Beyond the Medical Model: Can Family Systems Therapy Influence Chronic Illness?

While chronic reproductive conditions like endometriosis are often treated exclusively through medical interventions, emerging research suggests that family systems therapy may offer a complementary pathway for improving patient outcomes. Emotional stress, which is deeply embedded in family dynamics, has been linked to inflammatory responses that can exacerbate reproductive health conditions [1-5]. Emotional stress has been linked to inflammatory responses that may exacerbate endometriosis and impact reproductive health [6]. Bowen Family Systems Theory (BFST) offers a framework for addressing the interplay of emotional processes within families and their impact on chronic health conditions [7-9]. In my recently published case study in The American Journal of Family Therapy, I explored systemic emotional processes through Bowen Family Systems Theory (BFST). In this commentary, we highlight the study applying a psychosocial framework to reproductive health by examining how BFST therapy may support chronic endometriosis management in underserved populations. I also suggest potential factors that could strengthen the intersectionality of family systems approaches with physical health [10].

Differentiation of Self (DoS) was my focal point in my approach with this case study. BFST's goal is to increase one's level of DoS through the work facilitated by emotional coaching with a BFST therapist working through Dr. Murray Bowen's eight concepts. The case study underscored how enhancing DoS might have helped the client navigate emotional cutoffs and triangulation within her family system. Thus, these efforts may have indirectly influenced her physiological stress responses, aligning with literature correlating emotional regulation to the reduction of corporal systemic inflammation [1,2,3,7,8,11-13]. 

The client’s psychotherapeutic journey revealed a critical insight in that emotional reactivity within familial relationships can potentially impact chronic health conditions such as endometriosis. Addressing these dynamics with a BFST therapist may provide a dual pathway for improving both emotional regulation and reproductive health. When coming from a culturally, and socially marginalized position, therapy in general is not a resource that is sought in the treatment of chronic illness or disease [14]. Using a well-developed and ever-changing family diagram, the BFST therapist can maintain neutrality and perspective while aiding the client to potentially reach a level of differentiation of self in their emotional reactivity.

Telehealth provides an opportunity to expand access to systemic therapy approaches like BFST, which are often overlooked in reproductive health care. Studies have demonstrated that virtual interventions for chronic gynecological conditions, such as endometriosis, can enhance patient engagement, provide mental health support, and facilitate interdisciplinary collaboration with medical providers—offering a more integrated alternative to a strictly medical model approach [15]. Addressing both the emotional and physiological factors of reproductive disorders through a telehealth-based BFST approach may improve overall treatment outcomes in underserved populations. 

Culturally, providing therapy in Spanish not only facilitated communication but also created a therapeutic environment where the client felt understood and validated. Using culturally relevant language and idioms potentially enabled the therapist to connect with the client on a deeper level, fostering trust and engagement. This can be particularly significant in a collectivist culture where family dynamics and shared experiences are central to the client’s worldview. By incorporating the client's cultural context into the therapeutic process, telehealth in Spanish can potentially and effectively bridge the gap between systemic therapy concepts and their practical application in diverse populations [14,16].

While the case study demonstrated promising outcomes, it also highlighted challenges in establishing causality. The client’s use of complementary practices such as yoga and journaling complicates attribution solely to the treatment using BFST. This case study is limited by its lack of biomedical validation, as no physiological measures were used to assess inflammation or reproductive health markers. Additionally, future research should incorporate biomedical assessments (e.g., hormone levels, inflammatory markers) and interdisciplinary collaboration with reproductive health professionals to strengthen the integration of BFST into comprehensive treatment models for chronic gynecological conditions. 

Moreover, the case study underscores the need for nuanced approaches to emotional coaching, particularly in collectivist cultures. Therapists must navigate cultural expectations sensitively, balancing differentiation of self with familial obligations. “Machismo,” “Marianismo,” “Familismo,” and other cultural concepts were not explored as part of the case study to see the impact these additional concepts might have influenced the multigenerational transmission process, nuclear family emotional process, family projection process, sibling position, emotional cutoff, triangulation, and societal emotional process of BFST outcomes in this case study [17,18].

This case study illustrates that addressing chronic illness solely through a medical model may overlook key emotional and systemic factors that contribute to health outcomes. By integrating BFST into reproductive health care, clinicians can adopt a more holistic, patient-centered approach that may acknowledge the complex interplay between emotional, familial, and physiological health. While promising, further research is necessary to establish the full potential of systemic therapy in influencing chronic illness outcomes beyond traditional medical interventions. 

This case study highlights the potential of BFST, delivered via telehealth in Spanish, to overcome logistical and cultural barriers while fostering emotional regulation and increasing Differentiation of Self. While promising, the findings emphasize the need for further research into cultural influences, complementary practices, and physiological measures. To move beyond a solely medical approach, future research should expand on the intersection of family systems therapy, reproductive health, and chronic illness by integrating physiological measures and interdisciplinary care models. By fostering collaboration between family therapists, gynecologists, and endocrinologists, systemic therapy can become a vital component of holistic reproductive care. By fostering collaboration between family therapists, gynecologists, and endocrinologists, the long-term impact of systemic therapy on reproductive outcomes can be more rigorously explored.

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