MacKay, L. & Harrison, V. (2024) The biology of reactivity in human relationships: a conversation with Victoria Harrison. Australian and New Zealand Journal of Family Therapy, 00, 1–9. Available from: https://doi.org/10.1002/anzf.158
Linda MacKay1 & Victoria Harrison2
Correspondence: linda@lindamackayconsulting.com; vaharrison@csnsf.org
Abstract
The concept of differentiation of self and its relationship to the natural capacity of humans and other social animals to adapt underpins clinician and researcher Victoria Harrison’s long-term investigation of the biology of reactivity in relationships. Victoria’s early research related to infertility and reproduction demonstrated how reactivity in at least three prior generations can contribute to chronic conditions, such as endometriosis, that are less amenable to intervention. Her most recent project, the “Observations of Change in Physiology and Family” research, highlights how work on differentiation of self improves functional outcomes in physical and mental health for the family. Whilst an individual may not experience the “calm mind” that is often the goal of conventional therapeutic intervention, a significant reduction in symptoms and an improvement in overall functioning and relatedness are outcomes. This occurred when participants focussed on increasing person-to-person contact with extended family members, reducing their emotional reactivity to significant others in the important triangles of their life and family, and maintaining intellectual activity, often described as curiosity, even while reacting.
Keywords:
Bowen family systems psychotherapy, differentiation of self, biofeedback, physiology, reactivity, relationships, triangles, anxiety, reproduction, endometriosis, intellectual activity.
Key Points:
- Emotional reactivity in previous generations can contribute to chronic physical and emotional health conditions.
- Working on increasing one’s level of differentiation of self leads to improvement in emotional and physical health.
- More energy may be mobilised in the effort to differentiate a self.
- Improved functioning, increased contact with family, sustained intellectual activity, and symptom reduction are better indicators of improvement than a “calm mind”.
- The triangle is the key emotional molecule of a relationship system.
- Working to differentiate a self involves increasing person-to-person contact with extended family members and managing one’s emotional reactivity in the important triangles of a person’s life and family.
Introduction
Victoria Harrison, MA, is the Director of the Center for the Study of Natural Systems and the Family (CSNSF), which is based in Houston, Texas. In 1976, Victoria began studying Bowen theory in Washington D.C., at the Georgetown Family Center where she was introduced to the seminal work of Dr Murray Bowen. Victoria became a member of the faculty of the Bowen Center for the Study of the Family in 1992, where she served on the Board of Directors at the Bowen Center, directed the Postgraduate Training Program, chaired the monthly Research Meeting, and taught and supervised trainees until she resigned in May 2023.
Her research involves the natural sciences, evolution, reproduction and health, biofeedback, and more specifically, the biology of reactivity in relationships. Victoria’s “Observations of Change in Physiology and Family” research project documents changes in physiology and functioning that occur while someone is working on differentiation of self in their family (Harrison, 2023). Victoria’s published works can be found at www.csnsf.org.
Linda MacKay PhD is a university lecturer and the clinical supervisor of several child and adolescent mental health services across Sydney. Linda utilises Bowen family systems theory to guide her work with couples and families and in her coaching of individuals and clinical teams. In the following interview with Linda, Victoria discusses many of the core concepts from Bowen family systems theory, including differentiation of self, triangles, emotional cutoff, the nuclear family emotional process, and the family projection process. These concepts, along with the multigenerational transmission process, sibling position, and societal emotional process, were developed by Dr Murray Bowen through detailed research undertaken at the National Institute of Mental Health (NIMH) in the 1950s (Bowen, 1978; Kerr & Bowen, 1988, Bowen & Butler, 2013).
Central to Dr Bowen’s initial observational research with families with a schizophrenic young person is that the family is an emotional unit in which every member of a family is inextricably linked at all levels of functioning. Individual functioning is never independent from the emotional processes that govern reactivity and behaviour – this interdependence is a product of evolution and is core to all natural systems. Dr. Bowen included the study of one’s own family and work on differentiation of self as fundamental to training in family systems theory (Bowen, 1978, p. 544). A clinician must recognize and manage his or her reactivity and represent differentiation of self in relation to the complexity of clinical practice and client families.
Fundamental to Victoria’s long-term efforts in research and clinical practice in Bowen theory is the natural adaptational capacity of humans and how this is influenced by the level of differentiation of self. Differentiation of self, unique to the human, is the ability to better negotiate this interdependence by separating thinking from the automatic emotional reactivity that connects and promotes survival on one hand but can also limit more autonomous functioning that is also necessary to growth and wellbeing. This capacity varies from more to less ability to think and function as a separate individual. Some individual family members are more vulnerable to the inherent anxiety that is involved in being receptive and responsive to the emotional process of the family. In the family projection process, parents may unconsciously transmit any unresolved emotional issues to a child, who then may become more vulnerable to symptom development.
Interview:
LINDA: I first met you, Victoria, at a Family Systems Institute (FSI) Conference in Sydney in 2010 when you presented your research to an Australian audience. You also presented some of your earlier findings of your Observations of Change Project at the FSI Conference in 2016 and I have also been fortunate to hear you present at the Bowen Center in Washington D.C. and in Houston. Before we talk more about your research, can you tell me how you first became interested in Bowen theory?
VICTORIA: I began my contact with Bowen theory through coaching, as many do, for help in dealing with major problems in my life and in my family, one of which included cut off from my then 12-year-old daughter, a cut-off that had been running for about 7 years. Bowen theory was immediately and extremely helpful in resuming contact with my daughter and in dealing with her dad, my ex-husband, who had taken her out of the country. I was one of those people who had an immediate result from following the direction that my coach could provide, based in Bowen theory. I had been in conventional therapy off and on for a decade, and not found it useful, in fact, those are some of the years where the cutoff occurred with my ex-husband and my daughter.
Once I realized that Bowen theory was such a powerful and different way of thinking, I wanted to study it, and I asked Dr. Bowen, “What does it take? What’s the best way for me to learn this way of thinking?” He said, “Immerse yourself in the theory”. I began to attend everything available at the Bowen Family Center at the Georgetown Family Center in Washington. That was in 1976. I began to study in the postgraduate program in 1977 and added the use of the biofeedback instruments to better study my own physiology. Lilian Rosenbaum had established a biofeedback lab and program at The Family Center, and I was fortunate to study with her. It became clear that biofeedback was a window to the physiology of reactivity for anybody. That launched my research on how relationships between people regulate the physiology, brain activity, and the reactivity of each individual.
I started with very simplistic ideas, but it became obvious that the reactivity in the mother was affecting the child. You could see it on the equipment. You could see that the child was affecting the mother and her reactivity, and both were connected to a dad who was often distant but influencing that triangle. I began to use biofeedback instruments to study physiological reactivity to relationship processes, not just to distress, but to the marriage, to mother, father, child, to study it in the triangles. Bowen theory made this possible.
Obtaining concurrent physiological measures on individual family members came later. Initially, I had only one instrument. I was able to observe the readings of one member of the family who was hooked up to the instruments while talking to other members of the family. For example, when the father was hooked up, I spoke with both mother and son, or when the son was hooked up, I spoke in his presence with his father and/or his mother, and so on. I would talk to more than one person in the room and watch reactivity in one person at a time on the equipment. This was published in Lilian Rosenbaum’s book Biofeedback Frontiers (1989). It was an opportunity to watch the son’s adrenaline, that is, his skin sweat response, react to his mother’s focus. When this boy’s mother described her anxiety about her son and his symptoms (which were migraine-like symptoms that would happen at school and on the basketball court), he went into migraine physiology. His adrenaline went way up, and his fingertip temperature went way down.
I saw this reaction, and I said to her,
“Mrs. S., when you were growing up as one of thirteen kids, do you recollect any reason to be anxious when your younger siblings began to reach age 12 or 13 years old? Was there anything in particular that you recall?”
Now, it’s rarely as dramatic as it was in this situation. But Mrs. S. said,
“Oh, my gosh! When I was 16 and my youngest brother was 12 years old, he went off with the rest of the boys to swim in a lake, and he drowned. And I was supposed to be in charge!”
This is what she remembered when I asked her to shift her focus to describing her own family history. And then I asked,
“Where was your mother? Where were the adults who should have been in charge?”
When I started asking factual questions…who, what, where, when, and how questions…her son’s physiology stabilized. His fingertip temperature warmed up, his adrenaline settled down, and he moved out of migraine physiology. The mother saw that, and she could entertain the idea that his reactivity was connected to the anxiety that she experienced based on family history. She began to work on reconnecting with her mother and aunt and talk and think through the history of a family that left a 16-year-old in charge. The son never had another migraine. Change is rarely that dramatic, but that is what actually happened. Being able to watch one person and their physiology react to what they say about family history and to watch while someone talks with another family member in the room took me a long way. I could see how reactivity was in the relationship between people. I’m still studying the heck out of that, to try to see it more clearly and understand how that works.
LINDA: As you are describing this, I start to think about adolescents and their families that I have contact with, and the emergency department presentations. I wonder what difference it might make if parents can start to think about their family history, about what happened and their reactions, thoughtful and otherwise?
VICTORIA: That is worth research. Biofeedback equipment is not necessary. I think people can see this if they pay attention to what is going on. People can see their part when anyone in the family develops symptoms without fancy physiological equipment. Being able to see it and study it, publish it, and write about it can give people data that can inspire or engage their own research without the equipment. I think biofeedback research is important, but the equipment isn’t necessary.
The Observations of Change Project is one example. The project began in 2013 and involved volunteers from the Bowen Center’s Postgraduate Program, who wanted to carefully study the differences in their work on differentiation of self-made in their own functioning and in symptoms in their nuclear family, their spouse, and children. The first clinical case report was published in the journal Family Systems in 2023. This article documents the format of the study and the changes one woman was able to observe in symptoms, and in herself, her spouse, and her two children. It’s very exciting to see it. In this study, participants measured their physiology, muscle tension, sympathetic nervous system activity via adrenaline and fingertip temperature, and brainwave activity, which is a proxy for the connection or disconnection between intellect and emotional reactivity. Physiological data was gathered four times a year, as participants talked about the steps they were taking to study their family and work on differentiation. Cortisol levels were also noted – cortisol is a measure of longer-term stress and the reactivity present. Participants documented, dated, and described the steps they were taking and with whom. This study is rich with qualitative data and quantitative information about changes that occur in physiology and about symptoms that people were describing, counting, and reporting.
There are several surprises just from analyzing the data on one person. There are 15 people in the study. I will eventually analyze the data one by one and then as a group. This takes a lot of time and energy, as any research does. The surprises from this one study are very interesting. One observation made possible by measuring the physiology and the brain activity is that symptoms decrease for the children and for both parents, for the woman and her husband, as well, even though the participant continues to demonstrate stress reactivity in some measurements, in her sympathetic nervous system activity, for example. She does not experience the calm body and the quiet mind that mind-body medicine and mind-body methods propose as necessary for the resolution of symptoms or improvement in functioning. Even though the physiology and the brain activity continue to be somewhat reactive, symptoms decline. Her intellectual activity and ability to be thoughtful and curious are higher and more sustained, even while reacting during her family work. The symptoms declined in both symptomatic children very quickly over the first year of the study and stayed moderate, if present at all. The participant and her husband experience improved closeness, sexual enjoyment, and a closer one-to-one personal relationship. As she does work in her own family, her husband also begins to do work in his family.
LINDA: That piece of the data jumped out of me because, as a coach and as a coachee, I know I run from the experience of anxiety. I want to rid myself of any anxious symptoms I have. I want to feel calmer. But your research is demonstrating that functioning is still improving on many other levels, including at the level of physiology and across various other domains. This doesn’t fit with conventional medicine in terms of what constitutes improvement, that is, feeling less anxious. And you also have some facts around the differences it makes in the person’s life and in other family members’ lives.
VICTORIA: What do you think is clinically important about that?
LINDA: Clinically, I think it fits for me in terms of thinking about the anxiety of progression rather than regression. It’s a way of thinking that may help my clients accept that, of course, they are going to be anxious. They’re doing something that is really different and really challenging in working on differentiation of self, which involves more thoughtfulness on their part. Physiologically it does not feel that managed, but a person is acting as if it is more managed by staying more actively connected to their thoughtfulness and having more thoughtful conversations.
VICTORIA: I agree. But I don’t think about it quite like that. Systems, natural systems, and families are comfortable with habit patterns. They have evolved because they were successful for survival. Imperfect but successful under a certain set of conditions. Patterns of reactivity, even if they are symptomatic, can be more comfortable than change. And when one person begins to change her functioning, the system may react as if that is a problem or react to the discomfort that it produces. If someone knows that is predictable and can persist with well-worked out, thoughtful steps that make sense, they will be better able to tolerate the discomfort in the service of a greater good, greater accomplishments, and greater functioning.
There’s a Bowen quote I love:
Anxiety is inevitable if you solve the problem. When anxiety increases, one has to decide whether to give in and retreat and carry on in spite of it. …. People can even grow and become more mature by having to face and deal with anxiety situations (Bowen, 1978, p. 85).
I also want to say that the intellectual activity generated in planning steps toward differentiation has anxiety built into it. It is a challenging effort to contact people with whom there has been little or no contact. As I looked at the research data, it occurred to me that the stress response that shows up as vasoconstriction, or adrenaline changes, or muscle tension may also propel intellectual activity. The oxygen that shifts from our fingertips when we’re stressed or anxious or exerting effort may be going to the brain rather than just fueling a fight or flight response. The interpretation of cold fingers has traditionally been an indicator of stress and symptoms. That may not be completely accurate. It may mean that oxygen is fueling the intellectual activity involved in progress and, for some of us, the future of evolution. It isn’t always a stress response. It is an indicator of effort and the shift of oxygen and energy to fuel that effort, and that effort is, in part, intellectual. The capacity to remain intellectually active while reacting may involve a similar physiological response. This possibility transformed my interpretation of this physiology. I will need to examine the data collected in the other studies to see if it looks similar to the other participants.
The Observations of Change Project has not been the only direction for my research based in Bowen theory. When I was in my second year of the Bowen Center’s Postgraduate Program in 1977, Dr Bowen said to the class,
“You need to study something. If you’re going to work on differentiation of self and Bowen theory, what are you going to study other than your own miserable family?”
And I thought,
“Well, damn! I’ve just started studying my own family! That’s going to take me forever. But I will see what else might be interesting to study. My clinical practice, which had begun in 1970, seeing people for psychotherapy, was full of people who were reporting difficulties with reproduction. And I realized: “I’m going to study how relationships impact ovulation and reproduction and the relationships between males and females.”
I had no idea what I was getting into. I went to the books first and thought, well, somebody must have written a paper on this, so I’ll find a paper on the impact of relationships on reproduction. I also began to attend the Society for Menstrual Cycle Research, where I presented an early paper on stress levels and ovulation (Harrison 1986). I just assumed somebody would have the answer and I would find a paper. Well, au contraire! People had not begun to study the impact of relationships in the family, or even in 1977, the impact of stress reactions on fertility or infertility. I was lucky that a reproductive biologist, Dr. Susan Atlas, was a participant in the postgraduate program studying Bowen theory and her family. She was one of my early collaborators. Once she knew that we had a common interest, she began educating me about the biology of reproduction, the hormones of reproduction, the follicle-stimulating hormone (FSH) and the luteinizing hormone (LH), sperm production, ovulation, and conception. Every detail of reproduction is under the influence of relationships between family members. I began to piece together the literature from a dozen fields, to pursue scientists who had done some of the original research, and to organize my own research projects. That led me to study with a group of reproductive endocrinologists in Houston who ran a research lab and a clinical practice. I took a box full of clinical cases to Houston and scheduled time with Dr. Emil Steinberger, Director of the Institute for Reproductive Medicine. I started going through the cases where women were tracking their basal body temperature and some of their physiology, and asked him, “Does it make sense…that stress and relationships impact ovulation, which was his field of study? Dr. Steinberger was really interested and invited me to open an office for my clinical practice at the Institute for Reproductive Medicine and Endocrinology. I moved back to Houston for a 6–8-month sabbatical to study reproductive endocrinology with this group of physicians and to interview their patients for family histories. It was just a wonderful opportunity to lay the groundwork for defining the ovulation research project that I did with his assistance and with the help of his wife, Dr. Anna Steinberger. (Harrison, 1996). This wonderful opportunity to develop a research focus went very well for about 6 years. When the founders began to age and fail, however, the turmoil stirred and required that I move to another location.
I moved my office to work with Dr. John Mathias, who was a neuroendogastroenterologist at Texas Women’s Hospital. He was an endometriosis expert. I began to learn that the same physiological and hormonal reactivity that stirs Gi symptoms is involved in endometriosis. They’re very close cousins in terms of their physiology. That launched what became a fascinating endometriosis research project (Harrison, 2005). It was so interesting to see how reactivity in the family over at least three generations stirred physiological reactions that produced chronic endometriosis, symptoms that did not respond to hormones or medical treatment. Someone could have their ovaries and uterus removed but still have the physiology that was producing pain and GI symptoms.
I continue to see people who are dealing with infertility and challenges around reproduction or reproductive health. There are fewer referrals from Medical Center doctors, but word of mouth in the infertility treatment world provides a steady number of reproductive referrals. Covid created the challenge of not seeing people in person on the biofeedback and neurofeedback equipment. It has been more difficult for people to recognize their physiological reactions to stress and the reactivity to relationships that are at play in interrupting ovulation, for example, sperm count.
It would take a weeklong conference to even begin to discuss the environmental and social factors that influence the decline in sperm count. They include estrogens, plastics, air pollution, and water supply. Such a large number of factors affect male hormonal functioning with declining libido, less interest in sex, and declining sperm motility and count. The same forces and factors impact and affect ovulation. Environmental dioxin, associated with endometriosis and cancers, is prolific on the petrochemical coast near Houston, Texas. I’m particularly interested in working with families who can reproduce in the face of all those same factors. But I’m not there yet. In fact, I don’t have the time and energy. I’m trying to analyze the data, and I’ve got to write it up so that it can be published and studied and generate questions.
What I found in looking at reproduction is that there are huge gaps in knowledge. There is a whole lot we don’t know about how relationships between family members regulate and govern reproduction in the face of these environmental factors and climate change. For heaven’s sake, the changing climate affects reproduction in every biological form of life. Why would it not affect human reproduction? I don’t think good air conditioning and a warm coat buffer humans from the impact of climate change. The impact is too pervasive, diffuse, and ever-present. And that’s an area for study and research. Bowen theory asks and addresses more questions, which is what a good theory will do. It’s what science hopes for, that is, to study something, learn a little something, and generate more questions. Bowen theory does that.
Well, here would be an example of how Bowen theory would guide research development. Most of psychology looks at the dyad if it gets beyond the individual. Bowen theory would say that the physiology, hormones, and behavior of individuals are regulated in triangles between family members, not dyads and so if someone knows that the triangle is important, their lab could invite mother, father, child! It’s not a big leap.
LINDA: Well, you made a statement in your Observations of Change paper, and I don’t know if I was asleep during my study of Bowen theory, but it jumped out at me. You said that Bowen observed that the family system is organized into emotional triangles in which the relationship between two people is based on our relationship with a third (Harrison, 2023, p. 109). That statement hit me between the eyes. The triangle is not just a variable!
VICTORIA: You read me correctly. That is the way I see it. The triangle is the emotional molecule of a relationship system. And those emotional triangles occur over the generations, and between parents and children. The triangle is not just a variable. The patterns of reactivity occur, all of them, within triangles, that is, conflict, the pursuit of closeness, distance, symptoms in a spouse, over and under functioning, and the projection onto a child or a third. I was talking to somebody earlier today, who said that she and her husband stabilize around projections onto their dogs, so projection onto a third living creature. All those are happening within triangles. Those patterns are better understood as occurring within triangles. I know that other people, some of whom are respected colleagues and peers, view triangling as a mechanism amongst the others. Some people fight, some people focus on a third, some people over and under function, for others, triangling is an “option”. I don’t think that. Triangling is part of the emotional system of the human family, and it may exist behind humans evolutionarily. It would be interesting to study at what point in evolution do creatures triangle. I know primates do. I know mammals do, and there may be studies that look at that in amphibians, reptiles, fish. But you have got to have the triangle in your head to study it and look for it.
Triangles are not about geometry. It’s a biological pattern between living creatures. Although Bowen struggled with the right term, I choose to use the word Bowen used, which is “triangle.” The patterns and the triangles in which they occur are not pathological. Those patterns occur in all families and contribute to stability as well as contributing to symptoms under certain conditions. The point is that if someone will and can maintain an open person-to-person relationship with the other two people in the triangle, relating to them and to their importance to each other, the triangle functions better, and the tension resolves between the other two people. The way I translate that is, if someone can work on differentiation of self in the triangles through having more of a person-to-person relationship with each of the other two people, recognize their importance to each other and keep the problem between the two of them, problems resolve. Symptoms improve by virtue of a triangling process that includes one person’s work on differentiation of self. And that’s what the Observations of Change project comes back to. Participants in the project are aiming to operationalize working on differentiation of self in the important triangles in their life and family, and then observing the difference that makes.
LINDA: Can you speak more as to what you see is the work of differentiating a self? I ask this, because for me, going beyond one’s parents and siblings to contact more distant family members remains such a challenge, especially with cutoff being one of the mechanisms by which relationship tensions have been managed…
VICTORIA: I say, pick your poison. Which is more challenging, living with miserable symptoms and the miserable symptoms in your family, or doing something differently that can make a significant difference? Pick your poison. It’s going to be difficult. Life is difficult. How are you going to choose the way you live it, and the contributions you make to greater stability in the family? What kind of responsibility are you willing to take for developing your own maturity, stability, and capacity to accomplish things, to contribute things?
Dr Steve Cole has done some very interesting research that Ann Jones reviewed for the Family Systems Forum (Jones, 2014). Dr. Cole’s research looks at the difference between functioning based on purposeful goals, and hedonic goals, living based on what makes you happy. He studied this difference at a molecular level for people who have cancer. And what he found was that biochemical changes and molecular changes that occur for people who are purposeful are greater and more associated with health and healing than hedonic goals, goals for happiness. Purpose trumps happiness in terms of human functioning. I think that’s important, and it shows up in the Observations of Change research.
LINDA: And that’s the difference between contacting a family member with the goal of having a “better” relationship and the goal of differentiating of self. When I suggest contacting a distant family member, clients will ask me, “Why should I have contact? I don’t want to have a better relationship with that person. They don’t make me happy. They do the opposite!” But that’s not the reason.
VICTORIA: Right. Making contact to differentiate a self, is a purposeful goal, not a hedonic one. It’s the capacity you develop in yourself and the changes that happen in your brain, in your biology and in your life that are a byproduct of engaging and dealing with those difficulties. Increased intellectual activity, separate enough from reacting, to be an influence in self and in the family. I think Murray Bowen developed a paradoxical methodology that, as you report, may not make sense to everybody. I find, with more years of practice, more people take it on. Don’t you?
It makes sense to more people. I think that has to do with one’s own practice and the ability to integrate it in such a way that the therapist transmits a different level of confidence, knowledge, and assurance. There is a reliable method here. You’re not flying blind if you go contact some particularly difficult family members and learn family history. You can see the benefits of that on the neurofeedback. You can see the benefit in cortisol measures. Knowing your family and family history develops more confidence in self. The family work decreases the anxiety people live with when they cut off or distance from it.
I don’t look at research based in Bowen theory as developing the theory, nor as filling in gaps of theory. I think of research as taking the concepts and some of the operating principles in Bowen theory and using them to design and conduct research to learn more about areas of human functioning that Murray Bowen didn’t have time to study. He did not study everything.
It has taken years to realize that connections to science and research are important for working on differentiation of self, the basis for change in Bowen family systems psychotherapy. I’m currently working on a paper for the Family Systems Forum (Spring, 2023) on “Erosion and Extension of Bowen theory.” When people memorize what Bowen wrote or taught, without developing their own thinking, they miss the mark. When people try to integrate Bowen theory into a different approach or append the concepts to more popular ideas, they miss the mark. Research and connecting to the sciences require that someone distinguish Bowen theory from other theories and understand the importance of those differences. Extending theory almost always involves recognizing one’s own erosion of theory and making corrections.
If there were enough time in life, I would try to develop an alternative to the field of “stress” research. I have drawn upon “stress research” to understand physiology of reactivity for years. Bowen theory can provide a different conceptual framework for studying reactivity, I believe. Relying on the individual or stimulus response focus built into “stress research” may be convenient, but it is not accurate for natural systems thinking. Perhaps someone will tackle this.
Thank you for inviting me to do this interview and the chance to think out loud.
References
Bowen, M. (1978). Family therapy in clinical practice. Jason Aronson
Butler, J. (Ed.) (2013). The origins of family psychotherapy: The NIMH Family Study Project. Aronson.
Harrison, V. (1986) Variation in physiological stress reactions over the menstrual cycle. In Proceedings of Society of Menstrual Cycle Research Annual Conference.
Harrison, V. (1997) Patterns of ovulation, reactivity, and family emotional process. Annals of NY Academy of the Sciences. The Integrative Neurobiology of Affiliation, 807, 522–524.
Harrison, V. (2005) Stress reactivity and family relationships in the development and treatment of endometriosis. Fertility and Sterility, 83(4), 857–864.
Harrison, V. (2013) Contributions of nuclear family triangles to variation in physiological reactivity. Family Systems, A Journal of Natural Systems Thinking, 9(2), 145–153.
Harrison, V. (2020) Bowen theory in the study of physiology and family systems. In: Keller, M. & Noone, R. (Eds.) Handbook of Bowen family systems theory and research methods. New York: Routledge, pp. 105–119.
Harrison, V. (2023a) On erosion and extension of Bowen theory. Family Systems Forum, 25(2), 1–12.
Harrison, V. (2023b) Observations of change while working on differentiation of self: a case study based in Bowen family systems theory and therapy. Family Systems: A Journal of Natural Systems Thinking, 17(2), 105–136.
Jones, A. (2014). The psychology and physiology of behavior change. Family Systems Forum, 16(2), 3-12.
Kerr, M.E., & Bowen, M. (1988). Family evaluation. W.W. Norton & Company.
Rosenbaum, L. (1989). Biofeedback frontiers: Self-regulation of stress reactivity. Stress in Modern Society, 15. AMS Press.
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