Between Give and Take: A Clinical Guide to Contextual Therapy by Ivan Boszormenyi-Nagy;

Barbara R. Krasner
Family Relations, Vol. 36, No. 3 (Jul., 1987), p. 349
Published by: National Council on Family Relations
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ing and reproducing Erickson's work,
O'Hanlon has made these important
contributions more usable to practic-
ing therapists. Peppered with illustra-
tions throughout, the book is very
readable. Additional resources are an-
notated and categorized in an addi-
tional section at the end of the book, in-
cluding print and tape materials by
Erickson himself and by others. An
Ericksonian Glossary is helpful for
those unfamiliar with his jargon. The
volume is also well referenced and in-
dexed.
Boszormenyi-Nagy, Ivan, & Krasner,
Barbara R. (1986). Between Give
and Take: A Clinical Guide to Con-
textual Therapy. New York: Brun-
ner/Mazel, 422 pp., $35.00 (cloth).
Written for theapists of all persua-
sions, this represents a clinical guide
to Boszormenyi-Nagy's Contextual
Therapy. It is assumed that the reader
has some familiarity with both
psychodynamic individual therapy and
systematic-classical family therapy. In
this volume, Krasner, as a co-develop-
er, contributes new formulations, fresh
perspectives, and illustrations of the
contextual approach. Organized into
seven sections, the authors argue "that
a truly comprehensive grasp of human
existence is inevitably composed of
both individual and relational realities"
(p. 7). Contextual therapy seeks to rein-
troduce individual uniqueness into
systemic therapy and to provide rela-
tional links and balances with in-
dividual therapy. More than a
therapeutic modality, contextual
therapy recognizes the unique and in-
tertwining dimensions of biology,
psychology, transactional patterns,
and individual responsibility for every
person and relationship.
In Section One "Premises," the
basic principles and implications of
contextual therapy are delineated. In
"An Orientation to Contextual
Therapy," the growth of the psycho-
logical "healing market" and the con-
sequential need for accountability are
explored. The rise of contextual
therapy as an integrative stance grows
out of the fundamental belief that the
consequences of a person's behavior
affect all other significantly involved in-
dividuals and relationships. The con-
textual therapist helps clients order
their life's priorities. This clinician also
helps clients discover relationship
resources that can help support at-
titudes and behaviors that contribute
to the well-being of the client's signifi-
cant relationships. In chaDter two, the
July 1987
This content downloaded from 91.229.229.129 on Wed, 18 Jun 2014 10:55:45 AM
origins of contextual therapy as an
outgrowth of "The Challenge of the
Therapy of Psychotics: Background of
the Contextual Approach" are pre-
sented. Contextual therapy's dialec-
tical perspective recognizes the
simultaneous coexistence of more
than one individual's rights and
motives and provides a bridge between
individual and relational motivations in
"A Dialectic View: The Development of
the Contextual Approach." Concepts
of need-complementarity, counter-
autonomous superego, invisible
loyalties, among others are introduced.
The importance of trust as a product of
the balance between the give and take
within relationships is presented.
Section Two, "Outlines of the
Human Context," defines the four
dimensions of the therapeutic process
of contextual therapy. In "The Four
Dimensions of Relational Reality," ob-
jectifiable facts, individual psychology,
systems of transactional patterns, and
the ethic of due consideration (merited
trust) represent relational paradigms.
Ethical guidelines for therapy grow out
of the merit dimension. "Interpersonal
Conflicts of Interests: A Four-Dimen-
sional Perspective" examines the in-
evitable conflicts of interest between
people as representations of the give
and take in relationships. In chapter
six, the "Three Aspects of the Dialogue
Between Persons," polarization be-
tween selves, symmetry versus asym-
metry, and inclusive multilaterality are
introduced and the therapeutic implica-
tions are explained. "Dialogue Be-
tween the Person and the Human Con-
text" is presented in chapter seven and
stresses the responsibility for the con-
sequences of behavior. Entitlement
and transgenerational mandates are
explored.
In Section Three, "Assessing the
Context," "The Client-Therapist
Dialogue" begins with the first meeting
of therapist and client. The assess-
ment of the relational reality and
available therapeutic resources can
help build immediate trust. In chapter
nine, "Assessing Relational Reality" is
the next step using the previously in-
troduced four dimensions of relational
real ity.
"The Process of Therapy" is the
subject of Section Four. Chapter 10
focuses on the process aspects of
"Health, Autonomy, and Relational Re-
sources" in maximizing one's quality
of life. In "Rejunction: Reworking the
Impasse," therapeutic interventions
following symptom improvement are
discussed as is constructive and
th FAMILY RELATIONS
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destructive coalescence. "Resis-
tances: Obstacles to Therapeutic
Progress" are discussed in terms of
the four dimensions in chapter 12.
"Therapeutic Methods," Section
Five, provides a clinical look utilizing a
detailed case analysis using contex-
tual therapy with a marital relationship.
The five chapters include "A Case Il-
lustration" (chapter 13) followed by
"Balance in Motion: Crediting," a
discussion of the state of dynamic
equilibrium present in all relationships.
The process of "Starting Therapy" is
explained in chapter 15. In "Multi-
d irected Partiality" the authors d iscuss
the therapist's commitment to help all
those involved in the client's relational
world who are most likely to be af-
fected by intervention. Multidirected
partiality is a guide to give and take. In
chapter 17, "Contextual Workwith Mar-
riage," the authors maintain that con-
textual therapy must explore the re-
sources deep within dysfunctional rela-
tionships as it demands that each fam-
ily member overcome the unilateral
considerations of the relationship.
In Section Six, "Applications and
Guidelines," a selection of specific
situations is presented along with the
application of contextual principles
and methods. Problems of marriage,
divorce and custody, remarriage,adop-
tion, parenting, foster home place-
ment, child protection, child abuse,
teenage parenthood, pregnancy
counseling and abortion, terminal ill-
ness, mental illness, depression,
therapy with psychotics, mental re-
tardation, suicide, addiction, sexual
identity, incest, and school problems
are recognized as issues of concern to
contextual therapists. These issues are
addressed within the context of four
chapters.
"The Making of a Contextual
Therapist" is discussed in the final
section/chapter. The personal qualities
of a therapist and how that forms the
basis for dealing with clients is ex-
plored within his or her own context. A
glossary follows the final chapter.
References and an index conclude the
work. Case examples illustrate points
throughout the book. While the work is
thorough and comprehensive, it is bur-
dened with extensive and qualified
jargon. A great deal of the jargon is new
and makes reading cumbersome for
one new to the contextual approach.
This is not a book for bedtime reading.
Rather, new ideas are explicated within
the detailed context of Boszormenyi-
Nagy and Krasner's philosophy.
349