How Can A Therapist Create An Environment For Clients' Self-Soothing Resources To Emerge?
With differentiation of self as the goal in Bowen Family Systems Therapy, the therapist invites the client to direct their own learning. The following principles outline how an increase in a client's awareness of self can be facilitated.
Invite responsibility for self as opposed to the therapist directing the work
The therapist uncovers, draws out and accesses client motivation through questions that elicit goals for SELF, not only goals for a change in situation. For example: "How would you like to experience yourself differently in this relationship?, How would you like to be able to respond in those particular situations?, What effect would that have?, What would be the significance to the way you think about yourself should such a change occur?, What would YOU want to work on in yourself to contribute to the kind of relationship you'd like?"
Through such questions, clients are encouraged to focus on their internal functioning rather than their perceptions or descriptions of the external stressors. Additionally through asking clients to share with you their own thinking and ideas about the most helpful starting point for them, a therapist can invite a client into more responsibility for self.
Invite empathy for self as opposed to the therapist being the key source of the empathy
The therapist enquires about clients' own initiative in ways to calm themselves and interrupt the anxiety cascade, what has prevented them acting on their own wisdom and what, if any, assistance they might need to implement their ideas. For example: "If you were listening to yourself telling your story, what reactions or thoughts might you have about your own resilience / courage / wisdom?" or "What do you need to do or obtain in order to observe and pay better attention to your own reactions and anxiety indicators"?
Invite clients to be researchers of themselves in their relationship systems
During each session, the therapist enquires about the client's own initiatives and efforts between sessions. For example: "What have you been working on? How have you been doing this? What ideas have you found yourself thinking about following our last session? What did you take away from the last session? What are you aware of trying to do differently? What have been the successes and setbacks in your efforts? What have you learnt from this? What have you been noticing about yourself - Is this a new or an old pattern?"
Create a "learning about self" environment
The therapist develops questions and experiments which invite a client to reflect on themselves and their own functioning (all aspects including physiological, emotional, behavioural etc) rather than inviting description and articulation of feelings. "The expression of intense feeling tends to activate the emotional chain reaction in the clinical session, to interfere with the participants ability to think clearly about the situation and to reinforce the very processes and patterns that clients find troublesome" (Papero 2000). Feelings are more helpfully expressed when clients have more capacity to understand and use their feelings helpfully as opposed to being at the mercy of them
Ask questions about clients' physiological response. For example: "What do you notice happening in your body as you speak about his event? What is the first thing you notice? How long does it last? How does it dissipate? If you didn't act immediately to banish this sensation how long do you think it would take to dissipate naturally? How do you imagine you would be able to tolerate it if you were to decide to experience the sensation for a short time? What is happening in your mind when this sensation begins?";
Ask questions which invite thinking about feelings and reactions (as opposed to the expression of feelings and reactivity). For example: "When you experience that gripping fear, how do you express it? Who to? How do they respond? How does this way of expressing yourself when you are scared /angry help you in the achievement of your goal of feeling a closer connection with you partner? What were you trying to achieve? Can you see any alternatives to............ when you feel that bad? As I see how intensely you are experiencing this grief /pain, can you work out what your strong feelings are telling you about how you wish to be treated in your relationship? How could you express this while at the same time acknowledging the value of your relationship?" Invite a logical and factual description of process i.e. the what, who, and where of situations.
Ask questions which assist clients to make connections and distinctions between different aspects of a client's functioning. For example: "how do you decide how to respond to your partner's expression of discontent? When grappling with this dilemma how much of your thinking is influenced by the facts of the situation compared with your assumptions and fears? What ideas guide you when making such decisions?
Encourage an awareness of relational patterns. For example: "I know you have learnt to speak for X's feelings, but what would you say, just this once, if you could speak for your own needs? When, do you think, did you start to take X's symptoms so personally, as if they were directed at hurting you? How do you think this way of thinking about it, impacts upon the way you relate to X?"
Share information without prescription
Share information about human functioning, especially the nature of and pervasiveness of anxiety, along with Family Systems principles.
Share information about the possibilities (techniques) for calming one's body and mind, as well as your thinking about the value of such endeavours but only after the client has communicated their own concern for a particular symptom or desire to make a particular change, not in response to the therapist's anxiety increasing in response to the client's situation. The therapist must do this with care, in order for the client to grapple with the options and make their own choices and decisions around these.
Relentlessly observe, question, evaluate and understand your own role as therapist in the client's journey
My own efforts to learn and apply the complexity of Bowen theory, both personally and in clinical work, have provided increasing clarity about the role of a therapist. This is not to relieve a client's suffering or distress, but as Bowen would say, to assist a person to make a research project out of their own life (Bowen, 1978). This means inviting clients to sit with themselves, know themselves, observe and report on themselves, to understand their functioning and responses. To consider their own resources and initiatives, desires, goals and options and to develop compassion for themselves.
What does this ask of a therapist?
Firstly, the ability to stay in contact with the problem without becoming part of it, or cutting off from it. Sounds simple enough, but in practice it is not that simple, because the doing of therapy does not only involve the intellectual system. The emotional system of the therapist is easily activated, as sympathy and the desire to help one's fellow in distress are instinctual human responses that are well (and maybe even overly) developed in most therapists.
Secondly, the ability to define oneself clearly and consistently to the client. In practice this means providing a stable and consistent source of information about, and modelling of knowing the self, expressing self (without desiring change in others) and having the courage of one's convictions despite any disharmony or disapproval this might create.
Finally, to facilitate a learning process for the client that is not solely dependent on the therapist or therapeutic relationship, but instead, privileges their own relationships with key family members and the relationship they have with themselves. This is possibly Bowen's most radical departure from his psychoanalytic roots, his hypothesis that a soothing or containing experience with the therapist will not necessarily be transferred by a client into their life outside the therapy room.