> "We are not born, we are made — and the making happens, mostly, in families."
In This Chapter
- Opening: What Comes With You
- 19.1 Family Systems Theory: The Whole Is Greater Than the Sum
- 19.2 Bowen's Family Theory: Differentiation and Triangles
- 19.3 Birth Order, Sibling Relationships, and Family Roles
- 19.4 Intergenerational Transmission: How Patterns Cross Generations
- 19.5 The Psychology of Family Loyalty
- 19.6 Early Influence: Adversity, Resilience, and ACEs
- 19.7 Breaking the Cycle: Change Within and Across Generations
- 19.8 Having Difficult Conversations with Family Members
- From the Field — Dr. Elena Reyes
- Research Spotlight: Parental Reflective Function and Intergenerational Security
- Common Misconceptions
- Chapter Summary
- Bridge to Chapter 20
- Key Terms
Chapter 19: Family Dynamics and Early Influence
"We are not born, we are made — and the making happens, mostly, in families." — Murray Bowen
Opening: What Comes With You
Jordan is sitting in a client meeting when he recognizes something. The VP of a partner company — a man who speaks with the slow deliberation of someone accustomed to being heard, who looks slightly past the person he is addressing — says something that Jordan doesn't quite register as the words, because the sensation of the room shifts.
He has felt this exact sensation before. He felt it, he realizes, at the family dinner table when he was twelve. His father spoke the same way: deliberately, with the implied authority of someone whose conclusions are already correct. The sensation is not fear, exactly. It is something in the old register of do not disagree, do not be too much, do not disappoint.
He notices all of this in approximately three seconds. Then he makes his point.
After the meeting, walking back to his office, he thinks: I just made my point to someone who activated my twelve-year-old self. Two years ago, I wouldn't have. I would have managed my state so thoroughly that the point would have never surfaced.
He doesn't know whether to call this progress or archaeology. It is, he suspects, both.
The family is where we are first taught what it means to be a person — what emotions are acceptable, what needs can be voiced, what the relationship between effort and reward looks like, who gets care and under what conditions. These lessons are not taught explicitly. They are transmitted through pattern — through the accumulated texture of thousands of daily interactions that create, over time, a set of internal maps that the person carries everywhere.
The maps are often invisible precisely because they were formed so early. They are not conclusions the person has drawn from evidence; they are the lens through which the person perceives. The child who grew up in a home where love was conditional on performance does not experience "love feels conditional when I underperform" — they experience "this is what love is." The child who grew up in a home where conflict was forbidden does not experience "conflict avoidance was modeled" — they experience "conflict is dangerous."
Unpacking these maps is one of the most important and most difficult projects of adult development. It requires enough distance from the family system to see it clearly — which is not the same as rejecting it, abandoning it, or blaming it for everything that has gone wrong. The goal is understanding, not prosecution.
19.1 Family Systems Theory: The Whole Is Greater Than the Sum
The dominant framework for understanding family as a psychological unit is family systems theory, developed primarily by Murray Bowen in the 1950s and 1960s. Systems theory proposed a fundamental shift in how the family is understood: not as a collection of individuals who influence each other, but as a system — an organized whole in which each member's functioning is shaped by and shapes the functioning of all others.
This has practical implications. In an individual-focused model, you explain a person's anxiety by examining their cognition, history, and temperament. In a systems model, you also ask: what is the anxiety doing in the system? What function does it serve for the family as a whole? Who would have to change, and how, if this person stopped being anxious?
These are not questions with obvious answers. But they are questions that often reveal that what looks like an individual problem is also a relational and systemic phenomenon — that the anxious child is, among other things, fulfilling a role in a system that needs someone to carry the anxiety.
Key Systems Concepts
Homeostasis: Family systems, like other systems, resist change. They develop equilibrium states — characteristic patterns of interaction — and exert pressure on members to maintain those patterns even when they are no longer adaptive. The teenager who starts therapy and becomes more assertive often encounters family resistance, not because family members consciously want to prevent growth, but because the assertiveness disrupts the system's balance.
Circularity: In systems thinking, causation is circular rather than linear. It is not that the father's coldness causes the son's anxiety causes the mother's overprotection causes the child's dependence — it is that all of these elements are parts of a circular pattern, each one maintaining and being maintained by the others. There is no first cause; there is only a pattern.
Subsystems: Families are organized into subsystems — the marital/couple subsystem, the parental subsystem, the sibling subsystem — each with its own functions and appropriate boundaries. Problems often arise when subsystem boundaries are violated: when a parent recruits a child into the couple conflict (triangulation), when a child is expected to function as a parental partner, when sibling roles become rigidly hierarchical.
Boundaries: Systems theorist Salvador Minuchin's work on structural family therapy introduced the concept of boundary quality as a primary dimension of family health. Enmeshed families have diffuse, unclear boundaries — family members are highly reactive to each other's states, individuation is difficult, and autonomy is perceived as abandonment. Disengaged families have rigid, impermeable boundaries — emotional connection is limited, support in times of need is unavailable, and independence is forced prematurely. Healthy families fall between these poles: clear enough boundaries to support individuation, permeable enough to allow genuine closeness.
19.2 Bowen's Family Theory: Differentiation and Triangles
Murray Bowen's contribution to family theory is one of the most comprehensive frameworks in psychology. Two concepts are particularly useful for applied purposes: differentiation of self and triangulation.
Differentiation of Self
Bowen's concept of differentiation of self describes the degree to which a person can maintain a clear sense of their own identity while remaining emotionally connected to others who think and feel differently. It is a measure of the balance between two forces: togetherness (the pull toward fusion, conformity, and emotional merger) and individuality (the pull toward autonomy and self-direction).
A highly differentiated person can: - Hold their own values and beliefs in the presence of family pressure to conform - Be emotionally present with a distressed family member without becoming equally distressed - Disagree without the relationship feeling threatened - Make decisions based on values rather than anxiety
A person with lower differentiation is more vulnerable to emotional fusion: their sense of self is so entangled with the family system that they cannot easily distinguish their own feelings from the feelings of those around them. They regulate themselves emotionally by attending to others' states — calm when others are calm, anxious when others are anxious, unable to be differentiated in the presence of family intensity.
Differentiation is not a personality trait but a capacity — one that can be developed, though it typically requires conscious effort and often therapeutic support. It is the psychological foundation of what was described in Chapter 17 as the differentiation concept in conflict: the capacity to maintain one's perspective while remaining connected to someone who disagrees.
Bowen observed that differentiation level tends to be transmitted across generations: people tend to establish intimate relationships with partners of similar differentiation level, and children tend to develop differentiation levels similar to their parents. This is the mechanism of intergenerational transmission — not through genetics alone, but through the relational patterns that are enacted and modeled.
Triangulation
Bowen identified triangulation as one of the most important mechanisms in family systems. When two-person relationships become anxious or tense, there is a predictable tendency to involve a third person — to diffuse the tension, to create an alliance, or to divert the anxiety onto a safer target.
The most common form is the triangulation of a child into marital conflict. Parents who cannot manage their couple anxiety directly often manage it through a child — by making the child a confidant, by competing for the child's loyalty, by focusing the family's attention on a child's problems as a way of avoiding the couple's problems. The child in this triangle carries relational anxiety that is not theirs.
Triangulation also occurs between adult family members: a parent confides in one sibling about another; a family member is recruited to take sides in a dispute that doesn't belong to them; alliances form that exclude and isolate.
The long-term effect of being chronically triangulated is that the person becomes an expert in managing others' relationships but poorly equipped to manage their own — because their emotional energy has been organized around others rather than self.
19.3 Birth Order, Sibling Relationships, and Family Roles
Birth Order
Alfred Adler was the first psychologist to systematically investigate birth order effects. Subsequent research has found some consistent patterns, though with considerable variation:
First-born children tend to receive intensive parental attention before siblings arrive, often producing higher achievement orientation, stronger identification with authority, and greater comfort with responsibility. First-borns are also disproportionately represented among high achievers, executives, and heads of state — a finding that has generated both research support and controversy.
Middle children often develop strong peer orientation and negotiating skills — they must navigate between older and younger siblings and frequently develop the empathy and flexibility associated with having no fixed position. The "middle child syndrome" (feeling overlooked, less special) is partly mythological but has some research support in families with three or more children.
Last-born children tend to receive less intense parental supervision and more freedom, which some researchers associate with greater openness to experience and creative nonconformity. They are also more often the recipients of family attention and protection.
Only children show outcomes more similar to first-borns than to other positions — high achievement, strong adult orientation, and comfort with individual work. The "spoiled only child" stereotype has weak empirical support.
These are tendencies, not determinants. Birth order effects are substantially moderated by family size, spacing, gender composition, and parental behavior. The most important caution is against over-reading birth order as deterministic — it is one variable among many.
Family Roles
In clinical family research, a consistent pattern has been identified in families under chronic stress (addiction, mental illness, chronic illness): the development of fixed roles that serve the system's equilibrium at the cost of individual development.
The most commonly described roles include:
- The hero/achiever: Often the eldest; brings the family external pride and internal hope; carries the message that the family is okay; often develops achievement dependence and difficulty asking for help
- The scapegoat: Carries the family's shadow, becomes the identified problem; often the child most in touch with the family's actual dysfunction; frequently the first to leave or seek help
- The lost child: Withdraws, is overlooked, requires little and takes less; survives by becoming invisible; often the child who does least damage but carries significant loneliness
- The mascot/clown: Manages family tension through humor; the entertainer who deflects difficulty; develops high social skills and poor tolerance of seriousness
These roles are not fixed across all families — they describe a typical pattern in families under significant stress. The important point is that the roles serve the system, not the individual. The hero's achievement is real, but it is also a function. The lost child's quiet independence is real, but it is also a response to unavailability.
19.4 Intergenerational Transmission: How Patterns Cross Generations
One of the most striking findings in family psychology is the degree to which relational patterns, attachment styles, and even specific behavioral tendencies are transmitted across generations — not through genes alone, but through the patterns of interaction that are modeled, enacted, and absorbed.
Attachment Transmission
The research on intergenerational transmission of attachment (reviewed in Chapter 15) is among the strongest in developmental psychology. Parents' Adult Attachment Interview coherence predicts infant attachment classification with approximately 75% accuracy across multiple studies. The mechanism is not simple replication — a parent who was anxiously attached as a child will not automatically produce an anxiously attached child. The mechanism is mediated by the parent's reflective function: their capacity to think about their own and their child's mental states.
Parents who have processed their attachment history — who can narrate it coherently, with both the negative and positive elements acknowledged — produce securely attached children even when that history was difficult. This is the finding behind earned security: security through experience and reflection rather than through having had ideal early circumstances.
Emotional Climate Transmission
Beyond attachment, families transmit emotional climate — the characteristic tone of emotional life in the home. Families with high expressed emotion (high criticism, hostility, and emotional over-involvement) tend to produce children with elevated rates of anxiety and depression; the effect is particularly well-documented for families with a member who has a serious mental health condition.
Families transmit implicit rules about which emotions are acceptable: in some families, sadness is acceptable but anger is not; in others, anger is modeled extensively but sadness is weakness; in others, emotional expression of any kind is discouraged in favor of productivity and composure. These implicit rules become the child's working assumptions about emotional life — what to feel, what not to feel, and what to do with whatever is felt.
The Parentified Child
A particularly significant pattern in families under chronic stress is parentification: the role reversal in which a child takes on the emotional or practical caretaking functions that belong to parents. The parentified child learns to read adult emotional states with great accuracy, to manage and regulate others, and to suppress their own needs in service of parental wellbeing.
This is often a survival strategy rather than a pathology — in genuinely chaotic households, monitoring and managing the caregiver's state is an adaptive way to maintain the caregiver's availability. The costs emerge in adulthood: difficulty receiving care, hypervigilance to others' states, poorly developed access to one's own needs, and relationships organized around caregiving rather than mutuality.
19.5 The Psychology of Family Loyalty
Family loyalty — the deeply felt obligation to family, the pull toward family ways of thinking and being, the guilt associated with departure from family norms — is one of the most powerful psychological forces in adult life. It operates largely unconsciously and is often experienced as the person's own desire rather than as an internalized obligation.
Ivan Boszormenyi-Nagy's concept of invisible loyalties describes the implicit ledger of debt and entitlement that governs family life: the unspoken accounting of who has given what, who owes what, and what behaviors constitute loyalty or betrayal. Adult children often find themselves making choices — career, partner, location, values — that are, at a level they don't fully recognize, responses to this invisible ledger.
The pursuit of differentiation — of a life that reflects genuinely chosen values rather than inherited obligations — requires not rejection of the family but genuine engagement with it. The person who cuts off entirely from a difficult family hasn't achieved differentiation; they have achieved distance, which is not the same thing. Bowen's concept of the emotional cutoff describes this: the distance that masquerades as independence but is actually another form of reactivity — because the cutoff is still organized around the family, just in a negative rather than positive direction.
True differentiation means: being in contact with the family system, being affected by it, and being able to return to one's own values and perspective regardless of the pressure to conform. It is the hardest psychological achievement described in this book — and it is never fully complete.
19.6 Early Influence: Adversity, Resilience, and ACEs
Not all families are benign. The Adverse Childhood Experiences (ACEs) research — initiated by Vincent Felitti and Robert Anda at Kaiser Permanente in the 1990s — documented the cumulative effects of ten categories of childhood adversity on adult health and psychological outcomes. The ten ACE categories include abuse (physical, emotional, sexual), neglect (physical, emotional), and household dysfunction (domestic violence, substance abuse, mental illness, incarceration, divorce/separation).
The research findings were striking: ACEs were extremely common in the general population (approximately two-thirds of respondents reported at least one), cumulative (each additional ACE significantly increased risk), and associated with a wide range of adult outcomes — including depression, anxiety, substance abuse, cardiovascular disease, and shortened lifespan.
A child with four or more ACEs had: - 2× the risk of developing heart disease and cancer - 4× the risk of depression - 12× the risk of suicide attempt compared to someone with no ACEs
These are population-level effects. Individual outcomes vary enormously, and the ACEs research documents risk, not determinism. The research also does not imply that ACEs are irreversible — early adversity shapes, but good subsequent experience can significantly alter trajectories.
Resilience in Adversity
What protects children from the effects of adversity? The resilience research (Werner, 1989; Masten, 2001) consistently points to several factors:
Relationships: A consistent, caring relationship with at least one adult — not necessarily a parent — is the single most protective factor across studies. The relationship need not be perfect; it need be consistent and genuine.
Self-efficacy: Children who develop a sense of competence — in school, in physical domains, in social settings — build a buffer against adversity. Mastery experiences matter.
Meaning-making: Children and adolescents who are able to make sense of their difficult experiences — who have a narrative that is coherent and that preserves their sense of value — show better outcomes than those whose experience feels random and self-indicting.
Access to resources: Schools, communities, religious organizations, and other social institutions can provide protective relationships and competence opportunities when families cannot.
The practical implication: it is not necessary to have had an ideal childhood to develop into a psychologically healthy adult. What matters is not only what happened but what happened next — and the quality of the relationships and reflection that mediate between early adversity and adult outcome.
19.7 Breaking the Cycle: Change Within and Across Generations
The phrase "breaking the cycle" is common in discussions of intergenerational patterns. What does it actually require?
It requires, first, visibility: seeing the pattern for what it is rather than experiencing it as simply "how things are" or "how I am." This is harder than it sounds. Family patterns are invisible precisely because they were formed before the person had language for them.
It requires, second, differentiation: not rejection of the family but genuine engagement that is not simply reactive. The person who breaks away from a controlling family by moving to the other side of the country has not broken the cycle — they have simply inverted their reactivity. Breaking the cycle requires being able to engage with the family system without being reorganized by it.
It requires, third, new experience: insight alone is rarely sufficient. People also need experiences that create new relational templates — relationships in which care is not contingent, in which conflict does not mean abandonment, in which vulnerability is met with response rather than rejection. These new experiences (in friendships, therapy, partnerships, and communities) gradually revise the working models formed in the original family.
It requires, finally, generativity: the willingness to invest in the next relationship with the understanding that the pattern can be changed forward as well as resolved backward. This is not only a therapeutic act; it is an act of meaning-making — the transformation of suffering into the capacity to do otherwise.
19.8 Having Difficult Conversations with Family Members
The psychological insight developed in therapy or self-reflection must eventually meet the actual family. This is where many people get stuck: they understand their patterns intellectually but remain reactive when the family system activates them.
Several principles apply to navigating family relationships more skillfully:
Lower your reactivity before engaging: Attempting to change family dynamics when emotionally flooded or highly reactive produces escalation, not change. The Bowen concept of the I-position — a calm, non-defensive statement of one's own values or perspective, without demanding that the other person agree — is most effective when the speaker is regulated.
Expect homeostatic resistance: When you change your role in a system, the system will press for your return. Family members who have benefited from your caretaking will, often unconsciously, behave in ways that recruit you back into the familiar pattern. This is predictable and not necessarily malicious. It is the system protecting its equilibrium.
Focus on your own behavior, not others' change: The most sustainable approach to family change is not "getting" family members to be different but changing your own participation in the patterns. This is both more achievable and, paradoxically, more likely to produce systemic change — because changing one element of a system inevitably affects the whole.
Preserve the relationship while changing its terms: The goal is not to win an argument with the family about who was right. It is to remain in genuine contact with people who matter while being less organized by the roles and patterns that the system has assigned.
From the Field — Dr. Elena Reyes
The most common thing I see in clinical practice is people who come in convinced that the problem is them — their anxiety, their relationship patterns, their self-sabotage — and who are completely correct and also only half right. The other half is that these individual patterns are also systemic patterns: they made sense in the family they were formed in, and they continue to be activated by relational contexts that resemble the original family.
The work with these patients involves two movements. The first is tracing: going back into the family history not to assign blame but to understand how the pattern was adaptive. The child who learned never to express a need because expressing a need was met with rejection or punishment didn't develop a pathology — they developed an intelligent survival strategy. The pathology, if you want to call it that, is what happens when that strategy persists in contexts where it is no longer necessary.
The second movement is differentiation — staying in contact with the family while being less organized by it. This is not quick work. People who have never experienced their parents as "just people" — flawed, finite, not all-powerful — often have a grief process when that perception shifts. The parents they needed didn't exist. The parents that did exist were doing the best they could with what they had. Both of these things are true, and holding both is the mature position.
I always tell patients: you cannot go back and change your childhood. But you can change your relationship to it. You can decide what you take with you and what you choose to do differently. Not out of rejection of where you came from, but out of genuine freedom.
Research Spotlight: Parental Reflective Function and Intergenerational Security
One of the most important findings in the intergenerational transmission research is the role of reflective function — also called mentalization — in the transmission of secure attachment. Researchers Peter Fonagy and Mary Target, building on Mary Main's Adult Attachment Interview research, proposed that what a parent transmits to a child is not simply their own attachment history, but their capacity to think about mental states — their own and their child's.
Parents with high reflective function think in explicitly psychological terms. They can: - Hold the child's perspective as distinct from their own - Consider the mental states (feelings, desires, beliefs) that drive the child's behavior - Reflect on their own mental states without becoming overwhelmed or defensive - Maintain their own perspective while being genuinely curious about the child's
Research found that parental reflective function predicted infant attachment security significantly, even controlling for the parent's own attachment classification. This means: a parent who was insecurely attached as a child can transmit security to their own child — if they have developed the capacity to think clearly about mental states.
This finding is important practically: it suggests that what can be changed across generations is not the fact of difficult early experience but the relationship to it. Reflective function can be developed in therapy, in trusted relationships, and through deliberate practices of self-examination. The work of understanding one's own history is also the work of protecting the next generation.
Common Misconceptions
"My family made me who I am, and there's nothing I can do about it."
Early family experience is highly influential. It is not deterministic. The biological capacity for change — neuroplasticity, the continuity of development through the lifespan — and the documented effects of subsequent experience, therapy, and reflection all support the position that early influence shapes but does not fix. The ACEs research documents this: having ACEs significantly raises risk but does not determine outcome. Subsequent relationships and experience modify trajectories substantially.
"Breaking the cycle means cutting off from your family."
Cutoff is not differentiation. Physical and emotional distance from a difficult family is sometimes necessary for safety — but it is not the same as the psychological differentiation that constitutes genuine freedom from family patterns. People who cut off often find that the same patterns are activated in subsequent close relationships, because the working models formed in the family travel with the person. The work of differentiation is interior, not geographical.
"Understanding your family's patterns means excusing what they did."
Understanding and excusing are not the same thing. Understanding the family of origin as a system — seeing the historical, social, and psychological forces that shaped its patterns — does not require removing accountability for harm or pretending that harm did not occur. It requires the distinction between explanation and justification. An explanation for behavior is not an endorsement of it.
"Happy families are all alike."
Tolstoy's famous opening to Anna Karenina is precisely backward, according to family research. Happy families are quite varied in their structure, style, and patterns. What they share is the quality of functioning — the capacity to maintain connection while supporting individuation, to repair after conflict, to provide care without suffocation, to adapt to change. The functional features of healthy families are more consistent than their surface characteristics.
"Sibling relationships don't matter as much as parent-child relationships."
Sibling relationships are among the longest-lasting relationships in most people's lives and have significant developmental effects. The sibling relationship provides the first experience of peer competition, negotiation, fairness, and shared history. Research by Judy Dunn and others has documented the lasting influence of sibling relationship quality on adult social skills, empathy, and relationship patterns.
Chapter Summary
The family is the first and most formative psychological environment. It transmits attachment patterns, emotional climate, beliefs about identity and worth, and models of relationship. These transmissions are not primarily explicit but patterned — absorbed through the accumulated texture of thousands of daily interactions.
Family systems theory (Bowen, Minuchin) describes the family as a system rather than a collection of individuals — one in which each member's functioning shapes and is shaped by all others. Homeostasis, circularity, subsystems, and boundaries are the key architectural concepts.
Differentiation of self — the capacity to maintain one's own perspective while remaining emotionally connected — is the central developmental achievement in family life. Low differentiation produces emotional fusion and reactivity; high differentiation enables genuine intimacy without merger. Differentiation tends to be transmitted across generations, but it can be developed through conscious work.
Triangulation describes the three-person relational pattern in which a dyad manages anxiety by involving a third; the most common form involves the triangulation of a child into parental conflict. The long-term effect is a person organized around others' relationships rather than their own.
Intergenerational transmission operates through attachment patterns, emotional climate, and the parentification dynamic. The research on reflective function (mentalization) suggests that the mechanism of transmission is not simply the parent's attachment history but their capacity to think about mental states — a capacity that can be developed.
ACEs research documents the cumulative effects of childhood adversity on adult health and psychological outcomes, while the resilience research identifies the protective factors — particularly consistent caring relationships — that moderate those effects.
Breaking the cycle requires visibility, differentiation, new experience, and generativity — not rejection of family but genuine understanding, sufficient to allow genuine choice.
Bridge to Chapter 20
The family is not the only social environment that shapes development. Beyond the family lies the wider network of friendships, communities, and social connections that sustain adult life. Chapter 20 examines friendship, social networks, and belonging — the science of what makes social connections nourishing versus depleting, how friendships form and are maintained, and what it means to belong in a way that supports rather than constrains the self.
For Jordan, this means examining why his professional relationships have come easily while his personal friendships have remained thin — and what it would take to build the social support that his achievement-focused life has consistently underinvested in. For Amara, recently arrived in a new city with the network she built in her previous home, it means building connection from scratch — and learning to do so without the anxious hypervigilance that has sometimes made intimacy feel threatening rather than nourishing.
Key Terms
| Term | Chapter | Definition |
|---|---|---|
| Family systems theory | 19 | Framework viewing the family as an organized whole in which each member's functioning shapes and is shaped by all others |
| Homeostasis | 19 | Family systems' tendency to resist change and return to familiar equilibrium states |
| Circularity | 19 | Systems concept: causation is circular rather than linear; no single first cause in family patterns |
| Enmeshment | 19 | Family boundary pattern with diffuse, unclear limits; members highly reactive to each other; individuation is difficult |
| Disengagement | 19 | Family boundary pattern with rigid, impermeable limits; emotional connection limited; independence forced prematurely |
| Differentiation of self (Bowen) | 19 | Capacity to maintain clear personal identity while remaining emotionally connected to others who differ |
| Emotional fusion | 19 | Entanglement of self with family system such that one cannot distinguish own feelings from others' |
| Intergenerational transmission | 19 | Transmission of attachment patterns, emotional climate, and relational tendencies across generations |
| Triangulation | 19 | Involvement of a third person to diffuse anxiety in a two-person relationship |
| Parentification | 19 | Role reversal in which a child takes on emotional or practical caretaking functions belonging to parents |
| Invisible loyalties | 19 | Boszormenyi-Nagy: implicit ledger of debt and entitlement that governs family behavior and adult choices |
| Emotional cutoff (Bowen) | 19 | Distance from family that masquerades as independence but is still organized reactively around the family |
| ACEs | 19 | Adverse Childhood Experiences — ten categories of childhood adversity with documented cumulative effects on adult outcomes |
| Reflective function / mentalization | 19 | Capacity to think about mental states (one's own and others'); key mechanism in intergenerational security transmission |
| I-position | 19 | Bowen's calm, non-defensive first-person statement of values or perspective in family interaction |
| Family roles | 19 | Fixed positions in stressed family systems (hero, scapegoat, lost child, mascot) that serve system equilibrium |