Case Study

Therapist: Eleanor Baxley, Ph.D.

Client / Client System: Matthew K.

Presenting Issue: Adjustment disorder secondary to girlfriend who "wants space."

Therapeutic Approach: Family Systems Therapy (Bowen Family Systems Theory)

• Dr. Baxley views all symptoms through the lens that symptoms are a product of one's environment and symptoms do not happen within a bubble. Therefore, client problems are understood within the context of the relationships in which those problems manifest.
• Dr. Baxley obtained her graduate training through a major southeastern university that's accredited by The Council for Accreditation of Counseling and Related Educational Programs (CACREP). Dr. Baxley's primary professional identity is that of marriage and family counselor/therapist.
• Dr. Baxley is the director of counseling at a small, southern university.

• Matthew, a 19 year old, white male, was raised in a two parent household as the only child. He acknowledges a long history of difficulty in managing his emotions and self-medicating
with cannabis and alcohol. In addition, Matthew reports that he had many sexual partners throughout his adolescence.
• Matthew is a recent enrollee into a major acting school, which is part of an arts conservatory. He is very attractive and well liked by his peers. Matthew feels that Laurie, his girlfriend, is the first woman with whom he has "truly" fallen in love. Matthew and Laurie spent the summer working closely together on a number of acting projects.

• Matthew arrived at the Student Health Center in a visible panic. He was tearful and having difficulty breathing. The medical personnel referred Matthew to Dr. Baxley where he reported that Laurie, his girlfriend, is wanting space, claiming that she "has to find herself." Matthew is confused because Laurie claims she wants space on one hand, but she spends excessive time with other friends and a new guy with whom Laurie smokes pot. Matthew feels betrayed because "getting high was what we did together."
• Laurie, a 21 year old, African American female, has distanced herself from Matthew over the last several weeks claiming that she's concerned that she has become too reliant on Matthew. She historically has not agreed with Matthew's drug use but has since become a user with a new, male friend.
• The referral source: Matthew was referred by the Student Health Center.

Bowen Family Systems Therapy (BFST) is a complex, but comprehensive approach, that is useful for understanding a wide range of clinical presentations. In short, BFST states that symptoms manifest as a result of one's perceived level of stress and anxiety is too intense for the client's level of differentiation, or emotional maturity, to manage the stress and anxiety. When stress and anxiety exceed one's ability to manage it, then symptoms develop.

Matthew's level of differentiation could not handle the emotional stress caused by the idea of losing his girlfriend. He could not manage emotionally. Matthew and Laurie are experiencing a high level of fusion which is manifested by Matthew feeling anxious that he would be without Laurie.

• The Assessment Process: Dr Baxley works to understand Matthews's behavior using the lens of family systems, which is different from the individualist approaches of other theories. In addition, Dr. Baxley considers other factors within Matthews's life (e.g., contextual conditions) that impact Matthew's functioning. In terms of Bowen theory, Dr. Baxley assesses Matthew's level of differentiation by asking questions regarding his ability to manage other stressful life events. Dr. Baxley will draw a detailed genogram, which is a graphical representation of the multi generational family tree. Using the family tree Dr. Baxley is able to assess how various family members deal with relationship loss looking at both the strengths and weaknesses.
• The Treatment Planning Process includes identifying the specific goals that Matthew has for himself, helping learn ways in which he can manage his anxiety. Furthermore increasing Matthew's level of differentiation through developing one-to-one relationships with his family of origin.
• The Therapeutic Process: Much attention throughout treatment is given to constructing, refining, and adding more and more information to Matthew's genogram. Every time that Matthew says "I don't know" about facts regarding various family members, Matthew is coached to find the answers. It is through finding the answers that Dr. Baxley hopes to help Matthew see that his family members are all human beings who are walking this earth trying to survive. As he becomes more understanding about these important family figures, and differentiates himself from the emotional system of the family, Matthew will be able to better differentiate from the fusion that developed between him and Laurie.
• The Treatment Outcome: Matthew attended treatment with Dr. Baxley over the course of two and half years. Matthew found that he was better able to function within the intensity of family relationships and develop healthier relationships with women.

Discussion: Bowen family systems theory is a complex theory. Unlike a number of other forms of family therapy, or individualistic approaches, Bowen therapy is not a short term therapy. Matthew had to understand and become fluid in viewing his and others behavior from a systemic perspective, which is difficult considering the linear mindset of western society. However, the hard work will create real, second order change, versus an approach that focuses solely on the symptom and not on the problem.