Therapy approaches, explained

Bowen family systems therapy

To Bowen, a family is an emotional system in which each member pulls on the others: anxiety spreads between people, and everyone's reactions move everyone else. Therapy isn't about fixing one person but about learning to stay clear-headed inside the system, and to be less pushed around by anxiety.^[1,2,14]

Start with the basics Find a therapist

When I'm in conflict with another person, I badly want to shift the tension in the relationship onto a third person. And that tension actually helps ease the conflict between me and the other person.

5-Minute Psychology, "Three family therapy theories: circular causality, feedback control, triangulation"

What is Bowen family systems therapy?

Have you ever hung up from a call with your mother too on edge to sleep? What she talked about was between her and your father, and you were only listening, yet it felt as though you'd been pulled into an argument that wasn't yours; you tried to smooth it over and neither of them was pleased. Why does something that seems not to be about you keep landing on you?^[4,14]

1The worldview

Why the call won't resolve: anxiety, reactivity and "self" feeding each other

Bowen family systems theory was developed by the American psychiatrist Murray Bowen (1913–1990). Trained in psychoanalysis, he moved in 1954 to the National Institute of Mental Health (NIMH) in the United States and began studying whole families rather than single patients: eleven families lived on the research unit, for up to three years, their behaviour observed and recorded daily. What he saw was that family members' feelings and behaviour are tied together, and that change in one person tends to be accompanied by change in the others.^[12,14]

The theory's core observation is that family members are so deeply connected that one person's anxiety spreads through the home. The Bowen Center (the research and training institute devoted to the theory) says family members seem to live under the same "emotional skin". When stress is low the connection supports; when tension rises it becomes more unsettling than comforting, and people accommodate, argue or move apart. The one who accommodates most tends to "absorb" the system's anxiety, and is the member most prone to depression, alcohol problems, affairs or physical illness. In this theory, where a symptom shows up does not mean where the problem began. The less flexible a person or family, the more readily it slides into periods of rising "chronic anxiety".^[2,3]

So the Bowen approach doesn't treat that phone call as your mother's problem, or only yours; it treats it as part of how the system runs, with each person both shaped by the system and helping to keep it going. This is not about blaming family members. The starting point is to see each person's part, rather than blame oneself or others, and the question shifts from "why is he like that?" to "what do I do in this circle, and how could I do it differently?" So how does the circle turn?^[2,14]

This circle is the backbone of the theory. When tension rises, people ease it by accommodating, arguing, moving apart or drawing in a third person. The relief lasts only a while and nothing is resolved; and the more of their own thinking a person gives up in relationships, the harder it is to stay steady under the next pressure, and the more anxious they become. The theory holds that a person's level of "self" is formed mainly by family relationships in childhood and adolescence, and rarely changes in adulthood without a long, structured effort. So what therapy changes is a person's position in the circle, so that they are less pulled along by anxiety.

AnxietyTension spreads between family members and everyone wants it down
ReactivityGiving in, arguing, drifting apart, or drawing in a third person
SelfThe more of your own thinking you give up, the harder it is to hold steady

One phone call, eight concepts: from one person to a whole society

Bowen theory is made of eight interlocking concepts. Here they run from near to far in four layers: one person, then the inside of the family, then across generations, and finally society. To show how they fit together, each layer uses the same invented family: Wai (38), the person on that phone call, who feels on edge after every call with her mother and lies awake at night.^{[2,3,4,5,6,7,8,9,10]}

These layers are not eight separate labels: when anxiety rises, less differentiated people and families show these patterns first, and the patterns are handed down the generations. To put the facts side by side, the therapist uses a family diagram, described below. The concepts don't all have the same amount of research behind them; see the evidence section.

1Differentiation of self
The theory's centre: how far a person can stay connected to others while keeping their own thinking and position. A less differentiated person either hurries to please, insists others go along, or opposes everything to prove they are a self; a more differentiated person, facing conflict, criticism or rejection, can still tell what rests on facts from what is only feeling. It isn't independence or distance: a well-differentiated person accepts that they realistically depend on others, and acts for the group by choice rather than under relationship pressure.
When her mother runs her father down, Wai agrees at once, then feels guilty after hanging up; she rarely says what she herself thinks.
2Inside the family
Triangles: a two-person relationship can bear little tension before it draws in a third to share the strain, so a triangle is the smallest stable unit of relationship; but the tension is only moved, not resolved, and someone is always left outside. Nuclear family emotional process: as tension rises, families tend to use four routes: conflict between the couple, one partner giving in until they become symptomatic, a child affected, emotional distance. Family projection process: parents focus their anxiety on one child, first fearing something is wrong, then reading the child's behaviour as proof, then treating the child as if something really is wrong; that child becomes more sensitive than the siblings and more prone to symptoms.
Her mother tells Wai her complaints about her father; Wai becomes her mother's ally and her father is left outside: the phone call is a triangle.
3Across generations
Multigenerational transmission: parents and children differ only slightly in differentiation, yet over generations small differences accumulate into very different branches of one extended family; people also tend to choose partners at a similar level. Sibling position: drawing on Walter Toman's research, Bowen held that positions such as eldest and youngest bring different tendencies (eldest children, for instance, gravitate to leadership), but only as tendencies, and a family's anxiety can make a younger sibling a "functional eldest". Emotional cutoff: some people manage tension with their family of origin by moving away, rarely making contact, or avoiding sensitive topics when they meet. The relationship looks calmer, but the problem is only dormant, and the more complete the cutoff, the more weight new relationships tend to carry.
Behind the call are three generations: Wai's father lost his own father as a boy and went to work early, used to carrying things alone and not discussing feelings; her older brother emigrated in his early twenties after a row with their father and has had little contact for over ten years; her mother, the eldest daughter, looked after her younger siblings from childhood.
4Society
Bowen held that the same process operates across a whole society: when chronic anxiety rises, a society tends to decide in order to relieve the discomfort of the moment rather than on principle and with the long view, which he called regression. He first saw the pattern in families of juvenile delinquents, then saw similar shifts in courts, schools and governments. This concept stretches the theory furthest; the research reviews deal mostly with the earlier concepts.
When anxiety rises across a whole society, the pressure on every family rises with it.

2The method

Back to the call: calm first, then see your own position, then hold your ground in your family of origin

Since the tension in that call comes from the whole circle turning, therapy doesn't start by fixing one person. The Bowen approach has no fixed techniques and no session-by-session script; what makes it systematic is a clear through-line: put the symptom into the context of family relationships, then raise a person's differentiation step by step. Bowen himself saw therapy in three broad stages, which line up with the three places in the circle above. The therapist guides the conversation, but each step is yours to take or leave.^[1,14]

1CalmSee the symptom as part of a pattern of mutual pull, and tension eases a littleAnxiety
2SelfSpot your place in the triangles; practise reacting less and standing on your own position moreReactivity
3Family of originMeet old patterns in your family of origin from a new positionSelf

3The skills

Six ways of working: from drawing the background to that call, to a trip home

With the through-line set, the doing rests on these ways of working. They aren't a fixed sequence but tools the therapist and you pick up as needed, grouped by the place in the circle they act on. The most unusual thing is that the therapist is expected to have done their own family-of-origin work first.

Anxiety: see clearly, steady first

Replace blame with facts and curiosity, and let tension settle.

The family diagram: three generations on one page
Therapy often begins with a genogram: the family drawn across three or more generations, squares for men and circles for women, lines for marriage and parentage and for closeness or conflict between people, with facts such as births, deaths, moves, illnesses and job changes noted beside them. The Bowen Center calls it "a graphic depiction of facts of functioning" over generations, used to see the family as an emotional system and to recognise the patterns of reactivity that govern its members. The therapist asks when the symptom began, what was happening in the family around then, and who held a particular role (say, "the rebel") in earlier generations. Questions like these make it harder to reduce the problem to one person's flaw and easier to move from blame to curiosity. What family members report is bound to be subjective, but stories of earlier generations are still clues to roles and tensions.^[11,14,16]
Hear it in a session
1. Client
  Every time I get off the phone with my mum I'm on edge and can't sleep. It isn't really a big deal.
2. Therapist
  It has been going on a while. Shall we draw your family on a page and see what background this tension sits in? Let's start with you, your parents and your brother.
3. Client
  OK. My brother is four years older, and he went to Canada at twenty-two.
4. Therapist
  What led him to leave then?
5. Client
  He had a huge row with Dad, and they've hardly been in touch since.
6. Therapist
  I'll draw a line for distance between your brother and your father. And your mother's side? Where did she come in her family?
7. Client
  She's the eldest, with three younger siblings, and my grandmother had her helping look after them from early on.
8. Therapist
  And your father?
9. Client
  When Dad was twelve his own father died, and he went out to work early. He doesn't talk much.
10. Therapist
  Putting these together, do you notice anything? I may be wrong, so please correct me.
11. Client
  …Mum seems used to looking after everyone, and Dad is used to carrying things himself. And I seem to be the one Mum has left to talk to.
12. Therapist
  You saw that yourself. Next, we can look at what it is like for you in that position.
Notice: This is the opening of a family evaluation, and the moment the background to that call is drawn: the therapist asks for facts (who, when, what happened), explains nothing and blames no one. The pattern is put into words by the client herself; the therapist only offers an observation at the end, open to correction. The diagram is a starting point, and nothing has yet been decided about what to do.
Method based on^[11,14]
The therapist as coach: staying differentiated
A Bowen therapist is not there to "cure" the family or solve its problems but to coach you in seeing the system; Bowen used the word coaching for this therapy. The therapist's main work is not being drawn in: not rushing to advise, not rushing to fix, and not pretending to be detached. Training in this approach therefore stresses the therapist's own family-of-origin work and level of differentiation over technique. The therapist usually directs the conversation actively, asks family members to speak to the therapist rather than to each other so the others can hear without having to react, and asks more about thoughts and observations than about expressing feelings. Because the focus is one person's change within the system, the whole family need not attend: work with a single adult counts equally as family therapy for Bowen, and often begins with whoever is most willing to change, on the belief that when one person reacts less, the whole triangle and eventually the extended family shift too.^[13,14,15]

Reactivity: spot and change your own reactions

Notice which triangles you are drawn into and learn to respond with less reactivity.

Detriangling: no longer rushing to take sides
Detriangling is often called the central technique of Bowen therapy. First you spot the triangles you are in: who complains to you about a third person, how you speak up for someone, how you draw others to your side. The therapist uses simple questions (who, what, when, where) to help you observe your relationships like a detective. Then you plan a more neutral, less reactive position: not discussing someone's faults behind their back, asking a person to take it directly to the one concerned, or swapping your usual reaction for a different one. The aim is not to change other people's relationship or to manoeuvre it, but to stop rushing to take sides because someone else is tense.^[4,14]
Hear it in a session
1. Client
  Mum rang again last night about Dad ignoring her all day, for twenty minutes. I could only keep saying "mm", and after I hung up I was angry with myself.
2. Therapist
  It sounds as if you were invited into a conversation that belongs to the two of them. How do you usually respond at times like that?
3. Client
  I help her work out why Dad is like that, and sometimes I promise to talk to him for her.
4. Therapist
  And after you do that, what usually happens?
5. Client
  She seems a bit better, but a few days later it starts again. Dad knows she talks to me and he isn't happy; he thinks I'm on Mum's side.
6. Therapist
  Have you thought about doing it differently next time? I don't mean changing your mother, but where you want to stand.
7. Client
  I want to listen to her, but I don't want to be the go-between any more.
8. Therapist
  In your own words, how would you start? We can try saying it once here.
9. Client
  "Mum, I can hear you're really unhappy. But this is between you and Dad, and I'd like you to tell him directly. If you want to talk about something else, I'm glad to listen."
10. Therapist
  Which part is hardest to say?
11. Client
  "Tell him directly." I'm afraid she'll think I don't care.
12. Therapist
  She'll probably react, which is normal. If she says "you never help me", how would you like to answer without arguing?
13. Client
  I could say, "I do care about you. I just don't want to stand between you two."
14. Therapist
  Good. Next time we'll look at what actually happened.
Notice: Back to the opening phone call: this shows detriangling and an "I-position" together. The therapist asks about process (how she usually responds, what happens next) and never tells her what to do; the aim is not to change her mother and father but where Wai herself stands. They also rehearse the likely reaction in advance. No result is promised: what actually happens is for next time.
Method based on^[14,15]
The "I-position": speaking for yourself, neither attacking nor defending
When you talk about someone who troubles you, the therapist brings you from "why is he like that?" back to "how do I see it, and what will I do?" This is the I-position: saying what you think and believe and what you will and won't do, without attacking or defending. For example, "You're so selfish, you worry your parents sick" becomes "I'm worried this will affect your grades." The point isn't the sentence form but that you can still say what you think and do when the other person is anxious. This self-focus is seen as key to lowering anxiety and to seeing your own part in the problem. Wai's line, "this is between you and Dad, and I'd like you to tell him directly", is one example.^[14,15,17]

Self: holding steady with family

Keep a new position in real relationships, and keep it.

Person-to-person relationships: just the two of you
A person-to-person relationship is one in which two people talk directly about themselves and each other, and not about a third party. When you discuss others' faults behind their backs less, and carry other people's worries around less, each side finds it easier to see their own part in the problem. It is what you keep doing in daily relationships once triangles are spotted: each time you go direct to the person concerned, you practise holding your own ground.^[14]
Returning to the family of origin: studying your own family by letter, phone and visit
Bowen held that shifting the focus from the tense nuclear family to the previous generation makes change more productive. In this coaching work you are the lead and the therapist is a consultant: you study your own family by letters, phone calls, visits and by asking elders about earlier generations, practise managing your reactivity with family, then report back. The therapist prepares you for the anxiety and resistance that rise when you step out of your usual role. Change runs in three steps: take a new position, family members react, then keep the new position under pressure; Bowen held that the third step decides whether change lasts. He also believed that lifting differentiation beyond the previous generation's level is slow and modest, while even small shifts can give a whole family more to work with.^[14,15]
Hear it in a session
1. Therapist
  Last week you tried the new wording. What happened afterwards?
2. Client
  Mum was upset at first and said I "don't care about the family now I'm grown up", then didn't call for two weeks. I felt so guilty I almost rang back to explain.
3. Therapist
  Did you notice how the guilt arrived?
4. Client
  It was like being small again: whenever she was unhappy, I felt it was my fault.
5. Therapist
  When you change position, the system tries to pull you back; we expected this. Did you ring her?
6. Client
  No. I sent a short message saying I was thinking of her, with no explanation.
7. Therapist
  How was that different from what you used to do?
8. Client
  I used to apologise and promise to talk to Dad for her. This time I didn't.
9. Therapist
  How would you like to keep that position this week?
10. Client
  I'd like to go home for dinner at the weekend and chat with each of them in turn, without getting into things between them. I'm a bit scared.
11. Therapist
  That's reasonable. Let's prepare for a few moments you might meet at the table, and if it gets too hard you can choose to leave early.
Notice: What happens after the call: this shows the last two of the three steps of change: the family reacts, and Wai holds the new position in part. She feels guilty and doesn't ring back to explain, but isn't unshaken. The therapist treats the guilt as expected, promises no result, and leaves her free to leave a gathering early. Visiting home is her choice, not a requirement.
Method based on^[14,15]

The dialogues are illustrative composites, not real clients; skills that stir strong emotion or touch on trauma should be done with a trained therapist.

In the room: no fixed script, starting from the symptom in front of you

Now you know how it sees a person and how it works. The next questions: what is it actually like, does it work, and what is it not for?

What does a course look like with these ways of working in it? The Bowen approach has no fixed number of sessions or session script, and unlike many brief therapies it doesn't treat symptom relief as the end point. Many people begin with the symptom in front of them and only later choose to look at the wider family history. Sessions leave space for you to try new ways in your real family and come back to make sense of them. One research example is a couple programme of eight 90-minute sessions, but that is a trial design, not a standard course. Participants are usually adults, alone or as a couple.^[14,15,27]

1Start with what worries youFirst the symptom or difficulty you bring: the therapist asks when it started and who is involved, and tries to bring tension down.
2Family evaluation: the problem on the diagramFollowing the symptom out through the nuclear and extended family, noticing patterns of closeness and distance, how anxiety is handled, which triangles are active, and any emotional cutoff.
3See your own positionQuestions of who, what, when and what next show how you get drawn into triangles and how you draw others in; the therapist asks about process, not about who is right.
4Plan and try something newPick one relationship and plan a less reactive response, such as staying neutral or stating your own position; try it between sessions and review it together next time.
5Weather the pushback and hold your positionChange upsets the family's balance, and relatives often react, hoping you will go back. Whether you can hold the new position then decides whether the change lasts.

Recurring family difficulties like Wai's: what can the Bowen approach help with?

The Bowen approach isn't built around any one diagnosis but around difficulties that recur in relationships, especially those tied to the family of origin, a partner or children. Note that most research tests the theory (differentiation and distress), not the therapy's effect on any given diagnosis.^{[14,15,25,26]}

Recurring tension with parents or siblings
Caught between a partner and your family of origin, or between your parents
A child's difficulties while the tension between the parents has never been discussed
Anxiety, low mood or strained relationships following a death, illness or family change
Always being the peacemaker, the rescuer or the one blamed

If there is violence or abuse in your family, tell your therapist before deciding whether to go back to your family of origin; safety comes first, and distance can sometimes protect. If you are thinking of hurting yourself or ending your life, please don't face it alone: call The Samaritans' 24-hour line on 2896 0000, or 999 in an emergency.

Is there evidence? A fair amount for the theory, almost none for the therapy

So does the research back this way of working? Two things need separating. Bowen theory (do family systems and differentiation of self work as it says?) has attracted a fair amount of research; Bowen therapy (does treatment built on it work?) has hardly been tested in rigorous trials. Below, from firmer to more preliminary.

People with higher differentiation of self have less anxiety and distress, and happier marriages
This is the best-supported point. A scoping review covering 295 studies concluded that differentiation of self predicts psychological health and marital quality, and is linked to better physical health and family relationships; an earlier review likewise found links between differentiation and chronic anxiety, marital satisfaction and psychological distress. But the usual measure is a self-report questionnaire, and the research lacks long-term follow-up and designs that can show cause: the findings show that the two go together, not that raising differentiation reduces distress.^[17,25,26]
In other cultures and Chinese samples: broadly similar direction, but differences unresolved
Research with ethnic-minority adults found that higher differentiation likewise predicted better adjustment, and a study of Chinese university students found a similar result. But a cross-cultural comparison found Korean students scoring lower than European American students, with a weaker link between differentiation and well-being, and a Chinese version of the measure, validated by researchers including some at The Chinese University of Hong Kong, advises taking the Chinese familistic orientation and the Chinese meaning of self into account. Whether such differences reflect relational selves in those cultures or a questionnaire that doesn't measure them fairly is not settled, and scholars argue for re-examining the concept through a cultural lens.^{[19,20,21,22,24]}
Sibling position, triangles, "partners at the same level": limited support
A research review found no support for Bowen's assumption that people of similar differentiation pair up, little empirical support for his theories of sibling position and triangulation, and that most research on multigenerational transmission had ignored Bowen's own perspective. A more recent review adds that the stability and cross-generational transmission of differentiation remain under-researched. That doesn't make the observations useless, only not yet properly tested.^[25,26]
Bowen therapy itself: very little direct trial evidence
One randomised controlled trial we found was run with 42 couples in Shiraz, Iran: a group given eight 90-minute sessions of Bowen systemic family therapy had lower marital conflict than a group given no intervention, straight after treatment and one month later. But the comparison group had no treatment at all, the sample was small, follow-up was one month, and it was not compared with other couple therapies. Reviews also note that whether therapy can raise differentiation, and whether any gain lasts, remains under-researched.^[26,27]

Overall: Bowen theory has been hugely influential, with later family therapists such as Betty Carter, Monica McGoldrick and Harriet Lerner building on it, but its empirical support is limited and mixed. Measurement is another limit: the common self-report scale is itself still being revised; its authors, for instance, rewrote the "fusion with others" subscale in 2003 because it fell short. "The theory makes sense", "the questionnaire correlates with distress" and "the therapy works" are three different things, and the third has the least evidence; we found no study comparing Bowen therapy head to head with other therapies. So the safe conclusion is that it is a perspective worth taking seriously, not one shown to work better than other therapies.^{[14,18,25,26]}

To be honest: what are its limits, and what do critics say?

Beyond the thin evidence, a few things deserve to be taken seriously:^{[3,14,15,22,23,24]}

1Bias against mothers and women

Feminist critics point out that Bowen's early theory did not place mothers' behaviour in its social context: women are expected to put others' needs first, then readily labelled "over-involved" or "fused". Later Bowen-based therapists such as Betty Carter have tried to reuse the concepts through a gender lens, no longer treating women's relational roles as deficits and expecting men to take responsibility in relationships.

2Culture: does "holding your own ground" suit Chinese families?

Some critics say the language of differentiation sounds individualistic. The Bowen Center says nearly the opposite: a well-differentiated person accepts a realistic dependence on others, and distance and cutoff are unresolved attachment. On the other hand, the questionnaire needs adapting for Chinese samples, and family therapists in Hong Kong note the challenges of applying Western models to Chinese culture and that, at the time, few professionals had systemic training. How filial duty, generational hierarchy and the like affect these concepts is under-researched. The sensible course is to judge with your therapist which ways of working suit your own family.

3Too rational, too little feeling?

Critics such as Deborah Luepnitz say the approach favours calm objectivity and puts expressing emotion second; Bowen himself tended to ask about thoughts rather than feelings. Practitioners reply that talking about several generations of family often stirs strong feelings, which here serve as clues to understanding relationships.

4The road may be longer than you expect, and social context is easy to miss

Many people want symptom relief first, whereas the Bowen approach treats it as a starting point and looks to the wider family history for a way into the present problem, so goals need agreeing at the start. The theory also leaves no room for social factors such as gender, race and class unless the therapist deliberately adds them. Bowen himself thought lifting differentiation beyond the previous generation's level slow and modest.

So the Bowen approach is a powerful lens on your family and yourself, suited to people willing to take time and to start with themselves. Back to that phone call, it offers a way to see the circle, not a promise of sleeping tonight; if you want quick symptom relief, or there are safety concerns at home, it is worth talking them through with a therapist first.

Take this with you

Back to that phone call: you may not be able to change the person on the other end, but you can practise how you pick it up, listening to her without taking sides between her and your father. The road is slow and comes with no guarantee; what the theory holds is that when one person reacts less, the circle gets a chance to loosen.^[14,15]

Bowen videos

Episodes are in Cantonese.

All episodes

Start with this one家庭治療三個理論：循環因果、回應控制、三角關係家庭治療認為，關係裡的問題很少是單方面造成的。伴侶不斷翻舊帳、一個逃避一個焦慮、父母吵架卻罵到子女身上，背後有三個基本理論：循環式因果、回應控制和家庭三角關係。這一集用球場上的衝突和一對老夫婦的個案，講解這三個互動模式，以及為什麼吵架本身其實不是壞事。Listen to the episode· About 12 min

A self-guided Bowen path

Not ready to see a therapist yet? Start with these three steps at your own pace. Work that involves going back to your family of origin is best planned with a therapist.

Courses

Therapists who practise Bowen

TreeholeHK's counsellors and clinical psychologists use Bowen to fit what you need, alongside other approaches.

Book therapy

Bowen is one route among several: family therapy and neighbouring approaches

This page goes deep on Bowen only; other schools of family therapy, and how it differs from neighbouring approaches, are on their own pages.

Family therapy: the wider fieldBowen is one school among several. Many influential later therapists, such as Betty Carter, Monica McGoldrick, Harriet Lerner and David Schnarch, wrote with Bowen theory at the core. How other schools see the family is in the overview.^[14]
Psychodynamic therapyBowen trained in psychoanalysis and then left it: the Bowen approach looks at how the system is structured and runs, not at a person's inner experience, and self-understanding comes less through the relationship with the therapist than through planned action in the family between sessions.^[14]
Couples therapyIn the room, Bowen himself avoided having partners interact directly, interviewing one in the other's presence so each could hear the other without reacting. For approaches centred on what happens between partners, see the couples therapy page.^[14]

Other therapy approaches

FAQ

Does Bowen family therapy need the whole family to come?

No. Bowen called work with a single adult family therapy too (he called it coaching), on the view that one person's change within the family can shift a triangle, and eventually the whole extended family. Adults can take part alone.^[14,15]

Is "differentiation of self" the same as independence, or cutting off from family?

No. In the Bowen Center's account, a well-differentiated person accepts a realistic dependence on others but can still tell what rests on facts from what is only feeling when faced with conflict, criticism or rejection. Moving away or rarely making contact is called emotional cutoff in this theory and treated as an unresolved attachment, not as differentiation.^[3,8]

Will Bowen therapy ask me to blame my parents?

No. The approach starts from seeing each person's part in the family's patterns rather than blaming yourself or others, and the family diagram is used to lay out the facts, helping people move from blame to curiosity.^[11,14]

What goes into a family diagram (genogram)?

Usually three or more generations: squares for men, circles for women, lines for marriage, parentage and closeness or conflict between people, with facts such as births, deaths, moves and illnesses noted. Its use is to see the family as an emotional system and recognise recurring patterns.^[11,16]

Is there scientific evidence for Bowen therapy?

For the theory, some: differentiation of self is linked to anxiety, psychological distress and marital quality, though mostly in questionnaire studies at a single point in time; other concepts such as sibling position and triangles have limited support. For the therapy itself we found only one small randomised trial (with a no-treatment comparison). So it is an influential perspective, not one shown to work better than other therapies.^[25,26,27]

How do I find a Bowen-informed therapist in Hong Kong?

Look for specific training in Bowen theory or family systems therapy and membership of a professional body, and ask before booking how they use the family diagram and coaching. You can browse TreeholeHK's psychotherapy services or ask a therapist about their training. Researchers on family therapy in Hong Kong have noted that few professionals have systemic training, which is all the more reason to ask.^[23]

References

1.Kerr, M. E., & Bowen, M. (1988). Family evaluation: An approach based on Bowen theory. W. W. Norton.
2.Bowen Center for the Study of the Family. (n.d.). Introduction to the eight concepts. thebowencenter.org
3.Bowen Center for the Study of the Family. (n.d.). Differentiation of self. thebowencenter.org
4.Bowen Center for the Study of the Family. (n.d.). Triangles. thebowencenter.org
5.Bowen Center for the Study of the Family. (n.d.). Nuclear family emotional process. thebowencenter.org
6.Bowen Center for the Study of the Family. (n.d.). Family projection process. thebowencenter.org
7.Bowen Center for the Study of the Family. (n.d.). Multigenerational transmission process. thebowencenter.org
8.Bowen Center for the Study of the Family. (n.d.). Emotional cutoff. thebowencenter.org
9.Bowen Center for the Study of the Family. (n.d.). Sibling position. thebowencenter.org
10.Bowen Center for the Study of the Family. (n.d.). Societal emotional process. thebowencenter.org
11.Bowen Center for the Study of the Family. (n.d.). Family diagram. thebowencenter.org
12.Bowen Center for the Study of the Family. (n.d.). Research in Bowen theory. thebowencenter.org
13.Bowen Center for the Study of the Family. (n.d.). Coaching. thebowencenter.org
14.Brown, J. (1999). Bowen family systems theory and practice: Illustration and critique. Australian and New Zealand Journal of Family Therapy, 20(2), 94–103. doi.org/10.1002/j.1467-8438.1999.tb00363.x
15.Brown, J. (2008). Is Bowen theory still relevant in the family therapy field? CAPA Quarterly: Journal of the Counsellors and Psychotherapists Association of NSW, (3), 11–17. (Author's version.) thefsi.com.au
16.McGoldrick, M., Gerson, R., & Petry, S. (2008). Genograms: Assessment and intervention (3rd ed.). W. W. Norton.
17.Skowron, E. A., & Friedlander, M. L. (1998). The Differentiation of Self Inventory: Development and initial validation. Journal of Counseling Psychology, 45(3), 235–246. doi.org/10.1037/0022-0167.45.3.235
18.Skowron, E. A., & Schmitt, T. A. (2003). Assessing interpersonal fusion: Reliability and validity of a new DSI Fusion with Others subscale. Journal of Marital and Family Therapy, 29(2), 209–222. doi.org/10.1111/j.1752-0606.2003.tb01201.x
19.Skowron, E. A. (2004). Differentiation of self, personal adjustment, problem solving, and ethnic group belonging among persons of color. Journal of Counseling & Development, 82(4), 447–456. doi.org/10.1002/j.1556-6678.2004.tb00333.x
20.Chung, H., & Gale, J. (2006). Comparing self-differentiation and psychological well-being between Korean and European American students. Contemporary Family Therapy, 28(3), 367–381. doi.org/10.1007/s10591-006-9013-z
21.Guo, X., Huang, J., & Yang, Y. (2022). The association between differentiation of self and life satisfaction among Chinese emerging adults: The mediating effect of hope and coping strategies and the moderating effect of child maltreatment history. International Journal of Environmental Research and Public Health, 19(12), 7106. doi.org/10.3390/ijerph19127106
22.Lam, C. M., & Chan-So, P. C. Y. (2015). Validation of the Chinese version of Differentiation of Self Inventory (C-DSI). Journal of Marital and Family Therapy, 41(1), 86–101. doi.org/10.1111/jmft.12031
23.Tse, S., Ng, R. M. K., Tonsing, K. N., & Ran, M. (2012). Families and family therapy in Hong Kong. International Review of Psychiatry, 24(2), 115–120. doi.org/10.3109/09540261.2012.656304
24.Erdem, G., & Safi, O. A. (2018). The cultural lens approach to Bowen family systems theory: Contributions of family change theory. Journal of Family Theory & Review, 10(2), 469–483. doi.org/10.1111/jftr.12258
25.Miller, R. B., Anderson, S., & Keala, D. K. (2004). Is Bowen theory valid? A review of basic research. Journal of Marital and Family Therapy, 30(4), 453–466. doi.org/10.1111/j.1752-0606.2004.tb01255.x
26.Calatrava, M., Martins, M. V., Schweer-Collins, M., Duch-Ceballos, C., & Rodríguez-González, M. (2022). Differentiation of self: A scoping review of Bowen Family Systems Theory's core construct. Clinical Psychology Review, 91, 102101. doi.org/10.1016/j.cpr.2021.102101
27.Yektatalab, S., Seddigh Oskouee, F., & Sodani, M. (2017). Efficacy of Bowen theory on marital conflict in the family nursing practice: A randomized controlled trial. Issues in Mental Health Nursing, 38(3), 253–260. doi.org/10.1080/01612840.2016.1261210

Want someone alongside you?

You can do the exercises on your own. When you're stuck, a trained therapist can take you further.

Book therapy

Bowen family systems therapy

FAQ

Does Bowen family therapy need the whole family to come?

Is "differentiation of self" the same as independence, or cutting off from family?

Will Bowen therapy ask me to blame my parents?

What goes into a family diagram (genogram)?

Is there scientific evidence for Bowen therapy?

How do I find a Bowen-informed therapist in Hong Kong?

References

1.Kerr, M. E., & Bowen, M. (1988). Family evaluation: An approach based on Bowen theory. W. W. Norton.
2.Bowen Center for the Study of the Family. (n.d.). Introduction to the eight concepts. thebowencenter.org
3.Bowen Center for the Study of the Family. (n.d.). Differentiation of self. thebowencenter.org
4.Bowen Center for the Study of the Family. (n.d.). Triangles. thebowencenter.org
5.Bowen Center for the Study of the Family. (n.d.). Nuclear family emotional process. thebowencenter.org
6.Bowen Center for the Study of the Family. (n.d.). Family projection process. thebowencenter.org
7.Bowen Center for the Study of the Family. (n.d.). Multigenerational transmission process. thebowencenter.org
8.Bowen Center for the Study of the Family. (n.d.). Emotional cutoff. thebowencenter.org
9.Bowen Center for the Study of the Family. (n.d.). Sibling position. thebowencenter.org
10.Bowen Center for the Study of the Family. (n.d.). Societal emotional process. thebowencenter.org
11.Bowen Center for the Study of the Family. (n.d.). Family diagram. thebowencenter.org
12.Bowen Center for the Study of the Family. (n.d.). Research in Bowen theory. thebowencenter.org
13.Bowen Center for the Study of the Family. (n.d.). Coaching. thebowencenter.org
14.Brown, J. (1999). Bowen family systems theory and practice: Illustration and critique. Australian and New Zealand Journal of Family Therapy, 20(2), 94–103. doi.org/10.1002/j.1467-8438.1999.tb00363.x
15.Brown, J. (2008). Is Bowen theory still relevant in the family therapy field? CAPA Quarterly: Journal of the Counsellors and Psychotherapists Association of NSW, (3), 11–17. (Author's version.) thefsi.com.au
16.McGoldrick, M., Gerson, R., & Petry, S. (2008). Genograms: Assessment and intervention (3rd ed.). W. W. Norton.
17.Skowron, E. A., & Friedlander, M. L. (1998). The Differentiation of Self Inventory: Development and initial validation. Journal of Counseling Psychology, 45(3), 235–246. doi.org/10.1037/0022-0167.45.3.235
18.Skowron, E. A., & Schmitt, T. A. (2003). Assessing interpersonal fusion: Reliability and validity of a new DSI Fusion with Others subscale. Journal of Marital and Family Therapy, 29(2), 209–222. doi.org/10.1111/j.1752-0606.2003.tb01201.x
19.Skowron, E. A. (2004). Differentiation of self, personal adjustment, problem solving, and ethnic group belonging among persons of color. Journal of Counseling & Development, 82(4), 447–456. doi.org/10.1002/j.1556-6678.2004.tb00333.x
20.Chung, H., & Gale, J. (2006). Comparing self-differentiation and psychological well-being between Korean and European American students. Contemporary Family Therapy, 28(3), 367–381. doi.org/10.1007/s10591-006-9013-z
21.Guo, X., Huang, J., & Yang, Y. (2022). The association between differentiation of self and life satisfaction among Chinese emerging adults: The mediating effect of hope and coping strategies and the moderating effect of child maltreatment history. International Journal of Environmental Research and Public Health, 19(12), 7106. doi.org/10.3390/ijerph19127106
22.Lam, C. M., & Chan-So, P. C. Y. (2015). Validation of the Chinese version of Differentiation of Self Inventory (C-DSI). Journal of Marital and Family Therapy, 41(1), 86–101. doi.org/10.1111/jmft.12031
23.Tse, S., Ng, R. M. K., Tonsing, K. N., & Ran, M. (2012). Families and family therapy in Hong Kong. International Review of Psychiatry, 24(2), 115–120. doi.org/10.3109/09540261.2012.656304
24.Erdem, G., & Safi, O. A. (2018). The cultural lens approach to Bowen family systems theory: Contributions of family change theory. Journal of Family Theory & Review, 10(2), 469–483. doi.org/10.1111/jftr.12258
25.Miller, R. B., Anderson, S., & Keala, D. K. (2004). Is Bowen theory valid? A review of basic research. Journal of Marital and Family Therapy, 30(4), 453–466. doi.org/10.1111/j.1752-0606.2004.tb01255.x
26.Calatrava, M., Martins, M. V., Schweer-Collins, M., Duch-Ceballos, C., & Rodríguez-González, M. (2022). Differentiation of self: A scoping review of Bowen Family Systems Theory's core construct. Clinical Psychology Review, 91, 102101. doi.org/10.1016/j.cpr.2021.102101
27.Yektatalab, S., Seddigh Oskouee, F., & Sodani, M. (2017). Efficacy of Bowen theory on marital conflict in the family nursing practice: A randomized controlled trial. Issues in Mental Health Nursing, 38(3), 253–260. doi.org/10.1080/01612840.2016.1261210

Bowen family systems therapy

What is Bowen family systems therapy?

Why the call won't resolve: anxiety, reactivity and "self" feeding each other

One phone call, eight concepts: from one person to a whole society

Back to the call: calm first, then see your own position, then hold your ground in your family of origin