Family Systems Research Articles

A personal reflection on Bowen family systems theory by Dr Michael Kerr

AbstractThis interview with Dr Michael Kerr highlights his ongoing interest in science, biology and neuroscience. Guided by Bowen family systems theory, Dr Kerr's observations examine how research is showing links between physical health, the immune response and psychological motivation and wellbeing. Wellbeing is compromised in less adaptive families, which succumb more easily to any anxiety generated outside the family, as well as the chronic anxiety generated within the family. Amid times of societal regression, the capacity to adapt in a way that promotes survival and wellbeing depends on the level of differentiation of self. Differentiation of self is the sum of the capacity to maintain emotional objectivity, emotional neutrality and to take action. Psychiatrist, Dr Michael (Mike) Kerr, who more recently published Bowen Theory's Secrets: Revealing the hidden lives of families (2019), co‐authored the seminal work on Bowen family systems theory, Family Evaluation, in 1988 with Dr Murray Bowen. From 1990 to 2011, after Dr Bowen's death, Mike was the Director of the Bowen Center for the Study of the Family in Washington, DC. He is passionate about the relationship between differentiation of self, illness and the family emotional process and how this relates to the biological and evolutionary processes that operate in non‐human species. Mike developed the unidisease concept and is well known for his work interviewing Dr Murray Bowen on Bowen family systems theory between 1979 and 1986 for the Bowen‐Kerr Interview Series. A special issue on Bowen theory would not be complete without a commentary from Mike. So, in this interview with Bowen family systems therapist, Dr Linda MacKay, Mike discusses his life effort to research and apply Bowen theory.

Novel CHATogether family-centered mental health care in the post-pandemic era: a pilot case and evaluation

BackgroundThe COVID-19 pandemic impacted children, adolescents, and their families, with significant psychosocial consequences. The prevalence of anxiety, depression, and self-injurious behaviors increased in our youth, as well as the number of suicide attempts and hospitalizations related to suicidal ideation. Additionally, parents’ mental health saw increasing rates of depression, irritability, and alcohol use combined with worsening family function, child-parent connectedness, positive family expressiveness, and increases in family conflict. In light of these statistics, we created CHATogether (Compassionate Home, Action Together), a pilot family-centered intervention using multi-faceted psychotherapeutic approaches to improve familial communication and relational health between adolescents and their parents. This paper discusses the implementation of the CHATogether intervention at the Adolescent Intensive Outpatient Program (IOP), providing an example of the intervention through an in-depth pilot case, and evaluation of the program’s acceptability and feasibility.MethodsThis paper describes a case in detail and evaluation from a total of 30 families that completed CHATogether in the initial pilot. Each family had 4–6 one-hour CHATogether sessions during their 6-week treatment course at the IOP. Before and after CHATogether, adolescents and their parents separately completed a questionnaire designed to explore their perceived family conflicts. After completion of the program, participants completed a brief quality improvement survey to assess their overall experience with CHATogether. In the reported case, the family completed Patient-Reported Outcomes Measurement Information System (PROMIS) depressive and anxiety symptoms scales, Conflict Behavior Questionnaires (CBQ), 9-item Concise Health Risk Tracking Self-Report (CHRT-SR9), and help-seeking attitude from adults during distress and suicide concerns.ResultsThe pilot case showed a trend of improvement in reported depressive and anxiety symptoms, child-parent conflicts, subfactors of suicide risk including pessimism, helplessness, and despair, help-seeking acceptability from parents for suicide concerns, and the establishment of individualized family relationship goals. Preliminary feedback from participating families demonstrated positive effects on intra-family communication and improvement in the overall family dynamic. Adolescents (n = 30/30) and their parents (n = 30/30) rated “strongly agree” or “agree” that their families had benefited from CHATogether and welcomed participation in future program development.ConclusionThis study presents CHATogether as a novel family-centered intervention to address post-pandemic family mental health stress, especially when a family system was disrupted and negatively affected the mental health of children and adolescents. The intervention facilitated positive child-parent communication on a variety of topics, through tools such as emotional expression and help-seeking behavior. The reported pilot case and evaluation suggested CHATogether’s acceptability and feasibility in a clinical context. We also provided quality improvement feedback to guide future studies in establishing the efficacy of CHATogether and other similar models of clinical family interventions.

Family influence on stigma internalisation in people with severe mental illness: A grounded theory study.

The internalisation of stigma has adverse effects on the recovery and quality of life of people with severe mental illnesses. Studies have shown that life experiences in one's close environment are highly relevant in explaining the onset and development of self-stigma. Families play a critical role in the daily care of people with severe mental illness and have a profound impact on patient recovery. This qualitative study explored the influence of family on stigma internalisation among people with severe mental illness in the context of Chinese culture. A grounded theory design was used. Semi-structured interviews were conducted with 20 patients with severe mental illness and 10 family members, and observations were carried out among five of the families. The data analysis followed three steps (open, axial and selective coding) and involved the use of a constant comparative method and memo writing. The COREQ reporting checklist was used to report the results. Our findings revealed that families can facilitate and impede stigma internalisation in people with severe mental illness via negative or positive daily interactions. A theoretical framework was developed to present the potential effects of the identified family factors on stigma internalisation. Three major family factors influencing patients' internalised stigma were identified, namely, "beliefs of family members" at the individual level, "responses within the family" at the intrafamilial level and "differentiated family environment" at the level of the whole family system, in which "biased beliefs of family members" could bring about "negative responses within the family" and further result in patients' internalised stigma. Our findings suggested that mental health stigma internalised by ill people should be viewed within the broad context of the family. Family-based programs aimed at improving positive interactions and support within the family need to be developed and launched, with particular attention given to interventions for affiliate stigma, coping with stigma and families' negative responses towards people with severe mental illness to prevent the internalisation of stigma by patients.

On declining parental agency and institutionalized forms of parentification: narratives of changing parenthood among refugee families and social workers in collective reception centres

Over recent years, the number of refugee families with children fleeing to Europe has increased. Although reception centres in Europe are not equipped to host families with children, families nevertheless remain for extensive periods in these collective centres, where they lack autonomy, privacy, certainty and often even a sense of security. Drawing on 123 interviews with parents (58), children (38) and social workers (38) in nine collective reception centres in Belgium, we analyse how the Belgian asylum regime impacts refugee parents’ capacity to fulfil parental roles and responsibilities and social workers’ relationships with refugee parents. Our analysis points to a complex combination of declining parental agency yet increasing responsibility on behalf of refugee parents across different parental roles and responsibilities. This in turn leads children to take on what are typically considered ‘adult roles’, raising concerns about parentification among social workers. By introducing the term ‘institutionalized forms of parentification’, we call for a re-politicization of social work with refugee families. Moving away from common approaches to family relationships that focus primarily on the individual or the family system, our findings draw attention to the impact of social spaces, policies and cultural value systems.

Borderline personality disorder: a symptom of the family system

AbstractThe present article explores the Bowen family systems theory (BFST) view that a mental disorder such as borderline personality disorder (BPD) is not a dysfunction occurring within an individual but a maladjustment of the family emotional system. A case study is presented illustrating how the emotional process moves between individuals within a family system so that when relationship processes become severely compromised, one member absorbs more of the stress, becoming vulnerable to acute symptoms. It is proposed that the use of a BFST approach with a client presenting with panic anxiety and low mood may have contributed to the lowering of symptom intensity for a sibling of the client. It appears that the client's work on her part in the relationship disturbances between her, her mother, father, and sister contributed to decreasing BPD symptoms in her sister and an improvement in overall family functioning. Therefore, the differentiating effort of one family member seemed to have a ripple effect on the whole family system. Shifting the theoretical lens from an individual‐medico‐diagnostic one to a BFST one sheds light on how all family members are expressions of a family organism and players in the symptoms emerging in one.

TIAP: an observational procedure for assessing family relationships: a clinical case from the parenting evaluation context

TIAP is an observational procedure to assess family functioning detecting simultaneously the role of each participant and the interdependence of relational behaviors. In particular, the procedure requires family members to play according to different interactive configurations (parent1-children; parent2-children, all together, children and parents as separate units) and therefore different microtransitions from one configuration to another. As such, the procedure allows to study how family members coordinate to maintain stability, promote change, and encourage members to explore different interactive configurations within the family system. TIAP has been validated through several studies conducted with different non-clinical groups of families that have highlighted the salient aspects of family functioning, and significant correlations with variables external to the family system, such as children’s social–emotional competence in the educational context. This paper focuses on the use of TIAP in the contexts of assessing parental competence. Specifically, the article aims to describe, through the reference to a clinical case, the results emerged from a study conducted with 33 families involved in a parenting assessment process. The study is part of a broader collaborative project between the Child and Adolescent Neuropsychiatry Clinic of the Italian National Health Service in Parma, the University of Parma, and the Bologna Family Therapy Center. TIAP was administered to all the families involved as a complement to other tools routinely used for all cases handled by the professionals of the clinic. The coding system includes different indices. Some analyze the interactive family modes: family coordination (mutual attention and responsiveness), the responses to potentials for change (disregard, absorption, amplification), and intra-familiar exploration. Other indices concern the quality of the interactions: the relational triadic dynamic of microtransition (detaching-entrusting-welcoming-joining) and the consistency/inconsistency of the communication channels. The results highlighted how TIAP makes it possible to identify the specific interactive modalities of the different members and their interdependence and reciprocity, favoring the identification of both family weaknesses and family resources, including the children’s contribution. Furthermore, the general data trend showed that TIAP indices detect some important prognostic elements capable of guiding the court’s decisions.

Latent profiles of dyadic parent–child interaction and associations with triadic family interaction in early childhood

AbstractObjectiveThis longitudinal study examined latent profiles of parent–child interaction and their associations with triadic family interaction.BackgroundA child's development is significantly influenced by early family relationships. Family systems theory emphasizes the interrelations between family subsystems, such as parent–child and parent–parent relationships, as well as the family as a whole. However, few studies have examined the relationship between each parent–child dyad and triadic family interaction.MethodFathers and mothers were separately videotaped interacting with their child (n = 120) at 4 and 18 months and assessed using the Parent–Child Early Relational Assessment. Triadic family interaction was evaluated at 18 months using the Family Alliance Assessment Scale within a Lausanne Trilogue Play setting.ResultsFour latent profiles of parent–child interaction were identified. Dyadic interaction that was characterized by reciprocity, positive affect, and low negativity was associated with higher family coordination. However, interaction characterized by a lack of reciprocity, negativity, and dyadic tension was related to less coordinated triadic family interaction.ConclusionsWell‐functioning parent–child interaction contributes to higher‐quality triadic family interaction. In contrast, challenges in early father–child interaction, including emotional distance, a lack of positive paternal involvement, and limited mutual engagement, are linked to lower‐quality triadic family interaction.ImplicationsThis study highlights the importance of supporting early parent–child relationships to promote well‐functioning and coordinated triadic family interaction, and the inclusion of fathers in interventions aiming to improve family dynamics.

Circular causality in daily coparenting processes among first-time parents.

Although coparenting has been widely studied, little is known about the daily processes of coparenting between mothers and fathers in early parenthood. Based on family systems theory and the ecological model of coparenting, we investigated new parents' day-to-day within-family processes of cooperative and tensioned coparenting. Mothers and fathers from 144 Finnish first-time couples completed daily mobile diaries for 7 consecutive days when their firstborn was 4-6 months old. The random-intercept cross-lagged panel model showed three types of within-family processes in daily coparenting, which we named continuity, spread, and shift. Continuity in cooperative coparenting occurred when a parent's previous-day cooperative coparenting positively predicted his or her own cooperative coparenting experiences the next day. We also found that coparenting experiences spread from one spouse to another: A parent's cooperative coparenting on the previous day negatively predicted his or her spouse's experiences of tensioned coparenting the following day. Finally, daily coparenting experiences also shifted from day to day: One parent's experience of tensioned coparenting the previous day positively predicted that parent's cooperative coparenting experiences the next day. No gender differences were found. These findings emphasize that the two daily coparenting dimensions seem to operate partly differently in daily life, as cooperative coparenting was slightly more often a cause and consequence in the observed processes than tensioned coparenting. Therefore, it seems that interventions should focus on enhancing cooperative coparenting. Moreover, the new concepts of continuity, spread, and shift are proposed as better descriptions of the three daily processes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Caregiver Burden for Carers of Chronically Mentally Ill Patients: A Study With Families in Cyprus

Having a chronically mentally ill person in the family presents a challenge for the entire family system, not only on a daily life basis but also regarding their psycho-emotional and social life. The present study focuses on caregivers of chronically ill patients' burden on four levels of possible disruption: the economic burden, the impact on family life, sociability, health, and behavior, and the impact of perceived aggression by considering the demographic characteristics of the caregivers, but also the socio-demographic characteristics of the chronically ill family member(s) they are taking care of. We conducted a quantitative survey with a sample of 90 family members/caregivers and the corresponding 90 chronically ill patients under their care from all districts of the Republic of Cyprus. Participants completed the "Family Burden Scale" (FBS-23) (Madianos et al., 2004), a personal information form with demographic information, and a questionnaire regarding the demographics and the illness trajectory of the chronically mentally ill family member (age of disease onset, diagnosis, frequency of episodes). Our findings showed that most caregivers providing systematic care for a family member experienced high levels of disruption in their daily routine and sociability, perceived high levels of aggressive behaviors, felt moderately affected in their health and behavior, and carried a heavy economic burden. Older participants felt a significantly higher economic burden than younger caregivers, who perceived a significantly more significant negative impact on their health and behavior from taking care of a chronically ill family member.

The association between family relationship patterns and preschoolers’ social and behavioral competence in Chinese urban families

Guided by family systems theory, this study examined how distinct patterns of family relationships were related to child social and behavioral competence among 314 intact Chinese urban families with preschool-aged children. Four distinct patterns of family relationships were identified using latent profile analysis: unbalanced, compensatory, moderately cohesive, and highly cohesive families. In unbalanced families, mothers perceived their marital, coparenting, and parent-child relationships as low in quality, yet fathers perceived them to have moderate quality. Compensatory families exhibited poor marital and coparenting relationships but high mother-child closeness. Highly cohesive families displayed high quality across all dyadic relationships, while moderately cohesive families showed moderate relationship quality. Children from highly cohesive families had the highest social and behavioral competence. Children from moderately cohesive families exhibited better social skills and fewer problem behaviors compared to unbalanced families, but were on par with those from compensatory families. No difference in social skills was found between children from unbalanced and compensatory families, but children in the former group displayed more problem behaviors. The findings shed light on the unique family relationship configurations among Chinese urban families with preschool-aged children. They highlight the value of using individual-centered approaches to understand holistic family relationship patterns from a family systems perspective. The findings also underscore the need to develop interventions tailored to families according to their unique family relationship profiles.

Long-term healthcare utilisation, costs and quality of life after invasive group B Streptococcus disease: a cohort study in five low-income and middle-income countries

IntroductionThere are no published data on the long-term impact of invasive group B Streptococcus disease (iGBS) on economic costs or health-related quality of life (HRQoL) in low-income and middle-income countries....

Intergenerational connections: Skipped generation family contact during the COVID‐19 pandemic

AbstractThis study investigates the association between the perceived impact of the COVID‐19 pandemic on skipped generation familial connections and subjective well‐being among grandchildren and grandparents across the United States. Guided by Walsh's family resilience model, this convergent mixed methods study drew on the survey responses of unrelated adolescent and young adult grandchildren (n = 66) and grandparents (n = 40). Correlational analyses revealed a significant association between perceived impact of COVID‐19 on one's skipped generation family relationships and subjective well‐being for grandchildren but not grandparents. The qualitative results demonstrate both a breakdown and build‐up of processes essential for family resilience: communication, organization, and belief systems. Together, these findings demonstrate the effects of COVID‐19 on skipped generation family relationships are complex, with ties between family members in younger and older generations being simultaneously strengthened and eroded. This study builds on our understanding of intergenerational familial contact when physical separation is present, allowing for more informed decisions as the effects of COVID‐19 on individuals, family systems, and relationships between family members—as well as geographic separation between generations more broadly—continue to evolve.

Adoption-Informed Care: What Clinicians in the United States Need to Know

Given the prevalence of adoption in the United States, adoptive families need clinicians to be informed and aware of the unique experiences and needs of adoptive families. This study adds to our knowledge of adoption through examining the stories of adoptive parents to gain a deeper understanding of the facilitators and barriers to effective parenting, building attachment, and maintaining post-permanency continuity for their families. Results highlight specific areas that practitioners working with adoptive families should pay close attention to including (a) family systems related issues, (b) attachment and trauma related factors, and (c) grief and loss.

Domestic Violence Victimization Risk Assessment in Children and Adolescents: A Systematic Review

Background: Risk assessment is the process of collecting information towards the goal of protecting the physical and psychological integrity of the victim, taking into account factors associated with violence to assess the severity of violence, protect victims, and prevent recidivism. This type of risk assessment is commonly used in situations of domestic violence and needs to be adjusted for the contexts of child and adolescent victimization. Objective: Resources and standardized criteria to guide a child-centered domestic violence victimization risk assessment are lacking. This systematic review aimed to evaluate the instruments, risk factors and outcomes identified in the literature for situations of domestic violence involving children. Methods: Following the PRISMA protocol, 313 articles from the EBSCO, Web of Science and PubMed databases were screened and 13 were identified for analysis. Results: An analysis of the characteristics of some instruments created to assess the impact of domestic violence involving children shows that caregivers’ risk factors are strong predictors of child abuse, highlighting the interrelationship with other factors, as well as warning about the cumulative risk, including child homicide. Conclusions: The literature confirms the importance of family system factors regarding the risk of the mistreatment of children in situations of domestic violence. Risk assessment must cater to the needs and specificities of individual children.

The role of family relationships on adolescents' development and adjustment during the COVID-19 pandemic: A systematic review.

In typical times, adolescents' relationships with family members influence changing cognitive, social, and physical aspects of their development. The COVID-19 pandemic, however, impacted the full family system in ways that were unprecedented. Scholars of adolescence worldwide were driven to understand how adolescents' relationships with family members changed due to these dramatic societal shifts and the influence these relationships had on adolescents' well-being. This systematic review examined two research questions with 189 articles published from 2020-2022: (1) How has the COVID-19 pandemic impacted families with adolescents, including broader family functioning, family relationship qualities, and parenting? and (2) How has the pandemic or pandemic-related stressors interacted with family functioning, family relationships, and parenting of adolescents to impact adolescent well-being and adjustment? Additionally, examination of the relevant studies were divided into sub-themes of pandemic influence: (a) family environment and routines, (b) family difficulties, (c) parenting and parent-adolescent relationships, and (d) sibling relationships.

Family dynamics in the context of elder family financial exploitation: Application of qualitative genogram analysis

AbstractObjectiveThis study examined family dynamics that are common in families experiencing elder family financial exploitation (EFFE) using an innovative analytical protocol, qualitative genogram analysis.BackgroundEFFE is a form of elder abuse that affects many older adults and their families. Individual factors associated with EFFE have been examined, but what is missing is a greater focus on the complex family dynamics that contribute to this violation of older family members.MethodUsing qualitative genogram analysis (QGA), a three‐step analytical protocol using family systems theory as a foundation, this study identified key relationship patterns commonly found in families where exploitation had occurred. Family genograms generated from 20 interviewees representing 20 families that reportedly experienced EFFE were used to identify common family dynamic themes.ResultsUsing QGA, we identified four relational dynamic themes across families: distance and closeness, triangulation, power and dominance, and partner influence.ConclusionThese themes illustrate that families experiencing EFFE have several similar relational dynamics, which may have contributed to creating contexts that made older family members more vulnerable to financial exploitation.ImplicationsThe findings of this study provide important indicators for practitioners (e.g., family therapists, family life educators, family attorneys) and policymakers in supporting older family members in making better financial decisions later in life.

Reflections on Recidivism and Relapse Prevention among Italian Justice-Involved Juveniles: A General Overview

Research interprets antisocial and illegal behavior among juveniles as an expression of needs, as a conscious action, or as an adherence to family, cultural, and social contexts. Professionals and researchers interested in the topic could benefit from reflections and insights on relapse prevention among justice-involved juveniles (JIJs). In light of these considerations, we investigated the criminal conduct of JIJs, identifying their background, individual characteristics, and the educational and rehabilitative programs of the 17 Italian youth detention centers from a sample of 234 JIJs (214 males and 20 females, 14–25 years old). The sample completed the following questionnaires: the high-risk situation checklist, deviant behavior questionnaire (DBQ), and the neighborhood perception questionnaire (NPQ). The study aims to provide a general overview of the justice-involved adolescents and young adults in Italian youth detention centers, focusing on perpetrator profiles, family systems and the quality of life in the Italian youth detention centers. To achieve our goals, we investigated their occupations and education, the perceived quality of life in their neighborhoods, the use of drugs, and the tendency to commit illegal or antisocial behaviors before incarceration. The study also explored the awareness related to the personal perception of the risk factors in relapse, with the aim of stimulating reflections on behavior and crime-related cognitions to promote relapse prevention. We discuss the main findings and future implications.

Balancing work and family when family is work: a reconceptualization of work–family integration, burnout and detachment in family business

PurposeBuilding from calls for greater interdisciplinary research in interpreting family business phenomena, we integrate research on work–family conflict, detachment and burnout from both organizational and family studies. Using the characteristic work–family integration of family business settings as a backdrop we develop theoretical arguments that emphasize the reconciliatory role of interdisciplinary perspectives to explain the ostensibly contradictory findings in extant research. The diminishing barriers separating work and life spheres occurring in most global industries illustrate the importance of conceiving the study of work–life phenomena through recursive, rather than linear, logics and emphasizing the relevance of family business research in providing a contextual foundation for interdisciplinary discussions.Design/methodology/approachThis theoretical paper integrates perspectives from the literatures on organizational behavior and family systems theory to form six propositions on the relationship between work–life integration and the antecedents and consequences of burnout and psychological detachment.FindingsThis paper explores the nuances that overlapping work and family roles might be a source of both harmony and discord in family firms. In doing so, our research contributes to the growing relationship between family systems theory and family business research, and creates the foundation for future empirical studies on the psychological dynamics that underlie work–family integration.Originality/valueThis research advances a novel perspective on the interactions between work–family integration and burnout and detachment, and does so by noting that the way the family business literature treats work–family integration may apply to any employee that experiences tension between these different spheres of their identity.

Women’s Economic Empowerment and Mental Health in the COVID-19 Pandemic

COVID-19 is a serious worldwide health emergency that is affecting many nations. The financial standing and mental health of women are negatively impacted by such widespread epidemics. Thus, the purpose of this study was to evaluate, among married women in Bangladesh during the COVID-19 pandemic, the level of women’s economic empowerment and mental health and related determinants. The author used secondary research from numerous published research articles, review articles, and published international and national reports like the World Health Organization (WHO), UNDP, and United Nations (UN) to examine women’s economic empowerment and mental health during the COVID-19 pandemic. The COVID-19 condition made it more common for women to experience loneliness, melancholy, anxiety, and sleep disruption. Women face the greatest risk because they make up 70% of the healthcare workforce and work in caregiving facilities. According to COVID-19, the primary causes of poor mental health in Bangladesh were being unemployed, being obese, lack of concealing, and having no family. Bangladesh’s patriarchal family system and physical weakness of women leads to increased mental disorders, workplace dangers, abuse, exploitation, harassment, and physical harm during crises and quarantine. This will promote women’s economic empowerment and improve mental health conditions. For this reason, more research about these vulnerable populations is required.

Social Network Characteristics Associated with More Frequent HIV and STI Prevention Conversations: The N2 Cohort Study in Chicago.

Black cisgender sexually minoritized men (SMM) and transgender women (TW) are subgroups at highest risk of HIV and sexually transmitted infections (STIs) in the US. We sought to identify factors facilitating continued conversations - social reinforcement - surrounding HIV/STI prevention among this subgroup. Participants were recruited in Chicago from 2018 to 2019 from community health spaces. Participants provided information about themselves (level 2) and ⩽5 confidants (level 1). We used multinomial multilevel modeling to identify associations with HIV/STI prevention conversation frequency. A total of 370 participants provided information on 987 confidants (mean = 2.6). We found significantly positive associations between having biweekly or more often HIV/STI prevention conversations and a confidant being a kin family member, older by 15 years or more, racially homophilous, and emotionally close. Future interventions should harness social networks by including components that consider racial homophily, respect for elders, and strong ties, in addition to applying kin family systems interventions approaches and decreasing stigma surrounding HIV/STIs.