WPFC Perspectives


WPFC Perspectives: Insights from Bowen Family Systems Theory, No. 2 Symptoms in Children
“Symptoms – any symptom, may be seen as the effort of the organism to adapt to surrounding conditions... If one were to exchange the words “individual” for “symptom” and “family” for “organism,” then it would follow that symptoms in an individual may be considered to involve the whole family. While it is vitally important that a clinician attend to the “symptom qua symptom,” that is, to the individual in distress and to the nature of the distress, it is also necessary, within Bowen’s approach, to expand the focus beyond the individual and the distress, to a wider view of the family phenomena.” PAULINA MCCULLOUGH THE WPFC QUARTERLY, VOLUME 1, NUMBER 6, WINTER 1988 REPRINTED IN THE COLLECTED PAPERS OF PAULINA G. MCCULLOUGH, 2001, P.P. 22-23
1. What factors do you think about when you are trying to understand the presence of symptoms in children? James Maloni: I find it useful to go to Bowen theory which states that emotional symptoms in children is one of three ways that dysfunction manifests itself in a family. According to the theory also, dysfunction is related to the two primary factors that determine the occurrence of symptoms, chronic anxiety and level of differentiation. The child most susceptible or receptive to being affected by the family anxiety is the one least able to separate himself or herself from the parents, especially the mother. This usually begins early on and can be observed in the mother-child relationship. Sibling position, gender of the child and parental and/or extended family anxiety at the time of the child’s birth are a few of many factors that contribute to the level of differentiation of this child. If life events in the nuclear and extended families remain fairly calm, emotional symptoms usually do not develop to any great extent in this child. He or she may show temporary difficulties negotiating transitions and new situations such as starting or changing schools, but things settle down after new routines are established. He or she may have difficulty developing or sustaining peer relationships, but this usually does not create undue concern when conditions are calm. However, if the emotional climate becomes tense and this persists for an extended period of time, emotional symptoms often appear in this heavily focused-upon child. The intensity of the focus has always been present to some extent, but up to this point, the intensity may have taken the form of a benign special-ness. However, if significant financial or health setbacks occur and persist in the nucleus or extended families, this intensity can take the form of a weighty urgency, and in a child-focused family, the intensity of focus can quickly be funneled toward the	least differentiated child. The child is not just a passive receptacle in this process. It is as if he or she reaches out and catches the tunnel of anxiety and seems willing to “run with it”. This occurs with the assistance of most, if not all, family members, but develops in an automatic rather than purposeful way. This vertically downward projection of anxiety toward the most emotionally susceptible child inadvertently keeps the marriage relationship and other family members relatively free of the anxiety and thus better able to function on an everyday basis. Jean Brannan: In thinking about symptoms in children, I am interested in a range of information. For example, I want to know who is describing the symptoms; when they first noticed them; who else in the child’s network (other family members, teachers, etc.) is confirming the symptoms or may have another view; and whether the child has any view of the “symptoms.” Especially pertinent might be the view of each parent, and how they are dealing with their concerns about the child. This can also lead to questions about the parental relationship in general, which can shed light	on the emotional field in which the child is functioning. Background information then becomes useful also, such as the child’s sibling position, other events in the family around the time of the child’s conception and birth, mother’s description of the pregnancy, and each parent’s view of the child’s early functioning. Extended family factors are pertinent, such as the grandparents’ relationship to the parents and the nuclear family as a whole, other family members’ views and relationship to the child and family, and presence or absence of physical, social, and emotional symptoms in the broader family. 2. How do you think about the interaction of individual and family factors in the emergence of symptoms in children? James Maloni: Once again utilizing Bowen theory, the two main variables of chronic anxiety and level of differentiation provide the foundation for my thinking. It is often reported that there has been a buildup of stress and anxiety in the nuclear and extended families for a period of two years or more prior to the onset of symptoms. This can lead to increased intensity and rigidity in triangular interactions in the family system. Individual differences exist among the children as to who gains primary focus. This has had much “exercise” and practice earlier in the family insofar as some children are easier to worry about than others. As stated earlier, the most susceptible child is generally going to experience more everyday difficulties in his/her life such as negotiating complex intersections in school and with peers. Perhaps these difficulties are perceived by parents and other family members in more threatening and ominous ways at times when stress and anxiety is high in the family. Perhaps the child exudes the tension more visually (possibly even in a chemical way) at times of high family anxiety.
This may contribute to more intense versions of the difficulties in school and with peers. In addition, there may be some degree of chance as to when there is a convergence of unpleasant circumstances in or outside the family, relevant to the individual child. Jean Brannan: There are different opinions on this question, including one view that individual factors really cannot be sorted out from the “family factors.” It may be an artificial distinction to try to sort out the individual from the family context. However, I do consider characteristics or variables which reside within the child – “temperament”, intelligence, other cognitive abilities, physical appearance, medical conditions, etc. – as they may impact a child’s ability to grow and adapt, as well as how these variables affect the child’s emotional position in the family. For instance, although one may not be able to definitively determine how one child eats and sleeps on a regular schedule, cries for short periods or in response to a particular aversive stimulus, makes eye contact, smiles, etc., and from how another child at the opposite end of these continuums behaves, these “temperament” differences may impact the parents’ ability to care for the child. If the parents react to a child’s inability to stop crying by feeling incompetent, they may distance from the child or become overprotective; they may be more vulnerable to perceived criticism from grandparents; they may blame each other. In general, the “family factors” – parents’ emotional functioning, extended family relationships, history of behavioral choices, etc. – seem to interact with “individual” factors in the child to produce a snapshot of functioning which may include symptoms in the child. 3. What contributes to the maintenance or relief of symptoms in children? James Maloni: In general, the length of time that symptoms have been operative and thus having more opportunity to “develop a life of their own” probably has something to do with how long they persist. This would be true with or without outside intervention. Also, if there has been prior intervention which places additional	focus on the child and his/her symptom, this can contribute to the maintenance of these symptoms. Some symptoms in children appear more difficult than others to reverse especially if these symptoms are being manifested primarily outside the home and interfering with overall functioning and development. While these symptoms are intrinsically related to family emotion process, they sometimes operate as if there is a disconnection between these behaviors and those observable in the home. For many symptoms in children, the lowering of stress and anxiety in the family and the environment pertinent to the child’s life is an important factor in the relief of symptoms. If circumstances remain favorable, this symptom relief can last indefinitely. The ability to go beyond symptom relief toward more substantive gains requires further work. According to Bowen theory, problems manifest themselves as dysfunction in the nuclear family when chronic anxiety persists for an extended period of time and when family members have not resolved emotional issues with their families of origin. One common pattern is for the mother to transmit chronic anxiety to one or more of her children to the extent that she has not emotionally defined herself in relation to her family of origin. This unresolved attachment is transferred to the child. The father is also a primary agent in this process. According to the theory, his level	of emotional differentiation from his family of origin is approximately the same as that of his wife. He contributes to the mother-child emotional dance both by his anxious reactions to the dance as well as by his own emotional dance with the wife. A clinical application of the theory is to work with one or both parents toward the initial goal of their becoming more observant and thoughtful toward their reactions to the child. Symptoms in one or more of their children provide an opportunity to learn about the emotional forces operating within themselves. If at least one of these parents can maintain this broader focus in a consistent manner over an extended period of time, the symptomatic child is granted an increased window to improve his/her functioning. Jean Brannan: One factor that immediately comes to mind is “anxiety.” The level of acute anxiety in a family may affect the intensity and duration of symptoms in a child. Symptoms may diminish when financial problems abate, when a medical condition of a family member goes into remission, when the school year ends and teachers quit calling. Some children may themselves be able to work toward established rewards or decide to avoid aversive consequences, producing improved behavior and/or less distress. Factors having to do with more “chronic” anxiety, such as the marital relationship, the closeness to or distance from grandparents, or alcoholism of a parent may also shift in a way that the child is less of a focus, less likely to express the problems of the broader family. In some instances, it seems that the “triangling in” of a therapist is enough to produce symptom reduction in a child. The above processes point to symptom reduction, which can be distinguished from more permanent or fundamental change. Although basic change is difficult to document in a short time period, it appears that children have a better chance of growing and adapting in positive ways when parents are able to see and take responsibility for their own emotional functioning. Basic change also is more likely when the child can identify and implement changes in how s/he relates to the anxiety in the family or other relationships.
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