CHAPTERT Contextual Therapy* Ivan Boszormenyi-Nagy, M.D., Judith Grunebaum, L.I.C.S.W., B.C.D., and David Ulrich, Ph.D. BACKGROUND OF THE APPROACH Current Evolution of Contextual Therapy Contextual therapy is a comprehensive rela- tional and individual therapeutic approac an effective preventive design based on our un- derstanding of basic relational structures and processes. At present, the field of psychotherapy is characterized by wide divergences in concep- tual points of view about goals and methods and philosophical debate about the basis of the ther- apist’s interventions. Criteria such as measur- able effectiveness or narrative meaningfulness "This chapter was coauthored by Ivan Boszormenyi-Nagy and Jadith Grunebsum. However, since Devid Ulrich ws coauthor with Dr. Nagy ofthe original version published in TOI. he remains a source of inspiration, an unportant con tabutor to, and coauthor ofthe present chapter “The authors wish to thank Catherine Ducommut-Nagy and Henry Grunebaum for their generous editorial and moral support 200 and commitments to epistemologies of “preex- isting reality” versus constructed “truth” are proposed as the significant parameters of ther- apeutic meaning and effectiveness. ‘These de- bates divide the entire domain of psychotherapy and are not limited to family-therapy discourse. ‘A goal of contextual therapy is to provide a conceptual schema that allows the inclusion of ‘many significant aspects of other approaches to psychotherapy, provided that they are ethically concerned and contractually responsible. We suggest that a multilateral contractual approach provides an overarching conceptual framework that can eventuslly integrate these divergent perspectives. In this sense, “contextual” means the total range of persons who are potentially affected by the therapeutic effort; ethical con- ccem regarding the impact on them of the ther apeutic intervention constitutes the essence of the “multilateral contract.” ‘The contextual orientation assumes that the leverages ofall psychotherapeutic interventions are anchored in relational determinants, andthat a comprehensive approach addresses these determinants in terms of the four interlocking dimensions of 1) facts, (2) individual psycholog (3) behavioral transactions, and (4) relational eth- ies. While we speak of relational determinants for therapy, the contextual approach never loses sight of the goal of benefiting persons, as well as promoting change within systems. The entry point and purpose of interventions are to pro- vide healing for an individual's pain or symp- toms, as well as to address relational problems. Development of the Approach Psychotherapy, in part, originated as a med- ical specialty and its scientific premises were based on the logical positivism and “work ma- chine” metaphor ofthe then-prevailing scientific philosophy. Consistent with this model was a hope for acomplete and “objective” understand- ing of the mind, and with ita scientific method for “curing” specific pathologies. The basic as- sumption eame to be that mental symptoms orig- inated within the mind of the individual. But with Freud's implicit theory of the “object-re- latedness” of human instinctual drives, a turn toward the relational occurred. This shift be- ‘came explicit in the writings of Ferenczi (1931, 1992), who, according to Guntrip (1961, p. 390) and Balint (1952, 1968), postulated a “primary object love for the mother" as underlying.all later development. According to Guntrip, Ferencai’s notions both disturbed Freud and influenced Klein (1992), Fairbairn (1954), Winnicott (1964), and Guntrip himself, Sullivan's interpersonal Psychiatry was another stimulus in Boszor- ‘menyi-Nagy’s early development as a therapist, as was Kalman Gyarfas as a mentor. In philos- ‘ophy, major progress toward the “relational” as @ fundamental category of reality was secured with the publication of Martin Buber's dialogic philosophy and_ philosophical anthropology. Buber's radical philosophy of “the interhuman” converged with and provided inspiration for a "Editors Note, While not alone inthis regard, contest therapy certainly i among a rater small group of (amy) 'herpy approaches tht i as explicitly concemed about in Aivdial funtioning, experiencing, and relating as about interaetonal and transactional matters CONTEXTUAL THERAPY 201 rowing conviction about the relational essence of life (Buber, 1958, 1965; Friedman, 1988). During the 1950s, a small number of clinicians (Bell, Boszormenyi-Nagy, Bowen, Fleck, Jack- son, Lidz, Satir, Wynne) gradually recognized the limitations of individual therapy, particularly with children and with psychotic adults. They began to explore conjoint therapy, initially for the nuclear family. In 1957, Boszormenyi-Nagy and his co-workers introduced family therapy as a research project at the Eastern Pennsyl- vvania Psychiatric Institute in Philadelphia. This project explored intensive psychotherapy of hospitalized psychotic patients. It was influ- enced by the psychoanalytically oriented ther- apy of schizophrenia, primarily the object relations theory of Fairbaien (1954), in addition to the interpersonal theories of Fromm-Reich- ‘man (1950), Searles (1955), and Sullivan (1953). Early contextual speculations relied on a He- lian dialectical integration of existential and object relational insights toward a more explic- itly relational model. The inseparabilty of the self (individuation) from relatedness was one of the early working hypotheses (Boszormenyi- Nagy, 1965). This dialectical model is different from both linear and circular principles of change. Synergistic with a phase of classical, systemic family therapy, an increasingly dialectical, con- textual understanding of depth relational dy- namies developed. Methodologically, emphasis shifted to total attendance, communications, and behavior patterns. In conjoint family therapy, treatment was not restricted to the diagnosed member. The work was rapidly expanded to people with a wide spectrum of nonpsychotic symptoms and their family members. Intrinsic to this new paradigm was a commit- ‘ment to a multilateral therapeutic contract. Al- though unrecognized as pivotal to conjoint family therapy, an implicit ethical reorientation was under way. However, the ethical implica- tions of this pluralistic contract were obscured by enthusiasm for the new causal clues, as in the work of Bateson (1951) and his co-workers, who were applying his systematic studies of communication within families (1956) to new therapeutic interventions. Initially, the explor- ative and technical innovations attracted more ‘enthusiasm than the contractual implications of the simultaneous care of several persons, often in conflict with one another. Although there202 have been numerous trenchant critiques, the cybernetic metaphor (Weiner, 1961) and sys- tems theory (von Bertalanffy, 1968) continue to be powerful theoretical models for the feld, de- spite some recent new directions (Anderson, 1987; Goolishian & Anderson, 1987; Hoffman, 1990}. During the 1960s, a number of family therapists began to discover that work should not be limited to the nuclear family or to trans- actions in the here and now; multigenerational patterns of connection began to find their way into conceptual frameworks and clinical meth- odologies (Boszormenyi-Nagy, 1966; Boszor- ‘menyi-Nagy & Spark, 1973), In the early 1960s, Boszormenyi-Nagy and his associates, including Spark and Framo, increasingly aware of depth relational processes, began to explore the ther- apeutic leverages to be found in the ethics of transgenerational relationships, for, example, “loyalty” and “rewarding allegiance” (Boszor- menyi-Nagy, 1966, p. 71; Boszormenyi-Nagy, 1972), and in the multilateral therapeutic con- tract itself. “Loyalty,” for instance, referred to the implicit ethical demand of filial indebtedness that life places on each new generation. Parallel with this, Bowen was also developing a multi- generational approach, culminating in his col lected works published in 1978, ‘The evolution of the contextual approach since 1958 has been an organic process. The impetus hhas been the societal background of overbur- dened, isolated, and fragmented nuclear fu lies. Contextual therapy is a discourse that has evolved in direct response to social, political, and economic realities. It isthe family approach that is most immediately resonant to the news in the daily papers and sociodemographic sta- tistics. The conditions under which the family as a social institution is trying to survive are visible to everyone. Divorce statistics document that families are trying to exist in the vacuum that was left when the connection between vi- able relationships and intergenerational root- edness broke down and the ethical implications of that connection were lost. In this social con- text, such ethical dynamics as family loyalty and ‘other imperatives that stem from common roots were severely tested. In our current social con- text, the family has become even more frag: mented, and there are growing numbers of women and children unable to maintain them selves above the poverty line. Ethical issues, HANDBOOK OF FAMILY THERAPY, VOLUME It both within the family and between the family and the larger society, have never been more urgent, In making these concerns primary, con- textual therapy departs from a primary emphasis on abstract hypotheses such as “structural” ab- normalities or “rigid rules” of communication, ‘The significant burdens for today’s nuclear fam- ily are complex, but they cannot be reduced simply to sequences of interactions occurring within the nuclear, or even extended, family itself. Multilateral concern is not limited to inter- generational connections as such. Whether one person or several are present at the session, the goal of contextual therapy is to achieve a re- sponsible orientation to intermember issues of tuust and fairness. The very use of the term “pa- tient” or “symptom” has to be questioned when the multilateral ethies of relationships becomes the guiding principle. In contrast with some other models, the contextual approach always retained interest in each individual's subjectiv- ity, not just psychologically, but also in terms of the inherent ethical properties of claim, obli gation, rights, entitlement, and relational merit Contextual therapy tends to avoid both the de- humanizing effects of techniques based on an overly simplistic understanding of systems phi- losophy and the inadvertent blaming of the “family” system, ‘The development of multilateral perspective challenges the reduetionistic application of psy- chological or transactional explanations of u- rehavior and emphasizes the risk of their use in clinical situations, especially those volving clear-cut and dangerous abdication of adult responsibilities and abuse of power and trust. Moreover, a distinction can be drawn be- tween those therapies that propose strategies within substitutive relational contexts (e.g, mainly through the utilization of therapeutic transference in individual and group settings) and those that offer assistance within the par- ticipants’ original or current relational context.” We agree with other family therapists that the latter avenue offers many therapeutic possibil- Edo! Note. Behavior therapy also emphssizes the im portance of treating bebavior init natural environment, ‘when posible, in order to promote generalization of treat rent electsically inefficient ities that are unethical and cli to ignore. ‘THE HEALTHY OR WELL- FUNCTIONING MARRIAGE OR FAMILY Four Dimensions of Relationships Four distinguishable but interlocking dimen- sions of relationships must be considered in or- der to describe what we regard as a “healthy” family. These dimensions make up the relational context and dynamics of family functioning (Bos- zormenyi-Nagy, 1979; Boszormenyi-Nagy & Krasner, 1986). Facts The first dimension of a comprehensive ap- proach to assessment and treatment planning has to do with facts, with what is provided by destiny, For example, ethnic identity, gender, physical handicap, illness, adoption, and survi Yorship are all given facts; they are parts of a configuration of destiny. Some facts are una- voidable—a distribution of chance and fate. Other facts are avoidable—a created reality, constructed by human understanding, agency, and choice. These actualities also become fact. For instance, the contingent historical context that one “inherits” and that influenced the lives of one’s parents and other predecessors becomes a set of facts or realities with consequences for future persons. The social context—especially injustices committed against one’s family or group, but also the priorities, definitions, and practices available at any given time in history ‘ culture—is an actuality with which every per- son or family must contend (Boszormenyi-Nagy, 1973; Grunebaum, 1987, 1990). These factual, historic injustices (dimension 1) become part of the legacy imperatives (dimension 4) for future offspring, The same holds true within the family for instance, unresolved marital conflict between ‘mistrustful parents becomes a fateful fact, im- plying a “split loyalty” situation for a child. The requirement to consider the welfare interests of others also has factual implications. For exam- INTENTUAL THERAPY 203 ple, ifone generation does not consider the con- sequences of damage to the environment, that failure becomes a fact for future generations. At this level, an obligation cannot be reduced to a value judgment as the outcome has survival im- plications. Here, “ethics” and factual conse- ‘quences merge. Psychology ‘The second, strictly individually based di- mension may be given the general heading of psychology, or what happens within the person, A significant characteristic of psychological phe- nomena is that symbolic meanings can be trans- ferred between persons. In this domain, one relationship may be substituted for another. Theoretical parsimony is not served by invali- dating the significance of drives, psychic devel- ‘opment, and subjective experience. On the contrary, the intensive, in-depth relational im- plications of psychoanalytic and cognitive theo- ries need to be explored, expanded, and tegrated with the other contextual dimen- sions. This dimension includes all phenomena based on psychic or mental functions, such as cognitive and emotional development, fantasy, dreams, and other symbolic processes. Transactions ‘The third contextual dimension may be char- acterized as the domain of transactions and is based on the patterns of organization within the family. Structure, power alignments, roles, and ‘communication sequences are different ways of describing observable aspects of the interactions ‘occurring in the present and how such interac- tions contribute to or prevent both change and stability, or adaptation, The goal that a family therapist tries to foster is progressive interac- tion. At this level, lack of sufficient “self-delin- eation” or differentiation of individuals leads to dysfinetional forms of reciprocity, whereby members protect one another from having to define boundaries, to make choices, and to function as whole, independent agents (Boszor- menyi-Nagy, 1965; Boszormenyi-Nagy & Kras- ner, 1986). Self-delineation isa dalogic process; in the context of a meaningful relationship,204 HANDBOOK OF FAMILY THERAPY, VOLUME It each person strives for identity, boundaries, and need complementarity (Bozsormenyi-Nagy, 1960). The family is viewed as an “organism” like other organisms, and the steering mecha- nisms by which it evolves are its relevant dy- namics. Most of the family-therapy literature, and even social science, pertains to this di- mension. Relational Ethics: The Balance of Fairness ‘The fourth dimension, which we regard as the comerstone of contextual therapy, is concerned with relational ethics. We consider relational ethics to be a fundamental dynamic force, hold- ing family and societal relationships together through reliability and trustworthiness. Accord- ing to multilateral logic, the balance of fairness among people is the most profound and inclusive “cluster” of relationship phenomena. This is the context to which the term “contextual therapy” applies. Here, “ethics” carries no implication of a spe- cific set of moral precepts or criteria of right versus wrong, It is concerned with the uniquely human process of achieving an equitable balance of fairness among people. By “fairness” we mean neither the mechanistic rigidity of giving all three children bicycles for Christmas, nor a bbarter system in which each item is exchanged for an immediate trade-off. Rather, the pres- ervation of a long-term, oscillating balance among family members, whereby the basic life interests of each are taken into account by the others, isthe eriterion of "healthy functioning,” This is not a self-denying ethic; it leads to ben- efits on both sides of the relationship. Further- more, what one person experiences is not the criterion of fairness. To gauge the balance, it is necessary to employ a multilateral process, by which we mean consideration by each family member of the interests of all family members, including his or her own interests—and a recip- rocal exchange of these considerations. Rela tional ethies are founded on the principle of cequitability, that is, that everyone is entitled to have his or her welfare interests considered by other family members. Multidirected partiality is the principle that balanced consideration be extended to the interests of those persons who will be affected by clinical intervention (Bos- zormenyi-Negy, 1967, 1986). In addition, ther peutic recognition of the multilateral nature of relationships is a central goal of contextual ther- apy, and suggests fundamental implications for autonomy and health. Entitlement and indebtedness vis-A-vis others are existentially given or earned, whether or not they are acknowledged or mutually validated. Trust is the fundamental property of relation- ships. It can be depleted or restored. Relation- ships become trustworthy to the degree that they permit dialogue concerning issues of valid claims and mutual obligation. Such issues cannot be reduced to a subcategory of the psychological dimension; basic trust and spontaneous concern may be a potential of all human beings, but the realization of trustworthiness is an ethical achievement (Erikson, 1964; Winnicott, 1971) It is the consequential outcome ofa relationship and does not originate primarily in the individ- ual's mind or mental state. Thus, satisfaction from relationships is determined not only by the fulfillment of one’s own needs, but also by the capacity for giving concern and gratitude (Er- ikson, 1964; Winnicott, 1963, 1971). Merited trust and accountability lead to participation in progressive interactions, as contrasted with re= petitive sequences that eventually deplete hu- man resources. The capacity to recognize and act upon indebtedness is an important criterion of functional adaptation and the continuing evolution of life. Receiving through giving is an important potential resource of all close rela- tionships. Entitlement eared through giving due concern and giving becomes an enabler of action, The motivational theory of contextual therapy postulates entitlement as a comotivator, along with needs and the biological and mental adaptations expressed by evolution, Together they codetermine the direction, form, and free- dom of action Unlike symbolic or transactional phenomena, the “credit” earned or inherited within the do- main of relational ethics allows no valid substi- tution, Merit earned by a mother through her actions can be repaid only to the mother. Con~ textual therapy differs radically from therapy based solely on psychological or transactional premises. Action or consideration of actions to- ward acknowledgment of a debt, or toward re- alization of one’s entitlement, is seen as @fundamental move toward building trust and health. The Basic Relational Context ‘The Multigenerational Perspective It is inadequate to assume that all of the vari- ables erucial to a child's development or family functioning could be found within the parents ‘or within the parental relationship. Instead, it is necessary to use a framework of at least three generations, including the historie, social con- text of each generation. At any point in time, at least three generations overlap. Even if the grandparents are absent or dead, their influ- ence continues and has consequences for their descendants. Psychological, transactional, and ethical dynamics lose crucial meanings and ther apeutic usefulness if they are not seen in this perspective, Legacy and the Ledger of Merit and Indebtedness ‘The term “legacy” has been introduced to de- note a configuration of expectations that origi- nate from rootedness and impinge on the offspring (Boszormenyi-Nagy, 1976). Certain basic contextual expectations convey an intrinsic imperative stemming not from the merit of the parents, but from the universal implication of being born of parents and other ancestors. At the current stage in the evolution of contextual therapy, the term “legacy” is used to denote the Universal injunction of parental accountability, including the human mandate to reverse the in- Justices of the past for the benefit of the next Beneration and posterity. This has also been called “the parental imperative” (Grunebaum, 1957), Thus, the roots of the individual's very existence become a source of mandates that af- fect his or her personal entitlements and in- debtedness, The origins of legacy mandates are ‘multigenerational; there isa chain of destiny an- chored in every generative relatonship and these chains determine the facts and the quality of the survival of descendants. CONTEXTUAL THERAPY 205 The Ledger In referring to personal entitlements and in- debtedness, we use the concept of the ledger. In the contextual approach, the ledger has to do with an implicit “accounting” of what has been ‘given and what is owed in return, It is hard to imagine a first interview, or even an ordinary conversation, that does not refer to premises about reciprocity. Ledger issues permeate our daily lives and relationships. Our efforts at sci- entific theory building have alienated us from the language of fairness and merit, and the prac- tices of care and connection. We are not dealing with ledger in the sense of barter, balancing of power alignments, or behavioral contracts that specify something for her and something for him. Here, ledgers a statement about the equi- librium between two ethical components. The first has to do with the debts and entitlements dictated by legacy and its counterpart, filial loy- alty. These may vary greatly even between two siblings; for instance, it may be imperative for one to become a success and for the other to become ill. Stierlin (1974) has called these spe- ciffe intergenerational expectations role “dele- gations.” Delegations stemming from one’s origins may place unfair burdens on the off spring, such as the consequences of aleoholism in the preceding generation, But whatever the specific terms, they derive their weight from the fact that the children were born of particular parents. Destructive “delegation” is not what we mean by legacy. Children are ethically bound to accommodate their lives somehow to their legacies, and to pass on the constructive possi- bilities within their inherited predicaments. The other ethical component of ledger has to do with accumulation of merit through contri- butions to the welfare ofthe other. In this sens ving is the “right” of the giver. Thus, “ent tlement” may combine what is inherently due as a parent or ehild and what one has come to merit. One who contributes to a balance of fuir- ness by supporting the interests and regarding the vulnerabilities of the others may be said to acquire merit and entitlement. In terms of re- Iational ethics, merit is the unit that counts. A natural mother who abandons her child may have earned no merit, yet the legacy of filial loyalty puts the child into a special ledger po- vis the parents, who still retain some206 HANDBOOK OF FAMILY THERAPY, VOLUME IT entitlement stemming from their reproductive roles. Therefore, it becomes inevitable that the child's loyalty will be split between the natural and substitute parents. Adoption studies have demonstrated this. ‘The family is strengthened by moves toward trustworthiness and weakened by moves away from it. Moves toward trustworthy relatedness we call rejunctive; moves away from such relat- ‘edness we call disjunctive. A family context is never enhanced by moves away from merited trust. A spouse, for instance, will not improve his or her marital relationship by trying to de- stroy the partner's residual trust in his or her parents. The descriptive term “relational stag- nation” (Boszormenyi-Nagy & Spark, 1973) is used for any instance of familial disengagement from concern about fairness. Ina stagnating fam- ily, moves toward rejunetion are blocked or ean- celed out. In a healthy family, conflict, position taking, negotiation toward mutual understand- ing, and recognition of mutual investments are accepted and valued. Major damage to trustworthiness enters the femily through the phenomenon of “destructive entitlement,” en- titlement earned through actually suffered past injustice, Asymmetry of the Parent-Child Relationship ‘A deep context of relational ethies exists in relationships stemming from intergenerational rootedness. Such rootedness provides an inher- ent synergism. Those who are linked by mem- bership in successive generations have an intrinsic convergence of loyalty that engenders profound consequences, We consider the anchor point of multigener- ational trustworthiness to be the responsibility for parenting, which is a structure basic to the lives of all higher animals. A central principle ‘of jintergenerational relationships is what we call “equitable asymmetry,” which recognizes that most of the giving flows from parent to young child (Boszormenyi-Nagy & Krasner, 1986; Grunebaum, 1990). Even if a person has no children, the “care-giving” imperative can be expressed through the commitment to relieve one’s own parents’ difculties and to contribute to posterity in many other ways. Parental ac- countability will affect the basie potential for trust in future generations. Here the ethics of accountability meets the ethics of “the right to five.” Parental responsibility can include the de- cision not to have children, Marital Relationships An ethical dimension exists in all relation ships. For marital partners, the criterion of “health” is linked to a symmetry of rights and responsibilities, Depending on their integrity and on the complementarity of their needs (Boszormenyi-Nagy, 1965), marital partners can develop trustworthy convergence and symmetry of give and take. But if their welfare interests clash, negotiation and compromise are known to be necessary and fair. Couples are usually members ofthe adult gen- eration, and, therefore, are potentially capable of the equality and reciprocity necessary for vi- able long-term, adult relationships. However, ‘many variables intervene, such as external events or social and political inequalities, that drastically alter the capacity for symmetrical give and take, and necessarily lead to a search for balance. There are also inherent asyrmme- tries, such as a man's and a woman's different relationship to and accountability for biolog- ical reproduction (Boszormenyi-Nagy, 1976; Grunebaum, 1987, 1985). However, it is within the social domain that equitable rebalancing can cccur, and thus the social ideology and practice that structure the allocation of responsibility for child care and breadwinning, the division of la- bor, must be considered an ethical dynamic on the societal level that fatefully influences the assignment of “roles” within the family. To a large extent, adaptive functioning depends on the partners’ ability to negotiate role allocations and definitions to suit their own personal rela- tionship and circumstances, and to redefine the dictates of social practice when necessary. In health, each couple chooses its own set of prac- tices based on complementarities at the trans- actional level, which are chosen and negotiated. In this sense, there is a continual interplay among individuals, relationships, ideas, values, and social practices within the larger societal context (Grunebaum, 1990),Loyalty “Loyalty” is one of the earliest concepts in the development of contextual therapy. Originally, the concept emphasized the merited “alle- siance” eared through due caring or generative contribution. Parental responsibility has a recip- rocal imperative in the child's loyalty to its roots. Loyalty is a factual, relational dynamic, central to the child’s functioning even into adulthood. ‘The child has a reservoir of trust out of which he or she can initiate advancements of trust to- ward the parents. This reserve of trust derives from the legacy of intergenerational relatedness. Additionally, it derives from the human concern for the fairness of giving and receiving. To the degree that the parents arc able to maintain @ balance of fairness, they acquire a merit that personalizes and validates the child's basic lo ally commitment, Ultimately, however, the child's right to give isa factor that codetermines the child's loyalty to the parent, along with the obligations arising from flial indebtedness. This current view expands the original obligation- based notion of the origins of filial loyalty ‘The fact that common rootedness ereates an interlocking. of vital interests is often obscured by divergence at the level of attitudes. Violent conflict can erupt when an adolescent's behavior challenges his or her parents’ view of how fast the adolescent should grow up. Yet, except in the most pathological instance, all three coneur that growing up is one ofthe child's basie welfare interests. As an essential part of this process, both parental accountability and filial loyalty are renegotiated and given new meaning at each new phase of family evolution. However, since the “self” evolves through transactions with others, each phase of the life cycle offers opportunities for dialogue; family members may react to individuation in a mem- ber with a growth-inhibiting or growth-validat- ing response. But developmental transitions afiord the opportunity for relational enrichment and mutual growth (Shapiro, 1985). Important ‘markers are the separation of children from the hhome, the marriage of children, the birth of srandchildren, and the sickness’ and aging of grandparents. Each of these phases requires @ redefinition of loyalty, and a shift in the direetion and distribution of accountability. The core eth- ical dynamic of fairness requires that the vul- CONTEXTUAL THERAPY 207 nerable person deserves consideration; the one siving consideration deserves acknowledgment. A Relational Definition of the Self: “Self-delineation” and “Self-validation” Individuation is a desirable goal. But our def- inition of individuation strongly emphasizes a “both/end” as opposed to an either/or orien- tation. Autonomy is measured by both the ca- pacity for seif-object delineation and the capacity for responsible engagement within relation ships, or “self-validation.” Sel-validation is both 1 condition for and a benefit of the mature re- Iational dialogue. SelE-validation expresses the ‘goal of multlaterality; it refers to the observation thatthe “sel” benefits both as a functional entity and in terms of increased value, when engaged in relating to others mutually and reciprocally. It is well expressed in the Talmudie saying, “If Lam not for myself, who am 1? If Tam not for others, what am I? If not now, when?” Noble or self-sacificial actions that are costly to the self are not considered healthy. Contextual Therapy and Feminist Values The contextual orientation (Boszormenyi- Nagy, 1965, 1967) anticipated the notion of the “relational self" currently being elaborated by contemporary feminists (Gilligan, 1982) and many other researchers concerned with under standing “prosocial” behavior (see Grunebaum, 1987, 1990). Bowen (1978) implies that “dilfer- entiation of self” ean occur only in a context of engagement with and responsibility to others The notion of health, which is basic to the con- textual approach, is that of interdependence and differentiation based on considerations of each person's needs and rights. Synergistic with fem- inism, the multilateral perspective and goals of contextual therapy extend into the social realm. The dynamics of the healing process are insep- arable from the recognition of social injustice, and thus of social responsibility and social change. Moreover, its concer about fairness makes contextual therapy part of a broad-based concern for humankind’s survival. The mult generational mandates and concern for the qual-208 HANDBOOK OF FAMILY THERAPY, VOLUME I ity of human relationships, made explicit by contextual therapy, can be conceived of as a “transgenerational tribunal” concerning the sur- vival of humankind (Bozsormenyi-Nagy, 19872) Conflicts of Interest Problems are considered ubiquitous in human life and often involve conflicts of existential in- terests, or conflicts among many desirable goals In contextual therapy, there is no assumption that the interests of individuals will be identical, cor even that there are no conflicting goals ofthe family as a whole (Ruddick, 1990). The process of facing conflicts of interests, often underplayed in other family-therapy approaches, is central to the contextual definition of relationships. Well- functioning families emphasize their own rela- tional resources for solving problems, rather than viewing life's problems as shameful and pathological events to be avoided. Intimacy Shared affection and sexuality are great re- sources of relationships. They are the valued rewards of risking intimacy. The search for in- timacy is a deep motive of human beings—the desire to be known, understood, and confirmed asa person on one’s own terms, a relational “en- titlement.” In our current era, itis not fashion- able to perceive sexuality and intimacy as ‘contingent on a context of trustworthiness and fairness. Yet clinical and human experiences demonstrate that interpersonal injustice even- tually will erode closeness and sexual attraction, Levels of intimacy and separateness are seen in terms of investedness in relationships. Be- havioral expressions of mutual investment in- dicate concrete availability for the sharing of burdens and emotional accessibility. However, investednessis not reducible to these behavioral expressions. Parent and child have a shared ex- istential interest in each other’s lives and welfare even if there is an emotional “cutoff,” or even Af there has been adoption ofthe child by others Parents have a shared interest in their children’s lives even ifthe commitment between them has ended. Relationships with extended family offer op- portunites for ongoing concern and periodic as- sessment of the multilateral requirements of caring relationships. Traditional extended-fam- ily patterns were arenas of a variety of modes of giving, taking, and receiving. Loyal belonging to a family is synonymous with the members’ needs and rights to give and receive. We con- sider the delicately balanced nuclear family as impoverished with regard to such opportunites However, the so-called normative nuclear fam- ily fortunately is more myth and ideolony than reality, as documented by research that dem- onstrates an uninterrupted flow of resources in both directions between adult child and grand- parent generations (Walsh, 1983) The Social Context Although we believe that the desire for terhuman fairness is basic and universal, it is also observable that ethnic, socioeconomic, ge der, and other “differences” bring out special forms of fairness, reliability, exploitation, and distributions of benefits and burdens. It is pos- sible to say that some cultural practices are more fair than others. For instance, it cannot be con- sidered “just” when a culture prescribes such human mutilation as wife burning or sacrifice, infanticide, or harsh and abusive child-rearing practices. Nevertheless, the persistence of such practices must be viewed in the context of the culture as a whole and in terms of the material contraints of its factual, contingent historical evolution, spiritual values, and the demands of reality with which the culture or community had to contend. Societies differ with regard to their respect for human rights The speeifie definition of group belonging and loyalty varies from family to family. Although loyalty is resource, adversity and injustice to- ward one’s group reinforces loyalty and may lead members t0 be prejudiced and fearful of out- siders. In healthy families, solidarity and inti- macy within nonkin relationships are desirable and are not based on the reactive need to be disloyal to one’s kinship group. The resources of relating to nonfamily members depend on shifting gears to a different level. However, re- lationships with friends, colleagues, subordi- nates, students, and business partners also have to be governed by the guidelines of due consid-eration. They are complementary to a healthy family and enrich family life. Prejudice toward outsiders is not considered healthy or desirable. Relationship with Posterity Akey feature of the contextual approach is the consideration of the interests of posterity. This transgenerational aspect of family relationships {sas crucial as are interactions with existing part- ners. The reason why this becomes an impera- tive is that members of future generations ‘eannot defend their own survival interests. They are entirely vulnerable to the consequences of the priorities and actions of past generations. Responsibility for posterity can become visible In family decisions about parenthood in cases of genetic or congenital damage threatening the offspring, How fair is it to have a child if its parents cannot secure its healthy growth? How fair is it to existing offspring, in terms of the istic appraisal of family resources? Never- theless, even in cases of severe handicap, famn- ilies often rise to the challenge and develop enriching resources for facing such circumstan- ces of destiny. An unfair burden can lead to a triumph for the whole family and for each mem- ber. The riterion of health is how equitably and realistically such a burden is shared, ‘THE DYSFUNCTIONAL FAMILY Contextual therapy deemphasizes pathology as its rationale and guideline; instead, it focuses on relational resources as leverages for change Since resources are conceptualized as interh man and dialogical (Boszormenyi-Nagy, 1966, 1973, 1986), descriptions of families in terms of their systemic patterns of organization or as ters of “conversing’” individuals each with his or own “construction of reality” are inadequate from our point of view (Goolishian & Anderson, 1957), The first model, based on an abstract de- scription of the family, discounts the factor of human agency. The second model makes all points of view equally valid and ignores both the social context of the family and the relative desirability of diferent perspectives. On the other hand, family descriptions emphasizing the CONTEXTUAL THERAPY 209 symptom of an individual member are also mis- leading. The family of the school-phobie child is, atthe same time, the family of the depressed ‘mother and the alienated father. Pathologizing the family as the cause of individual dificulties is the tragic mistake of many family-therapy schools, even if this covert blaming is couched in technical language. We are referring to the pathologizing use of such terms as “schizo- phrenogenic mother,” which wasa phrase much used and abused, but had the aura of legitimacy because it was stated in scientific language and fit with many cultural biases about women in their role as mothers. In our view, the family is the source of the most fundamental resources and relational op- tions, even if there are seriously shocking in- adequacies in the behavior of son and even if the family as a social inst been the location of flagrant injustices inflicted uupon women, children, and men, as well. In- ‘equitable allocation of reponsibility and lack of acknowledgment of the parenting role of mothers (Grunebaum, 1987) do not diminish the value and erucial importance of caring re- lationships. Yet these very injustices, as fem- inists have pointed out, must be implicated in any discussion of the causation of dysfunction Contextual therapy has the resources to join with other critiques of the contemporary family because it views long-standing interpersonal in- justice, especially within the family, as patho- genic in and of itself. The history of social injustice must be given a central place in the review of debts and entitlements, so as to over~ come the implicit assumption that the family, especially mothers, can compensate for any form of societal injustice and other historic hardships (Grunebaum, 1987, 1988, 1990) Regarding a rationale for any kind of therapy, we are far from a scientife formulation of the causes of family problems. As science has pro- gressed, explanations of how symptoms de- velop have become inereasingly complex and sophisticated. In the medical sciences, it is in- creasingly accepted that symptoms must be ap- proached as a failure of resistance to disease processes. Disease is considered to be a process Of the relations between host and environment. Environmental assaults on the immune system are one of the exciting frontiers in medical re- search, Contextual therapy converges with ad-210 HANDBOOK OF FAMILY THERAPY, VOLUME It vances in the fields of immunology, in the sense that its ultimate goal is prevention of dysfunction and the rehabilitation and strengthening of the immune system—the resources of care, concern, and connection. Distributive justice in the allocation of a fam- ily's resources, as well, and the process of ne- gotiation by which such decisions are made are crucial determinants of health—and pathology. Beyond the family, the community's priorities regarding the distribution of health and social resources are an important determinant of who develops symptoms and which symptoms de- velop.. While it may be difficult to claim a direct causal relationship between any two variables, the consequences of certain human choices are ‘often not difficult to predic: for instance, com- ‘munity decisions regarding how much to invest in breast-cancer research atfect the daily lives of thousands of women and their families. Ne ther biological nor social science encompasses all the values necessarily inherent in social de- cision making. Family Description Via the Concept of Stagnation Despair maintains family dysfunction. The type of despair is related to the loss of hope and trust in the world that results from ethical stag- nation (Boszormenyi-Nagy & Spark, 1973). Its ‘maintained by a form of “justification” that we call destructive entitlement (Boszormenyi-Nagy, 1981, 1986, 1986), a form of ethical credit based oon actually suffered past injustice. Destructive entitlement may lead people to relate vindio- tively to innocent others beeause something is actually “owed” to them from the past; it then seems justified to be callous concerning the rights of other people with whom they now live Itisa self-sustaining, cumulative social process, which, if enacted, leads to unfairness in new relationships. The concept of destructive enti- tlement captures well the self-defeating “spiral” that leads to depletion of the trust and reci- procity that sustain individuals and communities through periods of personal, familial, social, and environmental change. Destructive entitlement ray also tur to selfdestructiveness. Stagnation is the world of ethically invalid at- tempts at solving life's problems. It tells us that “the only one to whom you owe anything is your- self,” as if self-realization could oceur without responsibility and interdependence. The con- cept of relational stagnation challenges the di- chotomy of the “identified patient” and “the well sibling,” and questions the notion of “well” members in “pathological” systems. In this sense, contextual therapy is a “systems the- ory"—albeit, we believe, a more differentiated cone than those based on the cybernetic meta- phor alone. Wellness isa relative concept; from the contextual vantage point, the identified pa- tient may be the most resourceful member. Neither individual suffering nor good func- tioning and personal enjoyment are discounted. However, the relevant criteria for good family functioning are relational balances—for_in- stance, whether the suffering member is suffer- ing on behalf of other family members and whether the “well” individual or “functional re- lationship” is thriving at the expense of others or other relationships. Individual functioning or good role performance does not indicate any- thing per se about the “balance of fairness” within families. Trustworthy relating must be based on the awareness and consideration of the basic life interests ofall members. A sick person may be advancing trust and hope by giving oth- ers a chance to help; the well member may be overfunctioning to the point of depletion. Over- giving, martyrlike attitudes undermine family relationships and can create destructive guilt for others. Detrimental Relationship Configurations ‘The contextual approach distinguishes spe- cific relationship structures and configurations as keys to the family’s funetioning. We are guided by these principles and consider them tobe the basic structures of relationships within families. We have already discussed these struc- turing principles in the previous section on the “well-functioning family,” but will provide framework in this section for identifying some “miscarriages” of these basic principles and re- sources. In deseribing these typically encoun- tered family problems, we in no way intend to convey that they are not also potential resources In the broadest sense, the term “exploitation ay cover most of what is ethically stagnant or“pathological” between people. If people's ac- tions lack merit, there is an inequitability of give and take; then trustworthiness of relationshi breaks dawn, interactions become ethically stag- nant or “pathological,” and there is no support left for future acts of merit. When trust has de- teriorated, intention is diverted from the effort to balance the ledger in universal terms of hu- ‘man decency and concern. Some forms of ex- ploitation are transient interactions; others warp the growth prospects of the family and sap its health Split Loyalty One of the most salient points of connection between individual and relational theory, and the point of greatest relational tension, occurs when one person becomes involved in the pre- dicament of split filial loyalty; that is, when the parents express deep mistrust of each other and the child can offer loyalty to one parent only at the cost of his or her loyalty to the other. Whereas the term loyalty conflict indicates a breach between a trustworthy primary filial loy- alty and a competing peer loyalty, “spht loyalty” connotes a fragmented primary loyalty or trust base. The child is torn between mistrustful par- cents or other essential caretaking adults ‘A split between parents is not in itself the fssue. The fact that a child seems closer to one parent or the other does not have to cause con- cer. The issue is the unconditional nature of the child’s involvement in the split. The clinical clues may be subtle, for example, the mother “explains” the father to the children. Or they ‘may be more blatant. One parent confides to the children about the other. The mother and father engage in angry outbursts and the child takes ‘on the job of calming them. But the child cannot calm them. It does not work, so what remains for the child is a more and more desperate use of symptoms to bring them together. An an- ‘orexic girl reported a dream in which her parents were lying near death on adjoining gravesites. In the time it would take her to feed one, the other would die ‘A heavy impact on the child occurs when, for instance, the mother and her parents are aligned ‘against the father, and the child is expected to Join this alignment. Thus, the child is charged CONTEXTUAL THERAPY 211 with being loyal to one parent at the cost of is or her loyalty to the other. But the child cannot sive up the commitment to Father's side. “I can and have to side with my father.” (The dilemma for the child would be the same, of course, if the alignment were against the mother.) This impact becomes greater because the child's com- mitment ineludes not only the father, but also the exeluded grandparents. Therapeutic lever- age is invoked not by highlighting the ambiva- lence toward each parent, but by making the split in loyalties central. In conerete terms, a therapist might say, “When you have to stand up for your father against your mother, what do you do with that? That is a terrible dilemma.” It is emotionally costly for the young child to play the rejunctive role: “Ifyou are going to take me away, then I am going to stay with Mommy: ifshe is going to take me away, then I am goi to stay with you.” The therapist will at least attempt to acknowledge the child’s desperate predicament. Instead of inviting the child to be “disloyal” to either parent, the therapist adopts an action plan based on an alliance in the best interests ofthe family asa whole. However, by “the fami sacrifice of half of total family solidarity; rathe balancing of each member's best interests with the needs and valid claims of other family members. Invisible Loyalty We conceive of filial loyalty as a universal and central relational dynamic, originating from rootedness and parental merit, on the one hand, and from the offspring’s right to give, on the ‘other. Filial loyalty can take either overt or covert forms. One of its overt forms is the sometimes deeply anguished efforts of adults to keep their lines of earing open to aging and dif. ficult parents. In its covert forms, it may provide 4 far more powerful determinant of pathology and resistance to health than has yet been fully realized. Laing (1965) and Stierlin (1974) have de- scribed the “mystification” of the child that is seen when the child has no way of getting access to direct knowledge of the multigenerational ledger terms to which his or her own life has212 HANDBOOK OF FAMILY THERAPY, VOLUME 11 been subordinated. In developmental terms, the child is vulnerable. He or she may “buy into the expectation that the debt to the parents is endless and that its payment takes priority over every other human concern, The parent's un- willingness to accept “installment” payments on the indebtedness can make the obligations boundless. Or a nonreceiving parent can violate the other pole of the child’s loyalty, the need and right to be spontaneously giving, The covert connections may be infinite, though uncon- sciously perpetuated. If, for instance, the father scorns weakness, the son’s fear of weakness may repeatedly immobilize his efforts. Or if the mother is an obsessive housekeeper, the grown daughter, following a rupture with her parents, may go on a house-cleaning binge that alienates her husband, Indirect loyalty to the more distant parent ean be expressed in disloyalty to one's, spouse. Here, the intrapsychic process could be ‘one of unconscious displacement; the ethical dy- namics that of invisible loyalty. Neither of these dynamics excludes the other or can be reduced to the other. ‘The “Revolving Slate” and “Destructive Entitlement” Plays, novels, professional discourse, and daily experience all call attention to an extraor- inary aspect of the human condition. This is the fateful mandate that patterns shall be re- peated, against unavailing struggle, from one generation to the next. For instance, a young, rman decides against parenthood because, “I see too much of my father in myself, and I don’t ‘want to pass it on,” protecting against the pos- sibility of having such children, but depriving, himself of being a father. Conversely, the de- structively entitled parent repeats a damaging pattern both as an expression of invisible loyalty and as a lack of remorse. An ambivalent father abandons his wife, who, in tum, abandons their son. The father rescues the child, then abandons his second wife, and the child along with her. The stepmother is the only one with whom the child can have a relationship of trust. To exon- crate his mother, the son can only put his father down: "You are no better than she is.” To ex- onerate either the father or mother, he can only put his stepmother down: “You are no better than they are.” To exonerate her, he can only put down his therapist: “You are no better than any of us.” Much more is involved here than an unconscious displacement of hostility. The child is caught in a vicious self-destructive chain re- action. He tries to balance the ledger by sub- stituting his father as a monster instead of his ‘mother, and so on. As the child gets older, his vindictive behavior may extend to his own spouse and children. This intergenerational link- age of substitutive balancing is ethically invalid. Moreover, it blocks the possibility for selheal- ing remorse. All generations are caught on a revolving slate of vindictive behavior. Tobehave otherwise would require the grown son to step out of the context of his generative rootedness. Consciously, he may struggle to give his children a better life. But the unconscious, ethically binding premise is: “How can I treat my children better than my father treated me, ‘without being disloyal to my father?" So, while there are grounds for existential guilt, the child tured parent may actually feel little guilt over his unfairness to his own children. ‘We hold that this “revolving slate” aspect of invisible filial loyalties reinforced by earned “de- structice entitlement” is the chief factor in family ‘and marital dysfunction. Itis important to ree- ‘ognize that while destructive entitlement is valid in its past context, it becomes unjust when the person begins to act on it. Therapy ean never undo the extent of earned destructive entitle- ment. However, therapy aims to help the person rely less upon it Life cannot be lived over again. ‘The grown offspring who acts on destruct titlement will be disengaged from the ongoing task of weighing what is fair in his or her rela- tionships with spouse, children, and significant others. The disjunction may take symptomatic forms, such as contempt, hatred, avoidance, coldness, indifference, or cruelty. Liberation from the revolving eycle of destructive action can take place only through the discovery of re- sources of direct loyalty and trustworthiness. If they are to achieve freedom, individuals must discover rejunctive ways of preserving loyalty and exonerating the generations before.Interlocking-Need Templates: The Psychological/Interpersonal Dimension A husband and wife may be joined in collu- sive arrangements through their “interlocki need templates” (Boszormenyi-Nagy, 1962, 1965. Psychoanalytic object relations theory provides «a psychological framework for this pattern of re- lating (Fairbairn, 1954; Guntrip, 1961; Dicks, 1964). For instance, a spouse’s complaints about a partner's coldness or anger enable him or her to disown his or her own needs for distance. The two may be locked into a tightly overutilized relationship in which each serves as the mon- strous and denied part of the other. They can act out this substitutive victimization for years ‘One may then become symptomatic. They may try to salvage the relationship by drawing. on their child, whose burden may then become enormous. The interweaving of dimensions 2 and 4 can be seen in the the "bad object” attri- butions of people in the process of substitutive vindication. Preferences dictated by loyalty may determine the choice of projective identifica- tions. However, object relations theories do not fully address the dynamies of the choice of the target of projections Exploitation While providing a reservoir of trust, the child is vulnerable to the family’s definition of what is fair. This gives the parents a wide margin for exploitation, much of which can go unnoticed by outsiders. The most neatly tended suburban house can contain a jungle. The one who appears to the world as the “good sibling,” meeting all outward criteria of health, may be the most ex- ploited and the most vulnerable. When social agencies do become involved with a family, they may collude in the seapegoating of the “bad” child, whose “badness” may be the desperate move of any family member to secure resolution of some relational imbalance. We collude with culturally biased “ideal” to the extent that we regard as “normal” the pattern of the commuting father who believes he is “living his life by the book,” doing what is expected of a man and keeping his accounts in balance when he goes out into an untrustworthy competitive world and spends himself earning money. In turn, he may CONTEXTUAL THERAPY 213 expect his wife and children to offer him trust and emotions. Such a father may be acutely un- comfortable with any attempt to hold him ac- countable in human terms. Parentification It is in the child's interest to have a good parent. If the parent falls short, the child will try to make up the deficit. Thus, the legacy of filial loyalty tends to make the child parentified. In a healthy family, to the extent that a child supplements the parents’ resources, this can be an avenue of growth and enrichment, for ex- ample, the child who comforts the mother when she has suffered a loss. Yet, when parents begin to draw heavily on a child's resources, the child can become captive to devoting his or her life to being a parental figure. There is not much chance for normal growth. The damaging feature isnot the transactional role reversal between the parent and child, but the unilateral depletion of the child's resources and natural tendency to develop the capacity for trust To an outsider, the overresponsible, paren- tified child might appear narcissistic, unwilling to yield his or her place at center stage. To the child, however, being in the center may rep- resent an intrinsic command to which he or she loyally responds. Or the child's oedipal strivings ray mask the underlying care. As one 6-year~ old put it, "Tam an overconcerned child. Abrupt collapse during adolescence may ter- inate the effort. At the other pole of “paren: tification” is the “black sheep,” a psychotic, delinquent, or otherwise failing member with- out whom the parents could not survive. Or a son may drive himself to win glittering but empty suocesses to dispel the gloom of his par- ents. One result is predictable: unless the pat- tern can be overcome, the parentified child wall not be able to give freely to spouse or children. Upon leaving the family as a result of selecting 1 pariner or engaging in an activity that fall far short of one’s own intellectual and interpersonal capacities and is unacceptable according to fam- ily standards, disloyalty tothe family is only tem- porarily offet by sacrificial giving to the mate. A married couple may collusively share a denial of the importance of ties with the two families of origin. In a mixed-religion marriage, the214 HANDBOOK OF FAMILY THERAPY, VOLUME 1 spouses may promise unusually stable loyalty commitments to each other, as though both par- ties, by becoming outcasts from their loyalty groups, could form a new in-group. Such prom- ises, however, may mask the partners’ Jack of individuation within their families of origin, and the new commitment may be to a commonly shared “cause” rather than to each other. The ore passionately the family of origin rejects the traitorous member, the more likely itis that he or she will remain tied to the early loyalty sys- tem, albeit in this negative form. By remaining tightly bound in the posture of opposition, the person dramatizes an example of that which is ‘unacceptable to the family. Through this action, the defiant member may hold the rest of the family together at his or her expense, consol dating the family’s values through “Ioyal oppo- sition” while appearing to be “disloyal.” Long-suppressed anger about being given up for adoption or abandoned in other ways by par- cents may erupt through displacement upon adoptive parents or a mate, Unresolved marital arguing, sexual dysfunction, and the like may represent a functional atitude of rejection of the mate in order to bolster invisible loyalties to the family of origin. Even when other dynamics are ‘operating in marital conflict, we believe that this ethical dynamic influences the outcome. Finally, the “well sibling,” who, it appears, has successfully escaped the pathogenic system, ray often be caught in a guilt-aden commit. ment to overavailability. He or she may be com- missioned to take care of the entire family’s needs for manifest reason and organization, thus allowing the others to enjoy their regressive sratifications in safety. In therapy, one of the first steps toward de- parentification consists of helping the family to acknowledge the trust advances drawn from the parentified child. Acknowledgment helps to re- move the binding force that keeps the offpring captive ASSESSMENT OF SYSTEM FUNCTIONING AND DYSFUNCTION The concept of “family diagnosis” can easily be misleading and can limit the openness of the therapist to true understanding. The locus of a family’s resources lies in the success or failure of dialogue between people and not in bound- aries between “subsystems” or other abstract schema for describing ongoing relating. Never- theless, observations of family relationships suggest hypotheses that do include all four dimensions—the factual context, individual psychology, observable transactions, and the Aimension of relational ethics. In reality, all as- pects of relationships are inseparable and ever- present. While we distinguish these dimen- sions for the purpose of choosing a therapeutic method, for a contextual therapist, goals have to be consistent with each person's options for discovering the resources in his or her significant relationships and for selE-validation, The obsercations that are emphasized for as- sessment purposes are the qualitative aspects of amily relationships. From the fist moments of ‘contact, the therapist gathers impressions about the climate of trust within the family. Are people capable of listening and hearing one another and committing themselves to statements about their needs, desires, and rights? Are they free to make requests of others and to state grie~ vances and express gratitude? The contextual therapist will ask specific questions about the conerete availability of family members to one another and the degree to which they can share both the benefits and the existential problems of life. Even blaming and aceusatory discourse is valued because itreveals the longing of people for acknowledgment and fairness. Complaints are valued as a resource because they indicate «continuing reservoir of hope in relatedness. In contrast, if family members avoid issues of fair- ness, even vis-a-vis the therapist, it is not a good “prognostic” sign For a contextual therapist, emotional “cutoff (Bowen, 1978) from the family of origin are viewed as clues to invisible loyalties and re- lational stagnation. Severed relationships are also seen as indicators of psychological “freez- ing” of the self, emotional and cognitive disso- ciations, and a tendency to “polarized fasion” (Boszormenyi-Nagy, 1965) within new relation- ships. Dimension 2 character development often, serves as a vehicle for the transmission of de- structive entitlement, and destructive entitle- ment fuels repetitive and mutually damaging interactions in the present. Clinically, what mat-