The New Contextual Therapy

Guiding the Power of Give and Take

Terry D. Hargrave, Franz Pfitzer

• Publisher: Routledge
• Year: 2004
• ISBN:
  9781135952785
• Edition: 1
• Topic: Psicología
• Subtopic: Historia y teoría en psicología

Through detailing and examining the four interplaying dimensions of relationships, Contextual Theory gives therapists the ability to reshape human relationships and solve problems using the strengths of trust, fairness, and freedom. Not just a review of what came before, this brief clinical guide de-mystifies the Contextual Theory of family counseling for practitioners and students in language that is succinct and lucid in order to expose a whole new generation of therapists to this important approach to family therapy.

SECTION I
The Dimensions of Contextual Family Therapy

CHAPTER 1
The Basics of the Theory

Contextual family therapy is about understanding and intervening effectively in relationships. This is a description, more than a definition, of function. For years, students of therapy have been aware of the contextual family therapy approach as an important addition to the literature but usually are somewhat confused about the language, definition, and philosophy behind this type of therapy. It is as if people know that contextual therapy has something important and even profound to say about individuals and relationships, but they are not quite sure what that “something” is about. There are many reasons for this type of confusion, but a primary one is that the theory is so profound. It speaks about fair consideration, relational obligations, freedom, destructive entitlement, and loyalty. All of these concepts are not part of our everyday therapeutic language but carry hefty influence in the manner that individuals and relationships develop. The confusion, however, over the difficult language and the hard-to-understand philosophy usually translates into the profound concepts being little thought about and, more important, being little used.

This book attempts to change some of these problems. When we say new contextual therapy, we mean no disrespect to those who have written about the contextual approach in previous years. Indeed, the work of others in the contextual therapy arena has changed our lives and has certainly changed the way we do therapy. Neither is the term new meant to give the connotation that the approach that we describe in these pages is the definitive work about contextual therapy. When we say new, we mean that this book makes every effort to make the concepts of contextual therapy more accessible to the student of therapy and to the clinician interested in mastering the approach.

Our purpose here is to present the therapy in a clearer language and to underpin the concepts with clinical examples. Also, we hope to present some new formulations based on our clinical understanding of the dynamics of the therapy to move the contextual field forward. Some of these ideas do not hold with old conceptualizations of the theory and will move the reader outside the traditional understanding of contextual family therapy. Our intent, however, is not to try and reject the ideas of the past but to effectively build on them to provide the reader with a good primer on the subject of contextual therapy and to make the therapy usable and dynamic in a person’s clinical work.

Furthermore, we write this book now because contextual family therapy is at a critical juncture. Without clarification, this essential theory is in danger of being recognized by the larger family therapy field in only a cursory manner or being ignored totally. In order for this helpful model to grow, it must have a wider acceptance in training programs that eventually produce contextual therapists.

WHY ARE THEORIES OR MODELS NECESSARY?

We currently see two dangerous trends in the field of psychotherapy. The first concerns the nature of the psychotherapeutic field. The whole endeavor of the psychological pursuit has been the scientific understanding of behavior and mental processes. We are in agreement with the intent of science in psychotherapy. Psychotherapy needs to be about using sound empirical methodologies to “prove” the efficacy and the successful clinical outcomes of practice. The current trend in the last decade, however, is to insist that unless good science and research back up everything we do or say clinically, then our clinical work is at best questionable and at worst unethical. Government and the insurance industry have added to this notion that if you cannot prove clinical outcomes by the techniques used, then the clinical practice is largely useless. This has certainly made the psychotherapy community more responsible in consideration of techniques and practice, but it has also had the undesirable effect of making the community more tentative. Most who are in some type of psychotherapeutic work have a tendency to stick to the “book” of proven methodology and are hesitant to develop truly new ideas and techniques. In the field of family therapy, for instance, there was a time period in the 1960s and 1970s when new ideas and theories flourished. Yet in the last decade, very few “new” ideas have been developed and no new major theoretical perspectives presented. Although ideas of science and clinical efficacy are good, when taken to the extreme, they have resulted in the stagnation of therapeutic technique.

The second trend that concerns us is somewhat an outgrowth of the first. As individuals in the psychotherapeutic community are forced to “prove” their work, they become primarily interested in specific techniques. Instead of having a broad understanding of the complexity of human nature and the intricacies necessary to encourage change, many psychotherapists have become “technique junkies” (Hargrave & Anderson, 1992). In doing so, there is a performance of practice instead of sensitivity to need. It is similar to a person knowing one chord or a set of chords on a musical instrument. He or she may know how to play one note or one song but certainly does not know how to play or to be a master of the instrument. In order to really play or master the music, one must have an understanding of the dynamics and the unique character of the instrument and how it fits within the larger scheme of orchestration (Hargrave & Anderson, 1992). Without this understanding, psychotherapists become more or less assembly-line workers, turning out patients on whom they have performed the specified technique.

Psychotherapy is and should be based on good science, because science employs the empirical methodology necessary to lead us to what is true and what works. But in addition, we also believe that psychotherapy is an art. Art also pursues truth, but it uses a different methodology. Art’s methodology is aimed at expression, emotion, and perspective. Psychotherapy must always struggle to balance itself in this precarious position, striving for scientific investigation to legitimize practice and acknowledging that much of what is done in psychotherapy is about how therapists use themselves in an emotional and beautiful way to bring about change. When the psychotherapeutic community becomes imbalanced to either side of science or art, then the result will ultimately be irresponsibility or stagnation. Theories or models provide a guide for the psychotherapist on how to perform this difficult balancing act. Theoretical perspective gives broad understanding not only of the psychotherapist but also about human nature, change, and development. It provides the beginning point for people to express their ideas and allows them to apply perspective to the human condition. But good theory also provides the constructs necessary for testing and falsification. Science is therefore used to inform the theory about how the ideas and the perspective work in reality. This should, in turn, lead the psychotherapist into betterinformed artistic expression in clinical work. Good theory should give the psychotherapist an opportunity to produce synergy, as art and science both inform one another in the pursuit of truth.

Good theory also enables psychotherapists to organize not only their techniques but also their therapeutic talents. Instead of psychotherapists randomly using this or that technique, they have a theoretical organization that provides appropriate direction and understanding for when and how to use techniques. In addition, theory allows psychotherapists to understand how they best use the human expression of emotion and perspective to help patients who are in distress. To allude to the musical metaphor, theory gives the psychotherapist a musical score in which to refer, organize, and judge the performance of clinical work.

Contextual family therapy offers another dimension of theory that is unique to therapy. Not only does it help organize psychotherapists’ talents and offer a basis for diagnostics and assessment, it also provides ethical targets for the therapy. One of the foundations of this theory is to give due consideration to clients, their development, and how previous relationships have shaped their thoughts, emotions, and behavior. Just as important, however, is that the theory also considers how the actions, emotions, and thoughts of the individual have affected and will affect the person’s current relationships and the relationships of generations to come.

Contextual family therapy is a very good model for clinical practice because it is an integrative theoretical approach. As pointed out by others (Gurman & Kniskern, 1981), it is almost a compilation of approaches or a “theory of theories.” As such, contextual family therapy gives psychotherapists the opportunity to organize their perspective on the human condition, as well as to put meaning to the techniques of clinical practice.

INTRODUCTION TO CONTEXTUAL THERAPY

Life is relational. It is difficult to imagine any kind of learning, sense of self, or understanding of the world without relationships. The philosopher/theologian Martin Buber (1958) put forth these thoughts in his articulation of the idea of I and Thou. The basic idea behind Buber’s work is that without another person reflecting back to me interpretations about ideas, actions, and physical being, there is no effective way for me to understand what I think, what I do, and how I look. At a very simple level, for instance, there is no way for me to construct the idea that my hair is combed in a pleasing way unless I get or have gotten the feedback from others that my hair does indeed look good. I cannot construct this idea in a vacuum in my head. It is dependent upon my relating to the environment and to people around me. The environment and other people give me the action context needed to interpret the necessary concepts of self and worthwhile activities. It is my relationship with the environment and with people that gives me the ability to know anything. In order to understand I, therefore, I must be in context with Thou.

This simple, yet profound, concept gives us the ability to say that there is a relational imperative about life. Even if I give up on mankind and move to a deserted island, the conceptions that I have had in my past relationships with people will make up the necessary components of my self-understanding. Relationships with others serve as the basis for our understanding of ourselves, just as the relationships others have with us serve as the basis for their understanding of themselves. It is the relationship, therefore, that is essential to understand because it forms the basis of not only how people interact but also who they perceive themselves to be.

Because the contextual family therapy approach is integrative, the foundation is built on the idea that relationships are based on and influenced by four dimensions of reality. These dimensions are facts, individual psychology, systemic interactions, and relational ethics (Boszormenyi-Nagy & Ulrich, 1981). These four dimensions can be discussed separately for the purposes of teaching and articulation, but it is important to realize that they are always intertwined and inseparable in the effect of and work in relationships. The four dimensions always mutually affect one another and the relational field; the whole of the dimensions is greater than the sum of the parts (Hargrave & Anderson, 1992).

Facts

This first dimension is essentially about the facts about life and the relationship that are true but are difficult to change. It includes factors such as our genetic input, physical health, basic history, and events in our life cycles (Boszormenyi-Nagy & Krasner, 1986). We can easily see how this dimension plays into relationships. For instance, if a person is diabetic, he or she has to constantly be aware of how the condition will affect health. Diet, medication, and lifestyle are all affected by the disease. In addition, the people who relate to the diabetic are impacted by how the person manages life. One can see how a husband who is diabetic and is in deteriorating health and refuses to take care of himself might lead his wife to want to become overinvolved or even nagging in the relationship, in an effort to improve his condition. The factual condition would perhaps affect the relationship by producing fear, depression, resentment, and anger and might be the primary focus of interactions.

It is important to realize that the dimension of facts is objectifiable. In other words, there is a way to know, touch, or feel contact with this dimensional reality. We may not be able to discover all the facts that exist and affect relationships, but it does not change the reality that the facts can be discovered. For instance, people may not inform others that they come from a divorced family and may not believe that the divorce affected them in the least. However, the choice the parents made to divorce makes up a factual history for individuals that they cannot change and most likely affects, even if unconsciously, how they eventually interact with others. All facts—appearance, socioeconomic history, circumstances, and life choices, just to name a few—affect this first dimension and involve a dynamic interaction in relationships. The therapeutic conceptualization and effort in this dimension are described in the next chapter.

Individual Psychology

This dimension relates to how the individual took the information given in the external environment and in relationships and then internalized this into cognitive information concerning beliefs, experiences, emotions, feelings, volitions, motivations, and memories. It basically describes the process of how individuals develop traits that strive for love, power, and pleasure (Boszormenyi-Nagy & Krasner, 1986). In the past, contextual family therapy has been heavily influenced to describe this dimension in psychoanalytic terms. Fairbairn’s (1963) object relations approach is especially noteworthy, as is Erickson’s (1963) work in describing the psychosocial stages. In chapter 3, we present a different understanding of the underpinnings of individual psychology for clinical application. But no matter what the methodology of describing the process, this dimension concerns the process in which individuals eventually develop ideas about themselves and move toward expressing those ideas in action, which we eventually call personality.

As opposed to the first dimension of facts, the dimension of individual psychology is subjective in nature. In other words, we can never be quite sure about the dynamics and actions that lead an individual to construct certain ideas, beliefs, or motivations for behavior. Two individuals who come from the same genetic background and have very similar experiences may construct very different individual psychologies. This subjective fact of construction means that we can never articulate with absolute certainty the way an individual’s beliefs, motivations, and emotions are developed and will continue to change through the developmental life course.

Systemic Interactions

Simply stated, the third dimension of systemic interactions deals with the communication patterns in relationships. Our knowledge about this dimension is actually based on general systems theory and cybernetics (Goldenberg & Goldenberg, 2000) and puts forth the idea that the behavioral interactions of the supraindividual level constitute an entity of their own. This entity, or system, produces transactions that regulate and define the system that we can see in the way of organizational structure, power alignments, and common system beliefs. For example, if a family comes into therapy and a parent consistently dominates the conversation with the therapist, defining the problem and the efforts of the family to improve the situation, we could easily see that the parent holds most of the power, which creates a structure where he or she is in control of the family, which in turn produces a belief that perhaps that parent will not listen or that no one else in the family has anything important to say. Also, symptoms or dysfunctions may be interactions that actuall...