The Problem Isn't the Person — It's the System

Here's a question worth asking before you see your first family.

Why does the most symptomatic person in the room almost never turn out to be the actual source of the problem?

The answer is family systems theory. And it will change how you see every client you work with — not just the ones who come in with their whole family.

In Part 1 of this two-part series we slow down and go deep on the two most heavily tested family systems frameworks across the NCE, NCMHCE, LCSW, and MFT exams.

Bowen Family Systems Theory Murray Bowen spent decades asking one question: why do emotional patterns repeat across generations? His answer — differentiation of self — is the anchor of his entire model. We cover differentiation, triangulation, the genogram, emotional cutoff, the family projection process, and the four patterns of the nuclear family emotional system.

Minuchin's Structural Family Therapy Salvador Minuchin built an approach around one central insight: problems emerge from dysfunctional family structure. Change the structure — change the problem. We cover subsystems, boundaries, enmeshment, disengagement, hierarchy violations, and Minuchin's signature techniques — joining and enactment.

We also cover the universal systems concepts that apply across every family therapy model — homeostasis, circular causality, the identified patient, and the difference between first and second-order change.

Six exam-style multiple choice questions at the end — including the vocabulary distinction between Bowen and Minuchin that trips up most exam takers.

Want to go deeper? This week's newsletter covers additional Bowen concepts, the four nuclear family emotional system patterns, three more Minuchin techniques, and a full clinical case vignette. Link in the show notes — always free.

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Transcript

SPEAKER_01 0:11

Here's something that might surprise you about family therapy. It wasn't invented by therapists. The intellectual roots of what we now call family systems theory trace back to the late 1940s and early 1950s, not in a therapy office, but in a research lab. A group of scientists, mathematicians, and communication theorists gathered around a man named Gregory Bateson in Palo Alto, California. They were studying something that had nothing to do with mental health. They were studying communication patterns, how information moves between people, how systems regulate themselves, how feedback loops and works. But somewhere in that research, they started applying those ideas to families, and specifically to schizophrenia. The prevailing view at the time was that schizophrenia was an individual illness, something that happened inside one person's brain, but Bateson's group began to notice something different. The symptoms of their patients made a strange kind of sense when you looked at them in the context of the family. The communication patterns in these families were extraordinary. The contradictory messages sent simultaneously where the content said one thing and the relationship said another. They called it the double blind, and they argued that this kind of communication pattern didn't just confuse people, it could drive them to the edge of sanity. That insight was radical. It said the problem isn't just inside the person, the problem is in the space between people. The shift from the individual as the unit of treatment to the system as the unit of treatment changed everything. It gave birth to a whole new way of thinking about human suffering and eventually gave birth to the theorists we're covering today. Murray Bowen was studying families at NIMH in the 1950s and 60s, bringing family members into the hospital, observing them together, watching the patterns emerge. Salvador Minuchin was working with families in the inner city, watching how structure and hierarchy shaped the behavior of every person in the system. Both of them were asking the same fundamental question from different angles. Not what is wrong with this person, but what is wrong with this person's behavior doing in within the system? What function does it serve, and what would have to change about the system for the behavior to change? Those questions are at the heart of family systems theory, and they are going to change how you think about every client you ever see, whether you do family therapy or not. Let's get into it. Hey, welcome back to the Licensure Lifeline Podcast. I'm your host, Matt Lawson, and today we are diving into a very intellectually rich area within the mental health arena, family systems theory. Specifically, we're going to look at Bowen and Minuchin, two of the most heavily tested theorists across every Licenger exam, two completely different lenses on the same fundamental idea that cannot quite where you just can't quite understand a person unless you look at them through the lens of the systems that they live in. We're going to cover Bowen's core concepts, differentiation of self, triangulation, genograms, multi-generational transmission, then get into Minutians, structure models, subsystems, boundaries, ameshment, disengagement, and enactment. And we're going to tie this all together with the concepts that show up on the test in the little vignette. Before we get started, I want to mention the Leicester Lifeline Circle group is up and going. This is an online community. I'm calling it an educational ecosystem platform, you know, where you can go in there, connect with other clinicians that are studying for the test, do quizzes, have little areas. I also host a weekly study kind of group where you can just kind of come in, have some live support, or just hang out. But this is something that is meant to really build community around preparing for these tests. Also take a look at the newsletter. I'll have a link for that on the website, licensurelifelifeline.com. You can go there and check out both the group and the newsletter. I've also started a YouTube channel where I will be posting the podcast there as well. I'll also be going into what I'm calling uh kind of the seventh wave episodes where I kind of explore some of the tech and emergent technologies in the mental health world. So take a look into that as well. Um I'm looking forward to getting into the topic today, so let's get going. First up, let's look at the news. So this one caught my attention. Researchers have been using Chat GBT to analyze behavioral data from clients' sleep patterns, steps, incoming and outgoing calls and text, distance travel, time spent at home, and surfacing clinic clinically relevant insights for therapists to use in session. So this is what's interesting about this from a systems perspective. What these researchers are essentially building is a digital version of something family systems therapists have been doing for decades, mapping patterns across contexts to understand a person's functions in their environment. I love this. Um, you know, it it it I know it sounds very big brother to a lot of you, but you know, so much of the work, so much of what goes into a person's world takes place outside of the session. And unless that individual is reporting to us these things, it it does. It doesn't, um there's a lot of things that get lost. Um, the amount of time somebody's come into session with me and said, Oh, something happened last week I wanted to tell you about, but I completely forgot. You know, I encourage people to take notes. I encourage people to send send me emails when things happen. But the reality of it is, is a lot of this stuff gets missed. Um, you know, I I like the idea of having some of this data, having some of this information that really gives us a nice picture of the individual that were individuals that we're working with world, um, with their consent, of course. And uh, you know, it it does. Like I see a lot of the biofeedback from these wearables being part of the process. All right, next up in the news. This one's directly relevant to you if you're planning to sit for the NCMHCE. The NBCC has published new 2027 exam specifications for the MCMHC. If your exam date falls anywhere in the next 12 to 18 months, go to nbcc.org right now and check out the updates um content outline. So you'll just know exactly what is going to be on the test before. I mean, this happens every so often with all of these tests. They do updates. Sometimes it'll like this, they'll do these updates like right in the middle of the year. And it is like you need to stay on top of it. So go to the website and check that out. Finally, last story here. Um, this one's pretty significant and worth knowing. The FDA approved the second MDMA assisted psychotherapy protocol for PTSD treatment in January 2026, representing the first new class of treatment for PTSD in decades, with phase three trials showing remission rates of 67% compared to approximately 20 to 30 percent for the current standard of care. That's not a small number. Um, that paradigm shift for context, most of the treatments we're currently we currently consider for gold standard for PTSD, we're producing remission rates of that 20 to 30 percent range. So 67% is pretty remarkable. Um so for pre-licensed clinicians, you probably are not going to be administering MDMA um assisted therapy in your first years of practice, but you know, this is where it's becomes really helpful to know, you know, build your network in the medical community, partner up with individuals that do things like MDMA, um, ketamine, um, you know, psychedelics. Um, you know, have a team of people. Like it's it really is a great experience to have multiple individuals um supporting the work you're doing with uh with a person. Before we get into the main topic today, just a quick word from their sponsor. Here's something that nobody talks about when you're in grad school learning family systems. Minuchen talks about structure and hierarchy, Bowen talks about differentiation, emotional systems. All of this sounds elegant and clinical. And then you get to you get your license and realize you also have to manage scheduling for multiple family members, bill and billing, insurance, um, conjoint section sessions, and just keeping all these notes together. Um, you know, this is where something like simple practice steps in. The administrative complexity of all this stuff, doing family work is real and is exactly the kind of thing that can pull your attention away from the clinical work that you're doing. So, simple practice, you know, when a family or four shows up at your caseload, you can stay focused on the system in the room rather than the paperwork on your desk. Um, they're offering a free trial right now. I'll have a link for that in the notes for this episode that you can check out. So please take a look when you get a chance. Before we get into Bowen and Minution specifically, I want to make sure the foundational shifts in thinking is clear. Because if you understand this shift, everything else follows naturally. Individual therapy asks what is happening inside this person. Systems therapy asks what is happening between people, and what function does this person's behavior serve in this system? That's not a small distinction. It's a completely different frame for understanding human suffering. Here are the core system concepts you need to have locked in, regardless of which theorist a question is about. First up, homeostasis. Every family system has a strong pull toward stability, toward maintaining a pattern it knows, even when those patterns are painful. You see this in people, you see this in systems. Even when things are kind of toxic, um those systems, those people will lean toward the maintenance of what they know. And this is why change can be so difficult. Not because people don't want things to be better, but because the system itself resists disruption. When one person starts to change, the system often pushes back. You'll see this clinically when a client makes progress and suddenly their family starts acting in ways that pull them back toward old patterns. That's the homeostasis in action. Next up, circular causality. In individual thinking, we look for linear causes. A causes B. In systems thinking, everything is mutually influencing. A affects B, which affects A, which affects B. There is no singular cause. There is no singular person to blame. The behavior of every person in the system is simultaneously a cause and a response. This is one of the most important conceptual shifts in all of family therapy, and it's directly testable. Next up, the identified patient. We touched on this in the news segment a bit. The identified patient is the family member who has been labeled as the problem, the one who is symptomatic, acting out, or presenting for treatment. You're gonna see a lot of questions on the different tests where they're gonna say the identified patients or the problematic. Well, they won't say the problematic individual, but they'll say the identified patient. First order versus second order change. First order change is surface behavior change within the existing structure. The rule stays the same. Someone just behaves differently. Second order change is structural, the rules themselves actually change there. Most lasting therapeutic change is second order. This distinction distinction is also something that's very testable. All right, let's get into Bowen family system theory. Murray Bowen spent decades studying one question. Why do emotional patterns repeat across generations? Why does anxiety, dysfunction, and relational distress seem to travel through family lines like something something that you inherit, even when it is clearly not genetic? His answer was the concept of differentiation of self. And it is the single most important concept in his entire model. The differentiation differentiation of self is the ability to maintain a clear sense of your own identity, values, and thinking while relating remaining emotionally connected to others. Um again, something I see a lot in practice, something I talk a lot about in practice is this idea of, you know, within relationships, when it's within couples, within families, you have healthy identities that support a healthy system. There's something that happens when you have unhealthy identities, and I think we'll get a little bit more into that within this uh this episode. But you'll see this a lot of the times, like with things like emeshment, um, which we're going to be talking about. But the balance between the two fundamental life forces, the need for individuality and the need for togetheredness, um, highly differentiated people can stay connected to their families without being controlled by the emotional field. They can think clearly, understand pressure, they can be, and they can disagree without cutting people off. They can be present without losing themselves. Low differentiation looks different. People with low differentiation are what Bowen calls emotionally fused. Their sense of self rises and falls with the emotional state of the people around them. They can they can't separate their own thinking from their feelings. And I mean, how many times have you seen this? How many times have you seen this with couples where a person loses themselves in the relationship, or the couple loses themselves in the relationship, and they're no longer two healthy identities, um, but they're kind of a fused dual identity that doesn't actually go very well. So in becoming emotionally consumed by a relationship, um can cut off people entirely, right? This is why this is clinically relevant beyond just the exam. Bowen argued that therapists need to work on their own differentiation, that the clinical levels of differentiation directly affect what they can do in the room with a family. A therapist who gets triangulated, who takes sides, who gets emotionally reactive, that therapist is part of the system, not a resource for changing it. One of the very first times I did couples counseling, um, I I I immediately got triangulated within this uh the system of the people that I was working with. And what they're talking about here by being able to kind of work on yourself is there are like, you know, within that moment, within that, you know, when I when I kind of went back and talked to my supervisor about the experience and things like that, there were there were pieces, you know, that showed up in that session that I still had to deal with from growing up, um, from the family that I grew up in. And a lot of the things that were going on were, you know, I was I was reacting to um because of my life experience. And, you know, that is a big part of therapy, like being able to react is part of your life experience, but also understanding how that can work against the process, how that can work against you being the professional in the room that is trying to maintain some of these things is really important. Um, so triangulation is Bowen's second major concept, and it flows directly from differentiation. When anxiety rises between two people, the natural human response is to pull a third person in to form a triangle. The third person becomes the focus of the anxiety, which temporarily reduces the tension between the original two. A couple in conflict focuses on their child's behavior. Two employees in tension gossip about a third. The triangle stabilizes the system, but at the cost to the third person. This is this concept becomes a little scary when you think of people that do things like we can say things like, you know, we can potentially improve our relationship by having a kid. Um, you know, they're trying to address emotional distress within their relationship by bringing in a third individual, um, which, you know, only works for so long. Um, the system still remains unhealthy. There's just more people added to it. Triangles are basic um molecules of emotional systems. You can't have a stable two-person system under stress, it will always try to become a triangle. The goal of Bowen therapy Boinian therapy is to help family members um detriangle, to stay in direct contact with each other without pulling others in and help them manage their anxiety. So on the exam, triangulation questions usually describe a third party being pulled into conflict between two others. The Bowinian intervention is to help two primary parties stay in direct relationship with each other. All right, um, let's get into the genogram a bit. Um, I if you haven't done a genogram yet, I remember doing this um in grad school. They had us all do genograms. But Bowen developed the genogram as a clinical clinical tool for mapping multi-generational family patterns in uh in a visual way. At minimum, three generations, um, squares for males, circles for females, horizontal lines for partnerships, vertical lines for offspring. But the genogram is more than a diagram. It's a clinical conversation. As you draw it with a family, you're asking when did this anxiety spike? Who got triangulated? What patterns repeated across generations? So for the exam, know what a genogram is, know that it's a Bowinian tool, and know that its purpose is to identify multi-generational patterns, not just family structure. Um, you know, that I think that's where people tend to go with it, just the way that it looks is it looks like it's just like, oh, you know, mapping out your family structure. But it is. It's it's more about looking for patterns across generations. So speaking of generations, let's talk multi-general or multi-generational transmission. Um bone observe that differentiation levels are transmitted across generations, that children in the same family often develop different levels of differentiation based on how much they were triangulated into the parental anxiety. Um the child who was most involved in managing the parents' emotional systems are oft often end up with the lowest differentiation. And their children face a similar dynamic over multiple generations. Some family lines can show progressively lower differentiation, what Bowen called a multi-generational transmission process. All right, last concept here for Bowen: emotional cutoff. This is what happens when a low differentiation meets unbearable anxiety. People physically or emotionally distance themselves from their family or of origin to manage the unresolved attachment. The cutoff looks like independence. It isn't. The unresolved attachment travels with the person into every relationship they form. Bowen would say you can't run far enough from your family of origin to escape the emotional system you carry inside. This is the kind of work that we do for ourselves, on ourselves, is we address things like this so we can show up the best way possible for the people that we're working with. Um, you know, at minimum, we need to be aware of, you know, where we come from and what we do. Um, you know, this the the work that therapists do on themselves, it it's part, it's part of being a therapist. Um, you know, you to have that regular therapy, to have things that you're addressing. Um, as a as part of your work, so you can um show up for the people that you're working with. Okay, that's gonna be it for Bowen. Let's get into Salvador Minuchin. Um, came from a completely different world than Bowen. He was working in Philadelphia in the 1960s with low-income urban families, many of them dealing with delinquency, school failure, and poverty. He needed an approach that was practical, directive, and produced change fast. What he developed was structural family therapy, and it's built on one central insight. Problems emerge from dysfunction, dysfunctional family structures. Um, change the structure and you change the problem. Minuchin's, I know I'm gonna, I'm gonna I'm going to stumble over this throughout the entire podcast, and I apologize. Minuchen's model is organized around three core concepts: subsystems, boundaries, and hierarchy. Subsystems, this is where every family contains small units, subsystems, that perform specific functions. The three main ones are the marital or couple subsystem, the parental subsystem, and the sibling subsystem. Each subsystem has its own rules, its own roles and its own task. The marital subsystem is about intimacy and partnership between the adults. The parental subsystem is about raising children, nurturing, and setting limits. The sibling subsystem is where the children learn peer relationships, negotiation, and competition. Problems arise when subsystems boundaries are violated, when the children are pulled into adult roles, when parents compete with children, when a child becomes the emotional partner of one of the parents. So boundaries are the rules about participants in the subs participation in the subsystems. Minution describes three types. Clear boundaries, the healthy middle ground type of boundaries. Information flows appropriately between subsystems. Family members are connected but have distinct roles. Then you have rigid boundaries. These are a little bit too thick. Subsystems are disengaged. Members have little emotional contact with each other. Children may be neglected emotionally. Family members seem in indifferent to each other's distress. And then you have diffuse boundaries. These are too thin. Subsystems are enmeshed. Everyone is over involved in everyone else's business. There's high reactivity, high loyalty, low autonomy. Children can't develop independence because the system collapses with every attempt of that individuality. So let's talk about enmeshment and disengagement. These are the extreme ends of the boundary continuum. Enmeshment is when boundaries are so diffuse that individuals' autonomy is lost. The family operates as an undifferentiated mass where everyone feels everyone else's feelings, and in any attempt at independence feels like betrayal. I see this a lot, unfortunately. I see this a lot between couples. I see this a lot in families. You know, there's there should be boundaries there. There need to be boundaries there. And um enmeshment is something that, you know, it becomes a really significant topic to address in any couple's counseling or families, there's family therapy that you do. But as you can imagine, disengagement is the opposite. Boundaries are too rigid, um, that there's virtually no emotional connection. Members live parallel lives. For the exam, know that enmeshment and disengagement are not diagnoses, they're descriptions of boundary patterns. And I know that both can be present in different subsystems of the family simultaneously. So you can have subsystems within the family that are enmeshed, you can have them where they are disengaged. Um, but there are ways to describe these things. Another one of Minuchin's concepts was the idea of hierarchy. And he was explicit that healthy family function requires clear generational hierarchy. So parents are in charge of children, not authoritarian. Um, when hierarchy is inverted, when children are parent parentified, when a child holds more power than the adults, the family structure is dysfunctional and the system often follows. So we're going to talk technique for a second here. So joining and enactment, these two techniques are worth knowing for the exam. Joining is how the structural therapist enters the family system. Before you can change the structure, you have to be accepted into the family. You have to accommodate, be you have to accommodate to their style, their language, their tempo. Minuchin was famous for his ability to join families very quickly and become a part of the system before reorganizing it. I feel like when I studied this in grad school, I actually watched some YouTube videos of him doing this kind of thing. And he was like, you know, he could get into these families and you know, really connect with them very quickly. Um actomic is a signature structural technique, asking the family to play out or interact in a room rather than describe it. Instead of asking a couple to tell you about their conflict, you ask them to have a conversation right now in front of you. The therapist can observe the structure directly. Who speaks for whom, who gets excluded, where the boundaries are thin, where hierarchy breaks down. Then the therapist intervenes in the enactment to reshape the interaction. This is a great technique. I use this again all the time, especially in couples counseling, um, having them just have a conversation, not tell you about things, but have them just have a conversation about a topic that they're struggling with and being able to see what it looks like and you know where the pieces and parts are that um could be improved. All right, let's get into multiple choice questions. A family therapist working from a Boenian framework observes that whenever the parents in a family argue, their 10-year-old son begins acting out at school. The parents then shift their focus to the son's behavior and their conflict temporarily decreases. This pattern is best described as a meshment, b triangulation, c emotional cutoff, or d per parentification. Answer here is gonna be B. Triangulation occurs when anxiety between two people is managed by pulling in a third person. The son acting out becomes the focus of the parent's shared attention, which you know temporarily reduces the tensions tension between the parents. This is classic Bowening um triangle. The child is not the source of the problem, he is the stabilizer of the too unstable person system. Question number two. According to Bowen's theory, a person who cannot separate their own thinking from their emotional reactivity, whose sense of self rises and falls with the emotional state of those around them, and who tends to either merge completely with the relationship or cut off entirely, is best described as a a rigid having rigid boundaries, B low differentiation of self, c enmeshment, or d high multigenerational transmission. Answer here is gonna be B low differentiation of self. The differentiation of self is Bowen's central concept, the ability to maintain a clear sense of identity and think clearly while remaining emotionally connected to others. Low differentiation means the person's function is governed by the emotional field around them rather than their own thinking. They either fuse, lose themselves in the relationship, or cut off entirely. Alright, question number three. A structural family therapist asks a couple to stop describing their conflict and instead have a conversation directly with each other in the session right then and there. The therapist then observes who speaks for whom, who gets excluded, and where the interaction breaks down. This technique is best known as A joining, B reframing, C enactment, or D triangulation. Answer here is gonna be C. Enactment is a signature Minution technique, asking the family to play out an interaction in the room rather than describe it. By bringing the interaction into the present moment, the therapist can directly observe the family's structural patterns, hierarchies, boundaries, coalition rather than relying on the family's description of them. Question number four: a family presents for therapy. The mother and her 14-year-old daughter share everything. The mother cries when the daughter tries to spend time with friends, and the daughter feels responsible for her mother's emotional state. And any attempt at independence creates a family crisis. According to Minution's structural mode's structural model, this family's pattern is best described as a disengagement disengagement, b triangulation, c emotional cutoff, or d-emmeshment. Answer here is gonna be de emeshment. So much so that overlap the individual autonomy is lost. The daughter's attempts at normal adolescent independence are experienced by the mother as abandonment, and the daughter has taken on emotional responsibility for the mother's well-being. This is a boundary violation between parental and child subsystems. Question number five. A therapist is beginning work with a large family. Before attempting any structural intervention, the therapist spends the first session accommodating the family's communication style, using their language, matching their tempo, and tracking what matters most to each member. This initial phase of the structural family therapy is best described as A enactment, B joining, C reframing, or D. D. Triangulation. This is gonna be B joining. Joining is how the structural therapist enters the family system. Before you can recognize a structure, you have to accept be accepted as part of it. You have to accommodate the family style, language, and pace. Minuchin was famous for his ability to join families rapidly and authentically. Last question. A family therapist observes that a 12-year-old child consistently makes decisions for the family's um for the family, mediates arguments between the parents, and is treated by the parents as an equal rather than a child. According to Minuchin's structural model, the most clinically significant problem in this family is a enmeshment between sibling systems and the parental subsystem, B disengagement between the marital and parental subsystems, C a violation of generational hierarchy with the child in the inappropriate elevated position, or D. Triangulation of the child into the parental conflict. Answer here is gonna be C a violation of generational hierarchy. Minutin was explicit that healthy family function requires clear generational hierarchy. Parents in charge of children. When a child is elevated to an adult role, making decisions, mediating conflict, functioning as a peer to the parents' hierarchy is inverted, and symptoms typically follow. Alright, folks, that is gonna be a wrap for today. We covered lots of ground, and I want to acknowledge that family systems theory is one of those content areas that can feel overwhelming at first because there are so many theorists, so many concepts, and so many ways that can be tested. But here's what I want you to hold on to. Both Bowen and Minucin were asking the same fundamental question from different angles. Not what is wrong with the person, but what is the person what is the person's behavior doing in this system? That question will serve you on the exam. It will serve you every time a client walks into your office and you're trying to make sense of what's happening. Here are your three takeaways from today. One, know your bow and concepts cold. Differentiation of self is the anchor. Everything else, triangulation, emotional cutoff, multi-generational transmission in the genogram flows from the central idea that the capacity to stay connected without being consumed is the foundation of a healthy emotion emotional functioning. Number two, know your minutia concepts, subsystems, boundaries, enmeshment, disengagement, hierarchy, and know how your technique joint techniques joining before enactment always in that sequence matters. And finally, this is the one that will save you on vignette questions. Watch the theoretical language. Bowen and Minution have distinct vocabularies. When a question uses the language from one framework, stay in that framework. Mixing them up is where points get lost. Next week, we're going to continue with family systems. Um, so we're going to be moving into some strategic family therapy and um some experiential um family therapy as well. Before I let you go, if you want the cheat sheets, um interactive quizzes, full resource libraries for today's episodes, all those are going to be in the circle group. Um I will have more um insights and things like that within the newsletter. Um you can check that out as well. Um again, check out www.licsterlifeline.com. Um and please don't hesitate to reach out if you have any questions, comments about the show. Um I'm at LeicesterLifeline at gmail.com. Until next time, never stop learning.