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Doing Contextual Therapy

Part One: Concepts and Techniques

Chapter 1: The Contextual Approach

Let’s consider one of the questions mentioned in the introduction: What does the contextual approach try to change? The broad goals are to help people who seek therapy, whether as part of a family group, a dyad, or as individuals, make fundamental changes in the ways they think about their relationships, and in the ways they act in those relationships with the aim of moving toward greater balance. One fundamental goal is to help people begin to change in ways that facilitate their abilities to acknowledge each other’s positive efforts. Whenever the therapist acknowledges either the positive efforts or past injuries of one person, the purpose of doing so is to facilitate people’s abilities to acknowledge each other’s efforts and contributions to the relationship; the therapist’s acknowledgment is not an end product, but a catalyst for further change. Beginning with the first session the therapist looks for ways to give credit to people in order to help them give credit to each other. As people begin to do this, both the one acknowledged and the one who does the acknowledging benefit significantly. This approach recognizes that pathology exists in both individuals and families, but its emphasis is on optimizing resources and catalyzing future growth.

Highlighting Fairness Issues
This approach seeks to highlight fairness as a major issue in all close relationships and to help people to talk with each other in ways that both help them to state their own sides in a conflict and to be able to truly hear the other person’s side. The therapist helps people to think and talk about what is fair and unfair by highlighting the issue in the very first session. It is extraordinarily difficult to define a concept like “fairness.” It is nonetheless a crucial concept, not only in this approach, but in all relationships. I cannot adequately define what fairness means or even stipulate what constitutes a fair relationship or what fair compromises among people in close relationships are. There are, however, some things that I believe can readily be agreed upon; for example, infants and young children deserve love, nurturance, protection, as well as trustworthy parents who do not use them to meet their unmet emotional or physical needs in harmful ways; any violation of this would clearly represent unfairness. Children also deserve to be free to love and show their love for both of their parents, regardless of whether those parents are happily married, unhappily divorced, or have never been married. It is clearly unfair for children of any age to be constrained so that loving one parent represents disloyalty to the other. Similarly, adults can rightfully expect that their relationships will balance out over time–that they will receive back in fair measure what they have given.

Fairness issues and their implications are inherent in this approach and dictate therapists’ activities from beginning assessments through termination sessions. They provide the foundation for the relationship between therapists and patients. They govern the questions we ask our clients and patients. They guide our thinking about what may have caused problems and what may be done to ameliorate them. They provide a context for understanding and integrating patterns of family communication and power transactions, historical information (both personal and intergenerational), and psychological issues. Observing, thinking about, and helping people think and talk about fairness provides the overall principle that creates the possibility for an integrative framework. The overarching concern with fairness leads to a model that can incorporate concepts, procedures, or techniques from any other therapeutic model as long as they are consistent with this concern for helping people to enhance the quality of their most important relationships.

The Importance of History
Helping people to move forward often depends on understanding not just their present difficulties, but also their past experiences, particularly those that caused them pain and injury. We seek information about people’s prior experiences, not because we wish to become archaeologists of the mind, but because we want to understand them, especially the ways they have been hurt, so that we may help them develop new ways of experiencing and relating. In order to be partial to all family members we need to know about the things that have hurt each of them earlier in their lives. In the language of contextual therapy, we need to know about their personal histories of experienced unfairness and injustice. Some aspects of people’s histories are strictly individual, some refer to their families, and some apply to members of their race, gender, or cultural group. The emphasis on understanding history shares much with other approaches that think about family issues over an intergenerational time frame (Levant, 1984). These "historical" approaches include the psychodynamic family therapies of Ackerman (1966), Framo (1976, 1982), and Wynne (1965), as well as the multi-generational approach of Bowen and his colleagues (Bowen, 1966; Kerr & Bowen, 1988).

Integrating Individual and Family Systems Issues
A third defining feature, and one that differentiates this approach from many others, is that it provides a framework for integrating concepts and techniques from diverse models of individual and family development, functioning, and therapy. Contextual therapy is based on the assumption that many personal and interpersonal problems will benefit from interventions that increase peoples’ capacities for achieving greater balance in their most important relationships. It enthusiastically endorses the use of any and all techniques likely to benefit people as long as they are consistent with this goal; it seeks to be inclusive rather than exclusive (Boszormenyi-Nagy et al., 1991). For this reason, and despite its many historical ties to the family therapy movement and its leaders, the label of "family therapy" does not adequately reflect the actual scope of this approach. Contextual therapy is more accurately thought of as an integrative therapy (e.g., Garfield, 1994; Goldfried, 1980, 1982; Norcross & Goldfried, 1992). While there is considerable variation in the way the terms are used (Garfield, 1994), Stricker’s (1994) description of theoretical integration, as “an attempt to understand the patient by developing a superordinate theoretical framework that draws from a variety of different frameworks (p. 5)” appears to fit the four-dimensional contextual model relatively well with one exception: In contextual therapy the superordinate framework is not theoretical, but ethical. The fundamental defining goal is to help people be more considerate in their relationships with those closest to them, to give more spontaneously and freely of themselves to those in their families, and state their own needs and wishes in a spirit of open dialogue.