Contextual approach to family therapy

Böszörményi-Nagy developed the Contextual approach to family therapy and individual psychotherapy. It is a comprehensive model which integrates individual psychological, interpersonal, existential, systemic, and intergenerational dimensions of individual and family life and development.

The contextual model proposes four dimensions of relational reality, both as a guide for conducting therapy and for conceptualizing relational reality in general:
 * (1) Facts (e.g., genetic input, physical health, basic historical facts, events in a person's life cycle, etc)
 * (2) Individual psychology (the domain of most individual psychotherapy)
 * (3) Systemic transactions (the domain covered by classical systemic family therapy: e.g., rules, power, alignments, triangles, feedback, etc)
 * (4) Relational ethics.

These dimensions are taken to be inter-linked, but not able to be equated with or reduced to one another.

The contextual model proposes relational ethics - the ethical or "justice" dimension of close relationships - as an overarching integrative conceptual and methodological principle. Relational ethics focuses in particular on the nature and roles of connectedness, caring, loyalty, legacy, guilt, fairness, accountability, and trustworthiness - within and between generations. It is taken to represent not just a set of prescriptive norms, nor simply psychological phenomena, perspectives, or constructions. Rather, relational ethics is seen as (1) having some objective ontological and experiential basis by virtue of being derived from basic needs and from real relationships with concrete consequences (i.e., as distinct from abstract or "value" ethics); and (2) as being significant explanatory and motivational dynamics operating - in both beneficial and destructive ways - in individuals, families, social groups, and broader society.

In a later formulation of the contextual model, Böszörményi-Nagy proposed a fifth dimension - the ontic dimension - which was implicit in the earlier formulations, but which considers more explicitly the nature of the interconnection between people that allows an individual to exist decisively as a person, and not just a self. (See also Intersubjectivity and Philosophy of dialogue.)

Multidirected partiality is the main methodological principle of contextual therapy. Its aim is to evoke a dialogue of mutual position-taking among family members. It consists of a sequential, empathic turning towards member after member (even absent members), in which both acknowledgement and expectation are directed at them. It is an alternative to the more common 'neutrality' or unilateral partiality of other approaches. It requires an appreciation of the 'ledger' from each person's point of view, even that of the current victimizer. . For example, a family comes into therapy desiring to fix their son's outbursts and oppositional defiant behavior. The therapist would firstly have each family member explain their side of the story, in order to begin to understand the problem in terms of background facts, the relational context (i.e., intergenerational, interpersonal, and systemic), and deeper motivational factors (e.g., psychological processes, hidden loyalties and legacies, ledger imbalances, destructive entitlement resulting from real or perceived injustices, parentification of the child, etc), and not simply (as is commonly done in some other approaches) in terms of the 'behaviour', 'systemic interactions', 'beliefs', or 'narratives' of the family and the son.

Having gained this preliminary understanding of the situation, the therapist would firstly address any issues requiring urgent attention (e.g., physical welfare, prevention of violence, etc), especially in relation to the interests of the most vulnerable member(s), whether or not they are present at the therapy sessions. The therapist would then go further, carefully and sequentially 'taking sides' with each member (while seeking to maintain overall balance), the aim being to begin a genuine dialogue of mutual accountability, to reduce the reliance on dysfunctional acting-out, and to find resources (e.g., hope, will) for rebuilding relationships through mutual acknowledgement of both entitlements and obligations, shifts in attitude and intention, fair exoneration, and redemptive or rejunctive (i.e., 'trust-building') actions, that will in turn build individual and relational integrity and trustworthiness, which contextual therapists see as the ultimate relational resource for individual and family well-being.

The contextual approach allows for the inclusion of many significant aspects of other approaches to psychotherapy and family therapy, provided that they are consistent with the overarching contextual principle of multilateral therapeutic ethical concern and accountability.