Journal of Family Psychotherapy

ISSN: 0897-5353 (Print) 1540-4080 (Online) Journal homepage: https://www.tandfonline.com/loi/wjfp20

Multifaith Perspectives on Family Therapy Models

Christie Eppler, Rebecca A. Cobb & Elisabeth Esmiol Wilson

To cite this article: Christie Eppler, Rebecca A. Cobb & Elisabeth Esmiol Wilson (2020)
Multifaith Perspectives on Family Therapy Models, Journal of Family Psychotherapy, 31:1-2,
1-35, DOI: 10.1080/08975353.2019.1695092

To link to this article: https://doi.org/10.1080/08975353.2019.1695092

Published online: 21 Nov 2019.

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JOURNAL OF FAMILY PSYCHOTHERAPY
2020, VOL. 31, NOS. 1–2, 1–35
https://doi.org/10.1080/08975353.2019.1695092

Multifaith Perspectives on Family Therapy Models

Christie Epplera, Rebecca A. Cobba, and Elisabeth Esmiol Wilsonb
a
Couples and Family Therapy, Seattle University, Seattle, WA, USA; bClinical Training, Marriage and
Family Therapy, Pacific Lutheran University, Tacoma, WA, USA

ABSTRACT KEYWORDS
Researchers used thematic analysis to identify participant per- Spirituality; religion; systems
therapy; Bowen family
ceptions of the alignment between their faith traditions and therapy; narrative family
family systems theory, structural family therapy, Bowen’s multi- therapy; structural family
generational theory, and narrative family therapy. Thirty-seven therapy
participants from six faith orientations, including 20 denomi-
nations or sects, responded to a survey. Patterns across
responses indicate that family systems theory concepts are
compatible across diverse faith traditions. Structural family
therapy’s emphasis on restructuring boundaries and hierarchy
is compatible across faith traditions as long as cultural and
religious norms are carefully considered. Bowen’s concepts of
detriangulation and differentiation are compatible across faith
traditions, but particular beliefs may contradict the transmis-
sion of family patterns. Core concepts of narrative family ther-
apy are compatible across faith traditions as long as therapists
honor intuitive processes, include stories from clients’ faith
traditions, and do not instill stories of false hope. Regardless
of model, some clients may resist definitions of psychological
dysfunction and understand illness and change as
supernatural.

Understanding the faith-based beliefs of clients and incorporating their

religious or humanistic spirituality into therapy enhances culturally attuned
therapeutic practice (Aponte, 2002; Dansby, Hayes, & Schleiden, 2017; Haug,
1998; Knight, Wilson, Ward, & Nice, 2019; Wilson & Nice, 2018). Faith
traditions guide meaning- and decision-making, which affects presenting
problems, and provide clients sources of resilience (Larner, 2017;
Marterella & Brock, 2008; Telfener, 2017; Walsh, 2009). Additionally, faith-
based precepts, rituals, and stories can be the basis of successful clinical
intervention (Coffey, 2002; Coyle, 2017; Errington, 2017; Rootes,
Jankowski, & Sandage, 2010; Walsh, 2009; Wilson, 2015). Many clients prefer
therapists who are aware of their religious or spiritual beliefs (Errington,
2017; Walsh, 2010).
Given the importance of faith in client systems, the American Association
for Marriage and Family Therapy (AAMFT) core competencies (American
Association for Marriage and Family Therapy [AAMFT], 2004; 1.2.1, 4.4.1)

CONTACT Christie Eppler epplerc@seattleu.edu Seattle University, 901 12th Ave, Seattle, WA, 98122-1090
© 2019 Taylor & Francis Group, LLC
2 C. EPPLER ET AL.

and code of ethics (AAMFT, 2015) direct clinicians to recognize religion and
organized belief systems as important dynamics in treatment. The benefit of
translating clients’ spirituality or religious constructs into clinical practice is
well documented (Anderson & Worthen, 1997; Coffey, 2002; Coyle, 2017;
Errington, 2017; Keeling, Dolbin-MacNab, Ford, & Perkins, 2010;
McGoldrick, Preto, & Carter, 2015; Stander, Piercy, MacKinnon, &
Helmeke, 1994; Walsh, 2010). There is also a wealth of information on the
intersections of faith traditions and family therapy (see Blanton, 2002, 2007;
Carlson, 2000; Carlson, McGeorge, & Toomey, 2014; Carneiro, 2013;
Daneshpour, 2017; Frame, 2000; Gehart & Paré, 2008; Grams, Carlson, &
McGeorge, 2007; Haque, 2018; Helmeke & Bischof, 2007; McNeil, Pavkov,
Hecker, & Killmer, 2012), as well as guidance for incorporating spiritually
integrated interventions into clinical practice (see Bermúdez & Bermúdez,
2002; Eppler, 2018; Helmeke & Sori, 2006a, 2006b; Hodge, 2005; Hoogestratt
& Trammel, 2003; Wilson, 2018).
However, many therapists report a lack of understanding regarding the
alignment between clients’ faith and clinical work (Carlson, McGeorge, &
Anderson, 2011; Errington, 2017; Trepper, 2002). Discussions involving faith
can be difficult for therapists (Helmeke & Bischof, 2007; Williams-Reade,
Lobo, & Gutierrez, 2018). These conversations are often seen as taboo and
religious constructs do not appear to align well with evidence-based practice
(Coffey, 2002; Errington, 2017). Oftentimes, the therapist’s discomfort with
religious-oriented discussions subverts integrating a client’s religion in clin-
ical practice (Errington, 2017; Griffith & Rotter, 1999; Yeo Jin & Miller,
2010). Accordingly, AAMFT clinical members reported that they favor inte-
grating spirituality, a focus on meaning, interconnections, and belief in
something larger than one’s self, rather than incorporating religious beliefs
in therapy (Carlson, Kirkpatrick, Hecker, & Killmer, 2002). Yet, therapists
must overcome their own discomfort and learn to successfully integrate
discussions of faith in ways that are most fitting for their clients. AAMFT
core competencies (AAMFT, 2004) guide therapists to recognize systemic
and contextual dynamics (1.2.1), such as how family functioning is guided by
the family’s spiritual or religious beliefs. An increased understanding of
clients’ belief systems increases the likelihood that therapists will incorporate
clients’ faith into clinical practice (Williams-Reade et al., 2018). Increasing
client-centered work by discussing clients’ faith may assist in strengthening
the therapeutic alliance, a critical component in therapeutic work (Sprenkle,
Davis, & Lebow, 2009).
Therapists are encouraged to learn about clients’ religious traditions (Duba
& Watts, 2009; Keeling et al., 2010) and to gain knowledge from extant
literature, mentors, and experiences (Cobb, Priest, & Strachan, 2017). This
information allows therapists to contextualize specific religious teachings and
their influence (e.g., the relationship between a family’s understand of Islamic
 JOURNAL OF FAMILY PSYCHOTHERAPY 3

teachings and their family structure) while simultaneously honoring client

values and traditions (Abbott, Springer, & Hollist, 2012; Knight et al., 2019).
An enhanced understanding of the intersections among various faith tradi-
tions and family therapy models may promote increased cultural competence
in clinical practice.
Systemic therapy models, sometimes referred to as family therapy theories,
are familiar and primary ways in which family therapists conceptualize
clinical work. A therapist’s theoretical orientation frames their understanding
of presenting problems, constructs that are important in family functioning,
and interventions used to ameliorate undesired symptoms. Sprenkle and
Blow (2004) suggested that there is a confluence of common and specific
factors, such as client/extratherapeutic events and the therapeutic relation-
ship, and therapeutic models or theories, which affect treatment outcomes.
Religious faith and inner strengths of clients are specifically identified as
examples of client/extratherapeutic factors (Blow & Sprenkle, 2007).
Accordingly, an enhanced understanding of the ways in which systemic
therapies align with particular faith traditions may increase a therapist’s
ability to build rapport, support clients’ strengths that are rooted in faith
and/or spirituality, and incorporate other aspects of client centered, spiri-
tually-integrated care.
AAMFT core competencies (AAMFT, 2004) encourage therapists to
choose a theoretical frame that is most effective for alleviating presenting
problems (3.1.1). Blow, Sprenkle, and Davis (2007) proposed that therapists
should be familiar with several family therapy models in order to adapt to the
client’s needs. Therefore, understanding the alignment between different
family systems models and various faith traditions may lead to more delib-
erate theory selection for increased client-centered work.
Systemic theoretical literature examines clinical faith integration from
Buddhist (Gehart & Paré, 2008; Stewart, 2014), Catholic (Bermúdez &
Bermúdez, 2002), Christian (Blanton, 2002, 2007; Carneiro, 2013;
Morningstar, 2010), Hindu (Karuppaswamy & Natrajan, 2005), Islamic
(Abbott et al., 2012; Daneshpour, 2017; Hall & Livingston, 2006; Haque,
2018; Springer, Abbott, & Reisbig, 2009), and wider socio-cultural perspec-
tives that emphasize religion as an important dynamic (McDowell, Knudson-
Martin, & Bermúdez, 2018). More specifically, researchers have considered
how particular faith traditions intersect with some family therapy models.
Rootes et al. (2010) examined how Bowen’s emphasis on values and meaning
fits with the experience of spiritual but not religious clients. Lee (2002)
related Satir’s congruence with spirituality utilizing theologian Paul Tillich’s
framework. Whitaker speaks about the influence of Tillich’s work on his own
experiential approach to therapy (Whitaker, 1989). Blanton (2002, 2007))
explored how Christian prayer, meditation, and spiritual direction intersect
with narrative family therapy. Morningstar (2010) described the ways in
4 C. EPPLER ET AL.

which Biblical stories have been used in narrative treatment. Additionally,

Bermúdez and Bermúdez (2002) detailed the narrative intervention of mak-
ing altars to re-story grief narratives with Latinx families, highlighting the
significant ritual in the Catholic tradition. However, the majority of existing
literature lacks religious diversity and is primarily rooted in Christian theol-
ogy or broader concepts of spirituality.
To date there has not been an empirical study where faith practitioners
with advanced knowledge of their tradition provide input on how family
therapy models support or contradict their faith-based precepts. Given the
call to hear directly from faith practitioners regarding their experiences, the
researchers created a qualitative study to explore how people of various faith
orientations respond to family therapy models. Participants explicated how
they saw connections and disconnections between their faith tradition and
systems theory, structural family therapy, Bowen’s multigenerational theory,
and narrative family therapy. Findings provide insight on ways in which
systemic treatment fits with various faith traditions by considering: Where do
faith-based principles, beliefs, and values converge and diverge with
a systems orientation and three family therapy models? For this study, faith
traditions or orientations are used interchangeably to denote organized
expressions of shared beliefs. These terms are used instead of religion,
a term that may not include all faith-based traditions, and spirituality,
which does not connote an organized set of communal beliefs (Wilson,
2016a, 2016b).

Method
The researchers used qualitative methodology (Creswell, 2014) to conduct
a thematic analysis (Braun & Clarke, 2006; Clarke & Braun, 2013; Guest,
MacQueen, & Namey, 2012). They surveyed 37 faith practitioners from six
faiths who self-reported advanced knowledge of their tradition. Participants
interpreted family therapy models through their knowledge and experience.
They responded regarding fit among their faith tradition and family systems
theory, structural family therapy, Bowen’s multigenerational theory, and
narrative family therapy. No participants indicated they were family thera-
pists, although several mentioned past or present employment in mental
health-related professions (e.g., chaplain, counseling or private practice in
a place of worship).

Participants
The researchers recruited participants aged 18 and over who self-identified as
persons of faith with advanced knowledge of their tradition. Advanced
knowledge was loosely defined intentionally to promote inclusion by not
 JOURNAL OF FAMILY PSYCHOTHERAPY 5

privileging one definition of faith leader (e.g., attending graduate school or

seminary, being ordained as a monk, elder, or lay minister). The researchers
chose not to include a survey question about leadership roles to include
participants who had knowledge of their tradition but were not currently
serving in a place of worship (e.g., academics) and to avoid minoritizing
participants in communal and non-hierarchal faith traditions. Through self-
report, participants identified their faith tradition, years in the tradition, level
of formal or informal education or experience in the tradition, current
vocation, age, gender, and ethnicity.
Thirty-seven participants represented six faith traditions, including Bahá’í
(2.7%), Buddhism (8.1%), Christianity (54.1%), Hinduism (2.7%), Islam
(10.8%), and Judaism (21.6%). Open ended self-reports on denominational
sects included: Bahá’í (n = 1), Buddhist (n = 1), Shambhala Buddhist (n = 2),
Anglican (n = 1), Christian Anglican/Church of England (n = 1), Christian
Orthodox (n = 1), Community of Christ (n = 1), Church of England (n = 1),
Episcopalian (n = 2), Lutheran (n = 1), Lutheran – E.L.C.A. (n = 2),
Mormon – Latter Day Saint (n = 1), Presbyterian Church – U.S.A. (n = 5),
Roman Catholic (n = 3), United Church of Christ (n = 1), Hindu (n = 1),
Islam (n = 2), Muslim (n = 2), Jewish (n = 4), Conservative Judaism (n = 1),
Orthodox Jewish (n = 1), and Reform Jewish (n = 2). See Mabry (2014) for
an overview of these faith traditions.
Fifty-seven percent of participants were female (n = 21) and 43% were
male (n = 16). No participants indicated transgender, gender fluid, or non-
binary. Their ages were: 18–24 (n = 2), 25–34 (n = 4), 35–44 (n = 7), 45–54
(n = 9), 55–64 (n = 10), 65–74 (n = 3), and 75–84 (n = 2). Per open-ended
self-report, participants’ race/ethnicities included: Asian-American (n = 1),
South Asian (n = 1), Southeast Asian (n = 1), Hispanic/Latino (n = 1), Jewish
(n = 2), and Caucasian/European/White (n = 19). Twelve did not report race/
ethnicity.
Seven participants indicated having 11–20 years of experience in their faith
tradition, three indicated 21–30 years of experience, and 27 indicated over
30 years of experience. Participants’ experiences in their faith tradition
included: graduate training (n = 31) and informal instruction under trained
and authorized religious teachers (n = 5). One participant did not respond.
Thirty-two percent (n = 12) indicated ordination (i.e., elder, lay priesthood,
monk). When asked, “How long has it been since you completed your formal
or informal education,” nine indicated five years or less, 10 indicated
6–10 years, two indicated 11–15 years, four indicated 16–20 years, 11 indi-
cated 21 years or more, and one did not respond. When asked, “What is the
context of your current vocation,” five indicated ‘academia,’ six indicated
‘place of worship,’ 25 indicated ‘other’ (i.e., wrote-in corrections facility,
health care setting, hospital, meditation center, writer, or retired), and one
did not respond.
6 C. EPPLER ET AL.

The distribution of faith traditions represented is slightly more diverse

than the general population within the United States (Pew Research Center,
2018): Christian (70.6%), Jewish (1.9%), Muslim (0.9%), Buddhist (0.7%),
and Hindu (0.7%). Yet, not all religions or various expressions within faith
traditions are represented. Moreover, there are vast variations within tradi-
tions and participants do not speak for an entire faith tradition. This con-
venience sample is not representative or generalizable beyond these
participants, per qualitative assumptions (Creswell, 2014). Social location
and intersectionality of age, experience, gender, immigration sexual identity,
among other factors, influence the experience of religion (McGeorge,
Carlson, & Toomey, 2014). For some, faith and culture are inextricable
entities that are impossible to parse.

Procedures
Using primary sources and family therapy texts (i.e., Gehart & Tuttle, 2002;
Wetchler & Hecker, 2015), the first author and a research assistant wrote
summaries of the models for the survey. The second author and four licensed
marriage and family therapists with doctoral degrees and experience teaching
family therapy theories and models reviewed the summaries and offered
feedback. Revisions were incorporated and a Qualtrics survey was created.
The survey explicated systems theory (Hecker, Mims, & Boughner, 2015) and
three family therapy models: structural family therapy (Minuchin, 1974),
Bowen’s multigenerational family theory (Bowen, 1978), and narrative family
therapy (White & Epston, 1990). The models were selected by the researchers
to represent major developments within systemic treatment. Structural ther-
apy was selected due to its foundational and theoretical underpinnings in the
field of marriage and family therapy, Bowen’s theory was selected to repre-
sent a traditional transgenerational theory, and narrative therapy was selected
to represent a post-modern approach.
The first and second authors’ Institutional Review Board (IRB) approved
exemption from review. To recruit participants, the researchers emailed
listservs, posted online (e.g., Facebook), and sent colleagues a call for parti-
cipants, which included a link to informed consent and the Qualtrics survey.
Participants received no compensation for their participation. All responses
were reported anonymously. Participants were offered the option of provid-
ing contact information in order to review the manuscript and offer feedback
upon completion. Participant recruitment continued as the researchers ana-
lyzed the data. The link to the survey site remained open and coding
continued until themes reached saturation (Creswell, 2014). Participants
were excluded from the study if they did not meet inclusion criteria (e.g.,
under 18) and if they did not submit complete responses for a minimum of
one model.
 JOURNAL OF FAMILY PSYCHOTHERAPY 7

Of the 37 participants included in the study, 27 completed the entire

survey. After participants signed an informed consent, they read
a description of family systems theory, structural therapy, Bowen’s multi-
generational theory, and narrative family therapy. The following provides an
overview of each theory or model and indicates the assumptions, terms, and
interventions highlighted in the survey.

Family systems theory

Family systems theory’s clinical focus is on relationships and context.
According to this perspective, people are interconnected and individuals
are best understood by assessing interactions among family members
(Hecker et al., 2015). Additionally, relationships (e.g., couples, families) are
more than the sum of their parts and are best understood within context. For
example, a client’s identified problem is often not simply a symptom of
individual maladjustment, history, or psychosocial development. Rather, it
is frequently a symptom of systemic functioning. Accordingly, couple and
family therapists examine context and patterns (e.g., reciprocal causality)
when assessing and treating client systems.

Structural family therapy

Structural family therapy provides a framework for therapists to understand
families by observing a system’s structure. The therapist, who takes
a directive leadership role, may map family structure by exploring rules,
roles, boundaries, and hierarchies (Durtschi & Wetchler, 2015; Minuchin,
1974). Assessment questions may include: What is each member’s position in
the family? Who makes decisions? Are there coalitions? Are family members
enmeshed (too close) or too distant? How do these boundaries affect func-
tioning? The therapist identifies goals based on family structure (e.g., break-
ing ineffective patterns, helping the family create clear and effective
boundaries, defusing power, establishing a clear hierarchy). Modifying
these interactional patterns creates change and can ameliorate presenting
problems.

Bowen’s multigenerational theory

Bowen’s multigenerational family therapy theory views the family as an
emotional unit where patterns are observed across generations (Bowen,
1978; Ramisch & Nelson, 2015). According to this perspective, healthy
individuals and families maintain higher levels of differentiation, or the
ability to maintain a sense of self that balances emotional expression, rational
thought, individuality, and connectedness. When those who have lower
differentiation are faced with systemic anxiety, they may respond by either
fusing with the family and losing themselves in the process or cutting off
from the family physically or emotionally. Family members may also attempt
8 C. EPPLER ET AL.

to reduce anxiety by triangulating others in their disputes or placing focus on

another family member to reduce focus from a concerning issue. Therapists
utilizing this theoretical approach work with families to build healthy emo-
tional bonds, detriangulate, and increase levels of differentiation throughout
the system.

Narrative family therapy

The goal of narrative family therapy is for therapists and clients to co-
construct new, preferred realities and healthy outcomes. This is done by
telling and retelling stories that discover strengths and conceptualize pro-
blems in new ways (Rambo & Boyd, 2015; White & Epston, 1990). It is based
on the assumption that family stories are influenced by the dominant culture
and may become problem-saturated. Therapists work collaboratively with
families to explore landscapes (internal and external actions, beliefs, and their
consequences), map the context of problems, and create unique outcomes by
utilizing metaphors, externalizing the problem, and deconstructing social
discourses that have affected family functioning.

Survey
The summaries, expanded yet similar to the ones listed above, were each
followed by the preliminary question, “Do you think this theory would be
useful for therapists working with families from your faith tradition?”
Responses were made on a 7-point Likert scale, with 1 indicating “extremely
useful,” 2 indicating “moderately useful,” 3 indicating “slightly useful,” 4
indicating “neither useful nor useless,” 5 indicating “slightly useless,” 6
indicating “moderately useless,” and 7 indicating “extremely useless.”
Following this one quantitative response, participants were prompted to
respond to three qualitative, opened-ended questions: “After reading about
this theory, how do the major concepts and assumptions fit with your faith
tradition?” “What stories, sacred texts, rituals, metaphors, symbols from your
tradition illustrate tenets of this theory?” “Are their disconnections? If so,
please explain.” At the end of the survey, there was one open-ended question
for participants to write additional information that was not included in their
answers to previous questions. Survey responses each averaged about two
pages of single-spaced typed text.

Researchers as instrument
The researchers are cis-female, European-American, heterosexual faculty in
programs accredited by the Commission on Accreditation for Marriage and
Family Therapy Education (COAMFTE). The first and second authors work
at a Jesuit university in a School of Theology and Ministry, where ecumenical
and multifaith dialogue are prioritized, and students are trained to integrate
 JOURNAL OF FAMILY PSYCHOTHERAPY 9

clients’ faith traditions upon request. The third author teaches at

a historically Lutheran University. All three authors hold advanced degrees
in marriage and family therapy. The third author also holds an advanced
degree in spiritual formation. The first and third authors are progressive
Christians; the second author is Agnostic. The graduate student who assisted
with writing the survey and coding is a cis-female, European-American, and
Presbyterian. As clinicians, researchers and authors, we believe that under-
standing the faith orientations of clients is a critical component of culturally
competent care. We acknowledge that our own social locations affect our
understanding of the extant literature and this study’s data analysis.
Throughout the study, we reflected on and discussed our own assumptions
and biases regarding the intersection of family therapy models and faith
traditions.

Data analysis
Thematic analysis is a qualitative method where researchers identify, exam-
ine, and name themes within parts or the whole of a data set (Braun &
Clarke, 2006; Clarke & Braun, 2013; Guest et al., 2012). This method differs
from phenomenology’s descriptions of participants’ views of their lived
experiences and grounded theory’s outcome of model building (Braun &
Clarke, 2006). For this study, we generated themes by examining partici-
pants’ responses to each family therapy model presented. Braun and Clarke
(2006) example where they subdivided a data set to examine physician-only
responses influenced this design.
This study’s thematic data analysis began when researchers read and
reread participants’ responses, reflexively recording their impressions, or in
qualitative terms, they soaked themselves in the data (Creswell, 2014). The
first two authors and a graduate assistant began coding after receiving 26
completed surveys. They divided the surveys into four sections, one for each
theory. Independently, these coders read each survey line-by-line to generate
initial codes. For example, words from the faith tradition or the family
therapy models became codes if there were mentioned multiple times by
participants. Important words or phrases were highlighted (e.g., ethics, aligns
with the ritual of, our sacred text illustrates).
The initial coders met together four times, one meeting per model, to
group the initial codes into themes (e.g., challenging hierarchy and ethics,
which were ruled out as themes). They discussed their processes and shared
how they approached the data. One coder began by grouping data sets by
faith orientation, another examined the data as a whole, and a third divided
the data by family therapy model. Collaboratively, the researchers decided
that the data’s meaning was best telegraphed by using themes identified
within each of the models. Continuing the coding process, the coders
10 C. EPPLER ET AL.

considered and discussed contextual factors, such as how social locations of

the participants and researchers influenced the meaning and interpretation of
codes and themes.
After tentatively formalizing themes for each theory or model, the third
author, who had not been involved in the previous coding meetings, read the
surveys and compared her analysis to the proposed themes. Using established
themes while considering new ideas, the team coded the additional surveys
that had been collected after initial analysis and reviewed the surveys already
analyzed. We debated additions and ruled out themes that did not pinpoint
the participants’ meanings. When no new themes emerged, we determined
that the themes were saturated (Creswell, 2014). We met again to identify
salient direct quotes to illustrate the finalize themes. Participants were offered
the opportunity to review the final manuscript and provide feedback; one
participant took this opportunity, expressed enjoyment of the paper, and
suggested no changes.

Findings
In Table 1, we indicate the themes that were established for each of the four
therapeutic models based on participant survey responses. The themes high-
light model characteristics that resonated with participants as connecting or
not connecting with their faith traditions. We explore the therapy models

Table 1. Overview of themes.

Systemic Theory
Theme 1: Individuality embedded in interconnectedness
Theme 2: Reciprocity and transformation
Theme 3: Disconnections with systems theory
Structural Family Therapy
Theme 1: Degrees of inclusive connectivity
Theme 2: Honoring and challenging boundaries and patterns
Theme 3: Honoring and challenging hierarchy
Theme 4: Reframing for growth and change
Theme 5: Disconnections with structural family therapy
Bowen’s Multigenerational Family
Therapy
Theme 1: Differentiation that enables connection
Theme 2: Honoring multigenerational hierarchies and structures
Theme 3: Transmission of family patterns
Theme 4: Detriangulation
Theme 5: Disconnections with Bowen’s multigenerational family
therapy
Narrative Family Therapy
Theme 1: Using stories to create meaning
Theme 2: Externalization
Theme 3: New possibilities through reframing and re-storying
Theme 4: Disconnections with narrative family therapy
 JOURNAL OF FAMILY PSYCHOTHERAPY 11

and their related themes in more detail below by abstracting survey quota-
tions that have been edited to improve readability.

Multifaith perspectives on family systems theory

Participants described a fit between their faith tradition and family systems
theory’s emphasis on interconnection. They also highlighted the influence of
their faith culture and community on issues within the family. When asked
about disconnections between their faith and family systems theory, some
participants shared skepticism of psychological explanations of suffering.

Individuality embedded in interconnectedness

Participants across faith traditions perceived compatibility between family
systems theory and their faith traditions, recognizing that their individual
personhood was embedded within an interdependent system of the indivi-
dual, family, community, and larger society. A Muslim said, “The Shari’a
emphasizes both the individual and the community,” and another Muslim
shared that “individuals are indeed interconnected. Islam focuses on healthy
relationships between family members. It encourages parents, children, and
couples to fulfill each other’s rights and to always be kind to each other.” This
respondent then concluded by indicating that family systems theory and
Islam were consistent in that both focus on the “betterment of the family.”
Other respondents spoke of how their faith communities resembled
families. A Jewish participant explained that “Judaism emphasizes the link
between generations and the tradition passed down from God to Moses and
to each individual in the chain. There is a kind of generation system similar
to family systems [theory].” A Roman Catholic shared that a “Parish or
congregation [may be viewed] as a ‘family system,’” and a Presbyterian stated
that “the governance of the Presbyterian Church operates in a system, much
like a family, with each member taking on certain roles in the church
according to their gifts and abilities.” Likewise, an Anglican described inter-
connection, a key component in systems theory, as “the idea of family and/or
church as being interrelated,” emphasizing that “the body of Christ” is
a community “where each has a part to play and where each affects others
and is jointly responsible for the wellbeing of others and the whole.” This
sense of faith community members having mutuality was echoed by
a Latter Day Saint (LDS) participant who shared that “if one person does
not do their part, everyone else has to pick up the pieces. … No one is more
important than another, and everyone contributes.”
Some participants extended the interrelatedness of individuals and com-
munity, important constructs in systems theory, to the theological concept of
salvation. An Anglican, for example, offered the following insight: “There
remains an emphasis on the individual’s experience and responsibility. In the
12 C. EPPLER ET AL.

general confession, we admit that we have sinned, which implies both

corporate or collective patterns of sin and also individual shortcomings.”
An Orthodox Jew indicated that “We are part of our families and commu-
nities. Thus, our prayers are in the plural, and our ‘salvation’ is communal. …
There is no such thing as an individual apart from a context.” Likewise,
a Lutheran shared that “confession is communal. Faith can only be lived in
community. … Yet, we are also individuals in the face of God. But as such,
we are influenced by communities.”
Participants from Eastern traditions referred to interconnectedness more
generally, without specific reference to the individual, family, or religious
structures. A Shambhala Buddhist stated, “It is not really possible to identify
a discrete causal factor for any phenomenon … . systems theory at least
implies this intrinsic connectivity.” Another Buddhist said, “Dependent ori-
gination – everything is arising in this moment interdependently,” and
another similarly shared, “Reciprocal causality [intersects] with Buddhist
teachings on interdependent origination … as well as shifting away from
individuality, which mainly is illusory according to Buddhist teachings.”
A Hindu participant explicitly highlighted connectivity to larger systems,
stating that “the most important consistency is the fact that we are all
interconnected and interdependent, not just to each other but to all of
those around us, and to nature itself.”

Reciprocity and transformation

Participants discussed the reciprocity of personal choice and collective action,
key ideas within systems theory. They emphasized the importance of reci-
procal relationships that transform through kindness, teaching, volunteering
together, taking individual responsibility, pursuing shalom, making good
decisions, and considering others’ experiences and contexts.
Some participants sketched out broad faith patterns of collective recipro-
city. An Episcopalian, for example, spoke of the reciprocal relationship
between God and faith communities, stating that “God’s promises were
handed out to families and nations, not individuals. … God’s faithfulness is
always explained in the context of a larger family dynamic, one that is
undermined by the actions of individuals but has causation in family
dynamics.” A Buddhist reflected on aspects of Buddhist practice that assist
in understanding relational impact and cultivating kindness, highlighting the
concept of “transmission” as an “aspect of practice that lends understanding
into family systems. … transmission is always occurring … from one gen-
eration to the next, and leaves room for merciful kindness.”
Several participants discussed the impact of an individual on the collective.
An Orthodox Jew, for example, shared about the power of one to influence
many: “Our mystical tradition sees this truth as empowering every one of
us … to change the entire cosmos, all of history, simply by a single spiritual
 JOURNAL OF FAMILY PSYCHOTHERAPY 13

action, even an internal attitude.” Others more specifically reflected on

individual responsibility within their communities, like an LDS participant
who explained that “the LDS Church largely has a lay clergy, meaning
everyone is required to volunteer in order for the Church to work.”
A Buddhist reflecting on Karma shared, “We are responsible for our indivi-
dual actions knowingly or unknowingly. Through … ‘being mindful’ one is
able to deepen self-understanding [of] intention behind actions and move
toward aspects of non-harm: kindness, gentleness, caring, heartfulness.”

Disconnections with family systems theory

Participants offered disconnections that were not particularly germane to
family systems theory. Instead, participants identified disconnections with
therapy at large. A Roman Catholic shared, “Where symptoms such as
alcoholism, depression, or poor performance are seen as sin rather than
psychological dysfunction, there can be resistance to the notion that therapy
can or even should be effective.” Another Roman Catholic suggested that
therapy might focus too much on the dysfunction, or sin, instead of on
“wholeness, grace, reconciliation, and blessing.” An Anglican who hypothe-
sized that “it would be easy to characterize family therapy approaches to
individual behaviors as pointing to family or social dis-ease, and it’s a small
step then to avoid admitting personal responsibility,” went on to name
a faith-based solution: “I suppose that a Christian response is to encourage
admitting responsibility to individual sins of commission or omission, while
recognizing that God understands all extenuating circumstances.”
Others discussed the value of their religion over therapy in the context of
problem solving. A Muslim shared, “If a person truly follows his/her religion,
then they can deal with these problems on their own just by working on
themselves or understanding the religion in depth.” A Conservative Jewish
participant likewise offered that instead of therapy, families “often look to
their faith community for support and guidance.” Such comments reflect an
area of possible disconnection in which some religious clients may resist
understanding problems and solutions through psychological explanations.

Multifaith perspectives on structural family therapy

Thirty-five participants responded to the question, “Do you think this theory
would be useful for therapists working with families from your faith tradi-
tion?” Of those who responded, the majority indicated that structural theory
would be “extremely useful” (42.86%) or moderately useful (48.57%). One
indicated that it would be “slightly useful” (2.86%), and two indicated it
would be “neither useful nor useless” (5.71%). No participants indicated that
structural theory would be “slightly useless,” “moderately useless,” or “extre-
mely useless.”
14 C. EPPLER ET AL.

Qualitatively, participants described a fit between their faith tradition and

structural family therapy’s emphasis on connectivity. They spoke about how
their traditions embrace and push back against established patterns, bound-
aries, and hierarchy. They also explained that there may be complications
when challenging cultural structural norms.

Degrees of inclusive connectivity

The theme of inclusive connectivity, which was endorsed across faith tradi-
tions, highlights the degrees to which people are invited and even responsible
to connect with each other and/or the world. After reading about structural
therapy, an Anglican described “church/community as family,” which was
a view shared by many participants. A Muslim articulated this sense of
connection between faith community members as like “a body – if any part
of the body hurts, the whole body suffers.” Likewise, a Jewish participant
noted, “All Jews are a family and all Jews are responsible for one another …
we pray in the plural.” A Roman Catholic also spoke of family in the context
of structural theory, noting that “family roles may be compared to the
various vocations within the church, and how different charisms have to
engage with one another while promoting life-giving boundaries.”
Some participants directly linked their faith practices to structural family
therapy’s focus on interconnectivity, including a Presbyterian who explained
that rituals such as “the sacraments of Baptism and Communion … are
designed to invite the entire community into a shared experience.” Another
participant explained that in the United Church of Christ (UCC), “commu-
nion reimagines the altar of the Old Testament as a dinner table in the new
life in Christ. Everyone is invited to this table and every voice should be
heard.” A participant from the Church of England connected this kind of
view to their church’s history, noting that they “gathered and traveled
together … built cities together and cared for each other.”

Honoring and challenging boundaries and patterns

Structural family therapy emphasizes clients’ relationships to boundaries, and
participants across faith traditions named support for honoring traditional
roles, rules, boundaries, and patterns within systems. For example, an LDS
participant wrote, “The LDS Church is very organized. … Structural family
therapy would fit right in line with their organized nature.” A Jewish parti-
cipant spoke more specifically on rules and boundaries, saying, “In my
experience, Jews tend to understand the world through rules and boundaries,
more so in more traditional Jewish circles.” A Buddhist likewise explained
that “the breakdown of boundaries supports the tendency to be stuck, and
overly fixed in one’s view of life and oneself.”
Other participants welcomed intentional challenges to traditional struc-
tures. Several Christian participants suggested that the way boundaries are
 JOURNAL OF FAMILY PSYCHOTHERAPY 15

presented in the Bible may in fact invite the need to challenge or right
boundaries (e.g., Jesus overturning tables at the temple). A Shambhala
Buddhist stated, “Sometimes a cognitive insight can open insights into
habitual patterns; however, it would be helpful if this occurs in a more
holistic approach to the insubstantial nature of fixed thought.” A Buddhist
stated, “It’s always good to challenge your frame of reality and look at
habitual patterns,” noting the potential benefit of challenging existing
patterns.

Honoring and challenging hierarchy

Across faith traditions, participants identified ways to honor and challenge
hierarchy, another important characteristic of structural family therapy.
A Jewish participant reflected that “my tradition is often pretty hierarchical,
and I believe that people do respond to the therapist exercising authority.”
Likewise, several Anglicans recognized the role of authority in their faith
communities, with one sharing that “some Christians and other religious
people respond well to clear direction from an authoritative source and feel
comfortable with hierarchy,” and another noting that “Christ is the ‘head of
the church,’ and pastors/other leaders are heads of the congregation. Fathers
are often seen as default heads of the household.” Similarly, a Catholic
participant wrote, “Catholics are accustomed to hierarchical structures and
are often able to work within them without necessarily understanding or
approving of what is being asked of them.”
In contrast, several participants spoke about how their faith communities
viewed people at the bottom of hierarchies. A participant from the
Community of Christ indicated that “we frequently speak of the marginalized
and vulnerable – that Christ aligns himself particularly with that population,”
and a Presbyterian stated that “Jesus taught in parables and … consistently
taught a message that the weakest, poorest, most disadvantaged were to be
sided with and that they truly held the power of love.” A Community of
Christ participant extended this to feminism, explaining that “our more
feminist reading of the Hebrew Bible and New Testament supports the
equality of women and men in church, ecclesia, community, family, society,
etc.”
Furthermore, participants also welcomed taking action to address hierar-
chies. An Episcopalian stated, “I see shifting hierarchies and giving voice to
the voiceless in families to be on board with my faith tradition,” and another
Episcopalian indicated, “Jesus is very clear about hierarchy and how it stinks.
So, using this to shift power to weaker members I see as good.” A Roman
Catholic likewise wrote that “religious education may include ‘suggesting
alternative behaviors’ (e.g., promoting human dignity and protecting inviol-
able human rights).” In this context, a Jewish participant drew attention to
a historical example: “Sometimes an outside agent upsets the balance in
16 C. EPPLER ET AL.

a couple – like the messengers that visited Abraham and Sarah and
announced that she would have a child.”

Reframing for growth and change

More broadly, participants also articulated an appreciation for structural
family therapy’s emphasis on change through reframing perspectives. An
Orthodox Jew, for example, stated that “our tradition highly values learning,
growth, and change.” A Buddhist emphasized the importance of shifting
perception in order to promote growth, sharing that “One can be too fixed
in one’s internal identity, which provides an opportunity for one to free up
what is fixed, limiting. And preventing growth and movement in the rhythm
and natural flow of life.” Citing the Bible, a Church of England participant
spoke of changes in perception occurring by reframing: “[The] book of Jonah
[is] an exercise in reframing Israelite (and Christian) ideas about relations to
the Other, a sort of divine reframing of the scope of grace and mercy.” An
Anglican suggested more specifically that “reframing roles and responsibil-
ities and defining communication would be highly effective, especially since
the [Anglican] faith is so deeply rooted in values like humility, patience, and
respect. A new/fresh perspective would be well received.”

Disconnections with structural family therapy

Several participants noted that structural family therapy should not necessa-
rily be applied universally. A Presbyterian stated, “This theory may or may
not work in my faith tradition. I think the family members would have to
decide that.” Jewish participants did not identify disconnections, but one
mentioned that “this technique would not be ideal for every [client].”
Similarly, a Buddhist did not see a disconnection but noted that the client’s
situation would need to “be relevant.”
Other participants noted specific reasons that the challenging of cultural
norms by a structural therapist may be problematic, including in the context
of gender roles or among particular generations or cultural groups. For
example, a Muslim stated, “Sometimes Muslims tend to socialize more in
gender-segregated settings, which could be a problem when trying to imple-
ment [structural] theory.” A Church of Christ participant noted that “these
theories would be suspect in the eyes of most of the older congregation
members I know,” and a Roman Catholic shared that “some ethnic groups
who are traditionally Catholic – Italian and Irish ethnicities come to mind –
have fairly rigid notions of subsystems and how hierarchy within the family
should function. I would expect them to be more resistant.” Other partici-
pants discussed this in the context of parenting, as an Anglican cautioned,
“More traditional Christians may find it difficult to cope with restructuring,
especially of boundaries and rules or reimagining a strong-willed (disobe-
dient?) child as independent-minded.” Another Anglican shared that
 JOURNAL OF FAMILY PSYCHOTHERAPY 17

“undermining the authority of a parent, for example, could be rocky terri-

tory, or in some circles there could be resistance to flopping gender roles/
power.” Finally, a Muslim highlighted that while some members of their faith
community might object, structural theory was overall a good fit for the
Islamic faith:
If there were any objections by people of my faith tradition, they would only come
from conservative families who do not want a therapist to tell them what to do, or
people who may think such activities would waste time that they can spend in
religious practices. But these objections would be wrong because Islam is all about
kindness, helping your family, and being good to your children, wives, and parents.
I see no disconnections between my faith and this theory. This is a very productive
approach to solve current issues, most of which come from family problems.

Multifaith perspectives on Bowen’s multigenerational theory

Of the participants who responded (n = 30), the majority indicated that
Bowen’s theory would be “extremely useful” (43.33%) or moderately useful
(33.33%). Some participants indicated that it would be “slightly useful”
(16.67%) or “neither useful nor useless” (3.33%). One participant (3.33%)
indicated that Bowen’s theory would be “slightly useless,” and no participants
indicated that the theory would be “moderately useless” or “extremely
useless.”
Qualitatively, participants across faith traditions indicated support for
differentiation that enables connection, the honoring of multigenerational
hierarchies and structures, the transmission of family patterns, and detrian-
gulation, themes that are closely related to Bowen’s multigenerational family
therapy. Some participants, however, indicated the need for cultural under-
standing and sensitivity when using this theory and suggested using caution
when focusing on individualism and intellect.

Differentiation that enables connection

Differentiation as interconnected individuation resonated across diverse reli-
gious perspectives. A Lutheran stated, “Differentiation of self [is] a key goal
for transformation in both partners in a couple relationship,” and a Christian
Orthodox broadened differentiation to “the ability to be both an individual
and in community with others.” Some participants highlighted ways in which
differentiation allows for connection within both family and larger commu-
nities. A Presbyterian, for example, elaborated on how being “made in God’s
image” contributes to being embedded in community:
We are all part of the same family, but we carry uniqueness that God has given us.
This may help someone struggling with individuation if they realize that they are
meant to be an individual as much as they are meant to be in relationship with
each other.
18 C. EPPLER ET AL.

Several participants explicitly reflected on the compatibility of their faith

traditions with the concept of differentiation, including Buddhist and
Islamic participants who noted that differentiation enables connection
between different generations within their tradition. A Shambhala Buddhist
stated, “Differentiation of self while simultaneously preventing disconnection
from other sentient beings and not allowing any disconnect to transfer to the
next generation is a nice way to describe Buddhism.” A Muslim shared, “My
religion does not negate the biological fact that we adopt several character-
istics from our ancestors, but at the same time, it does focus on individuality,
how each individual is born alone and will die alone.”

Honoring multigenerational hierarchies and structures

Participants seemed to view Bowen’s multigenerational theory as potentially
supportive of the structures within their faith traditions regardless of whether
those structures were more or less hierarchical. In this context, a UCC
participant reflected that “my tradition [is] ‘bottom heavy.’ The church is
really run by the laity.” Other participants concentrated more on the relation-
ship between their faith communities and family structures. A Presbyterian
explained that “the Christian faith holds the family structure sacred and has
fears/joys related to this.” whereas a Muslim more specifically reflected on
the roles of parents: “The pivot of the family remains the parents. In Islam,
Mother is the third in the hierarchy after the God and the Prophet. Father is
fourth in the hierarchy. Any therapy that respects that will always help in
resolving conflict and anxiety situations.”

Transmission of family patterns

Participants across faith traditions also acknowledged the significance of
recognizing the transmission of family patterns. A Lutheran shared, “The
implicit value in the multigenerational approach [is] its focus on the
dynamics of family history and origin.” A Presbyterian similarly stated,
“This perspective fits with a multigenerational model where historical infor-
mation about the family is important to the understanding of the current
generation.” Likewise, a Bahá’í shared, “The understanding of our family
history and patterns seems very important to understand and to deal with
current issues that are being displayed.” And an Orthodox Jew more expli-
citly linked this theory to their faith, sharing, “We say in our prayers, G-d of
Abraham, Isaac, and Jacob, so we have a clear view of how generation is
important.”
Several participants from Christian traditions emphasized the importance
of understanding intergenerational patterns when addressing family pro-
blems. A Presbyterian stated, “The Bible is full of examples of generational
blessings and generational sin,” and an LDS member shared, “The Church
emphasizes the need to change unhealthy historical patterns in our families
 JOURNAL OF FAMILY PSYCHOTHERAPY 19

by developing healthy family traditions that support each member in the

family and emphasizes the importance of turning to God rather than man.”
A participant from the Community of Christ explained that “family mapping
[generational patterns] is both revealing and helpful, particularly in premar-
ital counseling.”
In addition, three Jewish participants, including one Reformed Jew and
one Orthodox Jew, referred to the intergenerational impact and transmission
of trauma. An Orthodox Jew explained that “we are aware that we carry our
parents’ and grandparents’ and great-grandparents’ experiences of the
Holocaust, anti-Semitism, immigration, and other traumas with us, as
families and as a community.”

Detriangulation
Many participants reflected on the appearance of relational triangles within
their traditions, on the importance of not creating unhealthy triangles, and
on the need to address problematic triangles before or after they form.
A Bahá’í’, for example, shared that triangulation “is something that we try
our best not to do as it can be a form of backbiting, which is very poisonous
for all involved,” and a Presbyterian reflected on a method of identifying
triangles before they form: “Genograms are helpful maps to show at a glance
the relationships/generations/triangles.”
Some participants considered triangulation in the specific context of
relationships with church leaders and teachers. A Mormon shared, “The
Doctrine and Covenants states that if we have a grievance with someone,
before we approach the Church leaders for help, we need to attempt to speak
with that person first.” Likewise, a Roman Catholic offered the following
insight on triangulation in the context of church leaders:
I think Catholics are particularly susceptible to the pitfalls of excessive triangula-
tion. They are encouraged to use the parish priest as confessor and confidant. This
is fine if the priest … has some training or natural ability in counseling, but too
often [the priest] … responds either by laying unreasonable expectations on the
individual or by encouraging overreliance on the relationship rather than encoura-
ging the person to interact with the family.

Similarly, another Roman Catholic simply stated that “detriangulation is parti-

cularly relevant [in] pastoral/ministerial relationships, addressing conflicts, etc.”
Conversely, participants also found useful examples of triangles in their
faith communities. A Presbyterian noted that “the holy trinity is perfect
example of a healthy triangle always in relationship but still with distinct
persons.” A Roman Catholic similarly highlighted the positive example of
a healthy triangle in the Christian tradition, sharing that “Christianity is
centered on the doctrine of a Triune God: Father, Son, Spirit – lover, the
beloved, and the fruit of the love between the lover and the beloved.”
20 C. EPPLER ET AL.

Disconnections with Bowen’s multigenerational theory

Several participants saw problems with Bowen’s precept that change occurs
when relationship patterns in one’s family of origin are understood and
challenged. In some instances, participants cited specific theological con-
cerns. An Anglican, for example, cautioned that “some Christians would
find the key concepts difficult to understand or might need help under-
standing patterns dealing with stress and anxiety, for example, seeing them as
patterns and habits, and not necessarily sinful.” Others articulated
a preference for letting go and accepting the state of things rather than
intellectualizing and seeking additional understanding. A Buddhist shared,
“At some point in one’s inner life there is a place and time to let go of trying
to figure things out. So that overthinking and intellectualizing at some point
may no longer be useful. One may arrive with clarity of heart/mind. Just as
there are times for therapy to end.” Another Buddhist shared, “I don’t really
think one can fully be rational and use one’s intellect to subdue emotional
reactivity. The absolute view in tantric Buddhism is that all emotions are
both endlessly painful but also the source of energy and power.”
Although some participants saw support in their faith tradition for the
transmission of family history and patterns across generations, several parti-
cipants were more skeptical, including a Presbyterian who shared the
following:

Because we consider ourselves “forgiven,” and that is the work of the Holy Spirit,
there could be some resistance to the idea that we still carry shadows, wounds, or
patterns from previous generations. Jesus is supposed to “fix” that and make us
whole.

Likewise, while one Muslim indicated that Bowen’s theory “can be useful to
some extent in managing relationships when people are less emotional,”
another Muslim directly questioned the transmission of emotion across
generations: “My religion … includes concepts that one can work on him-
self/herself to give this world the best of their personality … so to say
emotional problems adopted from the previous generation would remain is
wrong.” A Shambhala Buddhist addressed the generational aspect by offering
caveats: “It may be helpful to have some insight into family patterns, but
one’s very being is made possible by being born altogether, even into painful
circumstances.” Another Buddhist reflected, “Learning in relationship to this
faith tradition is to understand the patterns of familial suffering inwardly and
outwardly for the sake of freeing up from suffering, from resistance to the
way things are.”
Yet others saw a disconnect between their faith tradition and Bowen’s
theory by indicating that the transmission process seemed more related to
ethnic and national experiences than religious experiences. A Muslim shared,
“This is more relevant when discussing ethnic and national identity than
 JOURNAL OF FAMILY PSYCHOTHERAPY 21

religious identity. Often inter- and trans-generational familial issues unfold

in the context of cultural, especially ethnic and national, identities, and not
religious identities per se.” A participant from the Community of Christ
stated, “We may also fall into the American individualism trap, that some-
how our family histories do not determine/shape how we behave.” And
a participant from the Church of England reflected that “the sense of
British individualism would entail resistance [to this approach].”

Multifaith perspectives on narrative family therapy

Of the participants who responded (n = 30) to the question concerning
narrative family therapy, the majority indicated that it would be “extremely
useful” (63.33%) or moderately useful (23.33%). Some participants indicated
that it would be “slightly useful” (6.67%) or “neither useful nor useless”
(3.33%). No participants indicated that narrative family therapy would be
“slightly useless” or “extremely useless,” but one participant (3.33%) indi-
cated that it would be “moderately useless.”
In qualitative responses, participants indicated support for narrative ther-
apy’s use of language, stories, and metaphors. They explained that narrative
interventions, such as externalization and reframing, align with their faith
backgrounds, with the caveat that deconstruction should not excuse respon-
sibility. Some participants cautioned against the overuse of language and the
use of re-storying to replace stories that hold sacred meaning.

Using stories to create meaning

An array of participants reflected on the use of language, stories, and
metaphors in their traditions. A Muslim shared, “Qur’anic language is full
of narratological devices that model how to transmit these values in stories
and parables.” A Presbyterian similarly shared, “Jesus, at the center of the
church, is the ‘word’ of God. This means the logic of language is the very
heart of our beliefs.”
Many participants emphasized that because the use of storytelling was
common in their traditions, narrative therapy might be useful for clients
from their faith background. This was especially common among Jewish
participants. One shared that the “Jewish tradition of storytelling makes
this a comfortable, familiar-feeling technique.” A Reform Jew reflected that
“Jews typically love hearing and telling stories, so it could be a useful way to
bring up conflict in a less threatening way than direct discussion and con-
frontation.” And an Orthodox Jew shared, “As we are the ‘People of the
Book,’ we have a narrative in the Bible already, and the narratives of our
family stories are just another example of that.”
Christians participants emphasized storytelling in their tradition, focusing
on stories in the Bible. An Anglican explained that “the Bible is full of stories,
22 C. EPPLER ET AL.

metaphors, and anecdotes. People from a Christian background are usually

accustomed to hearing stories, reinterpreting them, and sometimes reimagin-
ing themselves within the story.” This person went on to explain a fit with
a specific Catholic tradition: “The Jesuits have also used imaginative stories
and reflections to help people understand themselves and their faith jour-
ney.” A Presbyterian shared that “Jesus taught in parables” and that “the
emphasis on life as a text is easy to access from those who put a sacred text
(Bible) at the center of their worship.” Another stated,
We tell the story of Jesus’s birth, life, death, and resurrection in everything from
our creeds and confessions to our sacraments and other rituals. Knowing the story
of Jesus is fundamental to our understanding of our faith. Each family has its own
story that fits within the fabric of the church and its history.

Another Presbyterian elaborated, specifically referencing the use of

metaphors:
In [biblical] stories images are created, connections are made. There are families in
the Bible; there are images such as rivers, mountains, rocks, water, and seas; there
is mention of animals, children, and sick people, lost people, lonely, outcast people.

Members of other traditions, including Islam and Buddhism, also reflected

on the use of stories in their faith and the consequent potential usefulness of
narrative theory. A Muslim explained the following:
All prophets, when they started preaching, faced many hardships by the hands of
the ones they were preaching to. Even at these times, they remained happy,
peaceful, patient, and never let the bad happenings get to them. They trusted
God. … If the prophets survived through all that, there is no problem faced by
them that cannot be solved.

A Shambhala Buddhist provided a specific example of how metaphor is

understood in stories from their tradition, sharing that “in the Tibetan
tradition Namthars, which are stories of enlightened beings, can be illumi-
nating, as one does not hold to the idea that any of it is intrinsically true.”

Externalization
Across traditions, externalization, a key concept within narrative family
therapy, was identified as a useful technique. A Bahá’í participant indicated
that “Externalization … [is one] of the great things that seems to align well
with this approach [and my faith],” and a Roman Catholic similarly reflected
that “the use of metaphor and of externalization might also be helpful.”
A Presbyterian offered some context for why externalization may be helpful,
stating that “this type of therapy may help in diffusing issues within families
because the problem is ‘external’ to all.” Another Presbyterian likewise shared
that externalization “may help others feel less defensive, [help] with self-
esteem, and reduce [use of] descriptive labels society has applied to kids,
 JOURNAL OF FAMILY PSYCHOTHERAPY 23

teenagers, wives, husbands, parents, etc.” A Muslim provided an example of

externalization that can be used in their tradition, explaining that “‘self-
control’ is one thing that my faith teaches. … [The therapist] can help the
client see that their problem is indeed not that big, and they can control it
themselves.”

New possibilities through reframing and re-storying

Participants identified interventions such as reframing and re-storying as
consistent with their faith traditions and useful for creating new possibilities.
A Roman Catholic shared, “Jesus taught through parables in the rabbinic
tradition. His narratives often had a radically liberating effect on his listeners,
freeing them to see themselves and each other in a new light and to find new
meaning and purpose in their lives.” Another Roman Catholic suggested,
“Reframing a family-imposed image of God from one who is a ‘God-fearing
believer’ to one who is in a loving relationship with a loving God.”
A participant from the Christian Orthodox tradition similarly stated, “The
curious stance of Christ creates a new story for us.” A participant from the
Community of Christ emphasized the potential usefulness of sharing stories
of times when others from one’s faith tradition were able to re-story: “I think
that referring to family stories from the Bible and how families or commu-
nities re-wrote/told their own stories and therefore redeemed their life
situation and relationships would be excellent.” A Lutheran shared about
the usefulness of re-storying, saying that “it helps me to notice how people
live by storying their lives and the possibility for re-storying that comes from
participation in our faith traditions.” An Orthodox Jew described the power
of re-storying “in the Bible where someone is given a new name and destiny,
such as when Jacob is named ‘Israel’ and when a sick person is given a new
name, and thus a new fate.”

Disconnections with narrative family therapy

Some participants identified possible disconnections between their faith
tradition and the collaborative aspects of narrative therapy, such as
a Lutheran who cautioned against narrative family therapy’s emphasis on
language, saying, “When we focus overly on language, we can miss the power
of intuitive and relational processes.” A Jewish participant stated that mem-
bers with “traditional orientations might prefer to go to someone who
exercises authority differently.”
Participants also indicated that their faith traditions would be wary of the
possibility that narrative therapy would sideline aspects of faith. A participant
from the UCC noted, for example, that the therapeutic story may not include
“the action of God,” which may be a barrier for some congregants, and
a Roman Catholic cautioned against replacing faith stories, indicating that
narrative therapy “would be less useful for families … than [structural or
24 C. EPPLER ET AL.

Bowen’s theory]. Many families would be resistant to unpacking or reconfi-

guring, still less replacing these stories with more germane or psychologically
helpful ones.”
Others cautioned against conveying hope through aspirational preferred
realities or against excusing behaviors. A Buddhist noted that “we tend to shy
away from affirming, or conveying hope, although acknowledging courage is
great, but suffering is real and endless.” A Christian Orthodox participant
noted that “social deconstruction could be explaining and excusing” rather
than allowing individuals to face their culpability. A Presbyterian who
seemed skeptical of the impact of context likewise emphasized that “society
may be influenced by evil people/forces, but the individual’s responsibility is
not to be influenced by the world.”

Summary of findings
In summary, we found that (1) family systems theory’s concepts seem
compatible across diverse faith traditions; (2) structural family therapy’s
emphasis on restructuring boundaries and hierarchy seems compatible across
faith traditions as long as cultural/religious norms are carefully considered;
(3) Bowen’s multigenerational theory’s concepts of detriangulation and dif-
ferentiation seem compatible across faith traditions, but particular religious
beliefs may contradict its emphasis on the transmission of family patterns;
and (4) narrative therapy’s concepts of externalization, metaphors, and re-
storying seem compatible across faith traditions as long as intuitive processes
are honored, faith stories are included, and the therapeutic stories do not
promote false hope. It also seems true that regardless of the therapeutic
theory, some religious clients may resist definitions of psychological dysfunc-
tion, resist prescriptions for behavioral change, and insist on understanding
both illness and change as supernatural. Overall, this research suggests that
family therapy models are likely to be perceived as therapeutically helpful,
particularly when applied with nuance and cultural sensitivity to specific
faiths.

Discussion
By gathering open-ended input from participants of diverse faiths, our study
offers unique and nuanced perspectives concerning the ways in which family
therapy models can be understood in relationship to diverse faith-based
belief systems. Our study highlights the importance of understanding clients’
faith orientations and how their beliefs may relate to the therapeutic
approaches that guide couples and family therapy. In that context, we
asked participants to share perceptions based on their personal faith orienta-
tions rather than asking them to definitively speak for the whole of their faith
 JOURNAL OF FAMILY PSYCHOTHERAPY 25

traditions, which are rich, complex, and beyond the scope of a single person
or group. The breadth of our findings, even among individuals who may
belong to similar faith groups, supports existing literature, which encourages
a client-centered approach to learning about clients’ religious traditions
(Duba & Watts, 2009) and encourages integrating clients’ faith into clinical
practice (Errington, 2017).
Therefore, we suggest that the incorporation of our findings in conversa-
tions with religious clients may be useful in supporting effective, collabora-
tive, faith-integrated treatment that is rooted in systemic therapy models.
Systems theory may be useful when serving families across the various faith
traditions represented in this study. Participants reflected that, like their
faith-based worldviews, systems theory helps one to understand and con-
textualize people within larger systems, and it helps one to see change that is
occurring both collectively and individually. We found that in their descrip-
tions of interconnections, Christian participants tended to emphasize family,
Jewish participants tended to emphasize community, and Buddhist partici-
pants tended to emphasize the natural world and previous lives. While the
specific emphases may have differed between groups, the common theme of
interconnection emerged. Indeed, the participants’ human and divine rela-
tional connections are meaningful in providing therapists an established
framework for integrating clients’ faith into clinical practice.
Structural therapy’s emphasis on inclusive connectivity, its ability to honor
boundaries and hierarchies, and its use of reframing resonated with partici-
pants. Similarly, Bowen multigenerational theory’s focus on building con-
nection, its honoring of hierarchy and structure, and its aim to understand
family patterns and communication also aligned with participants’ percep-
tions of their faith-based beliefs. Finally, narrative family therapy’s use of
stories to create meaning aligned with participants way of making meaning.
By recognizing the connections between a specific theory and client system
that identifies with a faith-based worldview, we believe that therapists can
better serve their clients.
Therapists should attempt to cultivate a cultural, faith-oriented humility
that includes remaining curious and open to altering their typical way of
being to honor client systems from various faith traditions (Griffith &
Griffith, 2002). The identification of disconnections between faith orienta-
tions and family therapy models thus seems particularly helpful for illumi-
nating ways for clinicians to offer faith-honoring case conceptualizations.
Indeed, some participants expressed concern regarding the emphases within
particular models (e.g., the role of the individual or the importance of the
intellect when dealing with problems). Some of the participants’ points of
disconnection parallel critiques found in the extant literature (e.g., the criti-
cism that narrative therapy releases individuals from acknowledging their
own responsibility; see White, 1995), whereas other appear to be novel.
26 C. EPPLER ET AL.

There were no specific disconnections between family systems theory and

the participants in this study. Disconnections that emerged in response to
systems theory related to a general hesitancy to seek psychotherapy treatment
and a distrust of psychological explanations of problems and solutions. For
these participants, the most significant obstacle to connecting with systems
theory seems related to a clinician’s ability to integrate the religious and
psychotherapeutic worlds.
One noted disconnection between structural family therapy and the parti-
cipants in our study centers around questions of who decides who is included
in treatment and when therapists should challenge current structures (see
Hare-Mustin, 1978). That is, the participant perspectives in our study suggest
that a more collaborative approach to decisions regarding who to involve in
therapy and what questions to address may benefit religious families when
using structural theory.
The importance of understanding faith-based beliefs about problem for-
mation seemed relevant to participants across each of the four family therapy
models, but this was especially true when discussing Bowen’s multigenera-
tional transmission process. Although participants may have held only an
introductory understanding of the way differentiation influences descendants
over generations, Buddhist, Muslim, and some Christian participants seemed
to have significant doubts about this transmission process. For example,
a Muslim participant wrote about how privilege is given to “individuality …
each individual is born alone and will die alone … so to say that emotional
problem are adopted from the previous generation would be wrong.”
Likewise, a Presbyterian gave an example of some congregation members
thinking that since “Jesus is supplied to ‘fix’ … and make whole … the idea
that Grandpa’s affairs could affect someone today might be seen as God not
taking away what wasn’t one’s own.” Furthermore, rather than seeing emo-
tional problems that are passed down generationally as a lack of differentia-
tion which needs correcting, Buddhism teaches that suffering is inherent in
life and that the way to freedom is through nonattachment (Stewart, 2014).
These findings suggest that clinicians must pay attention to how clients’
faith-based worldviews inform their understanding of problem-formation
and alter their theoretical approach to better align with clients’ faith-based
beliefs (see Erdem & Safi, 2018, for implementing a culturally sensitive
approach to Bowen’s theory).
In terms of disconnections between narrative family therapy and partici-
pant responses, the clearest objection to narrative therapy was related to its
potential to convey hope through aspirational preferred realities. In particu-
lar, a Buddhist highlighted the importance of accepting current circum-
stances rather than clinging to hope. They explained that acknowledgment
of courage might be a more acceptable alternative. This does not mean that
therapists must dismiss their systemic conceptualization and way of
 JOURNAL OF FAMILY PSYCHOTHERAPY 27

understanding change; instead, therapists may simultaneously honor their

theoretical approach and the clients’ worldviews by shifting language or
altering particular interventions (Choudhuri & Kraus, 2014; Moules, 2000;
Ybañez-Llorente & Smelser, 2014).

Implications for faith-based sensitive systemic practice

Our findings, both the connections and disconnections, have implications
for systemic clinical practice. For example, the identified areas of discon-
nection across models may offer possibilities for collaboration when clients
highly value input from hierarchical faith-based leaders (e.g., see Butler &
Zamora, 2013, for a discussion of the ethical and legal implications regard-
ing confidentiality of clergy-collaborative care). With regards to structural
theory in particular, participants suggested a more collaborative approach
in discerning who to involve in therapy. We therefore encourage clinicians
who use structural family therapy to spend time understanding faith-based
orientations and beliefs of clients, as family structures and hierarchies that
appear to be based on gender or age may also be rooted in religious beliefs
and practices. Traditionally, structural therapy promotes including as
many family members as possible (Minuchin, 1974), but to honor
a client system’s worldview, a faith-informed structural therapist may
consider how faith practices support delineating boundaries and excluding
someone or a subsystem from a session.
Additionally, the areas of connection identified in this study highlight
nuanced aspects of each model that therapists can utilize to most accu-
rately honor a client’s religious worldview. For example, narrative therapy
can utilize stories from clients’ own religious traditions to create new
possibilities. Likewise, when applying Bowen’s model, it might be helpful
to remember that participants illuminated how triangles with faith leaders
may be both functional and maladaptive: a Roman Catholic’s confession to
a priest may create a faith-sanctioned triangle, but this triangle has the
potential to distance partners if one person in the couple does not feel
included in what they perceive as secret confessions. These are areas that
are ripe for further exploration in clinical practice and research.
Across models, one approach that may be helpful is to be aware of
potential areas of faith-based disconnect and to name those areas for hesitant
clients. If clinicians are proactive in talking about potential disconnections at
the start of therapy, it may reduce resistance and increase engagement in the
therapeutic process. For example, a therapist might inquire about a client’s
understanding of psychological problems from the perspective of their faith
tradition. The therapist might state clearly that they understand that tradi-
tional views of pathologizing may not be consistent with the views of some
28 C. EPPLER ET AL.

people and that they are open to discussing difficulties within the clients’
families from perspectives that are fitting for them.
To that end, our findings suggest that therapists should consider whether
a different theoretical framework may be more appropriate based on the faith
beliefs of their clients. For example, although Jewish participants described
a fit between their faith and the storytelling traditions of narrative theory,
one cautioned that some Jewish individuals with more “traditional orienta-
tions might prefer to go to someone who exercises authority differently.”
Similarly, participants from Judeo-Christian traditions reflected that hier-
archical structures and people in their communities might respond well to
“clear direction from an authoritative source.” Structural theory may be
particularly fitting for clients who hold these kinds of views. Alternatively,
Bowen’s theory might fit particularly well for some families in the Jewish
community given the intergenerational focus and the intergenerational
impact of trauma that was described by our participants within this popula-
tion (e.g., Anderson, Fields, & Dobb, 2013; Shrira, 2016).
More specifically, our findings indicate that integrating clients’ faith into
systemic practice may necessitate the therapist adapting their theoretical
positions. For example, a narrative family therapist treating some Jewish
families may need to increase directiveness within collaborative communica-
tions. In this regard, our study enhances the work of Moules (2000) and
Ybañez-Llorente and Smelser (2014), which advocate for therapists to sur-
render a rigid theoretical application when integrating spirituality into clin-
ical practice.
Finally, many religions have a rich history of faith narratives, and partici-
pants cautioned against replacing faith stories with psychologically based
narratives. When utilizing narrative therapy, we therefore recommend weav-
ing clients’ personal and religious stories into healing narratives. Such stories,
which already exist in religious texts, are an important reservoir of narratives
and may be particularly useful. Therefore, rather than asserting psychological
narratives as a dominant and colonizing force, we recommend drawing on
clients’ faith narratives directly.

Limitations and suggestions for future research

The primary limitations of the study include our inability to ensure that all
participants understood the four therapeutic models, participant fatigue, and
the lack of inclusion of certain demographic and vocational questions. The
survey included a brief summary of each model, but it is unclear whether
those summaries allowed all participants to fully grasp the nuances and
complexities of each model. It could be beneficial to offer a class or include
links to in-depth modules or videos that further explicate the family therapy
models.
 JOURNAL OF FAMILY PSYCHOTHERAPY 29

We observed that several participants commented less as the survey

progressed, which resulted in fewer reflections on narrative therapy, the
last model in the survey. To gather more thorough responses, the survey
instrument could be replaced with a participant interview, and to prevent the
narrative therapy model from receiving the thinnest responses, the presenta-
tion of models in the interview or survey should be randomized.
In addition, future studies should consider adding additional demographic
questions. For example, the present survey’s question about vocation was not
specific, and although several participants indicated they worked in mental
health or hospital settings, we do not know if they held a license or specific
credentials (e.g., license marriage and family therapists or chaplains). It
would also be informative to inquire about whether participants had pre-
viously been members of a faith tradition different from their current
practice.
Another limitation of this study is its sampling strategy, which enrolled
participants who self-identified as persons of faith with advanced knowledge
of their tradition. These recruitment criteria meant that no persons who
identify as spiritual but not religious, agnostic, or atheist responded to the
survey. The participant responses also do not necessarily give voice to official
doctrinal stances, as participants spoke from their personal experiences, and
their responses therefore may have reflected beliefs that might differ from
other members of their faith traditions. The participants are not
a representative sample, and this research is not generalizable (Creswell,
2014; Morrow, 2005). For future research, we recommend utilizing sampling
strategies that seek to increase representation from diverse faith-based tradi-
tions as well as individuals who belong to no faith traditions.
Finally, future studies should undertake in-depth exploration of the nuan-
ces within faith traditions. One method of pursuing this goal might be to
collect data from therapy sessions and to thereby observe how the implica-
tions of our study play out in practice. Future studies could also use quanti-
tative methodology to expand upon the themes identified above. For
example, such studies could design a methodology that determines how
many faith practitioners agree with how our study’s participants saw the
intersections between their faith and systemic family therapy models.

Conclusion
Although cultural stigmas have prevented some clients from utilizing family
therapy (McDowell et al., 2018), our participants indicated that their faith
traditions are increasingly accepting of family therapy as a vehicle for change.
An Anglican, for example, stated that “over the years some of the ideas of
psychotherapy and counseling have become acceptable in Christian circles.
Many ministers take short courses on an introduction to counseling, and the
30 C. EPPLER ET AL.

importance of marriage preparation and relationship education has

increased.” Therapists may be likely to see an increase in clients from various
faith and spiritual orientations. In order to ethically integrate faith, religion,
and spirituality into clinical practice, clinicians must choose and adapt family
therapy models so they align with clients’ faith-based orientations.
In conclusion, this study informs discourse about faith integration in
systemic therapy. Our findings illuminate sensitive ways to integrate various
faith-based views with family therapy models. We sought to better under-
stand the necessary aspects of integration from insider perspectives, and our
findings indicate that therapists should approach integration with an aware-
ness that systemic treatment appears highly compatible with diverse religious
belief systems whereas some family therapy concepts and interventions may
be incompatible with clients who hold certain faith-based perspectives. These
findings provide helpful guidelines for adapting systemic therapy theories
and highlight the need to match or adjust family therapy models when
considering the clients’ religious belief systems in clinical practice.

Acknowledgments
The authors acknowledge Nicole Chilivis, M.Div., for assistance with creating the survey and
data coding, and thank Andrew Shutes-David for his expert editorial assistance. Data was
presented at the 2017 American Association for Marriage and Family Therapy National
Conference.

Disclosure statement
The authors declare that there are no potential conflicts of interest.

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