Between Give And Take

A Clinical Guide To Contextual Therapy

Ivan Krasner Boszormenyi-Nagy

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781134845255
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

In this volume, Boszormenyi-Nagy and Krasner provide a comprehensive, sharply focused guide to the clinical use of Contextual Therapy (CT) as a therapy rooted in the reality of human relationships. The authors describe a far-reaching trust-based approach to individual freedom and interpersonal fairness that makes possible a remarkably effective system of psychotherapy. Between Give and Take clearly delineates four basic dimensions of relational reality: factual predeterminants, human psychology, communications and transactions and due consideration or merited trust. It is this last dimension that is the cornerstone of CT. It builds on the realm of the "between" that reshapes human relationships and liberates each relating person for mature living.

V. THERAPEUTIC METHODS

CHAPTER 13

A Case Illustration

It is sometimes difficult to convey the therapeutic agenda of contextual work. Its scope and goals are rooted in the complex considerations of its four dimensions of reality and extend well beyond the limits of symptom corrections and techniques. On the other hand, live demonstrations readily show how, through the leverages of Dimension IV, family members can be reached at a deep level in the early moments of their first therapy session. Despite the undisclosed complexity in and between family members, it is relatively easy to surface every person’s fundamental longings, claims, disappointments, and discouragement with their lives together, as well as to surface their inevitable hopes for a better way.

It is relatively easy to elucidate the relational realities of closely relating partners. It is to be noted here that the emphasis is on the balances of fairness between individual members in their close relatedness rather than on “the family.” It is also relatively easy to demonstrate how to activate their residual or unutilized resources for commitment. Contextual therapy proceeds on the premise that people’s commitment to each other is the essence of relational reality.

Intermember behavior is secondary to the reality of their fundamental commitments. The origin of commitment is the fact of people’s existential relatedness and the family members’ desire to get something from that relatedness. Commitments obviously exist whether or not they are viable. The viability of commitments always depends on the relating partners finding ways towards fairness in the balances of give-and-take between them (Dimension IV)—time and time again. Consider the situation of the mother and her adult daughter and son whose respective outward be havior seemed dutiful, if rote. Twenty minutes into their first therapy session together was time enough to surface dynamics among them that none of them had ever addressed. The presenting issue was the superficiality of their exchanges and transactions. The underlying issues all had their roots in intergenerational injuries and injustices that motivate ethical disengagement.

The following excerpts illustrate the nature of some of the contextual interventions that can take place in the space of a few sessions. The daughter, already doing contextual work, invited her mother and brother in from out of town to attend some sessions with her. Therapy, like life, is never a short-term process. On the other hand, though, the period of intervention is not necessarily long. Contextual therapy, through its focus on Dimension IV, is immediately relevant to clients at deep levels of their existence. It takes time to learn how to be a competent therapist, of course, and it takes an even longer time to become a competent, short-term therapist.

At the beginning of therapy, Sarah presented herself as a hardworking, overburdened, frequently unappreciated person who was deeply committed to social and religious concerns. She sometimes suffered from insomnia and occasionally from suicidal thoughts. She also felt exploited by males. She had been married for a brief time in her early twenties. At some levels, she felt inferior to her mother who had been able to sustain the marriage to Sarah’s father, now dead.

Sarah was often guarded and suspicious of close relationships with men. She was wary of another marriage, though sometimes she regretted never having had a child. On the other hand, she was dubious over whether or not she would have offered good parenting “material.” In essence, she was highly defensive, if not paralyzed, in many areas of personal relating.

Sarah’s picture of her brother Will was one of a successful businessman who knew what he wanted from women even when it seemed difficult to get what he wanted. She was impressed with the courage it took for him to risk marriage for the third time. She longed for a closer relationship with him, but felt unable to reach out to Will in any significant way. Sarah also realized her own success and competence in her profession. In fact, her work as a helping agent provided her with her major source of deep satisfaction.

The therapist worked on preparing Sarah for the meetings with her mother and brother in earlier, individual sessions, conveying the importance of each family member taking a courageous stance. For Sarah to face and express her own needs was likely to serve her own and her relatives’ best interests in the long run. She had initially sounded all too eager to excuse her parents and could see very little of how her hurt feelings had originated from her relationship with them.

Sarah was concerned about her mother’s drinking. She remembered mother’s suicidal gestures and her past psychiatric hospitalizations. Recently, she had also begun to worry about Will’s increasing emotional isolation. He seemed emotionally remote from his children and his relationship with his daughter was especially angry and estranged.

Failing in outside relationships is usually the tip of the iceberg, characterized by stagnation over using dialogic resources, i.e., the capacity for reciprocal commitments to fair relating in significant relationships. Patterns of overgiving are often used as a substitute for a dialogue of reciprocal commitments. In the beginning, patterns of overgiving may seem to be an effective means of binding people. Yet it is likely that they originated from the fact that a person has been a parentified, exploitatively depleted child forced into a pattern of self-denial. The pattern of self-denial then develops from a child’s ambivalence over giving, while, at the same time, he or she fears being exploited by the very person he is giving to. The exploited overgiver is likely to develop destructive entitlement which is bound to surface in and poison later relationships.

Contextual therapy holds that overgiving relationships can often be reshaped through work on the interpersonal dialogue of fair balances. Overgiving can actually improve the quality of a person’s giving if, simultaneously, he or she can honestly claim his due (self-delineation), and his partner can validate herself through learning to acknowledge how she benefits from a more open exchange. First, however, the frustrated over-giver has to learn to credit the fact that, indeed, he was unfairly victimized.Only then is he genuinely ready to exonerate the exploitative parent.

The contextual therapist knows that a child is most destructively parentified when he is caught in the obligation to service the failing, mistrustful relationship between his parents. The more subtle the mistrust between spouses, the less manageable it is for their youngster. The covert collusiveness of extractive, dependent parents may make matters even worse. Their apparent, joint disregard for the child’s genuine needs will ultimately force him into becoming an even more desperate giver. By comparison, honest, parental quarrels are a much more tolerable filial burden than this hidden bind of severe parentification, with all of its subtle, guilt-laden implications.

Sarah brought her mother, Ms. L., and younger brother, Will, in from the Midwest for a series of four therapy sessions. The therapist opened the first session by asking Sarah if she had told her mother and brother her motives for bringing them together. Sarah said that her work as a lawyer underscored the significance of family relationships.

Daughter indicates her fear that family members will oppose the exploration of their relationships.	Sarah: At a conference last fall, someone said that it’s really hypocritical to ask families to come and talk about each other if you haven’t done it with your own family. There’s an integrity issue. For example, when I suggest that a client might benefit from therapy, I always say, “I’ve had therapy and it’s really changed my life.” The other thing is if you see connections in your own family, you’re more likely to see connections in other families too. But when I finally called, I found it was scary to ask my own family to come in.
Emphasizes hidden, relational resources. Implies courage to face option for self-validation through extending concern about the humanity of the other (Dim. IV). Emphasizes positive resources over a search for pathol-ogy. Appeals to the deeper truth of the search for love among close relatives.	Therapist: Well, my experience with my own relatives, as well as with clients, tells me that there’s typically a lot of love and care that often get derailed in families. People get stuck in terms of what they can safely say to each other, what issues they can discuss, what reactions they expect. Each of us builds up a kind of family fiction and loses the humanity of the other person. The issue today is not to emphasize anything negative—all families have negative aspects—but to gently nudge the caring so that some of the harder issues among you can get conveyed. That way you have a chance of getting closer. The problem is that people can love each other and still be distant from them.
Makes explicit the inclusiveness of therapeutic care and partiality. Thereby begins to define the therapist’s contractual attitude. Elicits daughter’s spontaneity in choosing an area of obvious concern. Directs same partiality towards son as well.	I guess, for me, the people in this room today include the three of you, plus Mr. L and your other son, Johnny. I hope they get incorporated in the discussion because, in many ways, they are here; there’s no way it could be otherwise. Beyond that, Sarah, where would you like to start? It may be one of the areas that you would like to change between you, for example, the anxiety you carry when you want to raise a difficult question. And you might have parallel issues, Will.
Mother credits daughter’s generosity in giving to people. Yet the childhood example she recalls raises the question of a familial pattern of sacrificial over-giving at the expense of legitimate efforts at self-delineation.	Mrs. L: I’m very proud of what she’s doing, helping people. As a little one she always wanted to do that. My husband didn’t like to go to things at school. She was president of some organization, so I said, “Come on now. This is a dinner and she’s down on the program three times.” We went but she didn’t say a word the whole time we were there, and my husband wanted to know why I had brought him. I asked Sarah why she didn’t speak if her name was on the program. “Oh,” she said, “I had friends who felt terrible because they weren’t included in the program. So I told them to take the time allotted to me.” She’s always helped other people.
Inquiry into the origins of the pattern and the question of whether giving to people binds them into undue obligations.	Therapist: From whom did she get that, Ms. L?
	Ms. L: My father was a Methodist minister and I think she may have gotten that from him.
The parentified daughter intervenes on her mother’s behalf.	Sarah: But you’ve always done a lot for people. Don’t you think so?
	Ms. L: Well, I don’t know.
Pattern is connected with self-denial and with the grief over the death of a family member. Acknowledges mother’s giving.	Sarah: I think you gave a lot of parties for people, and for us. You know, I guess w...

Table of contents

• Cover Page
• Half Title page
• Title Page
• Copyright Page
• Contents
• Preface
• Prologue
• Half Title
• I. Premises
• Chapter 1 An Orientation to Contextual Therapy
• Chapter 2 The Challenge of the Therapy of Psychotics Background of the Contextual Approach
• Chapter 3 A Dialectic View of Relationship The Development of the Contextual Approach
• II. Outlines of the Human Context
• Chapter 4 The Four Dimensions of Relational Reality
• Chapter 5 Interpersonal Conflicts of Interests A Four-Dimensional Perspective
• Chapter 6 Three Aspects of the Dialogue Between Persons
• Chapter 7 Dialogue Between the Person and the Human Context
• III. Assessing the Context
• Chapter 8 The Client-Therapist Dialogue
• Chapter 9 Assessing Relational Reality
• IV. The Process of Therapy
• Chapter 10 Health, Autonomy, and Relational Resources
• Chapter 11 Rejunction Reworking the Impasse
• Chapter 12 Resistances Obstacles to Therapeutic Progress
• V. Therapeutic Methods
• Chapter 13 A Case Illustration
• Chapter 14 Balance in Motion Crediting
• Chapter 15 Starting Therapy
• Chapter 16 Multidirected Partiality
• Chapter 17 Contextual Work with Marriage
• VI. Applications and Guidelines
• Chapter 18 The Evolving Face of Marriage
• Chapter 19 Divorce and Remarriage
• Chapter 20 Parenting Problems
• Chapter 21 Other Applications of Contextual Therapy
• VII. Therapists in Context
• Chapter 22 The Making of a Contextual Therapist
• Endnote: On Meaning Between the Generations
• Glossary
• References
• Index