Instructor’s Manual
for
BOWENIAN
FAMILY
THERAPY
with
PHILIP GUERIN, MD
Manual by
Ali Miller, MFT
BOWENIAN FAMILY THERAPY WITH PHILIP GUERIN, MD
The Instructor’s Manual accompanies the DVD Bowenian Family Therapy,
with Philip Guerin, MD (Institutional/Instructor’s Version). Video available at
www.psychotherapy.net.
Copyright © 2010, Psychotherapy.net, LLC. All rights reserved.
Psychotherapy.net
Instructor’s Manual for
BOWENIAN FAMILY THERAPY
WITH PHILIPIP GUERIN, MD
Published by Psychotherapy.net
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Email: contact@psychotherapy.net
Phone: (800) 577-4762 (US & Canada)/(415) 332-3232
Teaching and Training: Instructors, training directors and facilitators using
the Instructor’s Manual for the DVD Bowenian Family Therapy, with Philip
Guerin, MD may reproduce parts of this manual in paper form for teaching
and training purposes only. Otherwise, the text of this publication may not
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without the prior written permission of the publisher, Psychotherapy.net.
The DVD Bowenian Family Therapy, with Philip Guerin, MD (Institutional/
Instructor’s Version) is licensed for group training and teaching purposes.
Broadcasting or transmission of this video via satellite, Internet, video
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prohibited without the prior written permission of the publisher.
Miller, Ali, MFT
Instructor’s Manual for Bowenian Family Therapy, with Philip Guerin, MD
Cover design by Julie Giles
Table of Contents
Tips for Making the Best Use of the DVD
4
Guerin’s Approach to Bowenian Family Therapy
6
Guerin’s Reflections on the Session
9
Reaction Paper Guide for Classrooms and Training
12
Related Websites, Videos and Further Readings 13
Discussion Questions 15
Role-Plays
18
Session Transcript with Commentary
20
Video Credits
58
Earn Continuing Education Credits for Watching Videos
59
About the Contributors
60
More Psychotherapy.net Videos
61
Order Information and Continuing Education Credits:
For information on ordering and obtaining continuing education credits
for this and other psychotherapy training videos, please visit us at www.
psychotherapy.net or call 800-577-4762.
2
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BOWENIAN FAMILY THERAPY WITH PHILIP GUERIN, MD
Psychotherapy.net
Tips for Making the Best Use of the DVD
PERSPECTIVE ON VIDEOS AND THE PERSONALITY OF THE
THERAPIST
1. USE THE TRANSCRIPTS
Make notes in the video Transcript for future reference; the next time
you show the video you will have them available. Highlight or notate
key moments in the video to better facilitate discussion during and
after the video.
Psychotherapy portrayed in videos is less off-the-cuff than therapy
in practice. Therapists may feel put on the spot to offer a good
demonstration, and clients can be self-conscious in front of a camera.
Therapists often move more quickly than they would in everyday
practice to demonstrate a particular technique. Despite these factors,
therapists and clients on video can engage in a realistic session that
conveys a wealth of information not contained in books or therapy
transcripts: body language, tone of voice, facial expression, rhythm of
the interaction, quality of the alliance—all aspects of the therapeutic
relationship that are unique to an interpersonal encounter.
2. FACILITATE DISCUSSION
Pause the video at different points to elicit viewers’ observations and
reactions to the concepts presented. The Discussion Questions section
provides ideas about key points that can stimulate rich discussions and
learning. The Role-Plays section guides you through exercises you
can assign to your students in the classroom or training session.
3.LET IT FLOW
Encourage viewers to voice their opinions; no therapy is perfect! What
are viewers’ impressions of what works and does not work in the
sessions? We learn as much from our mistakes as our successes; it is
crucial for students and therapists to develop the ability to effectively
critique this work as well as their own.
4. SUGGEST READINGS TO ENRICH VIDEO MATERIAL
Assign readings from Related Websites, Videos and Further Reading
prior to or after viewing.
5. ASSIGN A REACTION PAPER
See suggestions in Reaction Paper section.
6. WATCH THE EXPERTS SERIES
This video is one in a series portraying leading theories of
psychotherapy and their application in work with families. Each video
presents a master family therapist working with a real family who have
real problems. By showing several of the videos in this Family Therapy
with the Experts series, you can expose viewers to a variety of styles
and approaches, allowing them an opportunity to see what fits best for
them.
4
Psychotherapy is an intensely private matter. Unlike the training
in other professions, students and practitioners rarely have an
opportunity to see their mentors at work. But watching therapy on
video is the next best thing.
One more note: The personal style of therapists is often as important
as their techniques and theories. Therapists are usually drawn to
approaches that mesh well with their own personality. Thus, while
we can certainly pick up ideas from master therapists, students and
trainees must make the best use of relevant theory, technique and
research that fits their own personal style and the needs of their
clients.
PRIVACY AND CONFIDENTIALITY
Because this video contains actual therapy sessions, please take
care to protect the privacy and confidentiality of the clients who has
courageously shared their personal life with us.
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BOWENIAN FAMILY THERAPY WITH PHILIP GUERIN, MD
Guerin’s Approach to Bowenian Therapy
Bowenian therapy is a model of clinical intervention that has evolved
over the past forty-five years. The method traces its beginnings to the
pioneering efforts of Murray Bowen. As a model of therapy, Bowenian
therapy is a multigenerational systems approach based on a series of
interlocking concepts and clinical models. These clinical models are
used for intervening with dysfunctional children, adolescents, and
adults as well as with individuals whose relationships are conflictual.
Guerin’s work has focused on clarifications and elaborations of the
concepts of Bowen theory, as well as the specific application of the
theory to the building of clinical models for the treatment of marital
conflict and child- and adolescent-centered families and the treatment
of the individual from a systems perspective. Guerin’s sophisticated
clinical approach has led to a more differentiated set of therapeutic
goals. These goals are derived from highly articulated clinical models
developed to deal with problems of children and adolescents, marital
conflict, and dysfunctional adults.
Guerin’s general goals are:
1.
Placing the presenting problem in the context of the multigenerational system by doing a thorough and accurate
genogram;
2.
Connecting with key family members and working with them
to calm their own anxiety and level of emotional arousal and,
thereby, lower anxiety throughout the system; and
3.
Define the parameters of the central symptomatic triangles, as
well as important interlocking triangles.
4.
More specific goals are determined by the presenting problem
and which unit of the family is the primary clinical focus.
In summary, the Bowenian model of therapy consists of the
multigenerational family unit as the context in which to study
individuals and their relationship conflicts under the siege of intense
anxiety.
6
Psychotherapy.net
Clinical Techniques in Bowenian Therapy
The major techniques used in Bowenian therapy include the
genogram, the process question, relationship experiments,
neutralization of the symptomatic triangles, coaching, the “I-position,”
and displacement stories.
The genogram, which is also known as the family diagram, is an
organizing tool that documents the developmental and situational
stressors in a three-generation family system. The function of the
genogram is to collect comprehensive information about individuals
and the family in a short time and to serve as a road map for the
development of a treatment plan.
The process question is a question aimed at calming anxiety and
gaining access to information on how the family perceives the problem
and how the mechanisms driving and maintaining the problem
operate.
Relationship experiments are behavioral tasks assigned to
family members by the therapist to first expose and then alter the
dysfunctional relationship process in the family system.
The neutralization of the symptomatic triangles is a method for the
management and neutralization of reactive emotional triangles. This
five-step process includes finding the triangle, defining the triangle’s
structure and the flow of movement within it, reversing the flow
of movement within the triangle, exposing the emotional process
and, finally, dealing with the process and moving toward improved
functioning.
Coaching is a Bowenian therapy technique that is used when highly
motivated individual family members have attained a reasonable
degree of self- focus, can be in charge of their own internal emotional
reactivity, and can read the predictable relationship patterns in their
system with some facility. With these conditions in place, the therapist
offers some options that might be tried as a change from the robot-like
usual patterns of behavior.
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BOWENIAN FAMILY THERAPY WITH PHILIP GUERIN, MD
The “I-position” is a non-emotionally reactive, clearly communicated
statement of opinion and belief. In a situation of increased tension
and emotional reactivity, it often has a stabilizing effect for one
person to be able to detach from the emotional furor and step into an
“I-position.” In Bowenian therapy, family members are encouraged to
take functional “I-positions.”
Displacement stories are used to teach people about the emotional
processes in their own families without raising their defensiveness.
Bowenian family therapy may be used across the diagnostic spectrum
with psychoses, anxiety disorders, major clinical depression, cognitive
and attentional difficulties, and all manner and forms of relationship
conflict. As a therapist working with this model, it is possible
to incorporate biological and behavioral interventions, and use
twelve-step programs to assist in the management and alleviation of
symptoms. In addition, techniques from other family systems models,
such as narrative therapy, may be used to facilitate the elaboration of
underlying relationship symptoms and process.
*Adapted from a chapter entitled “Bowenian Family Therapy” by
Philipip and Katherine Guerin in Theories and Strategies of Family
Therapy (John Carlson, editor) and from Family Therapy: Concepts and
Methods by Nichols and Schwartz.
8
Psychotherapy.net
Guerin’s Reflections on the Session
The family on this video is adult-child focused. “Adult-child focused”
means that the presenting symptoms reside in an unmarried adult
who presents to therapy as part of her family of origin. The symptom
bearer is an adult child, aged thirty-two, brought to therapy by and
with her parents. A young woman with physical and developmental
difficulties from birth, she is still living at home with her parents. The
mother works outside the home and appears, at best, unhappy. The
father, who retired at a fairly early age, appears angry, controlling, and
intimidating by nature.
In this demonstration interview we have seen an attempt made by
the therapist to: engage and connect with each family member; make
it safer in the therapy and safer in the family to address the family’s
phobic areas, which are the father’s anger, the mother’s loneliness,
the toxic issue of the brother’s death, the daughter’s restricted and
unfulfilling life, and the parents’ marriage; operate and neutralize
the relationship triangles as they presented themselves; and define
the symptoms and begin to propose a change in the direction of
movement in the central symptomatic triangle between mother, father,
and daughter.
The first goal of the interviewer is to engage the family in the joint
endeavor of alleviating their pain and gaining more control over
their problems. There is an attempt to make a connection with each
member of the family. This is done by assuming the position of a calm,
interested, compassionate investigator. As the session moves along,
an attempt is made to understand how they define the problem and to
validate for them their emotional experience. In addition, the therapist
attempts to avoid a control struggle with the father and to stand clear
of the fallout left behind from previous interviews. In other words, he
is attempting to make a connection with all three family members and
to avoid activating the preexisting therapy triangles. At the same time,
the therapist is trying to determine the pathway through which the
family will allow him access to their lives and the relationship process
of their family system.
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BOWENIAN FAMILY THERAPY WITH PHILIP GUERIN, MD
In the beginning of the interview, the father’s anger and need to
control are palpable. The potential traps for the therapist are manyfold. The therapist can be controlled and paralyzed by the father’s
anger and need to control, or confront the anger directly, risking
that the entire session will be absorbed by the fallout from his
confrontation or, even worse, the father might leave the session. True
to the model, the therapist uses a series of process questions aimed
at neutralizing the father’s anger. That is, he has as calm a discussion
as possible while putting the father’s anger on the table as an open
issue. The additional agenda of the therapist in this initial exchange
of comments is to probe this closed system by addressing the issue of
emotional safety. How safe is it to talk about emotionally loaded things
in this family? The implied message emphasizes the importance of
somehow making it safe to talk about difficult issues in the therapy in
order for that safety to carry over to the family system outside of the
therapy session.
Another critically important part of the successful engagement
process is the therapist’s avoiding triangular traps. As has been
mentioned, from the beginning of the session the therapist is making
his way through a maze of relationship triangles. In this instance, the
therapist chooses to attempt to avoid being triangled by being open to
the family’s discussion, hearing their message—talk to our daughter,
don’t focus on our son’s death. In addition, he doesn’t jump to defend
the previous five “bad guy” therapists or contend that he will somehow
be better than the one “good guy.”
After some success at engaging the family, the therapist turns to the
central dysfunctional triangle of father–mother–daughter and begins
his investigation of its structure with one simple process question: “Do
you think Pam has a kind of, you know, just as much a relationship
with you as she has with your wife?”
Psychotherapy.net
daughter’s terms and for the father to cease his efforts to promote the
relationship between these two women and let them get on with it
themselves. This entails not only an attempt to change the direction
of movement in the triangle, but also proposes using the technique of
relationship experiments in order to break the dysfunctional sequence.
In the final phase of the session, the therapist uses the triangle with
Pam’s geriatric friend Jesse. In doing this he challenges the mother to
face the reality of her daughter’s movement away from her and toward
Jesse and for the mother to learn from it, even to the point of studying
Jesse’s methods. Having done this, the therapist returns to the parents’
agenda and broaches the topic of Pam’s social phobia and gives Pam
total responsibility for dealing with it. In this way, he hopes to relieve
the mother of some of her guilt and feelings of responsibility for Pam’s
isolation, while challenging Pam to take on the social phobia and do
something about it.
If there were a follow-up session the next week, the therapist would
probably begin the session by checking in with the family to see if
they had tried his suggestions. He would ask Pam if she had done any
thinking about what was going on. He would check with the mother to
see if she had thought about Jesse’s method and why that worked with
Pam and her method didn’t. He might ask the father if he felt left out
because he didn’t have any assignments. He would then ask them what
they wanted to work within that session and he would expect that they
would go back to Pam. He wouldn’t be surprised if little or no change
had occurred between sessions.
It is clear from the structural set up, and the positioning of family
members in the room, that the father and daughter are linked in
alliance with the mother on the outside and unhappy about it. The
therapist tries to nudge the direction of movement in this triangle
by urging the mother to close the distance with her daughter on her
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BOWENIAN FAMILY THERAPY WITH PHILIP GUERIN, MD
Reaction Paper for Classes and Training
Video: Bowenian Therapy with Philip Guerin, M.D.
•
•
•
Assignment: Complete this reaction paper and return it by the
date noted by the facilitator.
Suggestions for Viewers: Take notes on these questions while
viewing the video and complete the reaction paper afterwards.
Respond to each question below.
Length and Style: 2-4 pages double-spaced. Be brief and concise.
Do NOT provide a full synopsis of the video. This is meant to be a
brief reaction paper that you write soon after watching the video—
we want your ideas and reactions.
What to Write: Respond to the following questions in your reaction
paper:
1. Key points: What important points did you learn about Guerin’s
approach to Bowenian Family Therapy? What stands out to you
about how Guerin works?
2. What I found most helpful: As a therapist, what was most
beneficial to you about the model presented? What tools or
perspectives did you find helpful and might you use in your own
work? What challenged you to think about something in a new
way?
3. What does not make sense: What principles/techniques/
interventions did not make sense to you? Did anything push your
buttons or bring about a sense of resistance in you, or just not fit
with your own style of working?
4. How I would do it differently: What might you have done
differently than Guerin in the sessions in the video? Be specific
about what different approaches, interventions and techniques you
might have applied.
5. Other Questions/Reactions: What questions or reactions did
you have as you viewed the therapy sessions with Guerin? Other
comments, thoughts or feelings?
12
Psychotherapy.net
Related Websites, Videos and Further
Reading
WEB RESOURCES
Bowen Center for the Study of the Family and the Georgetown Family
Center
www.thebowencenter.org
The Princeton Family Center for Education, Inc.
www.princetonfamilycenter.org
Murray Bowen, M.D. and The Nine Concepts in Family Systems Theory
www.ideastoaction.wordpress.com/dr-bowen/
Psychotherapy.net interview with family therapist Monica McGoldrick,
LCSW, PhD
www.psychotherapy.net/interview/monica-mcgoldrick
RELATED VIDEOS AVAILABLE AT
WWW.PSYCHOTHERAPY.NET
Structural Family Therapy, with Harry Aponte, LCSW (Note: features same
family client as Guerin session)
The Legacy of Unresolved Loss: a Family Systems Approach with Monica
McGoldrick, LCSW
Tools and Techniques for Family Therapy by John Edwards, PhD
Family Secrets: Implications for Theory and Therapy by Evan Imber-Black,
PhD
RECOMMENDED READINGS
Bowen, M. (1978). Family therapy in clinical practice. Northvale, NJ: Jason
Aronson.
Carter, B. & McGoldrick, M. (2004) (3rd ed.). The expanded family life cycle:
Individual, family, and social perspectives. Boston, MA: Allyn & Bacon, Inc.
Framo, J. L. (1992). Family-of-origin therapy: An intergenerational
approach. New York: Bruner/Mazel.
13
BOWENIAN FAMILY THERAPY WITH PHILIP GUERIN, MD
Psychotherapy.net
Guerin, P.J. (1996). Working with relationship triangles: The one-two-three
of psychotherapy. New York: Guilford.
Discussion Questions
Guerin, P.J., Fay, L.F., Burden, S.L. & Kautto, J.G. (1987). The Evaluation
and treatment of marital conflict: A four-stage approach. New York: Basic
Books.
Professors, training directors and facilitators may use some or all of
these discussion questions, depending on what aspects of the video are
most relevant to the audience.
Guerin, P.J. (Ed.) (1976). Family therapy: Theory and practice. New York:
Gardner.
Kerr, M.F. & Bowen, M. (1988). Family Evaluation: An Approach based on
Bowen theory. New York: W.W. Norton.
McGoldrick, M., & Gerson, R. (1999). Genograms: Assessment and
intervention. New York: W. W. Norton.
Nichols, M. F. & Schwartz, R. (2001). Family therapy: Concepts and methods
(5th ed.). Boston, MA: Allyn & Bacon.
INTRODUCTION
1. The Approach: What stands out to you as most important
in Guerin’s introductory description of the theory of
Bowenian Family Therapy? How would you describe your
understanding of Bowenian therapy in one or two sentences?
FAMILY THERAPY SESSION
2. Beginning: What did you think of Guerin beginning the session
by asking the father, Adrian, to start? Why do you think he
started with him? How do you tend to begin your sessions? What
factors do you take into consideration in deciding how to start?
3. Comparisons: How did you feel when the family was talking
about the previous therapists they have seen? What came up
for you when Pam said how much she liked the last therapist
they saw and when Adrian shared how angry he got at another
therapist? What did you think about how Guerin handled
it? Have you had clients who have expressed strong negative
and/or strong positive reactions to previous therapists when
they begin treatment with you? How have you responded?
4. Triangles: Which triangles stood out to you as you watched this
session? Where in the session did you notice Guerin defining
the triangles? What did you think of Guerin’s attempts to
change the direction of movement in the primary fathermother-daughter triangle? Were there any triangles that you
would have attended to more if you were the therapist? Do
you find the concept of triangles useful? Why or why not?
5. Therapeutic Style: In Guerin’s reflections on the session,
he described his style as that of a calm, interested, and
compassionate investigator. Do you agree with his self-
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BOWENIAN FAMILY THERAPY WITH PHILIP GUERIN, MD
description? Why or why not? If you were to describe your
therapeutic style using three adjectives, what would they be?
6. Making connections: One of Guerin’s goals was to connect with
all three family members. How successful do you think he was at
achieving this goal? Which family member do you think he had the
easiest time connecting with? The hardest time? Is there anything
you would have done differently to connect with this family?
7. Engaging Pam: Many therapists would find it challenging to engage
Pam, as she looked down and gave brief answers such as, “I don’t
know,” and “sometimes.” What do you think of Guerin’s attempts
to engage her? What did he do that you liked and/or didn’t like?
How do you imagine you might have attempted to engage her?
8. Emotional safety: How do you see Guerin establishing a safe
environment for the family members in this session? What
specific interventions or aspects of his style do you think
increased or decreased the emotional safety of the session?
Is there something you might have done differently?
9. Loss and sadness: What are your thoughts on how Guerin
engaged this family around their feelings of loss and
sadness. What reactions did you have to how he responded
to Pam and Judy when they cried? What did you think of
his choice to ask Adrian if he knew what their tears were
connected to? If you were their therapist, how might
you have worked with issues of loss in this family?
10. Fear of death: How did you feel during the part of the session
when Guerin asked Pam if she worried about her parents
dying? What did you think about Guerin’s way of being
with Pam during this emotional segment of the session?
Can you see yourself broaching this topic with Pam in the
first session? How might you have responded differently?
Psychotherapy.net
you might have approached the topic of Pam’s social life?
12. Process Questions: Guerin sees process questions as a way
to calm anxiety and to gain access to information about how
the family views the problem and how the family system
operates. What are a few process questions that stood out to
you as particularly helpful in this session? Were there any
process questions that you think were unhelpful? Why? What
are some ways you utilize process questions in your work?
After watching this session, do you think you are more or less
likely to utilize process questions with your clients? Why?
DISCUSSION
13. Closed system: Guerin described this family as a closed
system. What does this mean to you? Do you agree or
disagree with his assessment? What happened in the session
that you think led Guerin to view them as a closed system?
What experiences have you had working with families or
couples that you would characterize as closed systems?
14. Overall thoughts: What are your overall thoughts about
Guerin’s approach to Bowenian therapy? What aspects of
his approach can you see yourself incorporating into your
work? Are there some components of this approach that
seem incompatible with how you work with families?
15. Personal Reaction: How would you feel about having Bowen as
your therapist? Do you think he could build a solid therapeutic
alliance with you and help you? Why or why not? If you have
ever been in family therapy before, how does Guerin’s approach
compare with the approach of your family therapist?
11. Pam’s social life: Guerin hones in on Pam’s limited social life,
asking questions about her friendships and encouraging her
to be more social. How did you react to this? How receptive do
you think Pam was to his encouragement? How do you think
16
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BOWENIAN FAMILY THERAPY WITH PHILIP GUERIN, MD
Role-Plays
After watching the video and reviewing Philip Guerin’s Approach to
Bowenian Therapy in this manual, assign groups to role-play a family
therapy session following Guerin’s model. Organize participants into
groups of four, consisting of one psychotherapist and three family
members. If time permits, rotate so each person has a chance to play
the role of therapist.
Rather than conducting a full session, invite participants to choose
one segment of the session on the video to loosely reenact. The point
here is not to try to resolve the family’s issues, but to use this role-play
as an exercise in viewing the family from a Bowenian perspective and
trying on Guerin’s style.
INSTRUCTIONS FOR ROLE-PLAYERS
Psychotherapy.net
what it was like to role-play this family and how they felt about the
therapist’s interventions. Then, invite the therapists to talk about
their experiences; how did it feel to conduct a family therapy session
using a Bowenian approach? Finally, open up a general discussion of
the strengths and the challenges in applying a Bowenian approach to
working with families.
An alternative is to do this role-play in front of the whole group with
one therapist and one family; the rest of the group can observe, acting
as the advising team to the therapist. Before the end of the session,
have the therapist take a break, get feedback from the observation
team, and bring it back into the session with the family. Other
observers might jump in if the therapist gets stuck. Follow up with a
discussion on what participants learned about using Guerin’s approach
to Bowenian Family Therapy.
One person will start out as the therapist and the other three group
members will decide amongst themselves who will be what family
member. Choose a segment of the video that you would like to use
as a jumping off point; do not attempt to follow the sequence of
interactions, but rather use the clients and situation in the video as a
jumping off point, and allow the role-play to develop spontaneously.
Therapists should practice remaining emotionally nonreactive,
meeting the family “where they’re at,” while trying to calm their
anxiety. Get a feel for what it’s like to pay attention to triangles and
dyads by focusing on:
1. the major triangle of mother-father-daughter,
2. one of the dyadic relationships (choose between motherdaughter, father-daughter, or mother-father), and
3. focusing on an individual family member, and trying to get
them to take responsibility for themselves.
After the role-plays, have the groups come together to discuss their
experiences. What did participants observe about this family in terms
of the triangles and dyadic relationships? What did the therapist
do to calm the family’s anxiety? Invite the clients to talk about
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BOWENIAN FAMILY THERAPY WITH PHILIP GUERIN, MD
Psychotherapy.net
Complete Transcript of
Bowenian Family Therapy
with Philip Guerin, MD
Guerin: So you just keep escalating the volume and the intensity and
Pam would finally hear you.
GUERIN TRANSCRIPT: SESSION ONLY
Guerin: Okay. So, you came to get some help to try to find a better
way to make it work?
Guerin: Now, it’s my understanding that you folks have been part of
this program and have come already several times.
Adrian: Yeah, this is our seventh time now.
Guerin: So you are more veterans than I am because this is my first
time, so you will have to lead me through the field here. Adrian, can
you tell me what it is you came for, and maybe summarize for me what
you think you got out of the seven times and if it’s had any impact?
Adrian: Well, we came here because we were having problems with
Pam. For many, many years, we would tell Pam or ask Pam to do
something, and she would either refuse to do it or she just wouldn’t
do it. We’d ask her, we’d call her or something, but she won’t answer.
I don’t know, she just won’t give you an answer. Like we’d say, “Pam,
where are you?” Get no answer. Or “Pam, will you do this?” And you
get no answer. And you have to turn around and say it three or four
times. What else?
Guerin: Is that to both of you equally?
Adrian: Oh yeah, yep.
Guerin: And even if the two of you got together and said it in a
chorus, Pam still wouldn’t answer.
Adrian: She still wouldn’t answer. Very rarely would she answer. You
know, just to acknowledge that you had said something to her.
Guerin: And now you guys felt that was disrespectful, or it wasn’t
getting done, what you wanted, or . . . ?
Adrian: I mean, it would get done because I would get angry enough
where it would get done.
20
Guerin: And then she’d do it.
Adrian: It’s a wonder you didn’t hear it in New York. Right?
Judy: No, no.
Adrian: Trying to find a better way to make it work. But the last five
times it was always Judy and I, Judy and I that were doing the talking.
Out of the five times, I don’t think Pam said a dozen words. And then
the one guy that we had . . .
Judy: Last week. I mean last month.
Adrian: Two months ago the one guy we had ticked me off so bad-that’s why you heard me, I don’t know if you heard me apologizing to
people today.
Guerin: I heard a little bit of that.
Adrian: He ticked me off at the very end. And I mean, I got ticked.
And when I came in last month, I told her to tell them, “Don’t talk to
us.” I understand you have to have a, I’m trying to think of the
word . . .
Judy: A background.
Adrian: Background on us and everything else in order to get the
feeling of what’s going on. I do understand that, but nobody ever
talked to Pamela. They were always talking to us about things that we
didn’t even really want to talk about.
Guerin: Okay.
Adrian: And two months ago the guy really ticked me off. I mean,
he . . .
Guerin: He got you.
Adrian: He got me. He got me so bad that last month I turned around
and says, “If it happens again I’m out of here.” I mean, it would be the
last time I would come. There would be no more.
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Guerin: So, then, was it better last time?
Guerin: What was it about him that appealed to you?
Adrian: Yes. The gentleman was from--I think he was from New York
too, wasn’t he?
Pam: I don’t know. He, for some reason I was able to communicate
with him because he was more pleasant. I mean . . .
Pam: No.
Adrian: The other guys weren’t bad.
Adrian: Pennsylvania?
Pam: No.
Guerin: From Philiply?
Adrian: It’s just that they weren’t . . .
Adrian: And anyway, he was doing a lot of talking to Pam, and Pam
was doing the talking last month.
Pam: They were more focusing on you and Ma instead of me. And
when he really started getting mad, I almost stood up and said, “Hey,
we are not here for these two. We are here for me.”
Pam: Yeah, I liked the guy. It was good.
Adrian: And, it seemed to work a little bit. I mean, last month we
had, this past month we didn’t have that much of a problem with her.
Things seemed to . . .
Adrian: Why didn’t you?
Pam: I don’t know. I kept my quiet.
Pam: Change a little bit.
Guerin: What do you think it is about you that the three of you are
here for?
Adrian: Change a little bit. Of course, we did have a wedding that she
stood up to, where she was coordinator for.
Pam: To get me to communicate more, talk to these guys more.
Control my anger.
Pam: And he walked her down the aisle.
Adrian: And I walked my niece down the aisle. And so she was on
very good behavior situation this past month.
Guerin: You’ve got some, huh? And is that when you shut down, when
you are angry? Is that when you don’t hear and you don’t answer and
just--
Guerin: So, you felt like that last one worked for you.
Pam: I think so, I just . . .
Adrian: That last one worked more than any of the other five.
Guerin: --pull it all in? Do you ever blow?
Guerin: Put together.
Pam: No.
Adrian: All put together, yes, definitely.
Guerin: No. Leave the blowing to daddy?
Guerin: So maybe you don’t even need to be here today.
Adrian: She blows in her own way, by herself.
Commentary: With this question Guerin distances himself, avoids
selling himself and criticizing the other therapists. The family responds by
endorsing the potential usefulness of the consultation
Judy: She throws things.
Judy: No, we don’t need to be here. You’ve got to be kidding.
Guerin: Pam, what are you angry about?
Guerin: So, Pam, do you like it when the person sitting in my chair
talks to you?
Pam: Nothing right now.
Pam: Especially the guy last month.
22
Adrian: She throws things and she does damage.
Judy: She has tantrums. She does have her damage.
Guerin: No?
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Adrian: Yet.
Pam: I don’t know. I really don’t know.
Guerin: If I keep bugging you will you be angry in the next five
minutes?
Guerin: I mean, if your dad behaved in ways that really bugged you,
would it be safe to say, you know, “Daddy, when you do this and this it
really upsets me, makes me angry and makes me want to . . .”
Pam: I don’t think so.
Guerin: No? So somehow something happened between last time and
this time that you are a lot less angry. That means you got to talk and
that made it better. So what did you get to have to say that kind of
made some of that go away?
Pam: I don’t know. I mean, the guy last week, it was more pleasant to
talk to him. I don’t know, maybe . . . I don’t know how to explain it.
Pam: I can try that one.
Guerin: Would it be safe? Yeah? It would be safe to . . .
Pam: I can try that one. I haven’t tried that yet.
Guerin: No? How come?
Pam: I don’t know.
Guerin: Okay, but the anger, whatever happened, the anger has kind
of been . . .
Guerin: Is your dad an easy guy to talk to?
Pam: From way up here to down here a little bit.
Guerin: What’s that mean? I mean, when is he and when isn’t he?
Guerin: Okay. So then the next problem is to be able to communicate
better with the mama and the papa.
Pam: Well when he is hurting and real, real angry, no. No. I just back
off.
Pam: Uh-huh.
Guerin: So, when he is in a good mood and he’s kind of light and
stuff, then you can talk to him.
Guerin: Do you know what it is that you want to communicate with
them about?
Pam: Eh, sometimes.
Pam: Yeah.
Pam: Not so much about, but like they said, I have to answer, and I
don’t. And I don’t.
Guerin: And can you tell him negative stuff about him when he is in
that kind of mood? Not angry but . . .
Guerin: Now the anger is gone, so you don’t have to shut down
anymore, so why wouldn’t you answer?
Pam: I don’t know. I haven’t tried yet.
Pam: I don’t know why I don’t answer. I just don’t know why.
Guerin: So, it’s a puzzle.
Pam: Yeah.
Guerin: Do you let your parents know what it is about each of them
that bugs you? Do you know what it is about each of them that bugs
you?
Pam: Mm-mm.
Guerin: If you knew, would it be safe to tell them?
24
Guerin: Never tried it. Would it be safe, Adrian?
Adrian: I don’t know. What’s negative about me?
Guerin: Oh, you can’t even think what it possibly might be?
Adrian: No.
Guerin: No.
Adrian: Oh lord, it’s hard to be humble.
Guerin: Can you sing that for us? That was a good country western
song.
Judy: He used to sing it very well.
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Guerin: So, but be straight with me now. Could you take negative
feedback?
Guerin: Do you think Pam has just as much of a relationship with you
as she has with your wife?
Adrian: Oh, probably.
Commentary: After some success at engaging the family Guerin turns to
the central dysfunctional triangle of father–mother–daughter and begins
his investigation of its structure with this simple process question.
Guerin: Would it be easier to take it from Pam than from Judy?
Pam: Yeah, let me try that one.
Adrian: It all depends on what it is. When you say negativity . . .
Guerin: Well, if they say, “Daddy, you’ve got too hot a temper and you
scare me and you intimidate me,” would you be able to hear that?
Adrian: No, I think she is better with me than with my wife.
Guerin: Really?
Adrian: Yes.
Adrian: Oh yeah, I mean, I used to be a lot worse. A lot worse.
Guerin: Agree?
Guerin: Is that because you’ve been working on it or because you just
got older and it mellowed out?
Judy: Oh, yeah.
Adrian: No, I think I got older and it mellowed out, and I worked on
it. I used to drink a lot. Many years ago.
Judy: I have no idea.
Guerin: And so that would kind of . . . You were an angry drunk?
Judy: No, I just, I think it goes way, way back. I was the one that took
her to all the doctors that she had to go to. And I just feel that maybe
she associates me with hurt, you know--all the medical things and
things she had to go through because we had a lot of things when she
was a baby. And I was home, and so it naturally was me that took her
to all this. But it goes way back when she was four or give years old.
Adrian: Yeah, yeah. And since I quite drinking I think I’ve been a lot
mellower and everything else.
Judy: Well, it’s been many, many, many years, though.
Adrian: Yeah, it’s been many, many years. Yeah, I get angry, you know,
like anyone else does, I would assume.
Commentary: In this segment, as mentioned earlier, Guerin takes
the issues of emotional safety, open communication, and the father’s
anger and gently, but factually presses the father and daughter about
the presence of these issues in the family, attempting by this to open
communication and begin the process of detoxifying and neutralizing
these issues. If this can be successful, it will become safer in the therapy
session and at home to discuss more openly emotionally charged topics.
Otherwise, these toxic issues get buried, building negativity and tension.
An indication that Guerin is being somewhat successful in establishing
therapeutic safety is seen in the father’s disclosure of his anger and alcohol
abuse in the past and his improvement in the present. As you can see from
this segment of the interview, learning the art of asking process questions
is critical to using the Bowenian method of intervention.
26
Guerin: What’s that about? How come it sets up that way?
Guerin: No?
Guerin: Now, does it upset you, Judy, to remember those times, or
that the relationship with you and Pam isn’t better?
Judy: I’ve just grown to adjust to it, you know.
Guerin: I understand, but it seems like something we are talking
about is upsetting you, and what I am trying to get clear about, is it the
state of the relationship between you or is it some of that old stuff and
reflecting back?
Judy: Oh, no. It, I just wish, because she was the daughter I always
wanted, that we could be closer, yes.
Guerin: Okay, so you get kind of melancholy about that, wishing it
could be so.
Judy: Yeah. But she doesn’t, so . . .
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Guerin: Have you tried?
Guerin: Do you want me to stop talking about this?
Judy: Oh, I’ve tried. I’ve asked her to do things and come places with
me and she doesn’t want to, and stuff, so.
Adrian: How many times do I ask you to be nice to Mother when she
comes home from work? Before she comes home from work?
Guerin: So, when you say to her, you say, “Pam, listen, I got Saturday
off. I want to go with you do what you want to do. What are we going
to do?” She says “I don’t know,” and then she never . . .
Pam: I try to. I try to.
Pam: Exactly what I would say, too.
Adrian: No. None whatsoever.
Guerin: “I don’t know.”
Guerin: So you try to push them together.
Judy: Or it’s, “Come on, I’m going shopping,” or, “Come on, I’m going
up to the mall,” and she won’t come with me.
Adrian: I try.
Guerin: So, Pam, what’s that all about?
Pam: I don’t know. I really couldn’t say.
Guerin: Well, what about, let’s build some “supposes,” you know. I
mean, what could it be about? I mean, is it hard for you to be with
your mom? Is there something about her?
Guerin: Do you have a theory as to why the two ladies don’t do better
with each other?
Guerin: Doesn’t work.
Adrian: She gets angry with me sometimes.
Guerin: Judy does?
Adrian: Judy does. Because . . . I don’t know what it is I’m trying to say
there, but I had. . .
Pam: It’s not that hard, but it’s just, sometimes I like to go shopping by
myself.
Guerin: She gets angry with you for trying to promote the
relationship?
Guerin: Okay. Does she let you do that? Yeah? Does your mother
hover and kind of overprotect you, or does she let you do what you
have to do?
Adrian: She doesn’t get angry. I don’t know what the word would be,
but she just says, “Leave it alone, leave me alone,” and walks away.
Pam: She lets me do whatever.
Guerin: Okay. Now when Adrian talks to you about your relationship
with Pam, do you feel he is criticizing you?
Guerin: Uh-huh. But there is, I mean, because she gets kind of sad
that you and she aren’t better connected.
Judy: No, I don’t think . . . Well, a lot of times he’ll say . . .
Pam: Yeah, that’s what we have to work out, too.
Judy: “Change the tone.”
Guerin: So, what’s in the way? What’s the roadblock?
Adrian: That’s my biggest thing.
Pam: I don’t know what the barrier is.
Guerin: You get upset about it, too.
Guerin: It’s like you are being instructional in telling her how to do it,
you mean?
Pam: I don’t know what it is.
Adrian: Yeah, yeah.
Guerin: Have you thought about it?
Guerin: Uh-huh, like the boss.
Pam: No, not really.
Adrian: Well, not really.
28
Adrian: “Change the tone.”
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Guerin: No?
expect to have to clean house and . . .
Adrian: It’s the tone that she uses, would be the boss tone.
Guerin: You’re gone all day working?
Guerin: The tone Judy uses or you use?
Judy: Working, yeah.
Adrian: The tone Judy uses, and I would just turn around and say,
“Change your tone.”
Guerin: Do you like working?
Guerin: Oh, you say that.
Guerin: Do you like what you do?
Adrian: Yes.
Judy: But that’s just me. That’s just the way I talk, so.
Judy: No, not right now, but I do like my job. Right now I’m under a
lot of pressure.
Guerin: You’re bossy?
Guerin: At work?
Judy: I don’t know if I’m bossy or not, but, you know, it’s just probably
the tone of my voice or something, that he will always say that to me.
Let’s see, I’m just trying to think of something.
Judy: Yeah, it’s a busy season, and we lost three people and training
three new people is not...
Adrian: I was trying to think what you would say too, and I can’t
think of anything.
Judy: No, they quit, and now I am losing another one, so that . . .
Guerin: Are the two of them kind of in a conspiracy avoiding you
telling them what to do?
Judy: I work for a roofing company and I do the invoicing for them.
Judy: Oh, yeah.
Adrian: No, we’re not.
Judy: Like today, when she is home, she’s got the whole day off and
he’s home. And then when I come home and I see the house isn’t very
well cleaned or dinner isn’t made . . .
Pam: I did good today, so . . .
Judy: Yeah, I like work.
Guerin: They quit or they got let go or . . .
Guerin: What do you do, Judy?
Guerin: Okay. So any type of administrative help coming in, you have
to train them, and you just get them trained and they leave.
Judy: Yeah, more or less. Well, this one I didn’t really have to train
because the one that’s leaving is more in the accounts payable and I’m
on the accounts receivable side of it, but she is in our office. Anyway,
but . . .
Judy: You did real well today, but . . .
Guerin: So, if you come home all weary and upset from working, are
either of those two guys there for you?
Pam: Come on.
Judy: No.
Judy: We were coming here so . . .
Guerin: No?
Guerin: “I’ve got to be on good behavior,” right?
Judy: No, I don’t think so. He doesn’t like me working, and I don’t
think . . . He’s instilled that on her, so I guess . . .
Judy: Or I’ll say to him, “How come you didn’t make her do this?”
or something. Well, he said that she was gone most of the day today
again. So, I mean, you know, there’s just whatever comes up or
something. I’m gone all day, you know, and when I come home I don’t
30
Adrian: I did not.
Guerin: This means you are supposed to be home taking care of the
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two of them?
Pam: It depends on how I feel. So If I want to go, I’ll go.
Judy: Yes.
Guerin: Will they let you go with them?
Adrian: Isn’t that where every good wife is supposed to be?
Pam: Yes.
Judy: No.
Guerin: So, all you have to do is say yes, and you get to go.
Guerin: It’s so hard to be humble. We’ve got a real liberated husband
over there, huh? So how come you are working if they want you home?
Pam: Yes, I want to go this weekend.
Judy: Why? Because we can’t afford for me to stay home.
Guerin: Is that you can’t afford it financially or you can’t afford it
emotionally?
Guerin: So, how often do you go? Once a month, twice a month,
what?
Pam: I don’t know.
Judy: No, I can’t afford it financially.
Judy: Well, whenever we can get up there on the weekend we do try.
During the summer especially.
Adrian: Both. Both.
Guerin: And how often does Pam go with you?
Guerin: So you wouldn’t mind being home if you didn’t mind the
extra income?
Commentary: Not all questions in the interview are aimed at
elaborating or uncovering process. Some are what we call “information
questions” aimed at the elaboration of the facts. These questions serve
the purpose of opening a closed system and replacing overanxious
distortion with a more factual representation.
Judy: I don’t know. I really couldn’t say. I mean, we enjoy ourselves
when we are together. We spend weekends together.
Guerin: You mean you and Adrian or you . . .
Judy: Yeah, we go out of town on the weekend, and . . .
Guerin: Do you? Where do you go?
Judy: We go to Michigan.
Guerin: Do you have a place there?
Judy: Yeah, we’ve got a place up in Michigan.
Guerin: And Pam stays home?
Judy: When we beg her to come up and help.
Adrian: Maybe three times a year, four times a year.
Pam: No.
Adrian: If you come up that often now.
Guerin: So, what do you do when you stay home?
Pam: Clean house.
Pam: Cleans house.
Guerin: Just make the house immaculate so that when mother comes
home she’ll be real happy?
Adrian: It’s her choice.
Pam: Yeah.
Guerin: And you like that?
Guerin: Do you do anything else?
Adrian: Through choice.
Pam: Vacuuming, bathrooms, dishes.
Pam: Sometimes.
Guerin: What do you do for fun?
Guerin: Sometimes yes, sometimes no? What determines yes or no?
Pam: Fun? Just stay home, watch TV.
32
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Guerin: Right.
Pam: Thirty-two.
Pam: On Saturday.
Guerin: How come you don’t have some friends and some groups you
hang out with and stuff? You don’t want to do that? You just . . .
Guerin: Does anybody come and watch TV with you? Have you got
some friends?
Pam: Nobody that I want to.
Pam: I have a dog at home that keeps me company.
Guerin: No what?
Guerin: What kind of dog do you got?
Pam: Nobody that I want to hang out with.
Pam: It’s a German shepherd mix, collie mix.
Guerin: Really? You’ re sure, or is it just that it’s hard to find them?
Guerin: Yeah? Nice dog.
Pam: Mm-mm.
Pam: Mm-hmm.
Judy: Oh, she bowls.
Guerin: So you get a lot of TLC from, what’s your dog’s name?
Guerin: Do you?
Pam: Pumpkin.
Pam: Oh, yeah. I go to bingo.
Guerin: Pumpkin. How old’s Pumpkin?
Pam: How old?
Adrian: She goes to bingo on Tuesday nights and she bowls on Friday
nights.
Judy: About three years old. Three years.
Guerin: Are you a good bowler? You bowl on a team?
Pam: No.
Pam: Yeah. Mixed league.
Adrian: Three, maybe four. In that vicinity.
Guerin: Is the team made up at the bowling alley or is it from another
place like the church or something like that?
Guerin: You had her since she was a pup?
Pam: Six weeks old. No, she’s got to be five.
Guerin: Do you take care of her? Do you take care of her? Walk her,
feed her, get her her shots, all that stuff?
Pam: Uh-uh. I don’t know where . . .
Adrian: From the bowling alley I’d say.
Pam: Just the bowling alley. That’s fun.
Pam: I take her for her shots. I take her for the haircut. I don’t walk
her too much because from the gate to the driveway is a good running
area, and she runs.
Guerin: So, it doesn’t bother you that you don’t have friends to hang
out with, to come over to the house, to go to the movies with? You
haven’t made friends with any of the people on the bowling team?
Guerin: So she has a run, like?
Pam: Oh, yeah, but. . .
Pam: She runs. I have to feed her just about every day.
Guerin: But you never go to the movies with them or any of that stuff.
Guerin: But you don’t make your father walk her?
Pam: Oh no, because they all have families.
Pam: Well, we don’t walk her.
Guerin: They all have family, so they’re all older and they have
families. Do you want to have a family?
Guerin: How come you don’t get out and socialize? How old are you?
34
Pam: I don’t know. I’m still thinking about that one.
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Guerin: You’re still thinking about that one. How long are you going
to think about it?
Pam: Very rare.
Adrian: Another 30 years, huh?
Guerin: Me too.
Pam: No. No.
Adrian: I can’t even get into it anymore. When we first got it she
taught me how to get into it and that.
Guerin: So you don’t get upset about not having a bunch of friends to
hang with, go to the movies with, whatever?
Adrian: I am a complete illiterate with the computer.
Guerin: Who taught you? Judy?
Judy: She doesn’t care for movies, that’s why.
Adrian: Pamela.
Guerin: Oh, well, I mean, I don’t know. Whatever else--the
automobile races.
Guerin: Pam. Pam taught you.
Judy: She is great because she doesn’t drink. I mean, occasionally, but
she doesn’t go to bars.
Pam: Yeah, I taught him how.
Judy: You were playing.
Guerin: She can’t go to bars.
Adrian: Yeah, I did.
Pam: I don’t want to go to bars.
Judy: You were playing the games that were on it.
Judy: And she does not watch a movie. I mean even on TV, she will
not watch a movie through, almost.
Guerin: I’m going to make some trouble here now. Would you like to
be on the internet?
Guerin: Really? What do you like to do, Pam?
Pam: I won’t say internet. What’s the other one?
Pam: Play on the computer.
Judy: She asked for it and I told him to hook up the line, but she would
have to help pay for it.
Guerin: Do you? Are you good at it? Are you on the internet?
Adrian: I refuse it. I won’t hook up the phone line.
Pam: Yes, you will.
Guerin: You won’t go to the internet?
Adrian: Huh?
Guerin: Why not?
Adrian: Too much money.
Guerin: How much?
Adrian: Well, it’s going to run me at least 50 dollars a month.
Guerin: Do you do the computer?
Adrian: Do I mess with the computer?
36
Pam: Which is fine.
Guerin: Do you work?
Pam: Yeah, I work.
Guerin: What do you do?
Pam: In a grocery store.
Guerin: How many hours a week?
Pam: It depends.
Guerin: Thirty, twenty, ten?
Pam: No, it’s not 10.
Guerin: So it’s more like 15, 20?
Pam: No, more than that.
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Guerin: Thirty.
Pam: No, not that I know of.
Adrian: About 28 or 30.
Adrian: Oh, you don’t remember, huh?
Pam: Twenty-five, thirty.
Pam: Uh-uh.
Guerin: It’s hard to pin you down Pam, you know? Do you like
working in a grocery store?
Guerin: I guess that means you have.
Pam: At times yeah, at times no.
Judy: Oh, yeah. There is a nice young fellow that comes around and
has asked her to do things and she has treated him very . . .
Guerin: What determines whether you do or you don’t?
Pam: No, I have not. Not lately.
Pam: The customers. Some of the customers really get to me, so I have
to walk away.
Guerin: She is getting bugged at you just for mentioning it.
Guerin: Uh-huh, there’s that anger thing again. You walk away, shut
down your ears, right?
Pam: Well, he’s been working a lot, too.
Pam: From the customers. I mean, there are several that I will walk
away from.
Adrian: They are usually older people. Explain to him.
Pam: No.
Adrian: Well, he hasn’t been around lately.
Adrian: Well, I would too.
Judy: Some of the time what you say to him and the way you treat
him is not very nice.
Pam: Not lately.
Guerin: Older people bug you, Pam? Do they?
Adrian: You know the old saying, “You treat them like dirt, they keep
coming back”? Well, that’s the way she treats him. Worse than dirt.
Pam: No, they don’t.
Guerin: Why do you do that, Pam?
Adrian: Aren’t they the older ones?
Adrian: So he’s stopped coming around now.
Pam: No, these are specific customers that I will walk away from.
Pam: I have not.
Guerin: You mean like they are regular customers every week. You
know when they are coming. You see them coming, and you go back
and start rearranging the milk case rather than . . .
Guerin: Pam?
Pam: Uh-huh, you’d better hide.
Guerin: Now, do your parents get upset because you don’t have more
of a social life and stuff?
Judy: And he’s been around since they’ve been in college together, so .
..
Pam: I just don’t like . . . He’s not my type of guy.
Guerin: What’s the matter with him?
Pam: I don’t know. I never asked them.
Pam: I don’t know, he’s just not my type of guy.
Guerin: They never say anything to you about it? Would they tell you
if they were upset about it?
Adrian: He’s heavy like I am.
Adrian: Have we ever said anything to you about it?
Adrian: He’s a young man, but he’s very heavy like I am.
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Guerin: Yeah?
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BOWENIAN FAMILY THERAPY WITH PHILIP GUERIN, MD
Judy: Well, he just got heavy, though, in the last year or so.
Adrian: He always was . . .
Guerin: You don’t like heavy guys?
Pam: I just don’t like . . . there’s something about him I don’t like.
Psychotherapy.net
Judy: And if he’s asked you to go out, to go out with him. What does it
hurt?
Guerin: So you guys do worry, I guess, that she kind of spends most of
her time other than working in a grocery store and bowling . . .
Guerin: Why would you think it’s because he’s heavy?
Judy: Oh yeah, well, she was going up to the truck stop all the time,
and I am not in favor of her being up at the truck stop. So.
Adrian: Because of the way she used to talk about him.
Guerin: You think she might get herself in some difficulty?
Guerin: She used to say he’s a fat guy or something?
Judy: Yeah, I’m afraid, up there, with all the truckers and all the
things you hear. I mean, granted, truckers are good people at times,
but then there are also some that are out there that aren’t the greatest
either, so.
Judy: Well, she used to . . .
Adrian: She said it to me anyway.
Judy: She didn’t like him because he was hairy, is what she told me
once.
Pam: That, too.
Guerin: So, have you been trying to light a fire under Pam to get her
out and get her more active socially and get her . . . Or have you been
just letting her be the way she is?
Guerin: Oh, you think that’s really the reason?
Adrian: No, just more or less just letting her be now.
Pam: I don’t know, I just . . .
Guerin: You used to do that.
Guerin: Do you want to not talk about this? What’s this guy’s name?
Adrian: We used to try to.
Pam: Mark.
Guerin: You kind of gave up doing that?
Guerin: Mark? Where did you go to school with him?
Adrian: Yeah.
Pam: South Suburban.
Judy: Her trouble was that whenever she decided to go and do
something with somebody, she would not tell us until she was leaving.
Guerin: And so you’ve known him for how long now? A long time.
Ten years?
Guerin: How come?
Pam: Something like that.
Judy: I have no idea.
Guerin: And he still keeps coming around and you still keep . . .
Adrian: I mean, she could have had something planned for two weeks
ahead, and she doesn’t say nothing until she is walking out the door
and then maybe we would still have to pull it out of her.
Pam: I just don’t like, there is something about him I don’t want . . . I
just don’t want to deal with him.
Guerin: Do your parents pressure you to encourage him?
Pam: I don’t know. Do you?
Judy: I just say she has to be nice to him.
Pam: Which I do, which I have been.
40
Guerin: Well, sometimes that happens because kids think that their
parents are going to ask too many questions—“Where are you going,
who are you going with?”
Judy: Or tell her no.
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BOWENIAN FAMILY THERAPY WITH PHILIP GUERIN, MD
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Adrian: Well, that’s the basic questions.
Pam: A little bit better.
Guerin: But sometimes kids want to put that boundary in there. They
don’t want their parents to ask questions. They just don’t like their
parents asking questions.
Guerin: What would be better?
Judy: But it’s not just from teenage. It’s been back even when she was
little, she would not tell me things.
Adrian: Us. She would not tell us thing.
Judy: Well, I know she made plans to go to the library with somebody,
and their parents were picking her up. Well, all of a sudden she is
flying out the door. I was down in the basement and she’s flying out
the door, and I didn’t know about it. I didn’t even know where she was
going. And I just, you know, if I was there and she wanted to go to the
library I would take her to the library. Or tell me that she’s going, not
sneak out on me. So, I mean this stems back from since she’s been a
little kid.
Guerin: Maybe she feels like you guys are too controlling?
Pam: I don’t . . . I don’t know.
Guerin: Do you think about what it would be like if it were better, or
do you just not even think about it?
Pam: I don’t even think about it.
Guerin: Are you afraid to think about it?
Pam: No.
Guerin: Am I upsetting you now? So I can keep asking questions? I
told your parents not to ask too many questions, and here I am asking
a million questions, you know? Some guys got a lot of nerve, you
know? Do you ever think about the future? So you just take it a day at
a time?
Pam: Day at a time, yep.
Guerin: That works better for you?
Judy: I don’t, I’ve never been . . . I don’t feel I’ve been that way over
her. I’ve worked most of my time, so, I mean, there is . . . I just . . .
Pam: Mm-hmm.
Guerin: Are your parents too controlling? Do they ask too many
questions? They want to know what you are doing? They are bugging
you to do this, bugging you to do that? You just want to be left alone?
Pam: I don’t know. I just haven’t thought about it.
Guerin: What would be bad about thinking about the future?
Guerin: You’re not afraid of it?
Pam: No, they are not really controlling.
Pam: Mm-mm.
Guerin: No?
Pam: They just like to know where I’m going.
Guerin: Do you worry about these guys dying? How long have you
been worried about that?
Guerin: And you don’t want to tell them.
Pam: Oh, I don’t know. I can’t even tell you.
Adrian: Why? Why do we want to know where you are going?
Guerin: Ten years, five years, two years?
Pam: So that if something happens I get a hold of you.
Pam: Oh, more than that.
Guerin: And what do you think about that? Do you think it’s okay?
Are you happy with the way you got life, Pam?
Guerin: Yeah?
Pam: It’s all right.
Guerin: How often do you worry about it?
Guerin: Would you like it to be different?
Pam: Oh, I don’t know. I don’t know.
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Pam: More than that.
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BOWENIAN FAMILY THERAPY WITH PHILIP GUERIN, MD
Guerin: Do you talk about that worry?
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Pam: Mm-mm.
Guerin: Yeah. So do you guys talk about it? You and Adrian talk about
it.
Guerin: What do you do when we talk about that?
Judy: Oh yeah. Oh yeah.
Pam: I don’t know.
Guerin: But you don’t talk with Pam?
Guerin: Do you guys talk about that?
Adrian: Pam won’t talk. She won’t even be in the room with us.
Adrian: Every so often we would, and off she’d run.
Judy: I think we’ve mentioned it to her.
Guerin: Now, would you talk about it as a way to try to light a fire
under her by saying, you know, “We are not going to be here forever”?
Guerin: Don’t talk to anybody else? Do you talk to anybody else?
Adrian: That’s, that’s about the size of it. We’re not going to be here
forever.
Pam: Well, that’s different.
Guerin: Because you don’t look like you are worried about leaving
very soon.
Guerin: Who is Jessie?
Adrian: I’m not. When I go, I go.
Judy: I hope not. But there is that possibility.
Adrian: I just hope I go before she does.
Adrian: You talk to Jessie.
Adrian: Well, he said anybody else.
Pam: My bingo partner.
Guerin: Oh yeah?
Adrian: It’s an older lady that she goes to bingo with, I guess, she
could be in her seventies.
Guerin: Yeah, married people do that, you know. They get into, when
they get older--I mean you guys are young. But when they get older
they start racing each other. They get in their seventies, eighties, they
start racing each other. Who is going to get there first?
Guerin: Yeah? Jessie’s a good lady? So you can talk to her about lots of
things.
Adrian: No, we got a neighbor who is in his seventies and he just got
married.
Guerin: Some things.
Guerin: Yeah? God bless him.
Guerin: You wouldn’t talk to her about something personal like that,
though.
Adrian: He got remarried. His first wife passed away, and he just got
remarried. So.
Guerin: So, what would happen, Pam, to you, if they died? Would you
be okay?
Pam: I don’t know. I don’t know.
Guerin: So you like not to think about it.
Judy: See, that’s something we worry about.
44
Pam: No, I wouldn’t say lots of things, but . . .
Pam: Yeah.
Pam: Nope, nope. But she spoils me like a grandkid. She spoils me.
Guerin: She what, spoils you?
Pam: Like a grandmother would.
Guerin: Yeah? That’s good and that’s bad?
Pam: No, not really.
Adrian: Well, my girlfriend in back would treat you that way too if
you would do things for her.
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BOWENIAN FAMILY THERAPY WITH PHILIP GUERIN, MD
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Pam: Please.
had somebody to talk to about them?
Guerin: What would happen if you won a lottery and part of it was
that you go your own condo, you know? Fully furnished and you
could live?
Pam: Uh-uh.
Pam: Let’s go, guys.
Judy: No, she talks.
Guerin: You’d bring them with you? Yeah? You don’t listen to them,
you plug your ears, but you’d bring them along.
Guerin: Oh, who does she talk to?
Pam: Yeah.
Guerin: Now you know, when you are talking to a psychiatrist
and you say that, they are liable to say, maybe you have a problem
separating. What do you think?
Pam: Sure, I’d rather stay home.
Guerin: Yeah. Now, is that a problem, or should everybody just sit
back and accept that?
Pam: I don’t think that’s a problem.
Guerin: So, you’re not a talker. You keep things in? So you guys are
not the only people she doesn’t talk to. She doesn’t talk to anybody.
Pam: Not at all.
Judy: If we get out and it’s a family gathering, if somebody will talk to
her, she ends up rattling off, and I’ll even to say to him once in a while,
“Look at her over there talking like crazy,” and I says, “Yet she can’t
talk to us.” I don’t know what the conversations are, but you know,
socializing with somebody.
Guerin: But, you know, how unusual do you think it is for well you
say this went from when--how old was Pam when she stopped talking
to you?
Commentary: A third type of question is what we term a “suppose
question.” These questions displace the content to a “what if ”
scenario that allows the family to respond more openly by diminishing
their defensiveness. The “ just suppose” question is a variant of the
displacement story technique described earlier. It provides a fantasy
alternative as a way of uncovering and documenting underlying
individual and relationship process. In this instance, it documents
the degree of anxious attachment present in the family. Guerin offers
the daughter the fantasy of freedom and she automatically, in just a
heartbeat, elects to bring her parents along. This maneuver accomplishes
the parents’ goal of continuing to focus on the daughter, while
simultaneously allowing Guerin to define the level of the separation
difficulties inherent in this family system.
Judy: When she stopped talking?
Guerin: So, it’s not a problem as far as Pam considers it. So everybody
just ought to leave you alone with it.
Commentary: It is clear from the structural set up, and the positioning
of family members in the room, that the father and daughter are linked
in alliance with the mother on the outside and unhappy about it. Guerin
tries to nudge the direction of movement in this triangle by urging the
mother to close the distance with her daughter on her daughter’s terms
Pam: That’s true.
Guerin: Do you ever get kind of worked up about things and wish you
46
Guerin: Two or something?
Adrian: When she started talking she stopped talking.
Guerin: So, it goes way back.
Adrian: Yeah.
Guerin: Does that remind you of anybody in the family? Are there any
great non-talkers in the family?
Judy: Well, Pam is adopted, so we really don’t know too much about
her. And I just felt that . . . I just thought that maybe she kind of
associated me with suffering or something, because I was the one that
was always, you know, taking her here and taking her there.
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BOWENIAN FAMILY THERAPY WITH PHILIP GUERIN, MD
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and for the father to cease his efforts to promote the relationship between
these two women and let them get on with it themselves. This entails not
only an attempt to change the direction of movement in the triangle, but
also proposes using the technique of relationship experiments in order to
break the dysfunctional sequence.
be a pal with her, and with Pam, I don’t know. I think Pam is just
embarrassed to talk about it, and she is doing something that she
doesn’t want to do. So she will get very teary-eyed, and she’s sorry that
she’s acting that way towards her mother, but she’s still going to do it.
Guerin: Maybe she thinks you worry about her too much. Do you?
Judy: I don’t know. I cry very easily. I can watch a movie and sit there
and cry, and it could be the funniest movie in the world, but I still cry.
Judy: Well, I do worry about her, yeah. But you know, the way things
are out there, you know, nowadays, you can’t say you can’t worry. Like
when she comes home at night if she comes home late, I always tell her
to make sure she wakes me up.
Guerin: Is Adrian right about what you are tearful about?
Commentary: With her last comment, the mother boxes Guerin out.
Guerin: So we shouldn’t pay any attention to those tears?
Pam: Which I do.
Judy: Not always, no.
Judy: So I know she’s home.
Commentary: Guerin presses on.
Commentary: Guerin, having begun the investigation of the father–
mother–daughter triangle, moves first to the mother and then on to the
mother–daughter relationship.
Guerin: Is there a difference between when you cry just because you
are a sentimental person and when you cry because there is something
really pinching your insides?
Guerin: Would you say you’re an anxious mother?
Judy: Oh yeah.
Pam: A worrywart?
Guerin: How can we tell the difference?
Judy: No, I don’t walk the floors.
Judy: I don’t know.
Guerin: You go to sleep anyway.
Guerin: Can you tell the difference?
Judy: I do go to sleep.
Judy: I could probably tell the difference myself, yeah.
Adrian: She goes to sleep but you’re not sleeping. Do you have
children?
Guerin: Do you let anybody in on . . . ?
Guerin: Do I? Sure.
Guerin: Mm-hmm.
Adrian: I don’t know how old they are, but when they’re out late, you
go to bed, you’re sleeping, but when that door opens outside, you’re
really out.
Adrian: I caught you a couple of times.
Judy: No, I just hold it into myself.
Guerin: Everybody holds up into themselves. Do you do that too?
Judy: Yeah, but you know that I’m a very light sleeper. I hear all sorts
of noises and stuff.
Adrian: Yeah. Guerin: So everybody goes off into their box, right?
Pam does. She says, “Leave me alone.” Mother says, and you do too.
How come?
Guerin: Now, you know when we’ve been talking both Judy and Pam
get tearful. I’m not sure what the tears are connected to. Do you know?
Judy: It’s easier that way.
Adrian: I don’t know. I think Judy really wants Pam to love her, to
48
Guerin: It’s easier. What makes it easier, Judy?
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Judy: Well, there is no fighting, no arguing, or . . .
Pam: Mm-mm.
Guerin: So if you start talking about what’s upsetting you then the
fight would ensue?
Commentary: Guerin checks out the daughter’s availability and
openness to change in mother’s direction of movement.
Judy: Well, it might if it was something said that wasn’t. . .
Guerin: Would you prefer her not to tell you?
Guerin: You mean if it was critical or . . .
Pam: Prefer her to tell me.
Judy: Yeah, if it was something that. . .
Guerin: Would you? So, if she were to tell you, “It really upsets me
that you and I can’t find a way to be connected and have fun together
and be comfortable together,” you want her to say that? Do you believe
her, Judy?
Guerin: But suppose it was just sadness or upset . . .
Commentary: At this point Guerin pokes gently at the sadness,
loneliness, and sense of loss in the family without mentioning the dead
brother.
Judy: Oh, I think we can talk about that. I think we talk about that if it
was something sad or something was bothering us . . .
Guerin: So if the tears are coming from frustration and anger and it’s
frustration and anger with somebody else and you try to talk about it,
then it’s not safe. But if it’s because there’s been a loss, or your feelings
have been hurt, or you are frustrated because things are not going well
at work, then you can talk about that.
Judy: No.
Guerin: Why not?
Judy: Because if you knew Pam, she can sit here and tell you exactly
what you want to hear.
Guerin: Is that what she’s doing right now?
Judy: Mm-hmm.
Pam: No.
Judy: Probably, yeah.
Adrian: A lot of it.
Guerin: Now, what Adrian tells me is that you have upset feelings,
I’m not sure they are hurt, that you and Pam somehow can’t have the
kind of connection you would like to have with your daughter. Is that
accurate?
Pam: No.
Judy: Well, yeah. . .
Commentary: Guerin pushes the mother to move toward her daughter
and communicate directly with her.
Adrian: There is a lot of it that’s sincere, but there is a lot of it that,
because this is what she thinks you want to hear.
Guerin: Pam?
Pam: No, no, no, no, no, no.
Judy: Oh, I think so.
Commentary: To this point the session dealt with extra-familial
triangles involving the previous six visiting clinicians, and has been
defining the structure and process of the central symptomatic triangle
involving father, mother, and daughter, and proposing ways in which the
mother might experiment with change. Guerin now very gently opens the
issue of the brother’s death by returning to the previously discussed topic
of loss.
Guerin: Has she, Pam? Do you remember?
Guerin: Now, you’re getting mad. Okay.
Guerin: And have you told Pam about those?
Judy: I’ve asked her, you know, to do things with me and . . .
Guerin: Have you told her about your feelings?
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BOWENIAN FAMILY THERAPY WITH PHILIP GUERIN, MD
Judy: Because, we’ve told her that. You are going to tell us exactly
what we want to hear.
Pam: No.
Judy: And nothing more.
Guerin: So, then, if you tell her that and you are saying, “What I’d like
you to do is to pick some things to do with me. You pick the day, you
pick what we do, and I’ll go do it, and I won’t ask any questions, and I
won’t tell you what to do for the whole time we are out there doing it.
We’ll do what you want. I won’t tell you what to do. We’ll have a good
time, kinda light and fun,” would she go, or would she never set the
time up?
Psychotherapy.net
her timetable and doing what she wants to do. Is that hard for you?
Judy: No. There was a time a couple of weeks ago he was out, and I
says to her, “Well why don’t we go and play bingo together?” It was
Saturday night, and I said, “We can go and play bingo.” I had other
things to do, but I thought she enjoys playing bingo, and I enjoy going
out once in a while, and she said, “No.” Then a little later on she said,
“I’ll call Jessie up and I’ll get Jessie, and we’ll go together.” Well, I
wanted this time together.
Guerin: Mm-hmm, as opposed to having Jessie along.
Judy: And I said, “Well, forget it. I just don’t care to go then.” And, she
didn’t really . . .
Adrian: Never set the time up.
Guerin: And your feelings got hurt.
Judy: What was it? Last week Friday, Saturday. We went to get my hair
done together, the two of us went. And, oh, she wanted to go out to
lunch afterwards. Well, I knew it was late, and she knew it was late, but
she insisted on lunch, so I says, “All right. We’ll go to lunch. You pick
the place.” And I just thought we were going to a fast food place, you
know, real fast. Well, that wasn’t so. We ended up at a restaurant. Well,
that was fine. I didn’t care. We sat there and I figured, “This is my time
with her.” I wanted this to be a good time out, so. And then we were
sitting there, and I didn’t know what to order because I don’t normally
eat lunch.
Judy: Well . . .
Pam: I said, “Why don’t we split a taco salad?”
Judy: And I thought that was the greatest thing I could hear from her.
So that’s exactly what we did, and we ate, and we left, and we came
home.
Pam: We ate, we ate.
Judy: But that was a great . . .
Guerin: So that was a success.
Judy: Yes. I really enjoyed it, even though I was really in a hurry, but I
decided this was my time with her. I might as well go.
Guerin: And so maybe you need to do that more? To just let it be on
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Guerin: Yeah.
Judy: Yeah, I would guess so.
Guerin: Now what do you think it is about Jessie that Pam’s drawn to
spending time with her as opposed to you?
Judy: Well, Jessie treats her like her granddaughter, you know, and
that’s sweet.
Guerin: And you know how you treat granddaughters, like they never
do anything wrong and you never criticize them. Whatever they want
to do, that’s great.
Judy: She takes her out to lunch.
Guerin: But there’s a formula, so why don’t you try Jessie’s formula?
Adrian: Because Pamela don’t take Judy shopping. Go out for four
hours . . .
Guerin: Well, why I’m just talking about . . .
Adrian: That’s what I’m talking about. Today, that’s where Pamela
was today. Five hours. She went out and went shopping with Jessie. She
knew we were supposed to come here.
Guerin: I understand.
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BOWENIAN FAMILY THERAPY WITH PHILIP GUERIN, MD
Adrian: And she knew she was supposed to help me with dinner.
Guerin: but, I think that, you know, my thoughts on this whole thing
would be that there would be something you could learn from Jessie
in terms of what Pam feels comfortable with in a relationship. Not as
a criticism of the two of you, because Jessie doesn’t have any of the
responsibility. It’s kind of easy. That’s one of the great things about
being a grandparent. I’m a grandparent now, for three years. I’m a
grandparent, and you know, that’s great. You get to go home. You get
to not have to be responsible, you know, stuff like that. You get to not
have to yell.
Adrian: There’s the ice cream you threw up tonight. That’s fine,
because you won’t be here.
Guerin: But there is something to be learned from Jesse.
Judy: Well, like I said to him, I says, “Maybe she is looking for a
grandmother that she doesn’t have.”
Guerin: Where are the grandmothers? Were they ever there?
Judy: No, my mother passed away when she was about, what, six or
seven, we decided, and his mother had also passed away when she was
about three or four years old. So the grandparents, grandmas passed
away very early, so she didn’t have that.
Psychotherapy.net
Guerin: Do you think it would be a negative to take it out of the
compartment and work on it, or . . .
Adrian: I think it would be.
Guerin: Okay. Would you agree?
Judy: Well, we talk once in a while about the good times we had
together with him.
Pam: But that’s it.
Judy: We remember things that we did together, so.
Commentary: Guerin chooses not to press on here leaving further
exploration for another day. In the final phase of the session, Guerin uses
the triangle with Pam’s geriatric friend Jesse. In doing this he challenges
the mother to face the reality of her daughter’s movement away from
her and toward Jesse and for the mother to learn from it, even to the
point of studying Jesse’s methods. Having done this, Guerin returns to
the parents’ agenda and broaches the topic of Pam’s social phobia and
gives Pam total responsibility for dealing with it. In this way, he hopes to
relieve the mother of some of her guilt and feelings of responsibility for
Pam’s isolation while challenging Pam to take on the social phobia and
do something about it.
Guerin: That one’s kind of a no-no.
Guerin: Hey, Pam. I’m going to tell you something. You ready? I have
a hunch. Now, it’s only a hunch. I have a hunch that one of the reasons
you don’t kind of move out a little bit more and find some things to do
with people your own age is that you’re a little bit scared. And I think
you ought to work on that. I know it is not easy for you to talk about
these things, but it might help to have somebody, and maybe you can
talk to Jessie about it, and Jessie can help you with it. But I think that
it would be worth it for you to start working on that. Does that make
any sense to you?
Adrian: That’s a touchy one.
Pam: Mm-hmm.
Guerin: Real sensitive. Have you worked on getting that less sensitive
or have you just left it in its compartment?
Judy: I think she needs to find a nice young man.
Guerin: I don’t want to dwell on this. I just want to ask a question
about it because I know you’ve dealt with some of it in the other
session. Is it easy for you guys to sit around and talk about the losses
that you’ve had in your life like when the grandmothers died and
when your son died and stuff, or is it hard?
Adrian: Everybody but my son.
Pam: Left it be.
Adrian: We just put it away and let it be there.
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Guerin: Well, let’s start getting . . .
Judy: A friend. It doesn’t have to be . . .
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BOWENIAN FAMILY THERAPY WITH PHILIP GUERIN, MD
Guerin: I understand, but let’s not program it for it. I would like to
see Pam take the step to do it in whatever way. I mean I don’t care if
it’s a church social group that goes bowling or whatever she finds and
whatever she wants to do. Mostly, so she has to confront whether it is
that she is anxious and scared, because then she has something that
she can work on. And the more you guys are not hovering around to
see if she is doing it, the more likely she is to do it. She will shut down
and go back, you know? And it’s hard not to because you wish that for
her so much. You hear? I know that. But somehow she’s got to, and I
think it’s going to be scary for her, but I’d really encourage you to try
to do it. She can talk to Jessie about it because it’s probably too scary
to talk to you. She can maybe find somebody like me to talk to about
this. I think it would be useful. But let her think about it. It’s got to be
Pam’s idea or it’s not going to happen, you know? Right Pam?
Pam: Guess so.
Psychotherapy.net
Guerin: I haven’t figured out anything for you to do, Adrian. That’s
not good, is it? I’m going to let you off the hook easy. You guys got
any questions? Because we gotta stop. Okay, I want to thank you for
coming to meet with me.
Judy: Thank you for coming. You came a long way.
Guerin: Yeah, but it’s been enjoyable sitting and talking to you.
Judy: No, we’ll keep trying.
Guerin: You gotta remember what I said now. Everybody going to
remember?
Pam: Try to.
Guerin: Okay. I’ll be checking up on you. Take care. Thanks.
Judy: Thank you very much.
Adrian: What’s the small problem there, Pam? What is the small
problem with his last statement there, Pam?
Pam: I don’t know.
Guerin: What is it? What is it?
Adrian: It’s got to be Pam’s idea.
Guerin: Don’t you think that’s true?
Adrian: It’s true to a certain extent, but Pam won’t have the idea.
Guerin: Oh, but now I think there is a difference between having the
idea and acting on it. You see, my thought is that I bet the three of you
guys, I’ve only sat with you for 45 minutes, but I bet the three of you
guys can all be strong-willed, strong-headed you know? Am I right?
Pam: Mm-hmm.
Adrian: Yeah.
Guerin: Judy, you’re not chiming in. So, I mean I would just like to see
that be, you know?
Commentary: As the interview draws to a close, Guerin moves to
reinvolve the father.
56
57
BOWENIAN FAMILY THERAPY WITH PHILIP GUERIN, MD
Video Credits
Special Thanks to:
The clients for their time and their courage to share their personal
stories so that others may learn.
Graduate students, Barbara Milton and Teresa Hannon, for their
dedication to the success of this project.
The faculty and students in the Division of Psychology and Counseling
of the College of Education at Governors State University for their
participation.
Addison Woodward, Chair, Division of Psychology and Counseling,
and Larry Freeman, Acting Dean of the College of Education at
the Governors State University for their support, participation and
encouragement.
A very special thank you to Judy Fifer, Editor, Allyn & Bacon, for her
courage and vision.
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58
59
BOWENIAN FAMILY THERAPY WITH PHILIP GUERIN, MD
About the Contributors
VIDEO PARTICIPANTS
Philip Guerin, MD is a psychiatrist, family therapist, author, and the
founder of the Center for Family Learning in Westchester County,
New York. He has written several influential books and articles in
the field of family therapy, including The Evaluation and treatment of
marital conflict: A four-stage approach and Working with relationship
triangles: The one-two-three of psychotherapy.
Jon Carlson, PsyD, EdD, Host, is Professor of Psychology and
Counseling at Governors State University and a practicing clinical
psychologist. He has authored 40 books and 150 journal articles, and
developed over 200 videos featuring leading experts in psychotherapy,
substance abuse treatment, and parenting and couples education.
Diane Kjos, PhD, Host, now retired, was a professor at Governors
State University in Illinois for 22 years, and past president of both the
Illinois Counseling Association and the National Career Development
Association. She is co-author, with John Carlson, of two textbooks—
Theories of Family Therapy and Becoming an Effective Therapist—and
co-host of the video series Psychotherapy with the Experts, Family
Therapy with the Experts, and Brief Therapy Inside-out.
MANUAL AUTHORS
Ali Miller, MA, MFT, is a psychotherapist in private practice in San
Francisco and Berkeley, CA. She works with individuals and couples
and facilitates therapy groups for women. You can learn more about
her practice at www.AliMillerMFT.com.
60
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BOWENIAN FAMILY THERAPY WITH PHILIP GUERIN, MD
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62
Instructor’s Manual
for
STRUCTURAL
FAMILY
THERAPY
with
HARRY APONTE, LCSW
Manual by
Ali Miller, MFT and Harry Aponte, LCSW
STRUCTURAL FAMILY THERAPY WITH HARRY APONTE, LCSW
The Instructor’s Manual accompanies the DVD Structural Family Therapy,
with Harry Aponte, PhD (Institutional/Instructor’s Version). Video available
at www.psychotherapy.net.
Copyright © 2010, Psychotherapy.net, LLC. All rights reserved.
Psychotherapy.net
Instructor’s Manual for
STRUCTURAL FAMILY THERAPY
WITH HARRY APONTE, LCSW
Published by Psychotherapy.net
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Mill Valley, CA 94941
Email: contact@psychotherapy.net
Phone: (800) 577-4762 (US & Canada)/(415) 332-3232
Teaching and Training: Instructors, training directors and facilitators
using the Instructor’s Manual for the DVD Structural Family Therapy, with
Harry Aponte, LCSW may reproduce parts of this manual in paper form for
teaching and training purposes only. Otherwise, the text of this publication
may not be reproduced, stored in a retrieval system, or transmitted in any
form or by any means—electronic, mechanical, photocopying, recording
or otherwise—without the prior written permission of the publisher,
Psychotherapy.net. The DVD Structural Family Therapy, with Harry Aponte,
LCSW (Institutional/Instructor’s Version) is licensed for group training and
teaching purposes. Broadcasting or transmission of this video via satellite,
Internet, video conferencing, streaming, distance learning courses or other
means is prohibited without the prior written permission of the publisher.
Miller, Ali, MFT & Aponte, Harry, LCSW
Instructor’s Manual for Structural Family Therapy, with Harry Aponte, LCSW
Cover design by Julie Giles
Table of Contents
Tips for Making the Best Use of the DVD
4
Aponte’s Approach to Structural Family Therapy
6
Aponte’s Reflections on the Session
9
Reaction Paper Guide for Classrooms and Training
11
Related Websites, Videos and Further Readings 12
Discussion Questions 14
Role-Plays
17
Session Transcript
19
Video Credits
45
Earn Continuing Education Credits for Watching Videos
46
About the Contributors
47
More Psychotherapy.net Videos
49
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For information on ordering and obtaining continuing education credits
for this and other psychotherapy training videos, please visit us at www.
psychotherapy.net or call 800-577-4762.
2
3
STRUCTURAL FAMILY THERAPY WITH HARRY APONTE, LCSW
Psychotherapy.net
Tips for Making the Best Use of the DVD
PERSPECTIVE ON VIDEOS AND THE PERSONALITY OF THE
THERAPIST
1. USE THE TRANSCRIPTS
Make notes in the video Transcript for future reference; the next time
you show the video you will have them available. Highlight or notate
key moments in the video to better facilitate discussion during and
after the video.
Psychotherapy portrayed in videos is less off-the-cuff than therapy
in practice. Therapists may feel put on the spot to offer a good
demonstration, and clients can be self-conscious in front of a camera.
Therapists often move more quickly than they would in everyday
practice to demonstrate a particular technique. Despite these factors,
therapists and clients on video can engage in a realistic session that
conveys a wealth of information not contained in books or therapy
transcripts: body language, tone of voice, facial expression, rhythm of
the interaction, quality of the alliance—all aspects of the therapeutic
relationship that are unique to an interpersonal encounter.
2. FACILITATE DISCUSSION
Pause the video at different points to elicit viewers’ observations and
reactions to the concepts presented. The Discussion Questions section
provides ideas about key points that can stimulate rich discussions and
learning. The Role-Plays section guides you through exercises you
can assign to your students in the classroom or training session.
3.ENCOURAGE SHARING OF OPINIONS
Encourage viewers to voice their opinions; no therapy is perfect! What
are viewers’ impressions of what works and does not work in the
sessions? We learn as much from our mistakes as our successes; it is
crucial for students and therapists to develop the ability to effectively
critique this work as well as their own.
4. SUGGEST READINGS TO ENRICH VIDEO MATERIAL
Assign readings from Related Websites, Videos and Further Reading
prior to or after viewing.
5. ASSIGN A REACTION PAPER
See suggestions in Reaction Paper section.
6. WATCH THE EXPERTS SERIES
This video is one in a series portraying leading theories of
psychotherapy and their application in work with families. Each video
presents a master family therapist working with a real family who have
real problems. By showing several of the videos in this Family Therapy
with the Experts series, you can expose viewers to a variety of styles
and approaches, allowing them an opportunity to see what fits best for
them.
4
Psychotherapy is an intensely private matter. Unlike the training
in other professions, students and practitioners rarely have an
opportunity to see their mentors at work. But watching therapy on
video is the next best thing.
One more note: The personal style of therapists is often as important
as their techniques and theories. Therapists are usually drawn to
approaches that mesh well with their own personality. Thus, while
we can certainly pick up ideas from master therapists, students and
trainees must make the best use of relevant theory, technique and
research that fits their own personal style and the needs of their
clients.
PRIVACY AND CONFIDENTIALITY
Because this video contains actual therapy sessions, please take
care to protect the privacy and confidentiality of the clients who has
courageously shared their personal life with us.
5
STRUCTURAL FAMILY THERAPY WITH HARRY APONTE, LCSW
Aponte’s Approach to Structural Family
Therapy
Structural family therapy is the only model I know that grew
directly out of work with disadvantaged minority families. Back in
the late sixties, Salvador Minuchin with his colleagues, including
Braulio Montalvo, published Families of the Slums. In the book
he described a model of therapy that was designed to address a
distinctive feature of the most dysfunctional of these families, a
family structure often characterized as disorganized or chaotic that
presented the greatest challenge for therapists. I prefer to dub this
structure “underorganized” because it describes families who lack the
organization that is essential to effective functioning. There is often
no clear parental leadership, no consistent roles with corresponding
responsibility, and a pattern of communication that lacks the order
necessary to be efficient and functional. Therapists needed to learn to
recognize how the structure was not working and how to remedy it in
order to be able to use their tools to be helpful to these families.
The model addressed aspects of family structure which have been
variously named, and which I have boiled down to power (who
habitually determines the outcome of family transactions), alignment
(the coalitions and alliances in families), and boundaries (who is in or
out of the various systems and subsystems in families, and their roles
within these systems). I have also added the concept of values (culture,
spirituality and morals) as an underlying organizing factor the gives
human purpose to the functionality of structure.
Now, obviously these structural components are universal to all
families, and are factors that need to be considered in working with all
families. Consequently, the tools for dealing with these structures in
families, I believe, cut across therapeutic models making for common
factors. We deal with structure in the work with all families whether
we recognize it or not, a common reality undergirding all social
systems.
6
Psychotherapy.net
Some of the principal tools and approaches for working with family
structure form the basis for common factors with other therapeutic
models. There are seven principles of intervention that I particularly
identify with the structural approach.
1.
Focus on concrete issues: Structural therapists attempt to
organize the therapy around specific issues that grab the
family members’ attention and that contain within them the
dynamics underlying a family’s core issues.
2.
Locate the issue in the present: Without neglecting the
historical antecedents that help us understand the present,
therapists draw family members’ attention and energy to the
issues as they manifest in the here-and-now.
3.
Work through the family’s experience in session: Therapists
look for access to the issues, their dynamics and the players
through live experience in session, either in the enactment of
issues among the family members themselves and/or between
the therapist and the family.
4.
Attend to the underlying structure: Whatever issues therapists
work on and however they do so, they consistently attend to
the family structure that needs building and repair to make
possible lasting change.
5.
Build on client strengths: Therapists generate the momentum
for change by mobilizing the personal strengths of family
members and the resources of their ecosystems throughout the
actual and immediate therapeutic process.
6.
Aim for palpable outcomes: Therapists manage the therapeutic
process so that families see and experience positive change
in and out of session, from small to greater successes, ever
reinforcing the will to break new ground.
7.
Engage actively and purposefully with families: Therapists
“join” with families, actively connecting with them not only to
gain their trust, but also to form relationships with them that
are consciously tailored to promote the kind of change they,
with the family, are pursuing.
7
STRUCTURAL FAMILY THERAPY WITH HARRY APONTE, LCSW
It is apparent that these approaches to change are common factors,
explicitly or implicitly, contained in numerous other therapeutic
models. Differences may well be in groupings of interventions and
emphasis, if not just in language. It should also be understood that
structural therapists do not limit their theoretical considerations
and technical interventions to what we emphasize here. Structural
family therapy can certainly be viewed from an integrative perspective
that draws from the pool of wisdom of the field in general and of
specific models of therapy in particular with the structural approach
providing the integrating framework.
Psychotherapy.net
Aponte’s Reflections on the Session
This was a single demonstration session for me with this family. I
knew little about them before the sessi...
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