SOCW 674 Social Work And Families Lecture No' Eight

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SOCW 674 Social Work And Families Lecture No.
Eight

• Transgenerational Models

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Transgenerational Models

• Transgenerational approaches offer a
  psychoanalytically, influenced, historical
  perspective to current family living problems by
  attending specifically to family relational
  patterns over decades. Advocates of this view
  believe that current family problems are embedded
  in unresolved issues of families of origin. That
  is not to say that these problems are caused by
  earlier generations, but rather they tend to
  remain unsettled and thus persist and repeat
  themselves in on-going patterns that span
  generations. How todays family members form
  attachments, manage intimacy, deal with power,
  and resolve conflict, and so on, may mirror to a
  greater or lesser extent earlier family patterns.
  Unresolved issues in families of origin may show
  up in symptomatic behavior patterns in the later
  generations.

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Bowens Family Theory

• Family Systems Theory, Bowen was the developer
  of a system that emphasized interlocking
  relationships, best understood when analyzed
  within a multigenerational or historical
  framework. His theoretical contributions, along
  with the accompanying therapeutic efforts
  represent a bridge between psycho dynamically
  oriented approaches that emphasize
  self-development, intergenerational issues, and
  the significance of past family relationships,
  and the system approaches that restrict their
  attention to the family unit as it is presently
  constituted and currently interacting. His
  therapeutic stance with couples involved a
  disciplined, unruffled but engaged professional,
  careful not to be triangulated into the couples
  emotional interaction. By attending to the
  process of their interactions, and not the
  content, Bowen hoped to help the partners hear
  each other out ( sometimes for the first time
  without their customary passion and accusations
  of blame ) and thus learn what each other must do
  to reduce anxiety and build their relationship.

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Bowen believed

• Bowen believed the driving force underlying all
  human behavior came from the submerged ebb and
  flow of family life, the simultaneous push and
  pull between family members for both distance and
  togetherness (Wylie, 1990b). This attempt to
  balance two life forces- family togetherness and
  individual autonomy- was for Bowen the core issue
  for all humans.

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Murray Bowen remained

• Murray Bowen remained, until his death in 1990,
  a major theoretician in family therapy. Since his
  early work with schizophrenics and their families
  at the Menninger Clinic in Topeka, KS as well as
  the National Institute for Mental Health (NIMH)
  in Bethesda, MD, Bowen stressed the importance of
  theory for research, for teaching purposes, and
  as a blueprint for guiding a clinicians actions
  during psychotherapy. He was concerned with what
  he considered the fields lack of a coherent and
  comprehensive theory of either family development
  or therapeutic intervention and its
  all-too-tenuous connections between theory and
  practice. In particular, Bowen ( 1978 ) decried
  efforts to dismiss theory in favor of an
  intuitive seat of the pants approach, which
  he considered to be especially stressful for the
  novice therapist coping with an intensely
  emotional, problem-laden family

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Bowen trained

• Bowen trained as a psychiatrist and remained on
  the staff of the Menninger Clinic in Topeka, KS
  until the late 1940s. There under the leadership
  of Karl Menninger,
• .
• Innovative psychoanalytic approaches were tried
  in treating hospitalized persons suffering from
  severe psychiatric illnesses.

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Bowen became

• Bowen became particularly interested in possible
  transgenerational impact of the mother-child
  symbiosis in the development and maintenance of s
  schizophrenia. Extrapolating from the
  psychoanalytic concept that schizophrenia might
  result from an unresolved symbiotic attachment to
  the mother, herself immature and in need of the
  child to fulfill her emotional needs Bowen began
  studying the emotional fusion between
  schizophrenic patients and their mothers.

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Bowen moved

• Bowen moved his professional research activities
  to the National Institute Of Mental Health (NIMH)
  Bethesda, MD. Bowen soon began to have entire
  families with schizophrenic members living for
  months at a time on the hospital research wards,
  where he and his associates were better able to
  observe ongoing family interaction. Here Bowen
  discovered the emotional intensity of the
  mother-child interaction even more powerfully
  than he had suspected. More important, the
  emotional intensity seemed to characterize
  relationships throughout the family, not merely
  between mother and child. Fathers and siblings
  too were found to play key roles in fostering and
  perpetuating family problems, as triangular
  alliances were continually formed and dissolved
  among differing sets of family members.

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Bowen had moved

• Bowen had moved from concentrating on the
  separate parts ( the patient with the disease.
  ) to a focus on the whole ( the family ). He
  paid particular attention to what he called the
  family emotional system. Bowen increasing viewed
  human emotional functioning as part of a natural
  system.

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When the NIMH project

• When the NIMH project ended in 1959, Bowen moved
  to the Department Of Psychiatry at Georgetown
  University in Washington, D.C. the university
  was a place more conducive to his theoretical
  bent. He remained there for 31 years, until the
  end of his career. In 1978 he published Family
  Therapy in Clinical Practice. In 1977 Bowen
  became the first president of the newly formed
  American Family Therapy Association, an
  organization that he founded to pursue interests
  in research and theory.
• 1990 Bowen published the text
  Family Evaluation

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Other Leading Figures

• Michael Kerr ( Kerr Bowen,1988) and Daniel
  Papero ( 1990,2000) both at the Georgetown Family
  Center in Washington,D.C.. Also in Washington,
  D.C. Rabbi Edwin Friedman ( 1991), who was
  trained by Bowen, was able to apply family
  systems theory to pastoral counseling ( Friedman
  died in 1996). Philip Guerin , an early disciple
  of Bowens who founded the Center For Family
  Learning in New Rochelle, N.Y.
• Peter Titelman ( 1998) in Northhampton,
  Massachusetts, has demonstrated the applicability
  of Bowens work to a variety of emotional
  dysfunctional families ( e.g. families with
  phobias, depression, alcoholism ). Betty Carter (
  Director Emerita of the Family Institute in
  Westchester in White Plains, N.Y. ) and Monica
  McGoldrick ( 1999 ) at the Multicultural
  Institute in Highland Park, New Jersey, authors
  of the influential
• Multigenerational work on family life cycles, are
  Bowenian in orientation. The patter two also have
  paid close attention to the powerful influences
  of culture, class, gender and sexual orientation
  on family patterns ( McGoldrick Cater , 2001 ).

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Family Systems Theory

• Family systems theory has been referred to as
  natural systems theory to differentiate it from
  the cybernetrically based family systems
  theories. . It is derived from the biological
  view of the human family as one type of a living
  system. As Friedman ( 1991 ) points out, the
  theory is fundamentally not about families, but
  about life, ( or to what Bowen referred to as the
  human phenomenon ) and it attempts to account
  for humanitys relationship to the natural
  systems. As Wylie ( 1990b ) explains Bowen
  considered family therapy as a by-product of the
  vast theory of human behavior that he believed it
  was his real mission to develop.

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Eight Interlocking Theoretical Concepts

• Six of these concepts speak to the emotional
  process taking place in nuclear and extended
  families, two later concepts, emotional cut-off
  and societal regression speak to the emotional
  process across generations in society. The
  underlying premise is that chronic anxiety in
  omnipresent in life.
• Anxiety- arousal in an organism when
  perceived a real or imagined threat- stimulates
  the anxious-prone persons emotional system. In
  family terms, anxiety is inevitably aroused as
  families struggle to balance the pressures
  towards togetherness as well as to individuation.
  Chronic anxiety, then, represents the underlying
  basis of all symptomatology.

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Eight Interlocking Concepts

• Diiferentiation of self
• Triangles
• Nuclear Family emotional system
• Family projection process
• Emotional cut-off
• Multigenetrational transmission process
• Sibling position
• Societal Regression

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Differentiation of self

• Differentiation of self reflects the extent to
  which the person is able to distinguish between
  the intellectual process and the feeling process
  he or she is experiencing. Differentiation of
  self is demonstrated by the degree to which a
  person can think, plan and follow his or her
  values , particularly around anxiety-provoking
  issues, without having his or her behavior
  automatically driven by the emotional cues from
  others.
• Individuals with the greatest fusion between
  their thoughts and feelings ( i.e. schizophrenics
  dealing with their families ) function most
  poorly, they are likely to be at the mercy of
  automatic or involuntary emotional reactions and
  tend to be come dysfunctional even under low
  levels of anxiety.

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Undifferentiated Ego mass

• Undifferentiated. Ego mass conveys the idea,
  derived from psychoanalysis, of a family
  emotionally stuck together , one where a
  conglomerate emotional oneness exists in all
  levels of intensity.. Bowen later recast this
  concept as fusion-differentiation. Both sets of
  terms underscore the theorys transgenerational
  view that maturity and self-actualization demand
  that an individual become free of unresolved
  emotional attachments to his or her family of
  origin. A person with a strong sense of self
  expresses convictions and clearly defined
  beliefs. These are m opinions. This is who I am.
  This is what I will do, but not this. Such a
  person is said to express a solid self.

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People who are fused

• People who are fused and who are dominated by
  the feelings of those who are around them,
  feeling anxious, they are easily stressed into
  dysfunction. Fearful and emotionally needy, they
  sacrifice their individuality in order to ensure
  acceptance from others. This is expressing an
  undifferentiated pseudo self which may deceive
  others.

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Based on a scale of 1-100.

• Below 50 ( low differentiation ) tries to please
  others supports others and seeks support
  dependent lacks capacity for autonomy, primary
  need for security, avoids conflict, little
  ability to reach decisions or solve problems
• 51-75 ( midrwange differentiation ) has definite
  beliefs and values but tends to overconcerned
  with the opinions of others may make decisions
  based on emotional reactivity, especially whether
  decisions will receive disapproval from
  significant others.
• 76-100 ( high differentiation ) clear values and
  beliefs goal directed flexible, secure
  autonomous, can tolerate conflict and stress
  well- defined sense of solid self and less pseudo
  self . Roberto, 1992)

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Triangles

• One way to defuse an anxious two-person
  relationship within a family, according to Bowen
  ( 1978 ), is to triangulate- draw in a
  significant family member to form a three-person
  interaction. Triangulation, then, is a common way
  in which two-person systems under stress attempt
  to achieve stability ( Guerin, Fogarty, Fay
  Kautto, 1996 )
• According to Bowen the basic building
  block in the familys emotional and relational
  system is the triangle. During periods when
  anxiety is low and external conditions are calm,
  the dyad or two person system may engage in a
  comfortable back and forth exchange of feelings.
  However if the stability of this situation is
  threatened, one or both participants get upset or
  anxious, either because of internal stress or
  from stress external to the twosome. When a
  certain moderate anxiety level is reached, one or
  both parties will involve a vulnerable third
  person.
• According to Bowen ( 1978) the twosome
  may reach out and pull in the third person,
  the emotions may overflow to the third
  person, or that person may be e emotionally
  programmed to initiate involvement.

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Generally speaking

• Generally speaking, the higher the degree of
  family fusion, the more intense and insistent the
  triangulating efforts will b the least
  well-differentiated person in the family is
  particularly vulnerable to being drawn in to
  reduce tension. The higher a family members
  degree of differentiation, the better the person
  may manage anxiety without following the
  triangulating process ( Papero, 1995 ).

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When anxiety is so great

• When anxiety is so great that the basic
  three-person triangle can on longer contain the
  tension, the resulting distress can spread to
  others. As more people become involved, the
  system may become a series of interlocking
  triangles, in some cases heightening the very
  problem that the multiple triangulations sought
  to resolve.

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Kerr and Bowen ( 1988)

• Kerr and Bowen ( 1988) point out that
  triangulation has at least four possible outcomes
  ( a ) a stable twosome can be destabilized by
  the addition of the third person ( i.e. for
  example, the birth of a child brings conflict to
  a harmonious marriage ), ( b ) a stable twosome
  can be destabilized by the removal of a third
  person ( a child leaves home and thus is no
  longer available to be triangulated into parental
  conflict ) ( c ) an unstable twosome can be
  stabilized by the addition of a third person (
  a conflictual marriage becomes harmonious after
  the birth of a child ) and ( d ) an unstable
  twosome can be stabilized by the removal of a
  third person ( conflict is reduced by getting a
  third person, say a mother-in-law, who has
  consistently taken sides, out of the picture ).

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Generally speaking

• Generally speaking, the probability of
  triangulation within a family is heightened by
  poor differentiation of family members,
  conversely the reliance on triangulation to solve
  problems helps to maintain the poor
  differentiation of certain family members.
  McGoldrick and Carter ( 2001 ) observe,
  involvement in triangles and interlocking
  triangles represents a key mechanism whereby
  patterns of relating to one another are
  transmitted over generations in a family.

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Feminist Critique of Bowen

• Hare-Mustin ( 1978 ) and Lerner ( 1986 )
  challenge Bowens contention of differentiation
  of self. They argue that what Bowen values are
  qualities-being autonomous, relying on reason
  over emotion, being goal directed-for which men
  are socialized, while simultaneously devaluing
  those qualities- relatedness, caring for others,
  nurturing- for which women are typically
  socialized.

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However Bowenians,

• However Bowenians, McGoldrick and Carter ( 2001
  ) maintain that by distinguishing between
  thinking and feeling, Bowen was addressing the
  need for controlling ones emotional reactivity
  in order to control behavior and think about how
  we chose to respond, and was not arguing for the
  suppression of authentic or appropriate
  emotional expression.

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Nuclear Family Emotional System

• ( Bowen ( 1978) states that people chose mates
  with equivalent levels of differentiatiation to
  their own. Not surprisingly, then, the relatively
  undifferentiated person will be attracted to a
  person who is equally fused to his or her family
  of origin. It is probable , moreover, that these
  poorly differentiated people, now a marital dyad,
  will themselves become highly fused and will
  produce a family with the same characteristics.

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According to Bowen

• According to Bowen, the resulting nuclear family
  emotional system will be unstable and will seek
  various ways to reduce tension and to maintain
  stability. The greater the nuclear familys
  fusion, the greater the likelihood of anxiety and
  potential instability , and the greater will be
  the familys propensity to seek resolution
  through fighting, distancing, exploiting the
  impaired or compromised functioning of one
  partner, or banding together over concern for a
  child ( Kerr, 1981).

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Three patterns

• Three patterns are consistent with the Nuclear
  Family Emotional System
• Physical or Emotional dysfunction in the spouse,
  the undifferentiated functioning of each family
  member is being absorbed disproportionately by a
  symptomatic parent.
• Overt, chronic, unresolved marital conflict,
  cycles of emotional distance and emotional
  overcloseness occur both the negative feelings
  during conflict and the positive feelings for one
  another during close periods are likely to be
  equally intense in roller-coaster fashion the
  family anxiety is being absorbed by the husband
  and wife.
• Psychological impairment in the child enables the
  parents to focus the attention on the child and
  ignore and deny their own lack of
  differentiation as the child becomes the focal
  point of the family problem, the intensity of the
  parental relationship is diminished, thus the
  familys anxiety is being absorbed in the childs
  impaired functioning the lower a childs level
  of differentiation, the greater will be his or
  her vulnerability to increases in family anxiety
  and thus to dysfunction.

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Family Projection Process

• This process provides the means by which the
  parents transmit their own low level of
  differentiation onto the most susceptible child.
  The child can be mentally handicapped or
  psychologically unprotected. The projection
  process occurs within the mother father-child
  triangle, the transmission of differentiation
  occurs through the triangulation of the most
  vulnerable child into the parental relationship.
  ( Kerr 1981) believes that the greater the level
  of undifferentiation of the parents and the more
  they rely on the projection process to stabilize
  the system, the more likely it is that several
  children will be impaired

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The intensity

• The intensity of the family projection process
  is related to two factors (1) the degree of
  immaturity or undifferentiation of the parents
  and the level of stress and anxiety the family
  experiences. In one triangulating scenario
  described by Singleton ( 1982) , the child
  responds anxiously to the mothers anxiety, she
  being the principal caretaker the mother became
  alarmed at what she perceives as the childs
  problem, and becomes overprotective. Thus a cycle
  is established in which the mother infantilizes
  the child, who in turn becomes demanding and
  impaired. The third leg of the triangle is
  supplied by the father, who is frightened by his
  wifes anxiety and , by needing to calm her down
  without dealing with the issues, plays a
  supportive role in dealing with the child.

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Emotional Cut- Off

• Family members may attempt to insulate
  themselves from family by geographic separation (
  moving to another state), through the use of
  psychological barriers ( cease talking to
  parents), or by the self-deception that they are
  free of family ties because actual contact has
  been broken off. Bowen (1976) considers such
  supposed freedom to be emotional cut-off- a
  flight of extreme emotional distancing in order
  to break emotional ties- and not true
  emancipation.

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In Bowens formulation

• In Bowens formulation, cutting ones self off
  emotionally from ones family origin represents a
  desperate effort to deal with unresolved fusion
  of both parents- a way of managing unresolved
  attachment to them. More likely than not, the
  person attempting the cut-off tends to deny to
  himself or herself that many unresolved conflicts
  remain with family-of-origin members.

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. Kerr (1981)

• Kerr (1981) contends that emotional cut-off
  reflects a problem (underlying fusion between
  generations ) solves a problem ( reducing anxiety
  associated with making contact ) and creates a
  problem ( isolating people who might benefit from
  closer contact ). As

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As McGoldrick And Carter 2001

• As McGoldrick And Carter (2001) note, cutting off
  a relationship by physical or emotional distance
  does not end the emotional process, but actually
  intensifies it. Cut off from the siblings or
  parents, those individuals are apt to form new
  relationships (with a spouse or children) that
  are all the more intense and that may lead to
  further distancing and cutoffs from them.
  Cut-offs occur often in families where there is a
  high level of anxiety and emotional dependence
  (Bowen 1978). Bowen insisted that adults must
  resolve their emotional attachments to their
  families of origin.

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Multigenerational Transmission Process

• Bowen stated that this is when severe
  dysfunction is conceptualized as the result of
  chronic anxiety transmitted over several
  generations. Two earlier concepts are crucial
  here- the selection of a spouse with a similar
  differentiation level and the family projection
  process that results in lower levels of
  self-differentiation for that invested, or
  focused off spring particularly sensitive to
  parental emotional patterns. By contrast,
  children less involved in parental over focusing
  can develop a higher degree of differentiation
  than their parents (Roberto, 1992).

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Sibling Position

• Bowen credits Tomans ( 1961 ) research on the
  relationship between birth order and personality
  with clarifying his own thinking regarding the
  influence of sibling position in the nuclear
  family process. Toman hypothesized that children
  develop certain fixed personality characteristics
  based on the birth order in the family. He
  offered ten basic personality sibling profiles
  (such as older brother, younger sister younger
  brother, older sister only child, twins)
  suggesting that the more closely a marriage
  duplicates ones sibling in childhood the better
  will be its chance of success. Thus a first born
  will do well to marry a second born, for example.
  He maintained further that, in general, the
  chances for a successful marriage are increased
  for persons who grew up with siblings of the
  opposite sex rather than with same-sex siblings
  only. Note, however, that it is a persons
  functional position in the family system, not
  necessarily the actual order of birth, that
  shapes future expectations and behaviors.

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Societal Regression

• I n Societal Regression, Bowen extends his
  thinking to societys emotional functioning. He
  argued that society, like the family, contains
  within it opposing forces toward
  undifferentiation and toward individuation.
  Under the conditions of chronic stress
  (population growth, depletion of natural
  resources) and thus an anxious social climate,
  there is likely to be a surge of togetherness and
  a corresponding erosion of the forces intent on
  achieving individuation. The result, thought
  Bowen, was likely to be greater discomfort and
  further anxiety. ( Papero, 1990 )
• ( 1978 ) Bowens pessimistic view that societys
  functional level of differentiation had decreased
  over the last several decades. He called for
  better differentiation between intellect and
  emotion in order for society to make more
  rational decisions rather than act on the basis
  of feelings and opt for short-term Band Aid
  solutions.

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The Family Interview

• Bowen believed the more a therapist has worked
  on becoming differentiated from his or her own
  family of origin, the more the therapist can
  remain detached, unswayed and objective.
  Actually, as Friedman ( 1991) points out, it is
  the therapists presence engaging without being
  reactive, simulating without rescuing, teaching a
  way of thinking rather than using any specific
  behavior or therapeutic intervention technique-
  that is the ultimate agent of change.

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Bowen viewed

• Bowen viewed Family Therapy as a way of
  conceptualizing a problem rather than a process
  that requires a certain number of people to
  attend the sessions, he has content to work with
  one family member, especially if that person was
  motivated to work on self-differentiation from
  his or her family of origin. In fact, according
  to Kerr and Bowen (1988), while conjoint sessions
  are generally useful, at times seeing people
  together impede the progress of one or the other.
  Instead, they argue, if one parent can increase
  his or her basic level of differentiation, the
  functioning of the other parent as well as the
  children will inevitably improve.

40
The Genogram

• Bowen believed in multigenerational patterns and
  influences are crucial determinants of nuclear
  family functioning, he developed a particular way
  of investigating the genesis of the presenting
  problem by diagramming the family over at least
  three generations. To aid in the process and to
  keep the record in pictorial form in front of
  him, he constructed a family genogram in which
  each partners family background is laid out.
  Worked out with the family during early sessions,
  it provides a useful tool for allowing therapist
  and family members alike to examine the ebb and
  flow of the familys emotional processes in their
  intergenerational context. Each individual
  familys biological, kinship, and psychological
  makeup can be gleaned from perusing this visual
  graph (Roberto, 1992 ).

41
Many hypotheses

• Many hypotheses spring from the genogram,, to be
  explored with the family subsequently.
  Fusion-differentiation issues in the family of
  origin, the nuclear family emotional system,
  emotional cutoffs by the parents, sibling
  positions and may others of Bowens concepts
  appear as possibly relevant.

42
Therapeutic Goals

• Family systems therapy, no matter what the
  nature of the presenting clinical problem, is
  always governed by two basic goals ( a )
  management of anxiety and relief from symptoms,
  and ( b) an increase in each participants level
  of differentiation in order to improver
  adaptiveness ( Kerr Bowen, 1988).

43
Back Home Visits

• To help remove an adult from a highly charged
  emotional triangle with parents, solo visits to
  the family of origin may be arranged. Typically
  these structured visits are prepared before hand
  by telephone or letter, in which the client makes
  known those issues causing personal distress. The
  client is instructed to maintain an observer
  stance as much as possible, at first, monitoring
  distressing emotional and behavioral patterns
  while retaining a sense of separateness despite
  surrounding tensions and anxiety.

44
Bowen

• Bowen was particularly concerned that his
  clients develop the ability to differentiate
  themselves from their families of origin, the
  focus of much of the work was on extended
  families. I n this respect Bowen resembled Framo
  ( 1981) Bowen sent clients home for frequent
  visits ( and self-observations ) after coaching
  them in their differentiating efforts, while
  Framo brought members of the families of origin
  into the final phase of therapy with his clients.
  Going home again, for Bowen, was directed at
  self-differentiation from one another-not at
  confrontation, the settlement of old scores, or
  the reconciliation of long standing differences.
  Re-establishing emotional connectedness with the
  family of origin-especially when rigid and
  previously impenetrable boundaries have been
  built up is a crucial step in reducing a clients
  residual anxiety due to emotional cut-off, in
  detriangulating from members of that family and
  in ultimately achieving self-differentiation,
  free of crippling entanglements from the past or
  present.

45
Bowen referred to himself as a coach.

• Bowen referred to himself as a coach. He stated
  that self-differentiation, the basic goal of
  therapy, must come from the family and not from
  the therapist, on the basis of a rational
  understanding of the familys emotional networks
  and transmission process.

46
Bowens insistence

• Bowens insistence that a therapist not engage
  the family system-maintaining what Ahlmer (1986)
  calls a detached-involved position - is
  dramatically different from the total immersion
  approach of the family therapists such as
  Ackerman. Here the therapist remains
  unsusceptible, calm, objective, detriangulated,
  from the emotional entanglements between the
  spouses. If the therapist can maintain that kind
  of stance-despite pressures to be triangulated
  into the conflict-Bowenians believe tension
  between the couple will subside, the function
  between them will slowly resolve, and the other
  family members will feel the positive
  repercussions in terms of changes in their own
  lives-all adding to the likelihood of each member
  achieving greater self-differentiation.

47
The most differentiated person

• The most differentiated person in the family will
  be the member most capable of breaking through
  the old emotionally entangled patterns on
  interaction. When a person succeeds in taking an
  I stand , the others will shortly be forced
  into changing subsequently moving off in their
  own directions.

48
Doing family therapy by coaching

• moving off in their own directions.
• Doing family therapy by coaching individual
  family members to change themselves in the
  context of their nuclear and parental family
  systems ( McGoldrick Carter, 2001 ) has become
  a prominent part of the Bowenian family systems
  therapy. After defining the crisis that brought
  the family into therapy, the individual member is
  tutored to define himself or herself both in the
  family and the family of origin. By guiding that
  person to avoid triangles and getting embroiled
  in family emotional processes, the coach is
  helping change his or her emotional functioning
  in the family, eventually change the entire
  system. Genograms sometimes help to define that
  persons role in the family.

49
Contextual Therapy Relational ethics And the
Family Ledger

• Ivan Boszormenyi- Nagy in his contextual therapy
  (1987) is heavily influenced by Fairbairns
  (1952) Object Relations Theory, existential
  philosophy, and Suillivans interpersonal
  psychiatry. (1953) to which is added ethical
  perspective- trust,loyalty, transgenerational
  indebtedness and entitlements. Boszormenyi- Nagy
  believes that the burdens for todays families
  are complex, and a comprehensive picture of their
  functioning must go beyond a simple appreciation
  of the interactional sequences occurring between
  members.. What also demand attention, in his
  view, is the impact of both intrapsychic and
  intergenerational issues within families,
  especially each others subjective sense of
  claims, rights and obligations in relation to one
  another. To function effectively, family members
  must be held ethically accountable for their
  behavior with one another and must learn to
  battle entitlement (what one is due or has come
  to merit) and indebtedness (what one owes to whom
  ).

50
Also in contextual theory

• Also in contextual theory is relational ethics
  focusing attention on the long-term oscillating
  balance of fairness among members within a family
  whereby the welfare interests of each participant
  are taken into account by others. Relational
  ethics encompasses both individual psychology
  (what transpires within the person) and systems
  characteristics (roles, power alignments, and
  communication sequences within the family).
  Destructive Entitlements may occur within a
  family, for example, when parents exploit a
  childs loyalty by expecting the child to be
  available as a mature adult-parentification- or
  by hampering or preventing the childs
  growth-infantilization ( Ducommun-Nagy, 1999).

51
Leading Figures

• Ivan Boszormenyi-Nagy was a psychiatrist with
  psychoanalytic training who immigrated to the
  United States from Hungary in 1948. He founded
  the Eastern Pennsylvania Psychiatric Institutes (
  EPPI ) in Philadelphia in 1957 as a research
  center for studying s schizophrenia ( James Framo
  along with Geraldine Spark, Gerald Zak And David
  Rubenstein were early associates at this
  state-sponsored research and training institute.

52
When EPPI closed in 1980

• When EPPI closed in 1980 due to the loss of
  state funding, the researchers continued to
  refine contextual theories at nearby Hahnemann
  University Medical School.
• Boszormenyi-Nagy initially with Spark, a
  psychiatric social worker with an extensive
  psychoanalytic background and experience in child
  guidance centers. Together the pair advanced a
  theory based upon invisible loyalty within a
  family, in which the children unconsciously take
  on the responsibilities to aid their parents,
  often to their own detriment (e.g. become a
  failure to confirm parental forecasts).

53
Boszormenyi-Nagy and Sparks

• Boszormenyi-Nagy and Sparks proposed a set of
  therapeutic techniques that pertained to
  uncovering and resolving family obligations
  and debts incurred over time. The researchers
  introduced such new terms as family (
  expectations handed down from previous
  generations concerning what is expected, say, of
  men and women and family loyalty ( allegiances in
  children based on parental fairness ) in order to
  emphasize that family members inevitably acquire
  a set of expectations and responsibilities toward
  each other. Besides Boszormenyi-Nagy, leading
  exponents of this view include psychologist David
  Ulrich (1998) in Greenwich, Connecticut, as well
  as psychiatrist Catherine Ducommun-Nagy (1999),
  wife of the founder, at the Institute For
  Contextual Growth in Ambler, Pennsylvania.

54
Every family maintains a family ledger

• Every family maintains a family ledger- a
  multigenerational accounting system of what has
  been given and who psychologically speaking still
  owes what to whom.
• Therapeutic Goals
• Contextual therapists do not focus on
  pathology but rather attend to the familys
  relational resources ( Ducommun-Nagy, 1999). That
  is, they help each family member explore the
  possibility of earning entitlements from others
  by appropriate giving to them Advocates of this
  view insist that individual autonomy cannot be
  achieved without a genuine consideration of
  others. Clients are encouraged to consider the
  interests of others as ultimately benefiting both
  giver and receiver.

55
The Ethical Consideration

• Contextual family therapy maintains therapeutic
  interventions must be grounded in the therapists
  conviction that trustworthiness is a necessary
  condition for reworking family legacies and
  allowing family members to feel that they are
  entitled to more satisfying relationships.
  Practitioners of contextual therapy maintain that
  families cannot be fully understood without an
  explicit awareness of family loyalty- who is
  bound to whom, what is expected of all family
  members, how loyalty is expressed, what happens
  when loyalty accounts are uneven (We were there
  for you when you were growing up and now we, your
  aging parents, are entitled to help from you.)

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Contextual therapy

• Contextual therapy helps rebalance the
  obligations kept in the invisible family ledger.
  Once these imbalances are identified, efforts can
  be directed at settling old family accounts ( for
  example, mothers and daughters stuck in lifelong
  conflict ) exonerating alleged culprits,
  transforming unproductive patterns of relating
  that may have existed through out the family over
  generations..
• The major therapeutic thrust is to establish
  more trustworthiness and relational integrity in
  family relationships.