bowen based, not theory based. Bowen was a strong leader, but the theory had been transmitted
successfully to many others who would continue to develop it. Bowen died in October 1990,
but the family faculty that been assembled over many decades continued the Center’s programs
as a not-for-profit, 501(c)(3) organization in an off-campus location near the one it had occupied
for many years.
Bowen’s principal guidance in reference to the future of Bowen theory and its many applications (to non-family as well as family systems) for those that would follow him, both at the
Family Center, Inc. (a.k.a. Bowen Center for the Study of the Family as of the mid-1990s) and
at the myriad Bowen theory-oriented sites that had sprung up around the country and overseas,
was to keep Bowen theory an open system by maintaining viable contact with the sciences and
other relevant disciplines. The theory needed to be continuously exposed to new facts emerging
from other disciplines that would either support or contradict it. Failure to do so would render
the theory vulnerable to becoming a closed system, a dogma. A mantra of the Bowen network is
that theory can be changed by facts alone, not by personal opinion. Through the efforts of many
people in many places, the viable contact continues.
I have provided this background on the history of the development of Bowen theory to
emphasize the theory’s unique position in intellectual history. Using systems thinking to combine
facts about human behavior from many disciplines, especially family research, with facts about
human beings as a product of evolution is a genuinely new idea. The theory is not well established in the public consciousness at present, but I believe history will treat it kindly. This book
is about research that attempts to support and extend this idea, but an obstacle exists to acceptance of the theory.
The recently emerging field of systems medicine highlights some of the obstacles Bowen
theory researchers face. Systems medicine is an interdisciplinary field that looks at the systems of
the body as an integrated whole. Like a family system, the components of a body system interact
to create something that could not be predicted by just studying its individual components.
In systems medicine, the research effort is to elucidate the pathways in a network that regulate

the components of that network, and how networks interact with other networks in the body as
a whole. The ultimate goal is a better understanding of states of wellness and disease. An important component of the work in systems biology and systems medicine is computational biology or
mathematical modeling.
In a family system, it is difficult to quantify the communication signals that regulate the functioning of family members. When the Georgetown University Family Center was just getting
underway, Bowen invited the research chair of the medical school to a meeting that included
Bowen and his faculty. Prior to the meeting, the chair had been provided with two collections
of papers that had been presented at conferences related to Bowen theory. The first thing the
research chair said was, “I read these papers, but there are no numbers here. Where are the numbers?” This comment made quite an impression on me, and I think it highlights obstacles that
Bowen theory researchers face. A mathematical model is not reality; it is an attempt to match
natural phenomena with equations that can then be used to make predictions about natural phenomena. Mathematical models can be honed to fit reality. If a mathematical structure is a good
model of whatever reality is being addressed, it lends a certain credibility to the research. No one
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has yet developed mathematical modeling for a family relationship system, but that does not
mean it cannot be done.
An absence of mathematical models is not a reason for family researchers to get defensive.
A useful perspective on this issue has been provided by a young systems biologist, James Valcourt.
He compares the current state of systems medicine to the state of knowledge at the time
Johannes Kepler defined the laws of planetary motion. Kepler described what was happening,
even developing mathematical formulas about the phenomenon, but he could not account for it
being the way it is. Valcourt suggests it is necessary for systems medicine to get to the time of
Newton. Newton conceptualized gravitational forces that could predict everything Kepler
described. I interpret Valcourt’s point to be that systems medicine would benefit greatly from
a theory developed from all the factual information it is collecting. A theory would enhance
future research.
Bowen described myriad functional facts of family interactions gleaned from extensive observational research. Within a relatively short period of time he was able to construct a theory from
those facts. He did this without any numbers. I suggest that Bowen was like a Kepler-Newton.

This does not mean that computational biology does not have a place in Bowen theory research,
but the existence of family theory places Bowen theory research in a unique place that is different
from where systems medicine is today.
Observational research depends on overcoming what Bowen termed “observational blindness”
or what others refer to as “inattentional blindness.” Both phrases describe a psychological process
that results in an individual failing to perceive an unexpected stimulus that is in plain sight. It
took the application of systems thinking to get beyond the observational blindness generated by
individual psychopathological thinking and to see how patterns of interaction revealed by systems
thinking regulated the functioning and behaviors of individual family members.
Bowen made a quantum leap. Dysfunction in one family member is a symptom of
a disturbance in the family relationship system. The equivalent for systems medicine, if I am
interpreting the current state of that field correctly, would be shifting from the view that
a disease causes a disturbance in an organism’s homeostasis to the view that dysfunction in an
organ or tissue is symptomatic of a disturbance in the organism homeostasis. It would be
a quantum leap for systems medicine to view disease in this way.
All of us who became serious students of Bowen theory had to prove the theory to ourselves. Bowen got us interested in the ideas, but everyone has his or her own research to do.
No mathematical formulas exist about families to provide credibility. Proving the theory to
oneself is part of the process of differentiation of self. It involves becoming acquainted with
systems thinking and having the motivation (and courage) to apply it in one’s own family. It
is observational research on one’s personal life, recognizing previously unseen patterns, then
taking actions based on this new way of seeing what is unfolding. The actions are aimed at
changing self, not others.
Next comes the problem of assessing any progress that has been made. How to assess, let alone
quantify, progress in oneself and progress in a complex family system is difficult at present.
People fall back on self-observation and observations of the relationship system. Both assessments
are vulnerable to contamination by subjectivity. It is easy to fool oneself into thinking one has
made more progress than one has actually made. The research systems biologists and systems
medicine people are using will likely be of help to Bowen theory researchers over time. For
example, systems biology may be able to quantify levels of chronic anxiety in individuals and
family units to a degree that is not currently possible. To do this, systems biology would have to

include the impact of stress on the networks being studied.
The authors of the chapters in this book are serious students of Bowen theory. Each comes up
with his or her own creative way of approaching research, either to document the accuracy of
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Bowen theory’s predictions and/or to extend the theoretical concepts. I hope the background
I have described conveys something about the challenges they face in studying a complex system
such as the human family. I commend and admire their efforts. I suspect I will end my career by
saying what Bowen often said, “I know within me that the theory is accurate.” This, of course,
proves nothing.
Michael E. Kerr, MD
July 2019
Islesboro, Maine

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Preface

This multi-authored volume provides a framework for examining principles of the research process through the lens of Bowen family systems theory. This publication discusses the links
between theory, data collection, and data analysis from a systems perspective. The authors of the
chapters discuss the core concepts within family systems theory, developed from the study of
the human family, with emphasis on strategies for addressing theoretical and methodological
issues inherent in family research.
This book also provides a framework for acquiring new knowledge and expanding the understanding of both theory and research methods in family research. This is accomplished through
an in-depth discussion of recurring theoretical and methodological issues encountered in family
research. In addition, examples are provided that illustrate the application of Bowen family systems theory in empirical family studies.

The seminal work by Dr. Murray Bowen, Family Therapy in Clinical Practice, published in
1978, provides an in-depth discussion of family systems theory and its early development.
Many have written notable publications based on Bowen family systems theory, which tend
to have a clinical focus. They significantly expanded the theoretical knowledge and an understanding of issues related to the clinical application of Bowen theory. However, a greater
focus on the expansion of family research to ensure its viability and contribution to future
generations of clinicians and researchers in the social and natural sciences involved in family
research is needed.
The purpose of each chapter is outlined below.

Chapter 1: The Role of Theory in Family Research
In the search for knowledge about human behavior and the human family, theory and
research methods are interdependent and complementary. Both are important in family
research because they are critical to the collaborative search for science. Science is
a systematic and logical approach for gaining knowledge and an increased understanding of
the predictability of human life in the universe through the testing and analysis of observable
and measurable facts. This chapter examines the role of Bowen theory in the research
process.

Chapter 2: The Origins of Family Research
We are fortunate today to have many sources related to Dr. Murray Bowen’s National Institute of
Mental Health (NIMH) Family Study Project 1954–1959. This chapter has several purposes. First, as
other sources provide comprehensive details about Bowen’s project, the emphasis of this chapter is

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on the research methodologies of the project, which have not been discussed consistently as much as
have other aspects of the project. This chapter also reviews some seminal results of the project.

Chapter 3: Developing a Systems Model for Family Assessment
Since the publication of Michael Kerr’s outline of a procedure for assessing family functioning,
several attempts have been made to use the outline to develop a model for family assessment.
Although these efforts have been informative, no clear model has emerged and been tested. In
2011–12, the NIMH began development of the Research Domain Criteria (RDoC), a research
framework for studying the full range of human behavior from normal to abnormal based on
biology, behavior, and context. The RDoC moves away from the categorical classification model
of the DSM to a dimensional or continuum model.
The RDoC use of dimensions led the author to consider a new approach to family assessment that
differed from the Kerr model. Beginning with Bowen’s conceptualization of the family as a system and
his focus on the functioning of that system as it faced adaptive challenges and accompanying anxiety and
stress, it becomes possible to develop a dimensional model of family system functioning. That model
includes five dimensions, each ranging from optimal to dysfunctional: resourcefulness, tension management, connectedness and integration, systems thinking, and goal structure. At present, the work remains
a proposed schema for evaluation, not a validated instrument, which will require further testing.

Chapter 4: Bowen Theory: A Systems Model for Family Research
A systems model for family research based on Bowen family systems theory is proposed. The purpose
of family systems theory is to observe the facts of functioning in human relationships. The facts can
be observed to repeat consistently across generations. The Bowen theory focuses on “what happened
and how, when, and where it happened.” The assumptions and theoretical principles within Bowen
theory provide the framework for further understanding family functioning and advancing knowledge
through empirical research. When using the scientific method, the replication and affirmation of findings based on the theoretical formulations of Bowen theory will demonstrate the potential of the conceptual framework as a viable approach for family research.

Chapter 5: Data Collection and Family Research
This chapter discusses the family diagram, a theory-driven assessment instrument, based on the
formulations of Bowen family systems theory. The assessment procedure is designed to systematically collect factual family data (who, what, when, and where) on all family members that provide a multigenerational diagrammatic description of the relationships and emotional patterns in
the nuclear and extended family system. The chapter provides strategies for making the family
diagram a reliable assessment instrument for empirical research.

Chapter 6: Data Analysis and Family Research
The family data used in family research, which is based on Bowen family systems theory,
differs from conventional clinical and social science family data. For example, Bowen theory
consistently focuses on assessing and measuring functioning differences in family dependencies
and relationships. Consequently, conventional ways of measuring family exchanges—through
gender, race, social class, or religious beliefs—are often essentially discounted. Furthermore,
reliability and validity are deliberately sought through use of innovative techniques such as
family diagrams and life histories. Thus, adequate primary and secondary family data are
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Preface

collected by quantitative and qualitative research methods that allow researchers to operationalize Bowen theory’s concepts.

Chapter 7: Stress, Chronic Anxiety, and Symptom Development:
A Family Systems Perspective
A wealth of research evidence over the past several decades supports the relationship
between stressful life events and health. This evidence has contributed to an understanding
of how stress and the response of individuals to stress are significant factors in the development of physical, emotional, and behavioral symptoms. Knowledge about the neuroendocrine systems involved in the physiological stress response and their influence on various
other systems has shed light on how the response to stress can contribute to a wide range
of symptoms. Bowen theory describes how such processes within individuals are regulated
by family interactions.

Chapter 8: Bowen Theory in the Study of Physiology and Family
Systems
This chapter describes research projects using Bowen family systems theory, along with physiological measures, cortisol assay, and brain wave information, to address questions about the regulation of emotional reactivity in the family. The relevance of Bowen theory and the study of
physiology are discussed in relation to the literature of several fields. The challenges involved are
described, and future directions are proposed.

Chapter 9: Human Stress Genomics and Bowen Theory: Potential
for Future Research
Murray Bowen theorized that the human-interaction phenomena described in his theory could
eventually be identified and measured at the cellular level, as well as at the psychological/relationship level. An emerging field of human social genomics, based in changes in genetic expression
in response to social stress, has the potential to offer evidence of Bowen theory on the level of
molecular physiology. There is broad congruence between Bowen theory and social genomics in
identifying three major factors that contribute to human functioning: (1) degree of sensitivity to
social regulation, which Bowen saw as an aspect of his concept of differentiation of self; (2) the
effects of one’s position in the social group in determining health, illness, and well-being; and (3)
the consequences of social stress, or anxiety, from intimate, family relationships to the level of
society.

Chapter 10: Use of Differentiation of Self in Family Research
This chapter describes the multifaceted concept of differentiation of self and reviews and evaluates
ways in which the concept has been operationalized for family research. Other concepts such as
resilience, coping, adaptation, and self-esteem will be examined for possible relevance to research
on differentiation of self.

Chapter 11: Emotional Cutoff
Emotional cutoff is one of the eight concepts of Bowen theory, a family systems theory developed by Murray Bowen based on viewing the family as an emotional unit. Emotional cutoff is
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the distancing of a relationship, physically or emotionally, in reaction to tension or anxiety. The
relationship might appear as distant or “not important,” but cutoff signifies that effort is being
expended to isolate oneself from someone with whom one has an intense bond and strong
reactivity. One reaction to intense fusion is to sever the relationship to gain more autonomy or
emotional breathing space. Bowen observed that cutting off only intensified the fusion in other

relationships, resulting in vulnerability to new symptoms. Concepts such as social support and
social network will be examined for their relevance to research on emotional cutoff.

Chapter 12: Cutoff and Self-Functioning in Three Generations of
Families with Substance Abusing Teenagers
Cutoff is one concept of Bowen family systems theory that addresses emotional cutoff or physical
distancing as a way of handling unresolved attachment between generations of a family. The pulling away of the child from the parent or the extrusion of the child by the parents is a means to
resolve tension in the relationship. However, the cutoff also prevents a resolution of the difficulties, which may impact on the child in their subsequent relationships, nuclear family, and parental
functioning. This chapter will describe the findings in a research study conducted with sixty families who were referred to a mental health center for a substance-abuse evaluation of a teenager.

Chapter 13: Within Family Variability: Intergenerational Cutoff and
Family Projection in an Adopted Family
Research on within family variability has provided an exhaustive exploration of the multiple factors that contribute to why children in the same family turn out differently. This chapter will
briefly review these research findings and describe a family systems view of the subject. Family
systems theory, specifically Bowen theory, offers a broad view of variability in human functioning
that includes family variables such as emotional cutoff between generations and family projection
process, where the parental anxiety is focused on the children to varying degrees. The aforementioned concepts will be elucidated in a long-term case study of a single parent family with two
children, one birth child and one child by adoption. The family emotional process has variable
long-term consequences for each child.

Chapter 14: Nuclear Family Emotional Process
The concept of the nuclear family system describes both the interdependent functioning of the
family unit and the interactional patterns involved as family members adapt to one another and
to the environment. Defined as an emotional system, family processes are viewed as largely automatic and, for the most part, operating outside the awareness of the members. This chapter will
discuss the nuclear family system as an adaptive system and describe the mechanisms or processes
families utilize in the effort to maintain stability. Implications for research will also be discussed.

Chapter 15: The Primary Triangle and Variation in Family Functioning
The triangle, a concept in Bowen theory, is the emotional context in the family system that
shapes the human over the course of life. This longitudinal study explores the influence of the

family of origin primary triangle on fifty-one couples’ reproductive functioning over ten years.
The quantitative analysis identifies associations between reproduction and three variables: distance
versus openness in the family of origin, the degree of inside and outside positions in the primary
triangle, and the degree of projection as expressed in worry.
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