Family Systems and Depressive Disorders
Introduction
The main purpose of this study is to evaluate the importance of family systems interventions in
the treatment of depression. Biomedical treatment which focuses on system resolution is the most
commonly applicable model for assessing and treatment of depression. The Biomedical treatments of
depression include pharmacotherapy and psychological treatment. In spite of the efficacy of
contemporary psychiatric treatment, a significant portion of patients with depression are irresponsive to
such treatments and continue experiencing problematic residual symptoms. A case study on the
outpatients with mild-to-moderate depression showed that the remission rates were 46% for
psychotherapy, 46% for medication, and 24% for control conditions, meaning approximately 50% of
patients are left with some degree of persistent symptoms. Therefore, it is essential to resort to other
forms of depression treatment and management to improve the general results of treatment. For
instance, a biopsychological model which mainly focuses on the social environment in which the
depressive episode evolves can be an effective way to approach the management of depression. It is
necessary to pay attention to the insufficient effectiveness of biomedical treatment among other
reasons when dealing with depression.
Over 50% of patients with chronic depression are normally associated with distressing and
problematic family functioning. Like patients, families of patients with major depression also experience
the same levels of family dysfunction. Depression is associated with the changes in the social
environment as well as the level of social support. For instance, one of the most regularly reported
incidents leading to depression is marital arguments. The lack of support by a partner, or the inability to
confide in a spouse can lead to depression. Families with one individual with depression or couples with
one depressed partner experience the lowest level of family/marital cohesion. A study on individuals
with depression and their partners reveals that majority experience negativity, hostility, mistrusting, and
detachment. Depressed patients usually exert aversive control over their partners’ behaviors. Family/
marital/ social conflicts increase the risk of depression which causes family stresses and burdens.
During the acute phase of a depressive episode, marital/family dysfunction is very common,
always associated with difficulties in most family domains. Some of the areas affected during this phase
include role functioning, communication, and problem-solving. The family burden increases significantly
as a result of financial worries, fears of recurrence, loss of status, social isolation, and chronic tension.
Family dysfunction during this phase of depression not only affects family distress but also has a great
impact on the general depression management. Patients who experience family/ marital distress
respond slowly to depression treatment. Thus, family dysfunction has a negative effect on the short-
and long-term recovery from depression. However, patients who are able to improve their family
functioning may recover from depression quicker than those with family problems.
Family functioning is also associated with a higher likelihood of relapse or recovery. For
example, family criticism towards the depressed patient or marital distress is strongly associated with
the relapse. The way the patient’s family or spouse respond to and deal with depression is essential in
This study source was downloaded by 100000856941565 from CourseHero.com on 12-01-2022 03:21:48 GMT -06:00
https://www.coursehero.com/file/43237329/Family-Therapy-in-Treatment-of-Depressiondocx/
, managing and recovery from depression. When a depressive illness is responded to effectively at its
onset, it can be brief, and the patient might take a short time recovering. However, if the family does
not respond effectively to the depressive illness, it might a long time to recover since the chances of
recovering are low, and there is a high possibility the patient will relapse into subsequent episodes.
Pharmacotherapy and psychotherapy treatments may be effective when dealing with genetic
vulnerability, current life stresses, and early life experiences, while family intervention is essential in
increasing the family’s responsibility in responding to illness.
Family Systems Theory and Models of Intervention and Treatment
The family systems theory or the Bowen Family Systems Theory was developed by Murray
Bowen who was a pioneer of family psychotherapy. Bowen worked at Menninger Clinic, Kansas
between 1946 and 1954 where he studied the relationship between patients with schizophrenia and
their mothers. He continued his research study in the National Institute of Mental Health between 1954
and 1959 where the whole family stayed in the ward with patients. It is the study of these families and
their relationship pattern that led to the development of family theory. After concluding his study at
NIMH, Bowen continued developing his theoretical concepts and refining the theory at Georgetown
University.
There are eight interlocking concepts of family systems theory including differentiation of self,
the family project process, an emotional triangle, the multigenerational transmission process, sibling
position, the emotional cutoff, the nuclear family emotional process and the societal process. The core
concept of Bowen’s theory is the differentiation of self which is the ability of an individual to cope with
changes, respond to anxiety, and separate thoughts from goals while pursuing personal goals. People
with high level of differentiation are better at maintaining individuality as well as emotional contact with
the group at the same time while individuals with low level of differentiation feel what the group feels
and usually, experience emotional fusion. An emotional triangle is the network of human relationship.
For instance, a two-person dyad may exist but eventually destabilize when anxiety is introduced.
However, a three-person system offers more resources for management and reduction of anxiety.
The family projection process involves transferring of parent’s anxiety, relationship
problems, and emotional issues to the child within the emotional triangle, a process which may lead
to the development of emotional concerns and other issues in the child. The multigenerational
transmission process entails individuals seeking out spouses with a same level of differentiation
which potentially leading to certain traits being passed on through generations. For example, when
both partners have high levels of differentiation, there is a chance that their children will also have
higher levels of differentiation.
An emotional cutoff is an incidence whereby an individual deals with emotional issues or other
difficulties within the family system by cutting emotional connections from other members of the
family. Sibling position is the habit of oldest, middle, or youngest children to adopt certain roles within
the family as a result of the difference in expectation and other factors. For instance, oldest siblings
normally act like miniature adults within the family setting. The societal emotional process shows how
the factors influencing the emotional system of the family also impact the emotional system of the
society. The
This study source was downloaded by 100000856941565 from CourseHero.com on 12-01-2022 03:21:48 GMT -06:00
https://www.coursehero.com/file/43237329/Family-Therapy-in-Treatment-of-Depressiondocx/
Introduction
The main purpose of this study is to evaluate the importance of family systems interventions in
the treatment of depression. Biomedical treatment which focuses on system resolution is the most
commonly applicable model for assessing and treatment of depression. The Biomedical treatments of
depression include pharmacotherapy and psychological treatment. In spite of the efficacy of
contemporary psychiatric treatment, a significant portion of patients with depression are irresponsive to
such treatments and continue experiencing problematic residual symptoms. A case study on the
outpatients with mild-to-moderate depression showed that the remission rates were 46% for
psychotherapy, 46% for medication, and 24% for control conditions, meaning approximately 50% of
patients are left with some degree of persistent symptoms. Therefore, it is essential to resort to other
forms of depression treatment and management to improve the general results of treatment. For
instance, a biopsychological model which mainly focuses on the social environment in which the
depressive episode evolves can be an effective way to approach the management of depression. It is
necessary to pay attention to the insufficient effectiveness of biomedical treatment among other
reasons when dealing with depression.
Over 50% of patients with chronic depression are normally associated with distressing and
problematic family functioning. Like patients, families of patients with major depression also experience
the same levels of family dysfunction. Depression is associated with the changes in the social
environment as well as the level of social support. For instance, one of the most regularly reported
incidents leading to depression is marital arguments. The lack of support by a partner, or the inability to
confide in a spouse can lead to depression. Families with one individual with depression or couples with
one depressed partner experience the lowest level of family/marital cohesion. A study on individuals
with depression and their partners reveals that majority experience negativity, hostility, mistrusting, and
detachment. Depressed patients usually exert aversive control over their partners’ behaviors. Family/
marital/ social conflicts increase the risk of depression which causes family stresses and burdens.
During the acute phase of a depressive episode, marital/family dysfunction is very common,
always associated with difficulties in most family domains. Some of the areas affected during this phase
include role functioning, communication, and problem-solving. The family burden increases significantly
as a result of financial worries, fears of recurrence, loss of status, social isolation, and chronic tension.
Family dysfunction during this phase of depression not only affects family distress but also has a great
impact on the general depression management. Patients who experience family/ marital distress
respond slowly to depression treatment. Thus, family dysfunction has a negative effect on the short-
and long-term recovery from depression. However, patients who are able to improve their family
functioning may recover from depression quicker than those with family problems.
Family functioning is also associated with a higher likelihood of relapse or recovery. For
example, family criticism towards the depressed patient or marital distress is strongly associated with
the relapse. The way the patient’s family or spouse respond to and deal with depression is essential in
This study source was downloaded by 100000856941565 from CourseHero.com on 12-01-2022 03:21:48 GMT -06:00
https://www.coursehero.com/file/43237329/Family-Therapy-in-Treatment-of-Depressiondocx/
, managing and recovery from depression. When a depressive illness is responded to effectively at its
onset, it can be brief, and the patient might take a short time recovering. However, if the family does
not respond effectively to the depressive illness, it might a long time to recover since the chances of
recovering are low, and there is a high possibility the patient will relapse into subsequent episodes.
Pharmacotherapy and psychotherapy treatments may be effective when dealing with genetic
vulnerability, current life stresses, and early life experiences, while family intervention is essential in
increasing the family’s responsibility in responding to illness.
Family Systems Theory and Models of Intervention and Treatment
The family systems theory or the Bowen Family Systems Theory was developed by Murray
Bowen who was a pioneer of family psychotherapy. Bowen worked at Menninger Clinic, Kansas
between 1946 and 1954 where he studied the relationship between patients with schizophrenia and
their mothers. He continued his research study in the National Institute of Mental Health between 1954
and 1959 where the whole family stayed in the ward with patients. It is the study of these families and
their relationship pattern that led to the development of family theory. After concluding his study at
NIMH, Bowen continued developing his theoretical concepts and refining the theory at Georgetown
University.
There are eight interlocking concepts of family systems theory including differentiation of self,
the family project process, an emotional triangle, the multigenerational transmission process, sibling
position, the emotional cutoff, the nuclear family emotional process and the societal process. The core
concept of Bowen’s theory is the differentiation of self which is the ability of an individual to cope with
changes, respond to anxiety, and separate thoughts from goals while pursuing personal goals. People
with high level of differentiation are better at maintaining individuality as well as emotional contact with
the group at the same time while individuals with low level of differentiation feel what the group feels
and usually, experience emotional fusion. An emotional triangle is the network of human relationship.
For instance, a two-person dyad may exist but eventually destabilize when anxiety is introduced.
However, a three-person system offers more resources for management and reduction of anxiety.
The family projection process involves transferring of parent’s anxiety, relationship
problems, and emotional issues to the child within the emotional triangle, a process which may lead
to the development of emotional concerns and other issues in the child. The multigenerational
transmission process entails individuals seeking out spouses with a same level of differentiation
which potentially leading to certain traits being passed on through generations. For example, when
both partners have high levels of differentiation, there is a chance that their children will also have
higher levels of differentiation.
An emotional cutoff is an incidence whereby an individual deals with emotional issues or other
difficulties within the family system by cutting emotional connections from other members of the
family. Sibling position is the habit of oldest, middle, or youngest children to adopt certain roles within
the family as a result of the difference in expectation and other factors. For instance, oldest siblings
normally act like miniature adults within the family setting. The societal emotional process shows how
the factors influencing the emotional system of the family also impact the emotional system of the
society. The
This study source was downloaded by 100000856941565 from CourseHero.com on 12-01-2022 03:21:48 GMT -06:00
https://www.coursehero.com/file/43237329/Family-Therapy-in-Treatment-of-Depressiondocx/
