REDISCOVERING NAGY: WHAT

HAPPENED TO CONTEXTUAL
THERAPY?*
Charlotte Wilhum-McCoy

ABSTRACT: Ivan Boszormenyi-Nagy, originator and leading propo-

nent of contextual family therapy, has been addressing relational
ethics for more than 40 years. During the 1980s there was a prolifera-
tion of contextual publications. Great interest in the approach seemed
to peak and then ebb silently. What happened to contextual therapy?
Why has contextual therapy not taken its place among the other
widely used and recognized therapeutic models? This article ad-
dresses these questions through a review of family therapy literature.

The contextual therapy framework is an important resource to

family therapists (Grunebaum, 1987). Although contextual therapy
has been well defined in family therapy literature, references citing
specific applications of the technique seem to be limited. According to
the contextual approach, problems arise in families when dialogue is
abandoned, and the only way the dialogue can be reestablished is
through renewal of trust among family members as evidenced by
talking, listening, and validating. This article presents a review of
recent literature for the purpose of exploring the ways contextual the-

Charlotte Wilbum-McCoy, MEd, is adult therapist and coordinator of the court-

ordered domestic violence counseling program at the North Dallas Help Center and a
PhD candidate at Texas Woman's University, Denton, Texas. Reprint requests should
be sent to the author at The Family Place, Help Center—North Dallas, 13777 North
Central Expressway, Suite 525, Dallas, TX 75243.
*I would like to acknowledge Dr. Gladys Hildreth, Department of Family Sciences
at Texas Woman's University, for her assistance in the preparation of this manuscript.
Acknowledgement also is made to Dr. Terry Hargrave, Department of Psychology, Am-
arillo College, for his contributions concerning implications for the future and the re-
view of the literature.
Contemporary FamUy Therapy, 15(5), October 1993
O 1993 Human Sciences Press, Inc. 395
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CONTEMPORARY FAMILY THERAPY

ory is being applied, criticisms of the approach, and any forthcoming

explanations for the slow establishment of contextual therapy as a
major method of therapy.

BASIC CONCEPTS IN CONCEPTUAL THERAPY

Conceptual therapy emerged from the practice of both individual
and classical family therapy. Ivan Boszormenyi-Nagy, originator and
leading proponent of contextual therapy, was trained as a psychia-
trist. He began a research program in 1957 at the Eastern Pennsylva-
nia Psychiatric Institute to develop more effective ways of working
with schizophrenics and their families. With colleague James Framo,
he co-edited the book Intensive Family Therapy (1965), a traditional
psychoanalytical approach to family therapy. A few years later, he co-
authored Invisible Loyalties (1973) with colleague Geraldine Spark.
The latter work reflected the contextual theory through emphasis
upon one's indebtedness to his or her family of origin, the continuing
influence of one's biological relatedness, and the conceptualization of
consequences of ethical and unethical relating. Nagy and Spark
maintained that there was an intergenerational ledger which bound
fjunily members to one another.
Contextual terminology began to evolve and appear in the litera-
ture in 1979 (Boszormenyi-Nagy, 1979). With Krasner (Boszormenyi-
Nagy & Krasner, 1980), Nagy began to call the contextual approach
an intergenerational approach and a trust-based approach. Building
trust within the family was the method of changing dysfunctions.
According to Nagy, there are four dimensions of relational reality
(Boszormenyi-Nagy & Krasner, 1981): Facts, individual psychology,
family or systemic transactions, and relational ethics. Relational
ethics is the most important therapeutic dimension for correcting
family dysfunctions caused by lack of fairness, trust, loyalty, vali-
dation, commitment, entitlement, or merit. There has been little
research in the relational ethics domain (Van Heusden & Van Den
Eerenbeemt, 1987).
From the contextual perspective a family in therapy is considered
to be experiencing painful relational imbalances in the immediate
family and imbalances due to unresolved issues from the families of
origin. Such imbalances may appear in the form of severe lack of
trust, an inability of members to give due credit to one another for
contributions to the family, or a lack of dialogue among family mem-
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CHARLOTTE WILBURN-MCCOY

bers. A therapist must examine violations of fair relating among fam-

ily members. Nagy recommends the use of a genogram: a three-gener-
ational diagram of the family. Grenograms are helpful in detecting
destructive pattems of relating such as over entitlement or overin-
debtedness which may be active in the daily life of the family and
other pattems resulting from unhealthy loyalties to one's family of
origin.
The contextual therapist starts family therapy by allowing each
member to present his or her opinions concerning the problems which
brought them into therapy. Nagy gave the name "multidirected par-
tiality" to the therapeutic technique of recognizing each person's view
of the problem. He feels that when people find that they will be lis-
tened to in the session, they will be more willing to listen to other
members of the family. Thus, the multidirected partiality begins the
process of "rejunction" which Boszormenyi-Nagy (1979) identifies as
the goal of tberapy. Rejunction is the process of giving due credit, a
returning to a fair balance of give and take, and an identification of
family resources.
Multidirected partiality is modeled by a contextual therapist. By
creating dialogue among family members, the therapist reconnects
the family to trustworthiness, which Boszormenyi-Nagy (1986a) iden-
tifies as the most fundamental resource in family relationships. Mul-
tidirected partiality performed by the therapist enables the family to
mobilize its own healing resources (Boszormenyi-Nagy, 1979).
A review of literature would be helpful to examine the ways in
which the contextual approach is being applied and in whicbfieldsof
endeavor. It may also be beneficial in answering certain questions
concerning the perspective: How is it being used? What are some of
the criticisms of the theory?

A REVIEW OF LITERATURE
A current review of tbe literature dealing with contextual ther-
apy reveals a wide range of contextual use. The approach was found
most often in works dealing with therapy for the elderly (Jones &
Flickenger, 1986; IngersoU-Dayton, Amdt, & Stevens, 1988; Ander-
son & Hargrave, 1990; Hargrave & Anderson, 1990) and treatment of
victims of incest (Lutz & Medway, 1984; Groodman & Noweik-Scibelli,
1985; Grunebaum, 1987). Two publications applied the perspective to
parent-child relationships (Kaslow & Kaslow, 1981; Van Hekken,
398

CONTEMPORARY FAMILY THERAPY

1990), while others have written about contextual therapy in the

treatment of bulimia (Roberto, 1987), the treatment of drug addiction
(Bemal, Rodriquez, & Diamond, 1990; Florez-Ortiz, 1990), Christian
counseling (Roberts, 1991), and child custody dilemmas (Cotroneo,
Krasner, & Boszormenyi-Nagy, 1981). Hargrave, Jennings, and An-
derson (1991) produced the only empirical research article with the
development ofa relational ethics scale based upon some of the major
constructs of the approach such as loyalty, trust, entitlement, fair-
ness, and obligation.
Friedman (1989) described the similarities of Martin Buber's phi-
losophy of dialogue and the contextual family therapy concepts of
Boszormenyi-Nagy. The particular emphasis of that work was upon
the "I-Thou" concepts of Buber and Boszormenyi-Nagy's techniques of
restoring trust in a relationship through validation in dialogue.
A closer examination of the previously cited works reveals a di-
versity of criticism of contextual therapy. Van Hekken (1990) sug-
gests that there needs to he some rethinking of the concepts of entitle-
ment and merit. Boszormenyi-Nagy defined merit as that component
of relating that one earns by meeting obligations, such as a parent
giving care and nurturance to children. Some of the parents in Van
Hekken's study debated this concept and made such statements as,
"How can you earn merit if you are just doing your duty?" (Van Hek-
ken, 1990, p. 542).
Grunebaum (1987) surveyed feminist criticisms that family sys-
tems theory and family therapy fail to recognize the unique position
of women in the family: Many women in the work force experience
unequal pay and thus unequal status in the financial and power
realm. Women also experience more sexual and physical ahuse in the
home. Contextual therapy was considered more acceptahle for use in
the treatment of incest survivors due to its emphasis upon fairness,
accountability, and multidirectional partiality. Goodman & Nowak-
Scibelli (1985), described the use of contextual techniques in group
psychotherapy for female incest survivors.
Brief contextual therapy was stipulated for the treatment of drug
addicts in the research of Bemal, Rodriguez, and Diamond (1990).
Contextual therapy was selected as the treatment of choice because of
its intergenerational stance of explaining addiction according to un-
fairness in relating and the continued downward thrust of destructive
entitlement.
In the area of therapy for the elderly, Hargrave and Anderson
(1990) pointed out several contextual interventions and made certain
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CHARLOTTE WILBURN-MCCOY

suggestions concerning work with the elderly. The suggestions in-

cluded slowing down the therapy regime by scheduling sessions every
two to three weeks and having the therapist adopt the role of being a
recipient of the client's teaching. Taking such a position, according to
the authors, engenders more success due to the fact that older indi-
viduals have lived through many life experiences that perhaps the
therapist has not such as world wars, depression, loss of family mem-
bers, and severe illness.
Roberts (1991) made major criticisms of therapy in general from
a Christian perspective, viewing therapy as ethically neutral. Be-
cause contextual therapy holds people accountable for their actions it
is considered a useful approach in Christian counseling. However,
Roberts stated that the loyalty to the intergenerational family must
he changed to loyalty to GJod first. Roberts also argues that for Chris-
tian use forgiveness is more important than the contextual concept of
exoneration.
Hargrave, Jennings, and Anderson (1991) produced a relational
ethics scale based upon the constructs of contextual theory, hut noted
the difficulty involved in quantifying relational ethics concepts for
empirical research. The concepts, seemingly simple at first glance,
are very complex. Norms for the scale need to be established so that
use of the scale results in a score for the client and therapist to dis-
cuss. The scale has not been tested in diverse populations, and, as a
result, the effects of such variables as economic status, ethnicity, and
gender have not been examined.
In the master of family therapy program at Hahnemann Medical
College in Philadelphia where Boszormenyi-Nagy has long been a
professor, a thesis is required in order to encourage creativity among
the students and literary contributions to the field. Staff members
invite students to join them in research efforts that are already in
progress Garfield (1979). Based on the present review of literature no
contributions have been produced from that family therapy program
other than from Nagy and Krasner.
Articles written ahout contextual therapy are very diverse. They
are not limited to the field of psychotherapy. Because of the philo-
sophical natvire of the approach, due to the justice hased concepts,
some articles relate to the ethical principles in their discussion of so-
ciety or social change. Ziter (1990) compared socialism and contextual
principles. Both are considered relational approaches involving jus-
tice and ethical behavior. Contextual therapy emphasizes the pri-
mary importance of the family and intergenerational issues whereas
400

CONTEMPORARY FAMILY THERAPY

socialism emphasizes the primary influences of larger systems upon

the family.
The most informative and concise criticism of the contextual ap-
proach appeeired in Kaslow's (1987) review of marital and famiiy
therapy approaches. She stated that the contextual approach is crit-
icized for being too intellectual and more appropriate for the highly
articulate, not lending itself well to the lower economic or less edu-
cated individuals. Boszormenyi-Nagy countered this criticism by
pointing out that the principles of contextual theory are housed in the
context of a person's history, whatever that may be, regardless of
race, creed, educational level, or monetary status. The contextual ap-
proach begins in the context of what is, what exists at the time family
members hegin to present their issues in therapy. Boszormenyi-Nagy
indicated that the basic components of relational ethics such as trust,
fairness, loyalty, and reciprocity are not limited to any one class of
people. He further emphasized that the contextual approach is not
only applicable for family problems of the present, but also it is valu-
able in assisting families in resolving issues which have been carried
over from the families of origin. In this rebuttal, he highlighted the
preventive component of the contextual perspective in that resolving
imbalances in present relationships clears the family ledger for fu-
ture generations.

SUMMARY AND IMPLICATIONS

Diverse applications of contextual therapy were discovered
through the review of literature. All of the review articles suggested
specific reasons for using the contextual approach. Three of the arti-
cles cited some problems with contextual therapy such as parents
having difficulty understanding the contextual concept of merit,
Christian therapists feeling the need to emphasize loyalty to Grod over
loyalty to the family, and the seemingly highly intellectual nature of
the approach. The overall acceptance of the theory was positive. Com-
pared to the prolific publications of other approaches such as solution
focused brief therapy and family systems theory, the number of arti-
cles concerning contextual application is small.
For more than 40 years, Boszormenyi-Nagy has devoted tremen-
dous time and energy to expounding relational ethics. During that
time, gradually, the contextual view of relating began to appear in
publications. Tracing the evolution of Boszormenyi-Nagy in the field
 401

CHARLOTTE WILBURN-MCCOY

of family therapy reveals that he began to define terms, solidify con-

cepts, and draw the theory together in 1979. Beginning in 1980 Bos-
zormenyi-Nagy, Spark, and Krasner launched a prolific period of pe-
riod of writing and publishing. It was during the 1980s that the major
books and articles on contextual theory were published, the last of
which. Balance in Motion, appeared in 1987. In view of this short
time span the theory is relatively new.
There are few articles which offer information to assist clinicians
with difficulties in actually using contextual techniques. However,
Boszormenyi-Nagy's (1986c) thoughts on the integration of therapies
offer clinicians some insight into the use of the contextual approach
as a theoretical foundation that can be used with any number of other
techniques and perspectives.
Although some authorities purport that integration of theories
would simplify and improve therapeutic endeavors, Boszormenyi-
Nagy reasons that such a consolidation is impossible due to the multi-
plicity of perspectives, each accompanied by unique terminology.
However, he states that there is one feasible way to integrate thera-
pies. Boszormenyi-Nagy suggests that all therapies need to be joined
at the level of justice, fairness, and accountability among human be-
ings (1986c). He contends that it is from those levels that confiict
evolves, and it is the unresolved confiict that motivates people to seek
intervention for solutions.
Boszormenyi-Nagy (1986c) emphasizes that in a "comprehensive
therapy" there would have to be an order of precedence concerning
"relational reality," techniques, and therapeutic goals (p. 70). In the
contextual approach relational reality is ordered into four dimen-
sions: 1) facts, 2) psychology of needs, 3) transactional patterns, and
4) relational ethics. All those dimensions must be considered. For ex-
ample, the fact of a diagnosis of cancer cannot be left out of a client's
treatment because the therapist deems the pursuit of personality dis-
order to be the most important issue.
Another example given by Boszormenyi-Nagy concems the treat-
ment of alcoholics. There may be times that personal motivation to
cease an addiction seems lacking; however, at the same time an alco-
holic may be very concerned about the opinion of his or her child. To
ignore this transactional dimension would seriously limit the thera-
peutic regime. Boszormenyi-Nagy is particularly assertive about pos-
terity, averring that therapists must be conscious of and accountable
for their actions, including being aware that clients' actions do effect
future generations. He concludes that while an adding together of
402
CONTEMPORARY FAMILY THERAPY

therapies is not possible, a joining of therapies on the level of rela-

tional ethics is possible.
Contextual theory has been criticized as being too intellectual
(Kaslow, 1987). There are no other authoritative publications which
specifically state that the complexity or highly intellectual nature of
contextual theory correlates with the slow establishment of the the-
ory as a widely used method of therapy. However, it seems reasonable
that this could be a contributing factor and what is needed are recom-
mendations to help clinicians bridge the gap between the acquisition
of theoretical knowledge and the actual applicability of the theory in
practice.
As with all theories, a solid foundation in the approach's theoreti-
cal framework is necessary. It is imperative to have a thorough un-
derstanding of the contextual concepts and terminology. This can be
attained by studying books written about the theory and taking the-
ory classes that specifically cover the contextual approach.
There are existing publications which cite case examples giving
verbatim dialogue among family members and between the therapist
and the individual family members. One such publication is Dia-
mond's (1988) "Thought and Action in the contextual Interview."
Other examples have been published by Hargrave and Anderson
(1990) and Anderson and Hargrave (1990) which specifically address
contextual techniques with elderly clients and their families. These
publications help the reader understand the wording of the tech-
niques and how such concepts as multidirected partiality and exon-
eration are woven into the therapeutic session. The newest publica-
tion containing specific contextual interventions is Hargrave and
Anderson's (1992) Finishing Well: Intergenerational Therapy with
Aging Families. This work is very informative concerning the begin-
ning of the therapeutic process with a life review, life validation, and
then moving into the contextual interventions of multidirected par-
tiality, exoneration, and ultimately the balancing of obligations and
entitlements.
In conclusion, the review of literature for this article shows evi-
dence that contextual theory is being applied in diverse areas. The
overall acceptance of the approach is positive. Contextual therapy
seemingly has not taken its' place among the other widely used ap-
proaches. One possible explanation for this may be the short period of
time that has transpired since Boszormenyi-Nagy began to publish
comprehensive works about the theory. Another possible reason may
be the lack of literature which clarifies contextual therapeutic tech-
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CHARLOTTE WILBURN-MCCOY

niques. Because contextual therapy is relatively new, there is a lack

of literature which clarifies contextual therapeutic techniques.
There is now a need for publications which transcend explana-
tions of contextual theoretical terminology and concepts. Clinicians
need literature which puts forth the "how tos" of applying contextual
therapy. Specifically, what is needed are articles which help clini-
cians put the theory into operation, bringing the contextual terms off
the pages of textbooks and articles and into the therapy session.

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