Running head: CLINICAL PAPER

Clinical Paper
Kelsey Nerland
Seattle University
STMM 5520: Family Systems in Ministry
Professor Rebecca Cobb, Ph.D., LMFT
March 16, 2015

CLINICAL PAPER

1
Clinical Paper
Bowen Family Systems Therapy

Assessment
Bowenian model is centralized around the concept of differentiation of self. Based on the
vignette, the therapist would need to clearly analyze Reynaldo, a Cuban American male, and
Sue, an European American women, and their individualized levels of differentiation. The
vignette explained how Reynaldo displayed similar irrational behavior since the time of his
childhood because his parents would often ignore his outbursts. It is clear that Reynaldo has a
high need to feel heard, and reverts back to his past behavior in order to get the attention he
needs when he feels like he is not being heard. Essentially, because transgenerational therapies
like Bowen Family Systems Therapy are more interested in how the past affects the present []
they are interested in how families develop patterns of behaving and responding to stress in ways
that prevent healthy development in their members and lead to predictable problems (Wetchler
and Hecker, 2014, p. 319). Specifically, a therapist using Bowenian therapy can assess that
Reynaldos outbursts in the pastwhen he was not getting the attention he wantedturned
into a pattern that is affecting how he presently deals with conflict in the present. When
Reynaldo faces conflict and feels unheard, he reverts back to this pattern and embraces past
emotions that attributed his ways of dealing with conflict. Bowenian theory also believes that
symptoms are indicators of stress and low differentiation. That being said, it is clear that any
time there is a conflict, Reynaldo explodes and becomes loud to the point where he becomes
verbally abusive. In moments of conflict, it is difficult for Reynaldo to think about what he is
saying before he reacts to the conflict. Reynaldo lacks responsiveness, and engages reactiveness;

CLINICAL PAPER

which causes him to react based on his emotions rather than making thoughtful decisions about
how he will choose to respond.
Intervention
Based on Reynaldos symptoms that are indicators of stress and low differentiation in this
assessment, it would be appropriate to encourage him to exercise [his] ability to think while
under emotional strain, not focus on what [he] is feeling (Wetchler and Hecker, 2014, p. 321).
Hence, differentiating thinking from emotion. Specifically, it would be important for the
therapist to promote awareness that Reynaldo is reacting to the conflict, rather than responding to
the conflict. As Bowenian theory suggests, instead of focusing on the problematic behavior of
the outbursts, the therapist would need to focus on the positive behavior of increasing
Reynaldos ability to think rather than act and therefore to choose responses rather than using
habitual, impulsive behaviors (Wetchler and Hecker, 2014, p. 328). The therapist has a unique
opportunity to coach and educate the client, as the therapist ultimately is the expert, and brings
stability to the session. Through asking engaging questions, the therapist helps the client become
aware of themselves. It is important for Reynaldo to develop typical patterns of dealing with
stress in order to reduce anxiety (Wetchler and Hecker, 2014, p. 323). This can be achieved
through not curing the symptom of the outbursts; but instead, helping Reynaldo find ways to
manage his own stress and reduce anxiety. This way, second-order change can occur, as it will
last and transcribe into other conflict situations that surface. Helping Reynaldo differentiate
himself from the impulsive reaction can be done through utilizing the technique of detriangling.
Detriangling will help Reynaldo think about times when he handled conflict in a less emotional
way, and was able to think clearly about the way he was choosing to respond to the conflict
instead of emotionally reacting. Essentially, detriangling helps increase intellectual functioning

CLINICAL PAPER

[] the client is able to prepare for new family interactions, ones in which [he] is an actor and a
responder rather than a reactor (Wetchler and Hecker, 2014, p. 331). Helping Reynaldo increase
differentiation will allow him to have the ability to remain autonomous in a highly stressful
situation. The therapist can encourage the use of I statements between both Reynaldo and Sue
as they talk out conflict. The tangible aspect of the I statement is a powerful tool Reynaldo can
adopt in order to help him increase differentiation and autonomy, while maintaining intimacy.
Exploring Spiritual or Religious Themes
Personally, I think this would be a unique opportunity to help Reynaldo explore spiritual
themes of feeling heard and validated in order to receive peace. It is clear that Reynaldo feels as
though he is not heard, and wants to feel heard. He feels the need to become loud and even
verbally abusive in order to feel heard and not overlooked. I could imagine how difficult that
must have been for Reynaldo to have his parents ignore him during his childhood to the point
where he felt like I needed to yell in order to feel heard. If I was the therapist, I would ask him
engaging questions about times he feels heard, times where he feels like his thoughts are
validated, and what that experience of feeling heard is like for him. I would ask him if he feels
like there is anyone in his life that hears him and does not overlook him based on circumstances,
and proceed into asking him about if he feels if there is a higher powerGodthat hears him. I
would also ask him where he receives peace, and how he receives peace when he feels angry or
frusterated. I would ask him about exploring prayer or meditation in order to think through and
differentiate himself through autonomy.
Personal Application
I enjoyed learning about this theory, and see myself using Bowen Family Systems
Therapy theory in my Student Affairs practice. Specifically, I will be working with students who

CLINICAL PAPER

are exploring differentiation from their family members, and I want to be able to be a
soundboard for them to vocalize their thought processes in order to encourage autonomy. I want
to be able to ask challenging questions, and always ask why they think the way they do. I am a
person that loves to dig deep and get to the root of the issue, and if I have a relationship with a
student that I feel can be pushed, I want to challenge their levels of differentiation so they can
experience growth. Additionally, I, myself, need to check myself in times of conflict, as I can
often revert to reacting rather than responding when I am around family members. Interestingly,
when I am around friends, I often think through my responses, and utilize I statements
regularly. When I am around family, I see the stark difference in our approaches to conflict, and
the bitterness in my heart causes me to react in an emotional way, rather than responding in a
thoughtful way. I want to encourage myself in that journey utilize detriangling to be able to help
increase my levels of differentiation.
Solution Focused Brief Therapy
Assessment
Solution Focused Brief Therapy is centralized the idea that language creates reality.
While assessing Reynaldo and Sue, it is important to keep reframing in mind when using word
choice that reflects a positive framework. It is clear that Reynaldo and Sue want to see change
happen before they have children; therefore, we can see that the clients want change. Instead of
focusing on the past as a means to interpret the future, Solution Focused Brief Therapy seeks to
focus on the present and the future. In this scenario, Reynaldos outbursts seem to control the
conflict situation while Sue chooses to withdraw in order to ease tension. The therapist would
want to coach the clients and look for the clients strengths in order to help them create a new
reality. The goal is to help Reynaldo and Sue do things differentlydiscuss and manage conflict

CLINICAL PAPER

differentlyin order for them to be satisfied with their lives. It is clear that Reynaldo cares about
his perspective, and wants to feel heard. It is also clear that Sue cares so much about Reynaldo,
that she will withdraw from the conflict in order to please Reynaldo; thus, putting him before
herself. Both of these clients have strengths and resources in order to change their realityas
there is so right reality.
Intervention
Reynaldo and Sue are caught up in the patterns of the past, and cannot seem to envision the
future without the way they both aid to managing the conflict. As the therapist, I would want to
come into the situation and address the positives. As an agent of hope, it is my job to look at
Reynaldo and Sues strengths, and help them see the great things they are already doing that can
transcribe into the future. This embraces possibility therapy, which shifts the clients attention
away from the problem to the absence of the problem, which encourages them to point out the
positives and possibilities (Wetchler and Hecker, 2014, p. 211). Personally, I would go about this
by asking them questions about how they healthily manage conflict when they get in small
disagreements. Essentially, I would like to direct the clients attention away from the presenting
problem and toward the absence of that problem (Wetchler and Hecker, 2014, p. 211). I want to
point out the exceptions to how Reynaldo and Sue handle conflict in a way they think is healthy,
and expand upon those exceptions. Based on what they say is positive, I want to ask them
questions and expand upon that healthy behavior. I want to give them compliments, and affirm
that positive behavior by asking questions like, How did you do that? and encourage them by
saying, It sounds like you did a great job handling that and thinking through what you were
going to say! Overall, I want to focus on positive behavior, instead of blaming or focusing on
negativity. Using the three As of affirmation, affiliation, and appreciation, I will use a positive

CLINICAL PAPER

framework to facilitate the non-judgmental, non-assuming discussion. Additionally, if Reynaldo

and Sue keep bringing up the explosive behavior, I will ask questions that address, What
happened between now and then? What seems to be going well? I believe that it is important to
look at positive responses and not dwell on negative reactions. If the clients can see that they
have the skills and resources in order to facilitate change, I want to empower them to see that
they can make the change on their own. If Reynaldo and Sue cannot seem to think past the
explosive behavior, I will ask them the miracle question in order to help them think about what
life would look like. It is important to keep the theme of redeeming stories in order to envision
what the future could look like.
Exploring Spiritual or Religious Themes
Moreover, that being said, there is a lot of power in a redemption story. As the agent of
hope, I want Reynaldo and Sue to be able to know that change is possible, and empower them to
use the skills, strengths, and resources they already have in order to facilitate that change.
However, in order for them to see redemption, they have to be able to recognize that they can
change their behaviors and work as a team to overcome conflict and manage it appropriately.
There is power in a turn-around story; and I believe that applying the redemptive power to
Reynaldo and Sues turn-around story can be a motivating factor for Reynaldo and Sue to use
and empower themselves to change the way they manage conflict. This can be achieved by using
the miracle question as a vehicle for seeing that change occur.
Personal Application
Personally, I resonate with the Solution Focused Brief Therapy framework, and want to
be able to use this perspective into all of my interactions with people. There is power in positive
language, and it can be an effective tool to give someone hope amidst a seemingly hopeless

CLINICAL PAPER

situation. Since I am going into the field of Student Affairs, I want to be able to use this
theoretical framework with my students. In my field, I deal with a lot of conflict situations.
Whether it be advising a student to student conflict, a university policy to student conflict, or
even a student leader expectations conflict, I want to be able to administer grace in situations of
conflict. Utilizing positive language, encouraging strengths, asking scaling questions, and asking
the miracle question can be helpful techniques to help a student understand that they can
facilitate change on their own with their own strengths, skills, resources, and positive framework.
Personally, in times of doubt or trial, I utilize gratitude to cure my own entitlement or
discouragement. I want to be able to ask myself scaling questions in order to reframe my
negativity and turn it into a positive. Keeping in mind that language creates reality can be a
influential game-changing concept.
Strategic Family Therapy
Assessment
While Strategic Family Therapy is purely contextual and needs to be facilitated by a
therapist with years of practice and experience, a therapist would use this framework after having
worked with the couple for a few sessions. This is because it is crucial to understand the client
and how they function before generalizing and applying strategies that would work for other
couples in a similar situation, as that is not the intent for Strategic Family Therapy. Strategic
Family Therapists understand that strategies do not encompass a one-size-fits-all mentality, as it
is important to understand the clients reality and apply specific interventions based on the
individual or couples reality. That being said, using a Strategic Family Therapy framework, it
would be in the therapists best interest to focus on the reality and address emotions as needed.
Emotions should not be the focus; however, it is important to use the emotions as a vehicle to

CLINICAL PAPER

speak into the interactions. The therapist can use Reynaldos emotions of feeling overlooked,
sad, unheard, and enraged to draw into his current reality that he feels the need to yell and
explode in order to feel heard. Essentially, Reynaldo uses the outbursts behavior as a way to
counteract those feelings of sadness, hurt, and anger. Strategic Family therapists tend to view
problems as resulting from applying a solution that does not work and continuing to do more of
the same despite undesirable results (Wetchler and Hecker, 2014, p. 157). Thus, the therapist
observes that Reynaldo has good intentions for wanting to feel heard; however, he is trying to
apply a solution that does not work, and is getting undesirable results from his behavior.
Reynaldo and Sue are saying that they are having unsatisfactory interactions, and it is important
for them to break the patterns of the yelling outbursts and withdrawing from the conversation
in order to manage conflict. It is important to address the problems that are most stressful to the
client; therefore, we would focus mainly on Reynaldos outbursts. Breaking the negative
patterns of the outburst-infused conflict essentially will help change the unsatisfactory
interactions into positive interactions. The therapist can see symptoms as messages. Specifically,
Reynaldos outbursts and verbally abusive behavior suggests the message that Reynaldo
feels the need to yell in order to feel heard. Additionally, Sues actions to withdraw from the
conflict suggest the message that she would rather stop the yelling and verbal abuse than win her
argument. These symptoms have functions in order to maintain the cycle; however, in order for
change to take place, the therapist must give directives in order to instigate change.
Intervention
Directives are the main technique utilized by Strategic Family therapists. Essentially,
The strategy the therapist develops to solve the familys problem is based on the therapists
thinking about what sequence of interaction might be able to replace another sequence of

CLINICAL PAPER

interaction (Wetchler and Hecker, 2014, pp. 160-161). It is important to keep in mind that since
Reynaldo and Sues goal is for the conflict to be managed more positively, and to also
discontinue the yelling and verbal abuse as a way to go about managing conflict, the directives
should be catered to help Reynaldo stop yelling as a way to handle conflict. Therefore, after
building trust with Reynaldo and Sue, the therapist would be able to craft directives that pertain
to what the client would actually listen to based on Reynaldos character and what would work
for him. The therapist is the expert, and works with the resistant behavior to craft directives that
would work for Reynaldo. This can be done through directness and by stating observations. For
example, if the therapist notices in the session that Reynaldo dominates the conversation, it
would be important for the therapist to point that out and give a directive to let Sue speak first
before Reynaldo. This would essentially restructure the system, and would give Sue an outlet to
feel heard and not dominated. It would also cause Reynaldo to see that Sue has important ideas
and feelings that need to be heard. It is also essential for the therapist to know the family and
implement strategies based on how they know the family. For example, since Reynaldo feels the
need to yell and outburst in order to feel heard, the therapist could give him a directive to
embrace the physical aspect of yelling and being above Sue, and substitute it with a directive
to counteract his impulsive behavior. Specifically, when Reynaldo and Sue get in an argument, it
starts to feel heated, and he feels like he is going to outburst, the therapist would give him the
directive to sit down on the floor wherever he is. This would strategically make Reynaldo
understand that he cannot dominate the situation if he is on the floor; therefore, making him
realize that he needs to take the power card out of the conflict. It is a humbling experience to
sit beneath someone and look up to someone; therefore, the therapist might argue that this would
be a good paradoxical directive to use in order to normalize the power balance to contradict the

CLINICAL PAPER

10

overpowering behavior. Additionally, another directive that could be used to keep Reynaldo
from yelling would be for him to physically step back from the conversation and count to ten
before he responds to Sue. This would allow Reynaldo to think about what he is about to say
before he actually says something. It would allow for Reynaldo to not react based off of his
emotions, but to respond in a thoughtful way. The therapist views the family as capable of
change, and while discussing the directives with the clients, the therapist is firm in their
directness, but also encourages the clients that they have the strengths for utilizing the directive
effectively. Based on how well Reynaldo cooperates, the therapist can give more directives
similar to the ones used previously, or change the directives if Reynaldo does not respond well.
Additionally, because Reynaldo and Sue are a married couple, it would be important to
incorporate Sue for accountability purposes; which essentially encourages them to work as a
team. Furthermore, any time Sue feels like the argument is getting out of hand and feels like
Reynaldo becomes explosive, the therapist could give a directive to Sue to either sit down on the
floor when she feels like the argument is getting out of hand. The therapist could also give Sue
the directive to step back from the conversation and say the sentence I feel discouraged when
you raise your voice. This highlights the technique of using a paradoxical intervention, which
highlights Sues inferiority and how Sue feels like she has to withdraw from the conflict in order
to make Reynaldo stop yelling.
Exploring Spiritual or Religious Themes
Metaphors can be a strategic way to help someone relate a familiar concept to their
personal reality. Personally, I would incorporate a metaphor that would not only relate to the
experience Reynaldo is facing, but also incorporate the religious theme of sin and the freeing
power of the Cross. I would talk about the power of the ocean, and how people play in the ocean

CLINICAL PAPER

11

for fun. They have the freedom to be able to play in the ocean when they want and however they
want. But because the ocean is mighty and powerful, it can take control and sweep anyone away
at any moment. The person has the ability to play in the ocean, but they also need to be cautious
because the ocean might overtake them. The ocean is when conflict becomes a monster; and
while it is encouraged to talk about conflict, we need to be cautious about how it can overtake us
if we are not careful. Just like the ocean, it can come out of nowhere and crash over us. We need
to choose to stay close to shore in order to not let the conflict overtake our emotions when we
least expect it. Similar to sin, it can get overwhelming if we do not control it properly. We need
to be cautious of letting sin overtake us. If we stay close to shore, we are practicing selfdiscipline. There is an experienced freedom when you take control of the situation, stay close to
shore, and practice self-discipline. It is important to know that the ocean exists and sin exists,
just as it is important to know the conflict can turn into a monster when we are not cautious. As
the therapist, I would want to take the time after explaining the metaphor to ask about reactions
and thoughts to the metaphor. Hopefully, when Reynaldo and Sue enter into an argumentative
conflict situation, they can both remember the oceans power and make the decision to not let the
ocean overtake them.
Personal Application
I enjoyed reading about Strategic Family Therapy and the implications of how to utilize
directives and interventions. While I believe it is completely contextual, it may be inappropriate
to use Strategic Family Therapy outside therapy sessions. I am not planning on being a therapist;
however, I believe there is significance in utilizing strategies as a way to counteract problematic
behavior for myself. Personally, I have a difficult time being self-disciplined. It would be
strategic for me to create a directive for myself that would help me realize when I am not self-

CLINICAL PAPER

12

disciplining myself. For example, every morning, I try to wake up, eat breakfast, drink tea, and
read Scripture. However, because of the lack of sleep, lack of motivation, or lack of
accountability, I get by and do not follow my goals. To counteract my poor behavior, I want to
be able to be able to give myself a motivational, strategic directive. An example of a
motivational, strategic directive could be to turn on a motivational song as my alarm sound, and
to place my alarm clock across the room from my bed. Thus, this directive would cause me to
wake up, be motivated and encouraged, get out of bed, and start my day.
Conclusion
It was definitely easiest for me to be able to write the section on Solution Focused Brief
Therapy. That being said, my preferred framework would be Solution Focused Brief Therapy
because it empowers the individuals to see that they have the capability of changing. Therefore,
it encourages them in a way where they can take ownership of their experiences, and create
second-order change. There is power in positive language, and I truly agree that language creates
reality. If we are using positive language to talk about issues, I believe that the issues loose their
power. This allows the individuals to become more confident in themselves to embrace
positivity. Out of all three theoretical perspectives, it would be easiest for me to utilize Solution
Focused Brief Therapy with the students I work with in the Student Affairs field I will be going
into. Personally, I appreciate how Solution-Focused Brief Therapy has a positive way with
reframing words. The power in positive language is encouraging for a student that is in distress,
or is experiencing confusion or frustration. I want to give the individuals and groups I work with
a comfortable space to feel like themselves and be honest with where they are at. I want to come
alongside them, and make them feel supported and valued, while also offering a sense of
empowerment, accountability, and stability. With that being said, the power of positive language,

CLINICAL PAPER

13

as well as the focus on what is working for them and where they would like to be in the future, is
a influential way to make the student feel encouraged, supported, and empowered. I think it is
easy for students to feel discouraged, or compare themselves to other peers that are succeeding.
Therefore, it would give students a positive and reframing way to go about their thinking and
processing. Overall, I feel like I am a positive person, and Solution Focused Brief Therapy
encourages me to attach a theoretical framework to my reasoning behind my positive language.

CLINICAL PAPER

14
References

Wetchler, J. L., & Hecker, L. L. (2014). An Introduction to Marriage and Family Therapy (2nd
ed.). New York, NY: Routeledge.