Contextual therapy

1. Introduction

Version followed: Boszormenyi-Nagy's contextual therapy as Catherine Ducommun-Nagy (Institute for Contextual Growth; Drexel University) sets it out in 2025–2026. That means the five-dimension model, where Nagy added the ontic Dimension V in 2000 to the four-dimension model in Boszormenyi-Nagy & Krasner (1986). For phases, the guide uses the three-phase Dutch model by van der Meiden et al. (2019). Hargrave's forgiveness/restoration extension appears only as a marked variant.

Contextual therapy was developed by Hungarian-American psychiatrist Ivan Boszormenyi-Nagy (1920–2007) and colleagues in Philadelphia, mainly with Barbara Krasner. Its foundations are Invisible Loyalties (with Spark, 1973), Between Give and Take (with Krasner, 1986) and Foundations of Contextual Therapy (1987). It is an intergenerational family therapy, but it can also be done with individuals and couples, because the "context" means everyone affected by the client's actions, whether or not they are in the room. [source: Ducommun-Nagy 2026; Ducommun-Nagy 2025 abstract; Routledge/T&F book page]

How change happens. Relationships run on relational ethics: mutual care for each other's needs, a fair balance of giving and receiving, and trustworthy parenting across generations. Fairness is worked out by dialogue between the people concerned, not by an outside moral code (Ducommun-Nagy links this to Buber's I–Thou). There are two kinds of injury:

Relational injustice: exploitation or unfair imbalance by another person.
Situational injustice: misfortune nobody caused, such as illness, disability, early loss or discrimination.

People who were wronged keep a valid claim to fairness. If no one recognises it, the claim turns into destructive entitlement: they seek compensation from people who did not cause the harm, often without seeing the new injustice they create. This can pass harm down the generations (the "revolving slate").

Change comes from two things. First, injustices are acknowledged. Second, people make gestures of giving, however small. Giving earns the giver constructive entitlement and self-validation, which Ducommun-Nagy calls the antidote to destructive entitlement. The "healing moment" is one person's gesture toward another. The aim is restored trustworthiness and fair relating, not symptom removal, although symptoms often ease as trust grows. [source: Ducommun-Nagy 2026; van der Meiden et al. 2017, 2018 abstracts]

Status. Contextual therapy is a school of family therapy with a theory and a clinical method. It is not a licensed or manualised programme. No certification is needed to use it, and the sources describe no fidelity monitoring. Training is given by the Institute for Contextual Growth (Ducommun-Nagy), by Dutch and Flemish training institutes, where the approach is widely taught, and through seminars in Switzerland. [uncertain: specific training providers]

2. Framework

Assessment frame: the five dimensions of relational reality. Assess every case on all five; work mainly on Dimension IV. [source: Ducommun-Nagy 2026; Boszormenyi-Nagy & Krasner 1986, per T&F abstract]

I. Facts: biological and historical givens such as illness, disability, adoption, deaths, migration, race and events.
II. Individual psychology: symptoms, defences, emotional development.
III. Transactions: communication, power, coalitions, systemic patterns.
IV. Relational ethics: fairness, merited trust, giving and receiving, entitlement, loyalty, legacy. This dimension is specific to contextual therapy.
V. Ontic: how each self is defined through relating to an other, captured in the phrase "no Self without another". Nagy added it in 2000. Ducommun-Nagy's example is narcissistic I–It relating.

Dimensions I–III roughly match Engel's biopsychosocial model; IV and V are what contextual therapy adds. [source: Ducommun-Nagy 2026]

Phases (van der Meiden et al. 2019 model). The Dutch research group built a three-phase model with 19 intervention guidelines. They drew on analysis of Nagy's own recorded sessions, which yielded six intervention clusters (2017), and of 14 sessions by 12 current contextual therapists, which yielded eight intervention categories and a consistent working method (2018). Only the abstracts are drawn on, so the full lists of 19 interventions, six clusters and eight categories are not given. [uncertain]

Exploring connectedness in close relationships.
- Goals: map the context on the five dimensions. Hear each person's side, including how fair or unfair they find their relationships. Identify injustices, situational and relational. Map loyalties, legacies, parentification and where destructive entitlement is coming from. Identify resources: who still cares about whom, and who gives.
Modifying/activating connectedness.
- Goals: acknowledge the injustices you found. Use multidirected partiality to open dialogue. Elicit gestures of giving. Work on exoneration and rejunction.
- [uncertain: phase name paraphrased from the abstract summary]
Reinforcing/consolidating connectedness.
- Goals: strengthen the new reciprocal care so it carries on outside therapy. Extend it to absent members and the next generation. Prepare to end.
- [uncertain: phase name paraphrased]

Format.

Flexible: individual, couple, family and multigenerational sessions, combined as needed.
Ducommun-Nagy's case examples move between family sessions and individual sessions. In one, a parent disclosed an injustice alone first. Another included a third-party helper, a life counsellor, to support a teen who found it hard to express himself. [source: Ducommun-Nagy 2026]
People who cannot or will not attend stay in the therapist's thinking. They are invited where useful. [source: open-exam-prep summary of Nagy & Krasner; uncertain]
Session count: no source specifies one. Courses are reported as anything from brief consultations to long-term work. [uncertain]

Criteria for moving between phases. The sources give none. The following is [synthesis]:

Phase 1 → 2: each key person has given their side and feels the therapist has heard it. The main injustices and loyalties are mapped. At least one person shows some readiness to consider another's side.
Phase 2 → 3: at least one concrete gesture of giving or acknowledgement has happened between members and been credited. Blaming has eased. Members can talk directly about fairness without the therapist translating.
Ending: the family keeps up reciprocal acknowledgement on its own. Destructive patterns toward the next generation, such as parentification and scapegoating, have stopped. Symptoms have eased or are no longer the main concern.

3. Guiding principles

[source: Ducommun-Nagy 2026 and 2025 abstract; van der Meiden et al. 2017–2019 abstracts; Boszormenyi-Nagy & Krasner 1986 via secondary summaries, uncertain where marked]

Relational ethics is the main lens. Ask what is fair and unfair here, and who owes what to whom, before you ask about pathology.
Multidirected partiality ("multilateral fairness"). Be partial to every person in turn, and to people who are absent, dead or not yet born. You are never neutral and never permanently on one side.
Everyone gets their own side, in their own terms. Give each person the same chance to state how fair they think the relationship is. Being heard is what makes people able to listen.
Accountability goes with partiality. You can recognise someone's suffering and still hold them responsible for how their actions affect others. [source: open-exam-prep; uncertain]
Reframe "entitled" behaviour as destructive entitlement. Look for the legitimate unacknowledged claim behind unreasonable demands. Acknowledging it often softens the demands.
Name injustice, including injustice caused by illness. Saying out loud that a disability, illness or loss was unfair reduces revenge-seeking and makes people more open to help. Ducommun-Nagy argues this does not stigmatise.
Giving heals the giver. Look for chances for each person, including ill, disabled or very young members, to give something within their limits. They "should not be dismissed as givers" (Ducommun-Nagy 2026).
Resource orientation. Look for remaining trust, care and loyalty, not only dysfunction. Relationships themselves are the resource for health. [source: van der Meiden et al. 2017 abstract]
Respect filial loyalty. Children are loyal to their parents whatever the parents did. Never ask a child, or an adult child, to condemn a parent. Help the loyalty find constructive expression. [source: open-exam-prep; uncertain]
Protect the next generation. Watch for parentification and for one generation's grievances being passed to the next. Intervene to stop the revolving slate. Parents should give more to children than they ask from them.
Parents and children can both be victims of the original injustice. Frame a harmful parent as also carrying an unacknowledged claim. This opens a path to exoneration without excusing the harm.
Dialogue over technique. Ducommun-Nagy places contextual therapy among postmodern, collaborative family therapies. The therapist sets up fair dialogue and does not prescribe solutions.
The ontic dimension. Each person's self takes shape through relating to others. Help people relate to each other as subjects (I–Thou), not as objects (I–It).

4. Intervention inventory

Scope note: Nagy and Krasner present multidirected partiality as a method, not a fixed set of techniques. The items below are what the sources describe, or what secondary summaries attribute to Boszormenyi-Nagy & Krasner (1986). The 19 intervention guidelines in van der Meiden et al. (2019) are not drawn on, so this list may group or name things differently from that model. [uncertain] Step sequences are [synthesis] built from the described principles unless tagged otherwise. All example language is illustrative.

4.1 Five-dimensional contextual assessment

Purpose: find both sources of pathology and therapeutic resources across facts, psychology, transactions, relational ethics and the ontic dimension, with most weight on Dimension IV. [source: Ducommun-Nagy 2026] Use it from the first session and keep it running throughout.
Steps [synthesis]:
1. Record facts (Dimension I): illnesses, disabilities, deaths, migrations, divorces, out-of-home placements, trauma, discrimination. Note which of these are situational injustices.
2. Note individual symptoms and diagnoses (II) without making them the organising frame.
3. Note patterns and coalitions (III).
4. For Dimension IV, ask each person three things: what they have given and to whom; what they received and what they missed; who they feel they owe and who owes them. Map where loyalties lie, including invisible and split loyalties. Note who is parentified and who acts from destructive entitlement.
5. For Dimension V, notice whether people relate to each other as subjects or as means to an end.
6. List resources: remaining trust, care, and existing gestures of giving.
Example language (illustrative): "Who in your family has given the most? Has anyone ever noticed it?" "Was there a time growing up when life was unfair to you in a way nobody caused?"
Watch for: sliding into diagnostic-only (Dimension II) or pattern-only (III) formulations. Ducommun-Nagy notes that contextual assessment does not mainly focus on DSM diagnosis. It is working when you can name, for each person, an injustice they suffered and a contribution they made.

4.2 Eliciting each person's side

Purpose: give everyone "the same chance" to present their side in their own terms, including how fair they think the relationship is. Being heard is what makes people willing to listen. [source: Ducommun-Nagy 2026] This is the core of every conjoint session.
Steps:
1. Explain the frame: everyone's side will be heard. [synthesis]
2. Invite one person to speak about their concern and about what they find fair and unfair. In Ducommun-Nagy's Case 2 the parents went first, and then the therapist turned to the teen. [source: Ducommun-Nagy 2026]
3. Reflect the injustice in that person's experience before any problem-solving.
4. Turn to the next person. Ask them to describe their own side, not to rebut. [synthesis]
5. Come back to anyone whose side has not yet been acknowledged.
Example language (illustrative): "Before we try to fix anything, I want to understand how this has been for each of you, starting with what has felt unfair." "You'll get your full turn too. Right now I want to make sure your mother feels heard."
Watch for: one member dominating, or a child speaking only for a parent. It is working when members start asking about each other's side without being prompted.

4.3 Multidirected partiality (sequential siding)

Purpose: the defining method. The therapist takes each person's side in turn, including people who are absent, and in doing so models fair consideration for all. [source: Ducommun-Nagy 2026 ("multidirected partiality, also understood as multilateral fairness"); open-exam-prep summary] Use it throughout, especially where there is blame, cut-off or scapegoating.
Steps [synthesis, from the described stance]:
1. With person A, acknowledge their suffering and their contributions specifically and warmly.
2. Explicitly turn to person B and do the same, including for someone A has just accused.
3. Raise each person's accountability for how their actions affect the others, after you have credited them, not instead of crediting.
4. Speak for absent or voiceless parties: a deceased grandparent, a child too young to speak, future children.
5. Keep track of whose side you have taken recently and rebalance over the session and across sessions. Balance happens over time, not in every sentence.
Example language (illustrative): "You carried a lot for your sister, and no one thanked you." Then, to the sister: "And you were sick for years, through no fault of your own. What was that like from your side?"
Watch for: turning into neutrality (bland, no real advocacy) or into a lasting alliance. Members may test whether you favour someone. It is working when people stop recruiting you as judge and start acknowledging one another.

4.4 Crediting

Purpose: explicitly recognise each person's contributions, including their unrecognised giving, and the suffering they did not deserve. This affirms merit they have earned and reduces the drive to seek compensation elsewhere. [source: open-exam-prep summary of Nagy & Krasner; uncertain on original definition] Use it whenever unrecognised giving appears, especially from parentified members and caregivers.
Steps [synthesis]:
1. Listen for giving that is hidden inside a complaint.
2. Name it concretely: who gave, what, to whom, at what cost.
3. Invite other family members to recognise it too. Credit from family members is worth more than credit from the therapist.
4. Also credit the merit of an offender who has given elsewhere, without minimising the harm they did.
Example language (illustrative): "From age ten you were the one checking whether Mum had eaten. That was real giving." To the parent: "Did you know how much she carried?"
Watch for: generic praise, which is not crediting, and crediting only the identified victim. It is working when the person softens or tears up, and when relatives start adding their own acknowledgements.

4.5 Naming and acknowledging injustice (situational and relational)

Purpose: recognise situational injustice (illness, disability, loss) and relational injustice (exploitation by another). Unacknowledged injustice feeds destructive entitlement, and acknowledging it reduces revenge-seeking. [source: Ducommun-Nagy 2026] Use it early, and before practical problem-solving.
Steps:
1. Separate what nobody caused (situational) from what someone did (relational). Only relational injustice has a party responsible for repair. [source: Ducommun-Nagy 2026]
2. Name the situational injustice plainly to the person who bears it. In Case 2 the therapist named the unfairness of a teen's learning disorder in a family session, and the teen then asked his mother why his brother had been made capable and he had not. [source: Ducommun-Nagy 2026]
3. Invite other family members to acknowledge it too. In Case 2 the parents and brother did so, and the teen's aggression at home decreased. [source: Ducommun-Nagy 2026]
4. For relational injustice, name who is responsible and keep repair possible.
5. Only then move to practical solutions. In Case 1 the mother's experience of injustice was acknowledged first, in an individual session, and then a voicemail solution was proposed. [source: Ducommun-Nagy 2026]
Example language (illustrative): "It is unfair that school is so much harder for you than for your brother. Nobody chose that, but you are the one who pays for it every day."
Watch for: colleagues may worry that this stigmatises. Ducommun-Nagy argues it does not. Siblings may feel blamed when you acknowledge one child's disadvantage; credit them too. It is working when the person becomes more open to help. In Case 2 the teen accepted special-education support after the acknowledgement.

4.6 Reframing "entitled" behaviour as destructive entitlement

Purpose: treat demanding, exploitative or vengeful behaviour as a legitimate but unacknowledged claim to fairness that is being expressed destructively, rather than as a character flaw. [source: Ducommun-Nagy 2026] Use it when a client or family member is labelled "entitled", demanding or exploitative, or when hurt people are hurting innocent others.
Steps:
1. Privately, form a hypothesis about the original injustice: early loss, parentification, abuse, illness.
2. Acknowledge that injustice to the person, separately from the current behaviour.
3. Then gently show them the cost of their current behaviour to people who are not to blame. [synthesis]
4. Open a route to constructive entitlement through giving (4.7).
Example language (illustrative): "You were let down badly, and it makes sense that you want things to be made right. The hard part is that your kids are the ones being asked to pay for it."
Watch for: acknowledgement being taken as permission. Hold accountability (4.15). Ducommun-Nagy reports that attitudes often shift once the underlying injustice is recognised.

4.7 Eliciting giving: the healing gesture

Purpose: help a person earn constructive entitlement and self-validation by giving to someone else, however modestly. This is the "healing moment", and it benefits both giver and receiver. [source: Ducommun-Nagy 2026] This is the main remedy for destructive entitlement, and it is used throughout phase 2.
Steps:
1. After acknowledgement (4.5), ask what the person could offer the other that fits their limits.
2. Shape the offer into something concrete and doable now. In Case 1, a mother with persecutory delusions, who had disconnected the phone, offered to connect an answering machine so her daughters' friends could reach them. [source: Ducommun-Nagy 2026]
3. Credit the gesture openly, and invite the recipient to acknowledge it. [synthesis]
4. Track what follows: hope, warmth, reciprocal gestures. In Case 1 the daughter reported renewed hope. [source: Ducommun-Nagy 2026]
Example language (illustrative): "Given everything you're dealing with, is there one thing you'd be willing to do so the girls can stay connected with their friends?"
Watch for: demanded or coerced giving, which does not validate the giver, and gestures that go unnoticed. Also watch for parentified children being asked to give still more. Direct the giving toward the children, not from them. It is working when the giver shows pride or relief and the recipient feels cared for.

4.8 Enabling ill or limited members to give

Purpose: people with mental illness, disability or cognitive impairment often cannot reciprocate in ordinary ways. That is a relational imbalance caused by reduced ability, not by ill will. They "should not be dismissed as givers". [source: Ducommun-Nagy 2026] Use it with parental mental illness, dementia, disability and chronic illness.
Steps:
1. Name the limitation as a situational injustice for everyone involved.
2. Help relatives see the ill person's care that is still there. Parents with severe illness often still care deeply about their children. [source: Ducommun-Nagy 2026]
3. Find forms of giving that fit the person's capacity.
4. Arrange for other adults or professionals to meet the children's developmental and emotional needs, so the children are not drawn into caring roles. [source: Ducommun-Nagy 2026]
Example language (illustrative): "Your illness takes a lot from you, and that's not fair. I can also see how much your children matter to you. What feels possible for you to give them right now?"
Watch for: relatives writing the ill member off, or over-functioning around them. It is working when the ill member takes part as a contributor rather than only as a patient.

4.9 Exploring loyalties and legacies

Purpose: make invisible loyalties visible, so they can be expressed constructively instead of self-defeatingly. An invisible loyalty is an unconscious commitment to the family of origin, for example sabotaging your own success, or failing at a marriage out of loyalty to a parent. A legacy is the set of expectations handed down from earlier generations. [source: open-exam-prep summary; Boszormenyi-Nagy & Spark 1973; uncertain] Use it when symptoms or repeated failures make no sense individually, and with conflict between loyalty to the family of origin and loyalty to a partner or children.
Steps [synthesis]:
1. Map three generations: who cared for whom, what was owed, what was never acknowledged, and what each generation expected of the next. A family tree drawing is a practical aid. It is not a named contextual technique. [synthesis]
2. Ask what success, leaving home or closeness to a partner would "mean" to a parent or grandparent.
3. Offer a loyalty hypothesis tentatively.
4. Explore other ways to honour the loyalty: visible acts of care for the parent, or carrying forward the good parts of the legacy.
Example language (illustrative): "If you did better than your father ever could, how do you think he would feel? How would you feel about him?" "What did your family hand down that you want to keep, and what would you rather your children didn't inherit?"
Watch for: blaming the parent, which is the opposite of the aim. It is working when the person finds a way to be loyal and still free to live their own life.

4.10 Releasing children from split loyalty

Purpose: split filial loyalty is the bind in which being loyal to one parent counts as betraying the other. It is common in high-conflict separation. The aim is to free the child from it. [source: open-exam-prep summary; uncertain] Use it in separation and divorce, couple conflict where children are recruited, and step-families.
Steps [synthesis]:
1. Meet the parents without the children. Name the bind and its cost to the child.
2. Credit each parent's real care for the child.
3. Ask each parent, in the other parent's presence if possible, to give the child explicit permission to love the other parent.
4. If you see the child, credit the child's loyalty to both parents and never ask the child to choose.
Example language (illustrative), to the parents: "Your son loves you both. Every time he has to pick a side, he loses a parent. The kindest thing you can give him is permission to love the other one."
Watch for: a parent using the session to recruit the therapist. Keep up multidirected partiality (4.3). Any safety concerns take precedence: see section 5. It is working when the child's symptoms ease and the child talks about both parents more freely.

4.11 Recognising and reversing parentification (deparentification)

Purpose: parentification is a reversal of giving in which the child is expected to care for the parent. Contextual therapy treats this as an ethical imbalance, not just a confusion of hierarchy. Parentified children have trouble setting limits, build up destructive entitlement, and are at risk of parentifying their own children. Deparentification restores the direction of giving so that parents give more than they take. [source: Ducommun-Nagy 2026] Secondary summaries also distinguish adaptive parentification (temporary, acknowledged help in a crisis) from destructive parentification (chronic and unacknowledged). [source: open-exam-prep; uncertain whether the distinction is Nagy's own wording] Use it with children in caring roles, and with adults who were parentified.
Steps:
1. Identify the reversed giving concretely.
2. Credit the child's giving (4.4). The giving was real and is owed recognition.
3. Help the parent take back the parental role and find support for themselves elsewhere, from adults and services. [source: Ducommun-Nagy 2026 for support for children's needs; the rest is synthesis]
4. With adults who were parentified, help them see that their parents acted from hope for compensation rather than malice. Parent and child were both victims of the original injustice. This loosens grudges and lowers the risk of repeating the pattern with their own children. [source: Ducommun-Nagy 2026]
Example language (illustrative): "You've been your mother's confidante since you were small. That took a lot, and it was more than a child should have to give. What would it be like to just be her daughter for a while?"
Watch for: the parent feeling shamed (credit the parent's own deprivation) and the child feeling guilty about "abandoning" the parent. It is working when the child takes up age-appropriate activities again, the parent finds adult supports, and the adult client changes how they treat their own children.

4.12 Exoneration

Purpose: lift the burden of blame from a parent or other person who caused harm, by understanding that person's own deprivation, legacy and limits. This is not forgiveness, forgetting or condoning. [source: open-exam-prep summary of Nagy & Krasner 1986; uncertain on original definition] It frees the client from stuck resentment and breaks the revolving slate. It supports constructive entitlement and gives the client freedom from the past. Use it in later phase 2 with adult clients stuck in grievances against parents, or before they reconnect with parents.
Steps [synthesis]:
1. First make sure the client's own injustice has been fully acknowledged (4.5). Exoneration offered too early feels like being asked to excuse the harm.
2. Explore the parent's own childhood, losses, situational injustices and loyalties. Use relatives as informants where possible.
3. Help the client form a more complex, realistic picture: what the parent could and could not have given.
4. Separate understanding from approval. Accountability for the harm stays in place.
5. Notice the effects: less rage, more freedom, a different stance toward their own children.
Example language (illustrative): "What do you know about what your father went through at the age you were when he left?" "Understanding him doesn't make what happened OK. It may just mean you don't have to carry the whole weight of it."
Watch for: pressure to exonerate before the client is ready, and exonerating someone who is still causing harm. Never use it to dismiss abuse. It is working when the client can hold both their own hurt and the parent's limitations.
Variant (Hargrave): Terry Hargrave developed a contextual forgiveness model that distinguishes exoneration (insight and understanding) from forgiving (giving the wrongdoer an opportunity to compensate, and an overt act of forgiveness). [source: Hargrave 1994; Hargrave & Pfitzer 2003] [uncertain] Treat this as a later extension, not as Nagy's method.

4.13 Rejunction: rebuilding trust through direct dialogue

Purpose: rebuild fractured or cut-off relationships through direct, accountable dialogue and renewed giving between the people concerned. This is not superficial harmony and not cut-off. [source: open-exam-prep summary of Nagy & Krasner; uncertain] Use it once acknowledgement and some exoneration have happened, typically with estranged family-of-origin members, siblings or partners.
Steps [synthesis]:
1. Explore with the client what they would want from, and could offer to, the estranged person.
2. Prepare for contact. Be realistic about what the other person can give. Plan to state your own side and to ask about theirs.
3. Choose the format: a letter, a phone call, or a joint session with the other person invited, possibly a family-of-origin session.
4. In joint sessions, use 4.2 and 4.3 so that both sides are heard. Facilitate a concrete gesture of giving or acknowledgement (4.7).
5. Afterwards, review what was received and what was given. Credit both.
Example language (illustrative): "If you met your brother, what would you need him to know about your side? And what do you imagine his side might be?"
Watch for: contact that could be unsafe (see section 5), clients seeking rejunction mainly to get an apology, and cutting off again after one disappointment. It is working when there is sustained, even limited, reciprocal contact.

4.14 Including absent members: absent, deceased and future generations

Purpose: take account of everyone the client's actions affect, including people who are absent, dead or not yet born. [source: open-exam-prep summary; Ducommun-Nagy 2026 for the ontic and "context" framing; uncertain] Use it in individual therapy, when someone refuses to attend, and when decisions affect children or posterity.
Steps [synthesis]:
1. Ask how each absent person would describe the situation.
2. Speak up for the absent person's likely side when no one else does.
3. Ask how present choices will affect children and future generations.
4. Consider inviting the absent person, with the client's consent.
Example language (illustrative): "If your mother were here, how would she describe what's been unfair for her?" "What would you want your kids to say, twenty years from now, about how you handled this?"
Watch for: the absent person being villainised. It is working when the client spontaneously considers the absent person's position.

4.15 Holding accountable

Purpose: each person is responsible for the consequences of their actions on others, whatever injustices they suffered. Accountability is the counterweight to crediting. [source: open-exam-prep summary; uncertain] Use it when a member exploits, harms or parentifies others.
Steps [synthesis]:
1. Credit and acknowledge first.
2. Ask the person to consider the impact of their actions on the other, from the other's side.
3. Ask what they could do to make amends.
Example language (illustrative): "I know how hard things have been for you. I also need to ask: what has it cost your daughter that she's been looking after you?"
Watch for: accountability delivered as blame, which hardens destructive entitlement. It is working when the person takes some responsibility and offers a gesture.

4.16 Combining individual and conjoint sessions, and involving helpers

Purpose: a person can sometimes disclose an injustice, or receive acknowledgement for it, only alone. Joint sessions then make dialogue possible. Helpers can support members who struggle to express themselves. [source: Ducommun-Nagy 2026, Cases 1 and 2] Use it when a member is too guarded or too fragile in front of the family, or when you work with services.
Steps:
1. After an initial family session, offer individual time to a member who seems unable to speak openly. In Case 1 the mother disclosed her experience alone. [source: Ducommun-Nagy 2026]
2. In the individual session, acknowledge the injustice and prepare for what can be shared.
3. Bring the material back to the conjoint setting with consent.
4. Include a trusted helper where that supports participation. Case 2 included a life counsellor. [source: Ducommun-Nagy 2026]
Example language (illustrative): "I'd like to meet with each of you separately once, so I hear everyone's side fully, and then we'll come back together."
Watch for: secrets that undermine your partiality. Agree confidentiality rules in advance. [synthesis] It is working when material from individual sessions turns into conjoint dialogue.

5. Handling problems

The sources say little about problem handling beyond the destructive-entitlement reframe and acknowledging injustice. Unless tagged with a source, the guidance below is [synthesis].

"Entitled", demanding or vengeful client. Don't confront the entitlement. Look for the unacknowledged injustice behind it and acknowledge it (4.5, 4.6). Ducommun-Nagy reports that attitudes often shift once the injustice is recognised. [source: Ducommun-Nagy 2026] Then open a small route to giving (4.7).
Stuck in blame; nobody will consider the other's side. Go back to 4.2. Someone has probably not yet felt heard. Use individual sessions (4.16) to acknowledge each person fully, then return to joint work. Lower the bar for giving: one small, doable gesture.
A member accuses the therapist of taking sides (rupture). Treat it as valid information about your partiality. Acknowledge their side explicitly and credit them. Say openly that you aim to be fair to everyone over time, and rebalance in the next sessions. If you have formed a lasting alliance, name it and correct it.
Key members refuse to attend. Keep them present through 4.14. Work individually on what the client can give, since that does not depend on the other person's participation. Offer an open invitation, and consider a letter from the client.
Client is not ready for exoneration or contact. Don't push. Acknowledgement of the client's own injustice may not be complete. Exoneration and rejunction offered too early feel like a betrayal.
Overwhelm (grief or rage surfaces when injustice is named). Slow down. Stay with acknowledgement and stop exploring. Work on one generation at a time. Use individual sessions for intense material. For trauma reactions, add standard stabilisation from other approaches. [synthesis: not a contextual technique]
Agreed gestures don't happen (non-adherence). Explore what made the gesture feel unfair or impossible, such as unacknowledged debts on the giver's side. Make it smaller and more concrete. Credit whatever small giving did happen.
Abuse, violence or ongoing exploitation. Safety and legal duties come first: child-protection reporting, risk assessment, safety planning. Do not hold joint sessions or pursue rejunction while one party is in danger, or where coercive control makes fair dialogue impossible. Exoneration is never a reason to keep someone in contact with an abuser or to drop accountability. Partiality toward the offender means understanding them, not excusing them, and it must never come at the victim's expense.
Suicidality or severe psychiatric crisis. Do a standard risk assessment and crisis management first, and coordinate with psychiatric care. Ducommun-Nagy frames illness as a situational injustice and supports biological treatment alongside relational work. [source: Ducommun-Nagy 2026; book chapter "Can giving heal?"]
Pressure on a child to give or to forgive. Never ask children to give more to parents, to exonerate, or to take responsibility for adults. Direct deparentification toward the parents.
Cultural and religious codes of obligation. The sources stress dialogue among the people involved rather than preset codes. [source: Ducommun-Nagy 2026] Explore what the family's own tradition counts as fair. Avoid imposing a Western view of individuation, and avoid endorsing obligations that exploit a member.
Therapist's own legacies. Your own unresolved loyalties can bias your partiality, for example over-siding with parentified children. Use supervision and work on your own family of origin. Many contextual training programmes include this. [uncertain]

Sources

Sources

Further reading (not drawn on)

Boszormenyi-Nagy, I., & Spark, G. M. (1973). Invisible Loyalties: Reciprocity in Intergenerational Family Therapy. Harper & Row (reissued Routledge 2014).
Boszormenyi-Nagy, I., & Krasner, B. R. (1986). Between Give and Take: A Clinical Guide to Contextual Therapy. Brunner/Mazel (reissued Routledge 2014).
Boszormenyi-Nagy, I. (1987). Foundations of Contextual Therapy: Collected Papers. Brunner/Mazel.
Boszormenyi-Nagy, I., & Framo, J. L. (Eds.) (1965). Intensive Family Therapy. Harper & Row.
Ducommun-Nagy, C., Meulink-Korf, H., & De Vries, G. A. (2023). Revitalizing Relationships: The Resources of Contextual Therapy. Africa Sun Media.
Ducommun-Nagy, C. Can giving heal? Contextual therapy and biological psychiatry. In D. Keith & P. Prosky (Eds.), Family Therapy as an Alternative to Medication. Brunner/Routledge.
Hargrave, T. D. (1994). Families and Forgiveness: Healing Wounds in the Intergenerational Family. Brunner/Mazel.
Hargrave, T. D., & Pfitzer, F. (2003). The New Contextual Therapy: Guiding the Power of Give and Take. Brunner-Routledge.

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