Mackay, 2013

Trauma and Bowen Family Systems
Theory: Working with Adults Who

were Abused as Children
Linda MacKay
The Family Systems Institute, Neutral Bay, Sydney
Working with survivors of trauma is mostly challenging, exhausting, long-term and

often ‘messy’, when interventions that ‘should’ work, don’t, or the unexpected arises.
Nevertheless, explanations that speak to recovery from trauma more and more
rely on neurobiological concepts to account for any positive change. Combining the
family systems approach of Murray Bowen and recent research on the brain and
trauma, post trauma symptoms are viewed as part of the ‘family emotional process’
even when traumatic events have emanated from outside the family system itself.
Variations in responses to trauma, including dissociation and self-harm are discussed
in relation to chronic anxiety and ‘differentiation of self’.
Keywords: child abuse trauma, anxiety, dissociation, Bowen family systems theory, differenti-
ation, neuroscience
For clinicians as well as researchers, there is an enormous challenge in bringing together

an understanding of neurobiology, trauma theory and therapy in order to assess and
intervene effectively with clients who struggle with the pervasive effects of trauma.
Bowen family systems theory joins these discursive threads in a useful way, promoting
an individual’s opportunities for emotional growth and viability. The word ‘viability’
is used here to point to the individual’s increased capacity to maintain optimum
equilibrium in stressful situations, to sustain meaningful relationships, and to recover
and develop more fully one’s potential.
Bowen Family Systems Theory

Based on his clinical observations of families, the hypotheses he made about these ob-
servations, and knowledge from the biological and evolutionary sciences as developed
at the time of his writing, psychiatrist and researcher Murray Bowen formulated a
theory of natural systems (Bowen, 1978; Kerr & Bowen, 1988). This theory, known
Address for correspondence: [email protected]
232 THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF FAMILY THERAPY

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Trauma and Bowen Family Systems Theory
as Bowen family systems theory (BFST) explains how potent relational forces ensure
survival and facilitate less anxious physiological states crucial to wellness.
In introducing BFST, I first define some key terms and core ideas, particularly
the forces of individuality (or separateness) and togetherness (or fusion); unresolved
attachment processes; differentiation of self; triangles and triangling; and chronic
anxiety.
1. The forces of individuality (or separateness) and togetherness (or fusion)
Two counter-balancing agents, ‘individuality’ and ‘togetherness’, play out between
members of a family, which is motivated by the need for approval, acceptance and
closeness on the one hand and the push to be autonomous and self-defining on
the other (Bowen, 1978, pp. 277–279; Kerr & Bowen, 1988, chapter 3). These
forces for togetherness and separateness operate between people in person-to-person
transactions that are inclusive of, but not limited to, the mother and child dyad, within
what Bowen termed, the ‘nuclear family emotional system’ (Bowen, pp. 376–377;
Kerr & Bowen, chapter 7).
In mammals, the togetherness force produces a symbiosis or ‘fusion’ that ensures
survival of the infant (Kerr & Bowen, p. 238). As the infant matures physically, any
symbiosis should reduce over time in both the parent and the child. Bowen also
theorised that in times of crisis, the togetherness force produces a visible fusion in
which people forget their individual differences and ‘pull-together’ for a higher good.
A person’s individuality needs can be appropriately sacrificed and replaced by a joining
with the needs of the group or community and this functionally promotes survival.
2. Unresolved emotional attachment
According to Bowen, the degree of ‘unresolved emotional attachment’ to one’s parents
drives the ability of a person to adapt to and manage thoughtfully the tension of
these two competing forces as an adult (Bowen, pp. 331–332). From this perspective,
attachment in relationships is understood as the degree to which individuals are able to
separate themselves from emotional dependency on significant others. Over time, if the
child remains overly sensitised to the needs of others, especially the needs of her parents
at the expense of herself, this other-directed focus dominates the person’s attention
and overall functioning. This continuing dependency on others for approval and an
emotional over-sensitivity to others’ feeling states also reflects the degree to which the
person’s parents have themselves moved out of the fusion of the ‘multigenerational
emotional processes’ embedded in their own families of origin (Bowen, pp. 384–
385; Kerr & Bowen, chapter 8). The greater the degree of unresolved attachment, also
understood as the ‘fusion . . . between emotional and intellectual functioning’ (Bowen,
p. 362), the more the person operates by accommodating, distancing, or using other
behavioural adaptations that challenge self-directed autonomy in relationships. The
person is less able to manage real or perceived changes and stressors in relationships and
the environment without a sustained increase in anxiety that reduces their functioning
and negatively impacts on their physical and psychological wellbeing.
3. Differentiation of self
Understanding what constitutes various levels of emotional maturity led Bowen to
develop the concept of ‘differentiation of self’ (Bowen, pp. 448–449, Kerr & Bowen,
THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF FAMILY THERAPY 233

Linda MacKay
pp. 89–111). Taking into account that the functioning of even highly differentiated
people is reduced when overwhelmed by multiple acute stresses, Bowen nevertheless
proposed that more emotionally mature people function effectively at one end of a
continuum; and people with severe symptomatology, such as schizophrenia function,
poorly at the other. Thus, the ability to adapt to stressors is subject to a number of
factors, the most salient of which is the level of chronic and/or acute anxiety (see
below).
A person’s emotional system, according to Bowen, includes survival mechanisms
that humans share with other species, such as instinct, reproduction and the in-
voluntary operations of the autonomic nervous system, that is, the activity of the
limbic or fight/flight system (Bowen, p. 70; Kerr & Bowen, pp. 35 & 92, refer-
ring to the work of Maclean, 1978, p. 339). Bowen theorised that the degree to
which a person is able to remain thoughtful and manage their emotional reactiv-
ity is indicative of the person’s level of emotional maturity. A person with a well-
defined or more ‘solid’ or ‘separate’ self, has a higher level of differentiation and is
guided into action by their values and principles, even when their stress or anxiety is
high.
4. Triangles and triangling
According to Bowen, ‘the molecule of any emotional system’ is the triangle (Bowen,
p. 198; Kerr & Bowen, chapter 6). ‘Triangling’ is a process whereby two people in a
relationship manage their anxiety by drawing in or focusing on a third person (Kerr
& Bowen, p. 135). At a critical point in the family life cycle, one child more than
another may become over-sensitive to the expectations of parents, the parents may
triangle the child by focusing on him or her, at the expense of resolving relationship
difficulties in the parental dyad. Anxious or depressed symptoms may have already
emerged in a parent if they have been unable to manage the anxiety of facing issues
with their partner in an emotionally mature way.
This is not to say that there are no attempts at managing conflict in functional
ways; however even in the face of ‘reasonableness’, the other partner may counter with
change-back’ strategies such as attacking, defending or withdrawing. These strategies
then may reduce the capacity of the first person to remain thoughtful, more responsible
to and for herself and less reactive to their partner (Papero, 2011). As this sequence
continues over time, symptoms may also emerge in the child in whom the unresolved
attachment processes between the parents are played out.
5. Chronic anxiety
Bowen argued that in relationships people experience ‘chronic anxiety’ in relation to
each person’s different needs for togetherness and separateness (Bowen & Kerr, chapter
5). Anxiety may be triggered by conflict, disapproval or rejection and individuals
develop ways to avoid conflict at the expense of their own differentiation. Research
into neurobiology has demonstrated that the experience of anxiety is physiological
as well as emotional and that relational cues significantly trigger and determine the
activity of our nervous system. Neurobiologist Steven Porges (2011) speaks to the
hard-wiring of our sociality in the ways that our brains function to respond to each
other. Certain transactions between individuals may down-regulate the action of the
sympathetic nervous system which is triggered by stress.

A person may, for example, agree to study medicine, not because they want to, but
because the anxiety of dealing with their parents’ disappointment may be too difficult
to manage. The young person’s limbic system and physiological stress reactions may
be temporarily reduced by accommodating his or her parents’ expectations, although
in the longer term, anxiety about the lack of autonomous decision making may
emerge through symptoms. In this way, one person may be symptomatic, but the
symptoms themselves have not ‘started’ in that person. Rather, the nuclear family’s
undifferentiation has become ‘bound’ in the symptoms and impaired functioning of
one or more vulnerable family members. In other words, the symptomatic person has
absorbed the chronic anxiety that belongs to other members of the system, and this
anxiety has manifested in symptoms.
In families with higher levels of differentiation, parents may express disappoint-
ment whilst still respecting their young adult’s move to more self-directed decision
making about their future. In a family that demonstrates higher levels of emotional
maturity, the young person is more likely to have the capacity to manage their par-
ents’ disappointment and find a way to ‘self-soothe’ or down-regulate their level of
anxiety (Wright, 2009). This is achieved without either accommodating to the par-
ents’ through attempting to please them or by cutting off contact with them, either
physically or emotionally. The ability to self-soothe in the face of physiological arousal
requires conscious awareness and more often than not, well-thought out and deter-
mined action, given a family member’s ‘exquisite sensitivity to another’s emotionality’
(Hanes Meyer, 1987, p. 44). In people, sensitivity to how others respond and react
organises behavioural adaptations, feeling states, neuro-endocrine stress responses and
mediates health and well-being.
Bowen argued that in the effort to maintain harmony over individual autonomy,
people adapt to the individuality-togetherness forces in relationships by being acutely
sensitive and accommodating to the other’s expectations. Emotional and physical
distancing is also evident either intermittently or in the long term. Many families
have sustained emotional ‘cut-off’ from each other, where members of the family have
failed to engage in meaningful and emotionally intimate person-to-person exchanges
for significant periods of time (Kerr & Bowen, pp. 273–274). Other families engage
in longer-term physical cut-off, when family members have not had contact with each
other for years due to their reactivity to each other.
Less obvious are those adaptations that include reciprocal functioning: one person
may over-function for another by being over-responsible for the other’s feelings or
performing tasks the other should perform whilst at the same time, under-functioning
themselves. The over-functioner consistently sacrifices their own needs to ensure
another’s well-being, whilst the other person, takes less and less responsibility. More
obvious is the emergence of symptoms in a partner or child, who expresses or ‘carries’
anxiety for others. Parent’s anxiety about their child’s symptoms may temporarily
reduce their anxiety about their own relationship.
Bowen Family Systems Therapy

The aim of a Bowen approach to family therapy is to reduce the client’s sensitivity to the
expectations, attention, distress and approval of others (Kerr, 2008). It usually involves
family research to identify the way previous generations of the family have managed

Linda MacKay
the togetherness-separateness forces. Thus the client can begin to contextualise the
behaviour of parents or caretakers within the landscape of patterned adaptive responses
to conflict and/or the avoidance of conflict. Adaptations that are uncovered in three or
more generations of the family system provide evidence of the emergence or prevalence
of less than viable functioning over the long-term.
Bowen used the term ‘coaching’ to distinguish his approach from psychothera-
peutic approaches. Coaching is focused on reducing client over-sensitivity to others
by increasing their capacity for more emotional mature responsiveness to others. The
therapist or coach acknowledges the difficulties the person is experiencing, taking into
account the capacity of the client to move into self-reflective responses when they
are distressed and highly anxious, given that ‘growing oneself up’ can be arduous and
painful (Brown, 2012). Coaching is carefully paced via interventions that assist clients
to increase their self-awareness and reduce anxiety and to enhance their ability to act
in accordance with their principles and values.
In this model, focusing on the client’s sensitivities to others can be emotionally
intense not only for the client, but also for the therapist (Brown, 1999). Bowen argued
that therapists are also subject to togetherness and separateness forces that influence
their ability to respond thoughtfully to clients. A therapist who in their own family,
works hard to avoid conflict and make others feel better may also over-function with
clients. For example, a therapist may sacrifice a well-timed and appropriate challenge
that would promote a move towards positive change in order to ensure that the client
leaves a session validated and appearing ‘lighter and happier’.
Child Abuse, Trauma and Family Emotional Processes

From the Bowen theory perspective child abuse is conceptualised as a facet of fam-
ily functioning, in which there is ‘insufficient emotional separation’ between family
members and the ability to act from principles and values rather than emotional
reactivity (Bowen, p. 209) Bowen, like most theorists of his time, did not account
theoretically for gender or power as mediators of behaviour and relationships. One
common critique of Bowen theory is that a focus on the whole family system may
effectively remove responsibility for the violence that ultimately lies with the per-
petrator. Bowen theory nevertheless provides a conceptual understanding as to how
an individual’s functioning plays a part, even if it is not an equal part, in abuse
and other forms of violence. Further, it assists with unpacking the important ele-
ments that may allow the abuse to remain unchallenged and the maintenance of
symptoms in the trauma sufferer well after the abuse has stopped. When individuals
experience overwhelming events outside of their family such as abuse in the work-
place, their family’s emotional processes may also influence the chronicity of their
symptoms.
One family member may react to a child (or partner) with violence and the
other parent reacts with emotional distance or accommodation, rather than under-
taking appropriate action to intervene and stop the violence caused by the other
parent. Whilst in no way transferring responsibility for the violence to this parent, it
does give credence to the idea that abuse is embedded within the family’s emotional
processes. The non-abusing parent sacrifices his or her principles about what consti-
tutes appropriate and protective care-taking responses in order to maintain relational

harmony. It goes without saying that the abusive parent also fails to abide by such
principles.
Dissociation and self-harm

Individuals who have experienced abuse often adapt by either distancing from the
abuser or fusing with the abuser. They may also dissociate or engage in self-harm. Such
trauma symptoms are at the extreme end of the continuum of Bowen’s concept of ‘cut-
off’, where a person manages overwhelming anxiety via the autonomic ‘shut-down’
or freeze responses as described by Porges (2011). The child unconsciously manages
being ‘overtaken’ by the perpetrator and the enormous anxiety that is generated, by
disconnecting from her own body. Dissociative responses become habitual when a
person is exposed to their family’s persistent and severe emotional fusion. Further,
these dissociative responses are maintained by the climate of the family emotional
process — family members who fail to intervene or minimise the abuse perpetrated
by another family member, play a part in maintaining the child’s symptoms. Self-
harming behaviours calm the amygdala, the primitive, flight and fight centre and
impact on the body’s release of endorphins providing analgesia from pain, ‘making
us calm, safe and less vigilant’ (Cozolino, 2002, pp. 264–265). Thus self-harming
behaviours and dissociative states function to reduce anxiety in the same way that
person-to-person exchanges ‘both symbiotic and reciprocal’ (Porges, 2011, p. 295)
fire neural receptors that promote less anxious physiological states.
Donna – A Case Study

Thirty-eight-year-old Donna came to therapy with a history of self-harming and
suicidal behaviour. Both her stepfather and her stepbrother, Steve, sexually abused her
from the age of five until she was twenty-five years old. Donna was diagnosed with
both schizophrenia and dissociative identity disorder. Unable to work, Donna has had
multiple hospitalisations for suicide attempts and came with a long history of ‘failed’
therapies. I viewed Donna’s symptoms as reflective of her family’s multi-generational
emotional processes, characterised by lower levels of differentiation and minimisation
of abuse.
Much of my work with Donna involved managing my own anxiety in the face
of the chronic nature of her symptoms, dissociative episodes that would occur in our
sessions and my tendency (resulting from my own level of undifferentiation and a
sensitivity to her distress) to be overly responsible for her. Furthermore, I had to set
limits in therapy, that is, hold an ‘I position’ as to what I was willing and not willing to
do. For example, early in therapy, after what had seemed to be an innocuous trigger,
Donna dropped to the floor, began screaming, and crawled under my desk. When she
seemed ‘unreachable’ and was not responding to my questions, I called an ambulance
and she was admitted to Accident and Emergency. On her return to counselling, I told
Donna calmly but firmly that I would not be able to work with her if that occurred
again, that no useful therapy could occur on the floor, under a desk and with her
crying and screaming especially as I had trouble thinking clearly in the face of such a
high level of distress. I also said that I knew this would be hard, as I understood, as
far as it was possible for anyone else to ever understand, that she had suffered greatly

Linda MacKay
throughout her life and had a lot to be distressed about. I asked what triggered her to
such a degree that she let herself fall to the ground and become so distressed. How had
this helped her in the past? Had it assisted any work she had previously undertaken
in therapy?
Donna responded that she ‘might as well behave like the insane person she is’, if
that was what she was expected to be. I replied that I wanted to assist her to think
about how she might manage herself differently; so that treatment of her by others,
particularly members of her family and other health professionals, would not ‘tip her
over the edge’. I also wanted her to be capable of obtaining paid work, both goals
she had articulated for herself. I added that this would involve a lot of hard work
on her part. I explained that my own values and principles about therapy involved
Donna managing her emotional states better so she could think more clearly to resolve
problems rather than invite others to see her as mad.
In this way, the therapy with Donna moved towards opportunities in which Donna
could experience herself as a person who could think beyond her emotional reactions
and take responsibility for her actions and decisions. Hence I assisted Donna to
unpack the person-to-person exchanges that caused her distress and work out ways
to manage that distress through self-soothing efforts. This involved Donna observing
what she did or didn’t do when upset and thinking about what she would like to be
able to do or say in relation to the other people present, particularly family members.
One telling exchange presented itself, which spoke to her family’s emotional
process. In great distress, whilst adding as an aside ‘Don’t worry, I’m not going under
your desk, Linda’, Donna told me about a conversation that took place when she
was with her sister who had just undressed her nine-month-old baby girl prior to a
bath. Steve, her stepbrother, walked into the room, peered over the change table at
the little girl, and said that she was ‘developing nicely’. When I asked Donna how
she responded, she told me she didn’t say anything except to say she had to go home.
Once home she cut herself badly and that the next thing she knew, it was morning,
but she didn’t remember sleeping. While I had gathered from a previous disclosure
that her stepbrother would comment on her own developing torso from the time she
was a pre-adolescent, subsequent therapy focused nevertheless on what Donna would
like to be able to say and do if this happened again, rather than remain silent, distance
and then hurt herself.
Coaching
After assisting Donna to manage her distress and reactivity through a very brief but
effective tapping technique and breathing exercises, she was able to decide the ‘right’
thing to do if her stepbrother made a comment like this again. I encouraged Donna
to reflect on the usefulness or not of ‘telling her stepbrother off’ if she had the courage
to do so. We then explored possible values that might guide her actions, identifying
her principles and ethics. What emerged was that Donna wanted to honour her own
experiences in this exchange and to say something like, ‘Steven, when you say that,
I feel really uncomfortable.’ With coaching, Donna was able to say just that when
a similar event occurred. In response to her mother’s comment that her stepbrother
didn’t say anything wrong, Donna was able to say that she ‘still found it made her feel
very uncomfortable and that it reminded her of things her stepbrother had said to her

in the past which made her distressed’. The minimisation of Steven’s comments by
her mother contributed to Donna’s symptoms.
The focus of this therapy was to help Donna learn to calm her anxiety in order to
become differentiated in her relationships within her family. Throughout three years
of a Bowen therapy approach, Donna was only hospitalised once in the very early
stages as recounted above. Since the moment of speaking for herself and her own
experience in a direct person-to-person exchange with her stepbrother and mother,
Donna has held down a paid position, her self-harming behaviour and dissociative
episodes have reduced dramatically, and she has consistently commented that she
‘does not feel so bad about herself’.
The focus of therapy was not to challenge her cognitions about ‘feeling bad’ but
on what she can do now, guided by her best thinking when difficulties arise in her
interactions with members of her family. In this way, Donna’s negative cognitions
about herself were implicitly challenged. When one grows in self-efficacy, in the
ability to be a separate and more solid self, whilst staying connected with one’s family,
negative cognitions lose their potency.
Therapy focused on coaching Donna to think about her reactivity in her significant
relationships as opposed to her transference relationship with me as her therapist.
When Donna expressed distress about what I might have said, or about my absence, I
asked her to think about this distress, who else in her family expresses similar distress
and to ask her to think about what research she might like to do to find out more
about the manifestation of this type of anxiety in her family system. That is, coaching
within the BFST frame does not directly focus on working through transference issues
in relation to the therapist.
Reflections
There is much more to this story of managing my own anxiety about Donna in my
attempts to become more differentiated. BFST insists that the therapist or coach work
on managing, for example, their own contribution to the under-functioning of their
clients. In my own family, I work consistently towards reaching for an ‘I position’,
speaking for myself without expecting a change from others. As Roberta Gilbert points
out, ‘there is no substitute for an ongoing effort to become more of a self in one’s
extended family . . . . without which, [therapists] don’t have an idea about how to
apply the concepts to real life’ (Gilbert, 2005, p. 2). Nor do therapists otherwise learn
that the concepts do work.
Whilst working concurrently on their own differentiation efforts, the therapist’s
work with the survivor needs to focus on assisting her to assume responsibility for
her own life, happiness and comfort. This means that the focus of therapy is not on
the client’s experiences and feelings of betrayal, abandonment, hurt and pain. What
is more useful is exploring the person-to-person behaviour that emanates from such
feeling states:
‘What do you do in relation to others when you feel shame? How do you communicate this
to others, or not? Do you reach out to others or distance? How does this serve you, meet your
goals for health and well-being? What do you imagine you would be able to do if you were
less reactive to others’ expectations?’

Linda MacKay
In this way, a Bowen approach moves to reduce less functional behaviour, manage
the anxiety of being in conflict with significant others and assists the survivor to
communicate her needs and wants in more mature ways. Further, a family systems view
of symptoms takes into account the survivor’s own reciprocal functioning in accepting
invitations to function for others at the expense of herself. It also encourages work
targeted at coming to grips with her own part in maintaining patterns of reactivity and
anxiety binding behaviours. In so doing, this opens up many possibilities for viability
and self-directed functioning.
Conclusion
Bowen family systems theory directs the trauma survivor towards reflectively examin-
ing her over-sensitivity towards significant others. Coaching is purposefully directed
to assisting her to reduce her reactivity in those relationships and usually involves the
utilisation of arousal reduction techniques before entering into work that encourages
non-blaming person-to-person exchanges. Freedom to think for oneself, and aware-
ness building around how some behavioural adaptations hold more possibilities are
core to this approach.
Work within a Bowen family systems frame recognises that any extended focus on
feeling responses reduces the ability of the survivor to think rationally, to have access
to her higher cortical functions, and consequently set a course of action, guided by
her own principles and values. Thus the focus is not on the reparative relationship of
therapist and client, given this can replicate the original fusion from which the survivor
is trying to escape. A focus on being responsive and sensitive to the client’s needs by
acting as a ‘healer’ and reparative parental figure can work to bind the anxiety even
further, reducing functioning and discouraging self-defining, self-responsible action
and self-soothing behaviours.
This is a significant challenge for therapists who have ‘grown-up’ through a val-
orising of the ‘healing agency’ of a traditional attachment theory frame, in which
therapists themselves are inculcated into acting through a discourse that consistently
blames mothers for their ‘non-attunement’ and ignores the embeddedness of relation-
ality and functioning within the wider system of the family.
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tralian and New Zealand Journal of Family Therapy, 20(2), 94–103.
Brown, J. (2012). Growing Yourself Up: How to bring your best to all of life’s relationships.
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brain. New York; London: W.W. Norton & Co.
Gilbert, R. (2005). Erosion of Bowen theory 3: Incomplete understanding of theory. Family
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Trauma and Bowen Family Systems

Theory: Working with Adults Who

Working with survivors of trauma is mostly challenging, exhausting, long-term and

For clinicians as well as researchers, there is an enormous challenge in bringing together

Bowen Family Systems Theory

Address for correspondence: [email protected]

232 THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF FAMILY THERAPY

THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF FAMILY THERAPY 233

234 THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF FAMILY THERAPY

Bowen Family Systems Therapy

THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF FAMILY THERAPY 235

Child Abuse, Trauma and Family Emotional Processes

236 THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF FAMILY THERAPY

Dissociation and self-harm

Donna – A Case Study

THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF FAMILY THERAPY 237

238 THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF FAMILY THERAPY

THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF FAMILY THERAPY 239

240 THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF FAMILY THERAPY

THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF FAMILY THERAPY 241

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