Mercer vs. Bowden Annotated Bibliography

MERCER vs. BOWDEN

Annotated Bibliography and Applied Summary

Annotated bibliography:

Murray Bowden and Ramona Mercer

Murray Bowen family systems therapy

Goldenberg, I. & Goldenberg, H. (1990). Family therapy: An overview. Pacific Grove:

Brooks/Cole Publishing Company.

A core concept of Bowen family systems therapy is that a psychologically healthy member of a family has a reasonable sense of differentiation from other family members. In contrast, an unhealthy family dynamic is one in which family members are poorly differentiated from others and are codependent upon other members of the family. This creates a dynamic riddled with tension and anger as family members are not able to fully appreciate or understand where their needs and boundaries begin and end.

Knauth, D. (2003) Family secrets: An illustrative clinical case study guided by Bowen family systems theory. Journal of Family Nursing, 9: 331

This article examines Bowen family systems therapy specifically from a nursing perspective and advocates Bowen therapy as uniquely beneficial for the nursing process. Bowen Family Systems therapy specifically describes family health in terms of interpersonal dynamics and the role that different family members play in relation to one another. The nurse acts as a facilitator to enhance family functions. This article focuses on concepts such as family 'triangles' and secrets -- the more intermeshed and more poorly differentiated the family, the greater the likelihood of secrecy and deceit.

Weinstein, D. (2004). Culture at work: Family therapy and the culture concept in post-World

War II America. Journal of the History of the Behavioral Sciences, 40(1), 23 -- 46.

Family therapy stands in stark contrast to the individualistic orientation of psychodynamic therapy. Family therapy arose during the post-Cold War era as more and more people began to be interested in the family as the central unit of society and the role of culture in the shaping of the individual psyche came to be of greater interest. Family therapy is an intensely interdisciplinary approach that brings sociology as well as anthropology into its foundational concepts. Human beings do not exist outside of the social unit and thus to some extent all family therapy is 'culturally-sensitive' therapy.

Ramona Mercer's theory of maternal role attainment

Husmillo, M. (2013). Maternal role attainment theory. International Journal of Childbirth

Education, 28 (2): 46-48.

This article explains the application of Mercer's theory to nursing practice. It is highly complementary of Mercer's theory and discusses the different stage-by-stage process of maternal 'becoming' critical to Mercer's theory. It emphasizes the importance of skin-to-skin contact between mother and child and breastfeeding. Potential barriers to maternal care are also addressed, such as socioeconomic status.

Mercer, R. (2004). Becoming a mother: Maternal role attainment. Journal of Nursing

Scholarship, 36(3): 226-232.

This is Mercer's original article, defining the core components of her theory. Mercer defines the process of becoming a mother as a learned process and one of acculturation, not simple instinct. The nurse must be aware of the fact that the birth experience, self-concept, role strain, perceptions of motherhood, culture, and many other factors will affect the ability of the woman to attain a positive self-concept as a new mother. As such, the nursing process can enhance the process of a positive transition into the woman's next stage of life.

Outline

I. Introduction to Bowen family systems therapy

A. History

1. Shift from individualistic psychodynamic view

B. Concept of independence and dependence

1. Triangles

2. Differentiation

II. Introduction to Ramona Mercer's maternal attachment theory

A. Social construction of motherhood

1. Becoming a mother as a process

B. Encouraging dependence of mother and child

1. Maternal touching

2. Breastfeeding

C. Role of nurse in acculturation process of motherhood

III. Comparison

A. Different views of dependence and independence

B. More limited scope of Mercer's theory -- only applies to mothers, not families as a whole

IV. Application

A. Cultural considerations for applying both theories

B. Need for sensitivity and individuation in applying both theorists to the individual circumstances of the patient

Interdependence and codependence:

Bowen family systems therapy vs. Ramona Mercer's theory of maternal role attainment/becoming a mother

Comparison

Bowen's family systems therapy was a ground-breaking development in the history of modern psychoanalysis. Previous to Bowen, the primary focus of most forms of psychotherapy was the individual in isolation (Weinstein 2004: 24-25). However, after the Cold War, the revival of interest in the family dynamic shifted the dominant thought processes within the psychoanalytic community. Instead of focusing on the internal dynamics of the human psyche, theorists began to examine how the family as a unit and family culture impacted the psychological health of the individual. Regarding the individual in a state of isolation was seen as less effective than analyzing relationships and culture. Family therapy interjected an element of sociological or anthropological analysis to the therapeutic framework, given that family structure by definition is produced by culture. "How does cultural change and migration affect a family's expression of psychopathology? Are there family structures or processes that are pathological in one culture but not in another? How do families contribute to socially destructive conditions such as prejudice and poverty "(Weinstein 2004: 25)?

Bowen focuses upon the family unit as an agent that can potentially foster health or, conversely, foster very unhealthy relationships. "To Bowen, the degree to which a differentiation of self occurs in an individual reflects the extent to which that person is able to distinguish between the intellectual process and the feeling process (emotions) he or she is experiencing" (Goldenberg & Goldenberg 1990:1). Many families, rather than supporting independence instead create a state of codependence, whereby individuals are unable to separate their feelings from other family members. A classic example of this might be that of a 'stage mother' who is unable to separate her ambitions from her offspring and her own sense of need and craving for self-worth.

In Bowen family systems theory, the fundamental unit of analysis within families is that of the triangle, an intermeshed network of three individuals. The most dysfunctional families exist in a state of pure 'ego mass' and Bowen rates family relationships based upon a scale regarding their sense of differentiation from others. Differentiation is healthy, not unhealthy and while differentiation is a continuum for all individuals, ideally a higher level of differentiation allows for more rational and less hurtful interactions with others, while low levels of differentiation pull an individual into the triangular dynamic of the undifferentiated dyad (Goldenberg & Goldenberg 1990:2). Yet another example of families with poor levels of differentiation are families where substance abuse is rife: the mother may constantly chide her substance-abusing son, get angry at herself and her husband for causing the son's problem, and use the son's problem to vent her other frustrations about the marriage. In many situations, one individual is hyper-functional and assumes the responsibilities of others, while letting others under-function and not grow up.

Within triangular relationships, there is a tendency to demonize certain family members, scapegoating them for all of the family problems. Conversely, some family members are deemed to be the 'good' ones. "To Bowen, the only effective way to resolve current family problems is to change the interactions with the families of origin" and to shift this type of black-and-white thinking (Goldenberg & Goldenberg 1990:4).

Bowen's theory is extremely all-encompassing and deals with families during multiple stages and undergoing varied levels and types of stress. Bowen's theory is not designed specifically to deal with nursing-related problems, but his concept of unconscious role-playing can be extremely useful for a nurse dealing with families under strain because of caregiving demands and the psychological or physical problems of a family member. Bowen's theory can also potentially help identify barriers to changing lifestyles. For example, a child may be labeled as the 'fat one' versus 'the pretty one' in the family unit, which can impede encouraging the child to make positive changes because family members unconsciously engage in sabotage of the child's weight loss.

In contrast, to Bowen's rather mistrustful view of family relationships, theorist Ramona T. Mercer stressed the positive implications of intermeshed relationships. Mercer specifically focused upon strengthening the bond between mother and child. She began her work as a nurse on maternity wards. Not unlike Bowden, Mercer's theory of maternal role attainment/becoming a mother arose as a result of changes in social philosophy during the era when she worked. Rather than viewing motherhood as something that naturally blossomed immediately after giving birth, Mercer stressed that motherhood was a socially constructed process that proceeded through a series of stages and was not an individualistic process (Husmillo 2013: 46).

However, while the goal of Bowen's family systems is independence (at least to some degree) of family members, the goal of Mercer's theory is dependence, namely the acknowledgement of the role of the mother of the child and the fostering of a mutually beneficial and loving relationship between mother and child. This is the result of Mercer's relatively narrow focus: her theory is designed to address the specific needs of mother and child during the early stages of development.

Mercer's theory is also explicitly a nursing theory, and while Bowen stresses the process of group therapy as an instrumental healing component of alleviating unhealthy codependency, Mercer instead suggests many biological coping mechanisms for the mother to foster a positive relationship with the child, including "the importance of early skin-to-skin contact and exclusive breastfeeding" (Husmillo 2013: 47). Mercer, like Bowen, focuses upon potentially negative social forces that could potentially impact the critical relationship at the heart of the theory. But once again, these potential negatives are rooted to some extent in biological as well as social and psychological factors. "Young maternal age and immaturity, socioeconomic status" are all potential red flags particularly since they have been shown to reduce the likelihood that the mother will breastfeed and 'bond' with the child in a meaningful fashion (Husmillo 2013: 47). A lack of appropriate mother-child bonding is seen as having significant psychological consequences for the baby over the course of its existence, as well as the fact that a failure to breastfeed and to reinforce trust and security for the child can result in compromised long-term health and a failure to thrive.

Mercer's theory is thus aimed to support a particular type of wellness promotion for the children involved. However, the theory can be differentiated for to allow for women's varied experiences of becoming mothers, including the type of birth they have (natural vs. C-section); having children who are born with birth defects, and other issues (Husmillo 2013: 47). This differentiation is strongly grounded in Mercer's sense of evidence-based practice, which clearly marks her theory as explicitly as a 'nursing' theory, versus Bowden's more abstract theoretical concept of family relationship triangulation. For example, to support her theory, Mercer notes: "findings suggest a strong correlation between the development of postpartum depression and a decrease in the mother's emotional bond to her infant. Negative impact on the maternal-infant bond was evident when maternal depressive symptoms were present two to three months postpartum" (Husmillo 2013: 47-48). Bowden views a lack of positive independence between family members as potentially damaging, but Mercer's specific, targeted focus on the mother-child relationship leads her to see a lack of interdependence as producing neurosis and alienation, not emotional enmeshment as in Bowden.

Mercer's nursing focus is also evidenced in the more physical component of her theory, reflecting her orientation as a nurse. Giving birth and nursing is a biological, not a purely psychological process and certain physiological conditions (such as touching) are necessary for the bond to take place. Other physiological conditions can potentially thwart the mother's physical attempt to bond with the child, such as an overly impersonal hospital environment or the mother's uncertainty about how to care for the infant and her withdrawal. Bowden's theory lacks this physiological, hands-on component.

A final, but significant component of Mercer's theory is her conception of nursing and definition of nursing, which is also clearly not present in Bowden's theory. Mercer sees the nurse as an educator. "Nurses and childbirth educators should model good behavior during each and every interaction with the patient while simultaneously providing valuable patient teaching in a sincere manner and in small amounts" (Husmillo 2013: 47-49). In Bowden, the therapist acts as a facilitator and offers objective guidance and analysis and is not an involved participant in the process of negotiating new family relationships as a 'role model.'