Nagy

Question 1

Theory Development: influences

Answer 1

1. Fairburn’s Object Relations Theory

2. Sullivan’s Interpersonal Psychiatry

Question 2

Theory Development: New theory of motivation

Answer 2

Not based only on needs and internal drives, but based on what is owned both to and by the individual

Question 3

Object Relations Theory

Answer 3

• explains motivating factors behind use of defense mechanisms
• people don’t seek pleasure (like Freud thought) they seek objects (relationships)

Question 4

Therapists motivation for object relations theory

Answer 4

people have a need for satisfying relationships

Question 5

Nagy’s view of the family

Answer 5

1. Facts (roots and events)
2. Psychology
3. Transactions
4. Relational ethics

Question 6

Facts (roots and events)

Answer 6

1 of Nagy’s view of the family

• roots = geneology, SES, culture, etc.
• events = traumas

Question 7

Psychology

Answer 7

1 of Nagy’s view of the family

• how family members regard relationships in the family’s development
• “The intrapsychic structure of individual family members”

Question 8

Transactions

Answer 8

1 of Nagy’s view of the family

- family structure/patterns of family organization

Question 9

Relational ethics

Answer 9

1 of Nagy’s view of the family
- Explains motivating factors behind defense mechanisms or cross-generational coalitions in terms of imbalances in ledger

Question 10

The Ledger

Answer 10

• Legacy
• Merit
• Issues of entitlement and indebtedness occurs when the ledger is not balanced

Question 11

Legacy

Answer 11

Acquired by birth into a family and by taking one’s place in the family
- SES, religious beliefs, health issues, wealth, last name, role acquired by certain familial expectations

Question 12

Merit

Answer 12

Accumulate merit through contributing to welfare of others. What an individual feels like s/he deserves.
- a parent might feel like their children owe them

Question 13

Trust and the ledger

Answer 13

relationships become trustworthy when there is equal give and take (a balanced ledger)
- a wife can rely on the fact that her husband will be there for her and vice versa

Question 14

How symptoms develop

Answer 14

1. trustworthiness breaks down (unequal give and take)
2. No valid substitutions (if you have a needy mother, you can’t substitute your need of affection by getting it from someone else)

Question 15

Examples of symptom patterns

Answer 15

1. split filial loyalty
2. revolving slate
3. relational stagnation
4. negative loyalty

Question 16

split filial loyalty

Answer 16

An example of a symptom pattern

- a child becomes more loyal to one parent than the other. Happens often in divorces.

Question 17

Revolving slate

Answer 17

An example of a symptom pattern

- negative family legacy. Problems occur from one generation to the next.

Question 18

Relational stagnation

Answer 18

An example of a symptom pattern

• lack of growth in a relationship.
• a child feels so loyal to the parents that the kid doesn’t make any outside friends.

Question 19

Negative loyalty

Answer 19

An example of a symptom pattern

- scapegoating

Question 20

Goals of Contextual Therapy

Answer 20

1. Face the invisible loyalties within the family
   - the scapegoat needs to speak up
2. Recognize unsettled “accounts”
   - figure out who is owed what and why
3. Rebalance one’s obligations and relationships
   - this rebuilds trust among members

Question 21

Therapy set-up: Who is seen?

Answer 21

The whole family - kids, extended family, etc.

Why? Rework trust (balance ledger) so that children don’t pass down the unbalanced ledgers

Question 22

Therapy set-up: role of therapist

Answer 22

co-therapy teams presents balanced relational model

- co-therapists can model what fairness looks like in a relationship

Question 23

Sullivan’s Interpersonal Psychiatry

Answer 23

How personalities develop

Question 24

Therapy Process: Assessment

Answer 24

• What is the relative balance and imbalance in family relationships?
• How are family members addressing separation-individuation of members v. family loyalty issues (loyalty issues often arise when kids try to differentiate)

Question 25

Therapy Process: Interventions

Answer 25

1. multi-directed partiality

2. transference relationships created

Question 26

Multi-directed partially

Answer 26

Co-therapy team is empathic for each client member but also holds them accountable. Family members should hold each other accountable while being empathic.

Question 27

Transference relationships created

Answer 27

Clients adopt therapists as “parents” to have a working model of fairness. As therapy progresses, the therapists let go (reduce transference) and the family takes over more responsibility.

Question 28

Therapy Process: Termination

Answer 28

Therapy ends when future families are safe

• therapy process of rebuilding trust is referred to as “rejunctive process”

Question 29

Nagy on IPCM…

Answer 29

Starts at organization of mind/object relations on the matrix