NCE – Contextual Family Therapy

Definition of Contextual Family Therapy (CFT)

​Developed by Ivan Boszormenyl-Nagy

Nagy was interested in being over knowing (Metcalf, 2011) and believed people cannot be understood in isolation.   He was interested in examining  individual relational patterns and needs.  Understanding the meaning we place upon our relationships is vital.

CFT is integrative, intergenerational, and multilayered (Metcalf, 2011, p65).

It is integrates perspectives of biology, psychology and sociology, seeks to understand the influence of several generations, and is partial to all family members’ perspectives (Metcalf, 2011). CFT is unique because it focuses on an inter-dimensional relational reality, comprised of multiple perspectives. For example, while our factual reality consists of the logical consequences of our lives that are unchanging. Against these objective realities are the individual’s interpretations of information of experiences into their subjective viewpoint. Finally relationships provide communication patterns and relational balances of give and take that define our day-to-day experiences. According to CFT, it is the therapist’s job to understand these multiple realities by validating and honoring the grain of truth in each viewpoint. In CFT, this is called “multi-directed partiality” (Metcalf, 2011).

  1. INTEGRATIVE – embraces biology, psychology, transactional patters, and responsibility.
  2. INTERGENERATIONAL – seeks understanding of an individual in the family context of at least three generations.
  3. MULTILAYERED – apparent in the therapist’s attempt to understand and be partial to all people who are affected by the discussions in therapy sessions.

​The uniqueness of CFT can be found in its multidimensional perspective of the family, which seeks the grains of truth in each viewpoint. Combining the insights of each perspective is essential in CFT to restore trust and re-establish a sense of balance and fairness.

Key concepts

​Relational Ethics

Metcalf, (2011), describes relational ethics as a unique concept in CFT that “distinguishes [it] from any other approach” (p70). While a laymen’s perspective of ethic refers to a moral standard of right versus wrong, ethics in CFT refers to a balance of give versus take (Metcalf, 2011). As I understand it, this concept acknowledges the fact that we do not exist in a vacuum. Instead our reality and very being is defined in relation to significant others in our lives. Understanding the concept of relational ethics to me may mean that the greatest character statement of who we are is found in the lasting impact we make upon those around us. It also means understanding that happiness can be found as a result of a healthy balance between our own individual needs with those of significant others in our lives. Attending to both are equally critical.

Ledger of Merits

Nagy believed relationships were built on a give-and-take.  Abstract ledgers of indebtedness bs entitlement exist in families.  For example, I believe as a mother, there is a specific indebtedness I have to my children, (i.e. unconditional love, happy memories, a stable home environment, food, clothing, shelter, and education).  I, in turn, am entitled to some respect as their mom.    This ledger of entitlement can include a psychological legacy in the form of  attitudes of destructive entitlement, (discussed next).

Entitlement

Nagy felt individuals had rights that belonged to them  (i.e, enjoy life, creativity and courage of commitment).  This concept of entitlement is not simply a feeling or idea but an ethical construct of fairness that guides our relationships.   As an ethical construct guiding relationships, it can provide a measuring stick against which a relational give and take can occur.  Internally, it can result in a feeling of entitlement.

Constructive entitlement can occur when family members receive respect, acknowledgement, and reciprocation.  We earn construction entitlement by being aware of others feelings and acting on this awareness.  In this respect, it is a reflection of our capacity for empathy.   It becomes destructive when there is no appreciation for the feeling of others, a attitude of over-entitlement, and an absence of give and take.  Situations such as these can become highly abusive.  Nagy used the term “revolving slate” to deceive how attitudes of destructive entitlement can be passed down from generation to generation, (Metcalf, 2011).

Loyalty

Loyalty is an thical concept of obligation to another person, in close relationships. It involved accepting these obligations in relatedness, sharing power, (i.e. give & take).  “Split loyalty – occurs when a person is forced to be more loyal or more disloyal to significant people in his/her life.” (Metcalf, 2011).

Parentification

Parentification can be thought of as a misuse of parental authority.  Englehardt (2012) states:  “The term “parentification” was first utilized in depth by Boszormenyi-Nagy and Spark (1973) to describe a common component of relationships whereby parental characteristics are projected onto an individual. Within the parent-child relationship, this process is often seen when the child performs chores or occasionally offers emotional support for a parent, and is believed to be healthy for the child as he or she begins to see the potential for him or herself in an adult role (Boszormenyi-Nagy & Spark, 1973). However, when the responsibilities become too burdensome, or when the child feels obligated to take on the adult position in order to maintain a balance in the family system” (p. 45).

Four Dimensions of Reality.

Contextual therapy assumes that the key dynamic of any relationship is trustworthi- ness, which is achieved by all family members having mutual consideration of each other (Boszormenyi-Nagy & Krasner, 1980). It also assumes that accountability and fairness are the essential connecting powers in the relational association” (Metcalf, 2011, p. 68).  Nagy uses the term contextual to refer to an ethical guidelines that influence our relational patterns.  These ethical guidelines reflect what Nagy calls “four dimensions of reality” (Metcalf, 2011, p. 68).

  1. “FACTUAL REALITY (DESTINY) – facts of life that are difficult to change including biological facts (i.e. age or sex), medical conditions, historical facts, racial, cultural or personal information” (Metcalf, 2011, p. 69).
  2. “INDIVIDUAL PSYCHOLOGY (NEEDS) – This dimension describes how people transform information from their external environment into cognitive information, experiences, emotions, feelings, motivations and memories. This contextual information can be described as their personality according to this theory.  Whereas facts objective, this is subjective” (Metcalf, 2911, p. 69).
  3. SYSTEMIC INTERACTIONS (POWER ALIGNMENTS) – this context deals with communication patterns in relationships.” (Metcalf, 2011, p. 70).  Family rules exist to maintain a sense of homeostasis…
  4. RELATIONAL ETHICS – “deals with the balance of what people give and what they are entitled to receive from others. Boszormenyi-Nagy (1987) described this process as follows: To the extent that I bene t from your contribution, I become indebted to you and you obtain entitlement on the merit side of your “ledger.” Then when I contribute to you or at least acknowledge your credit, I begin to restore the merit balance. (p. 207)” (Metcalf, 2011, p. 70).

Strengths & Weaknesses

A key strength of this perspective is its multidimensional nature. The multidimensionality of CFT is unique in that it appears to blend multiple perspectives and a relational reality [which is] combines often-divergent needs and motivations (Metcalf, 2011). A weakness of CFT can result from how effective the therapist is at communicating a multi-directive partiality. This concept appears to be a perspective that appreciates the validity in everybody’s viewpoint. In this respect, Metcalf, (2011), makes a point of noting that CFT is not neutral. Depending upon the skill level or contextual relevance of this theory a miscommunication of this concept can occur. For example, without multicultural sensitivity, miscommunication can occur in families with cultures divergent from the westernized perspective familiar to most of us.

Theoretical Assumptions

Nagy believed that people “are who they are” (Metcalf, 2011, p. 71).  For this reason he preferred to reserve judgment & instead assess the relational reality of his client’s.  In “CFT”, change occurs by examining the relational ethical concepts that guide familial interacting spontaneous motivations (see concepts above).  “Through [a] process of multidirected partiality, the therapist empathizes and gives credit to each family member, even if the credits may not be obvious at the beginning. This particular stance allows the therapist to open the dialogue among family members, which is based on responsibility, and encourages the family members to reinvest in trustworthiness” (Metcalf, 2011, p. 71).

A working template…

  1. “PHASE ONE – JOINING AND RAPPORT “What concerns brought you to this session?” What was it like growing up in your family?” (Metcalf, 2011, p. 74).
  2. “PHASE TWO – UNDERSTANDING PRESENTING ISSUE –  “I would like to hear your side of the story about what happened….What are the meanings given to these events?” (Metcalf, 2011, p. 75).  Use multi-directed partiality questions….”I am beginning to sense that in your family your father was HOH and you saw that it troubled your mother. Can you tell me what your view is today? ( Metcalf, 2012, p. 75).
  3. “PHASE THREE – ASSESSMENT OF FAMILY DYNAMICS – family should assess the fairness of their actions, not the therapists. “How did you know that you were loved in your family? How do you think about what your parents did as caretakers?” ( Metcalf, 2012, p. 75).
  4. “PHASE FOUR – GOALS increase trust and exoneration, hold all accountable. “what would it take for there to be more fairness..how will you begin to show your parents that you want things different?” (Metcalf, 2012, p. 75).
  5. PHASE FIVE – AMPLIFYING CHANGE “When the family members begin to recognize the change that they want in themselves and start doing things differently, it can be said that the goal has been met. Here are some comments or questions that a therapist might use during this ph ‘have noticed you’re making real progress.’” (Metcalf, 2011, p. 76).
  6. PHASE SIX – TERMINATION – a mutual decision..

References

Englehardt, J. A. (2012) The Developmental Implications of Parentification: Effects on Childhood Attachment.  Graduate Student Journal of Psychology. Vol 14, (pp. 45-53).
Metcalf, L, (2011). Marriage and family therapy: A practice oriented approach. New
​York: Springer Publishing Company

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