- Email: [email protected]
Contextual family therapy with the victims of incest
youma
of ;ldolescence
Contextual
1984, 7, 319-327
family therapy with the victims of incest
SUSAN
E. LUTZ*
AND
JO.AN P. MEDWAJ
The authors apply the concepts of Boszormenyi-Nagy’s contextual family therapy to the family treatment of victims of incest. Intergenerational bonds of loyalty and indebtedness are stressed, as is the therapist’s goal of increasing mutual empathy between the victim and the victimizer. Case examples are provided.
INTRODUCTION
Why will a devoted child run away from home and abuse drugs while she is trying to please her parents who are urging her to cease this behavior? Why, despite the interventions of a skilled therapist, despite the threat of court custody, and despite the additional urging of her siblings, will she persist? Often adolescents who have experienced incestuous relationships exhibit these symptoms. The broadest definition of incest will be used in this paper. It is the authors’ belief that incest can be viewed on a continuum of intensity of sexual involvement beginning with intense inappropriate sexual gazes, remarks or gestures and ending with vaginal or anal intercourse. The amount of intensity on the continuum is not as significant as the emotional havoc wrought by the destruction of generational boundaries. The different schools of therapy have varying views of the interpretation of these symptoms and the preferred manner of treatment in such a situation. Transactional analysis therapists would explain that she is playing out her life script. Bowenian therapists might postulate that her behavior is understandable according to the multi-generational transmission process-or the family projection process. Interactional family therapists would state that these symptoms are formed, selected and maintained as a function of the relational context in which they are found. Virginia Satir views symptoms in a child as indicative of dysfunction in the marital relationship. Although there are
l 4x05 Jenifer Street N.W., Washington D.C. 2ooi5, U.S.A. Joan Medway, LCSW is Director of Social Services at the Psychiatric Institute of Montgomery County and has a private practice of psychotherapy. Susan Lutz, LCSW is a clinical social worker in the private practice of psychotherapy.
014e1971/84/040319
+ 09 $03.00/0
@I 1984 The .4ssociation for the Psychiatric
3’9
Study of Adolescents
320
SUSAN E. LUTZ AND JOHN I’. MEDWA\r
various approaches to family therapy of the incest victim, most family therapists, including the authors, would agree that it is important to view and to treat the symptom bearer within the context of her family system. A closely related theory is that of Boszormenyi-Nagi, who believes that filial loyalty best explains her behavior. How, in this family, is running away and abusing drugs an act of loyalty? Is her acting out behavior an example of filial loyalty in that she is diverting attention from her parent’s dysfunctional marital relationship? To whom is this child being loyal by acting out?
LOYALTY:
THE TIE THAT
BINDS
At this juncture, a closer examination of the concept of loyalty might be helpful. The French root for loyalty is “loi” or law. Families have their own unwritten laws in the form of expectations for family members (Boszormenyi-Nagy, 1973). Internalization of these expectations provides direction and meaning to the family members’ daily activities. Thus, every family has a set of unwritten rules and expects each member to be loyal to the family by conforming to these rules. A family’s expectations are not necessarily constructive and, in fact, are often destructive, mandating co-operation in an incestuous relationship, maintenance of continued psychoses, criminal acting out or even suicide. Therefore, family expectations often explain many puzzling family situations that therapists confront every day. As is true in other groups, the most basic family loyalty commitment is the commitment to maintenance of the family group (Boszormenyi-Nagy, 197-j). Even incestuous behavior which appears to be disruptive to the family group may, in essence, be a successful manoeuvre to bind a family together. The daughter, who is a victim of incest, may feel she is being loyal to her father by participating in an incestuous relationship with him. She can be viewed as the family member who is the most loyal-the most caring-and the member who is working hardest to keep the family together. There are different types of loyalty. The bonds of loyalty can be viewed as being vertical or horizontal in nature. Vertical loyalty commitments are owed to either a previous or subsequent generation. The father who sexually abuses his daughter is not meeting his vertical loyalty commitment to her. Horizontal loyalty commitments are owed to one’s mate and siblings of peers in general (Boszormenyi-Nagy, 1973). The mother in this same family may not be able to meet her horizontal loyalty commitment to her husband. He, therefore, has inappropriately turned to his daughter to meet his needs. Often loyalty bonds conflict with each other, and a person feels torn with split loyalty (Boszormenyi-Nagy, 1979). This split loyalty is often due to a conflict between vertical and horizontal loyalty; however, this split loyalty
FAMILY
THERAPY
AND INCEST VICTIMS
32’
may be due to other loyalty conflicts. The adolescent girl who is a victim of incest may experience a loyalty conflict between her loyalty commitment to her family and her loyalty commitment to herself to separate and individuate. The following case example and subsequent analysis illustrate how these concepts of loyalty and trust can be applied to better understand family dynamics. A Is-year-old girl named Alice was hospitalized due to depression, frequent runaway behavior, truancy, declining school performance and drug abuse. The family consisted of the mother, the father, the identified patient and three brothers: a brain-damaged g-year-old who was institutionalized; a 6-year-old and a j-year-old. As a child, Alice had consistently been a “good girl” who caused her parents few problems and who asked for very little. Her brother, on the other hand, presented an extremely difficult management problem which the parents tried to handle at home for several years. His need for constant supervision by this parents left little time for Alice or her other brothers. This family had had an extraordinary number of pressures on it: the special needs of a brain-damaged child, the father’s excessive drinking and financial strains. The mother often felt overwhelmed by the demands of her husband and her children. She parentified Alice by expecting her to do the cooking and laundry and to provide child care for her younger brothers. When Alice was IO years old, her father began an incestuous relationship with her which continued for 5 years. Alice’s father told her to keep their “secret” or else the family would break up. Neither her mother nor her brothers were aware of this. When Alice was 13 years old, her father left the family for a short period with no explanation. Alice felt extremely guilty and thought she was somehow to blame for his leaving. He returned home after a month and Alice made every effort to be the good, co-operative daughter so he would not leave again. Not long after this, the mother’s level of functioning declined. She often became hysterical with her children and told Alice that she could no longer cope with their needs and found their demands intolerable. Subsequently, Alice ran away from home several times and began abusing drugs. So, what are the loyalty issues in this case example? Alice’s mother was parentified as a child. Out of loyalty to her mother, she accepted this role. She developed a caretaking relational style by the time she became a young adult, and was drawn to a man who wanted her to take care of him. When they were married, she parented her husband out of loyalty to him and out of
322
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E. LUTZ
AND JOHN P. MEDWAY
loyalty to her family of origin. However, she eventually found that she could not cope with the parenting needs of her four children and her husband, so she parentified her only daughter, just as her mother had done. As a loyal child, Alice accepted this parental role, including meeting her father’s emotional and sexual needs. During Alice’s early childhood, her parents had many difficulties. Their marriage was turbulent and, at times, violent. They had a child with very special needs which added to the pressures they were experiencing. The father’s drinking habits conflicted with his ability to support the family financially. The patient sensed that her parents were experiencing a lot of difficulty in coping and, rather than trouble them with her problems, she withdrew into a silent compliance in a gesture of loyalty. When Alice became an adolescent, she found her mother’s need for her to assume a parental role for her mother and her brothers conflicted with her need to begin separating from the family. She withdrew into a depression and continued as a parent to the family who needed her. Alice’s father became untrustworthy to Alice when: (I) he violated the generational boundary by having an incestuous relationship with her; (2) he drank excessively and did not meet his loyalty obligations to the family and (3) he left the family. The measure of Alice’s loyalty and indebtedness to her father was diminished by the magnitude of his lack of trustworthiness. A R/IATTER OF TRUST
As can be seen in the case of Alice’s father, these concepts of loyalty and disloyalty are based on trustworthiness. The more one’s environment is worthy of trust, the more that person feels indebted or loyal to her family (Boszormenyi-Nagy, 1973). The converse is also true. The less one’s environment is worthy of trust, the less one feels indebted or loyal to one’s family. It can be seen, then, that trust is a cornerstone of this theory. Ericson states that trust is the first developmental task that a person must accomplish. If a person fails to do this, that person will face a life full of mistrust (Ericson, 1963). Boszormenyi-Nagy emphasizes that the development of trust in the family is the family’s single most important task. Similarly, if the family fails to develop trust among its members, their lives are apt to be full of mistrust. The amount of trust established depends upon the degree of reliability of each family member to every other family member and their ethical sense of fairness and reciprocity in their relationships with each other. The disregard of one’s obligations to one’s children will create a void-an imbalance in the relationship with those children-which will then create a sense of mistrust on the child’s part. A father may be acting out his sexual
FAMILY
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AND INCEST VICTIMS
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abuse on his child due to his unmet emotional and sexual needs from his marriage. Nevertheless, he is failing to meet his present duties. Boszormenyi-Nagy (1973) portrays the indebtedness and entitlements in reciprocal relationships between the important people on a balance sheet which he calls a ledger. This ledger is an unwritten accounting of past and present obligations and is based on the fairness of, and the amount of reciprocity in, family relationships. On the plus side of the ledger, a person feels entitled due to credits or merits in the family. On the minus side of the ledger, a person feels indebted due to debits or obligations to the family. It is important to be aware of the family’s ledger because it determines the behavior of family members.
VICTIMIZERS
AS VICTIMS
For instance, the mother who acts out her neglect is doing so on the basis of her perception of her family ledger. She may see herself as a lienholder due to the injustice of her having been neglected as a child, therefore giving her the right to neglect her own child. As most therapists know, the neglector was often neglected; the abuser, abused. It is a well known fact that incestuous activity often occurs throughout the generations in many families. Often a parent’s or spouse’s actions go beyond mere neglect-to cruelty: such as physical, emotional or sexual abuse. The victim is then owed a great debt. The victimizer has lost his or her trustworthiness in the victim’s eyes. In such a case, the victim may not be able to face the reality of the cruelty which has been perpetrated. Often, the victim sacrifices herself to avoid facing that reality as did Alice in her self-destructive behavior. The case of Helen T. also illustrates this point. Helen T. is a rq-year-old attractive blond female who was hospitalized for a suicide attempt after being raped by her father. Helen is the eldest of two daughters in an intact, nuclear middle class family. Her mother, an attractive, intelligent, young-looking woman was herself the victim of childhood molestation. She married an abusive, disdainful man who helped her to maintain her self-hatred. When Helen reached adolescence, her mother, unhappv in her disintegrating marital relationship, ignored her husband’s inappropriate sexual behavior in front of their daughters and delegated all management of Helen’s behavior to him. This occurred at a critical time in Helen’s life when she was struggling with her own feelings of attraction to her father. Her father warned Helen not to reveal the incestuous activity to her family and she complied. Helen then began to evidence insomnia, loss of appetite, difficulty in concentrating and an inability to get along with male authoritv figures in school. She became
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SUSAN E. LUTZ AND JOHN P. MEDWAY
more and more seclusive and withdrawn-finally overdosing sleeping pills in an almost successful suicide attempt. In our practice, as well as in the practice family would be assisted to:
of most family
on her aunt’!
therapists,
the
(I)
Identify and express their feelings and understand how their feeling: have distorted their perception of reality and their communicatior with each other; (2) learn more adaptive behavior and more effective communication skill! and (3) restructure their relationships in order to strengthen intergenerationa boundaries and encourage healthy role assumption by each farnil! member. In Boszormenyi-Nagy’s contextual therapy, he would go one step furthe in achieving his goal of rejuncture. Rejucture is the facilitation of the development of mutually merited trust between family member (Boszormenyi-Nagy, 1979). To achieve rejuncture, the victim would bc helped to learn to trust the victimizer. In fact, in this treatment modeI, the primary goal would be building trust among all family members. This i: significant because there is little hope for the person who cannot trust he family. To her, the whole world appears untrustworthy. Boszormenyi-Nagy would build this trust by helping the victim: (I)
(2)
to build a relationship of understanding in which the victimizer has the opportunity to partially undo past abuses or repay the victim b; becoming more trustworthy and to understand the victimizer’s own past victimization.
If steps (a) and (b) are achieved,
then the victim
would
be helped:
(3) to repay the victimizer in appropriate, healthy ways for whateve loyalty obligations the victim feels she has to the victimizer. Therapists may have more difficulty with this concept than any other, du to their sense of injustice to the victim. However, it is important to remembe the reciprocal nature of establishing a rejuncture. In this way, the essential trustworthiness of the world is affirmed, for i one’s primary relationships are not reciprocal, not trustworthy, and made o fragile matter, then one’s view of the world will match those qualities. ‘Ih redemption of the victimizer in contextual therapy carries with it tremendou health-producing effects. It frees the victim to assume a new role-whils allowing the victimizer to balance the scales of justice. Premature death of the victimizer may present tremendous problems fo accomplishing this process. It robs the victim of the precious opportunity t
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\‘ICTIMS
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confront, to understand and to do acts to free herself. However, this process can still be attempted by investigating with relatives of the deceased to reconstruct the victimizer’s own victimization-for it has almost always occurred. The victim is robbed of the opportunity to thoroughly work with the victimizer, but a partial working through is nevertheless possible. In Helen’s case, she was victimized by her mother who abdicated parenting responsibilities to her father, and by her father who failed to maintain generational boundaries and sexually abused her. For Helen, the sexual seduction, in fact, may have meant to her “My father really turns to me. He needs me”. In the Oedipal transition, a young woman traditionally is viewed as having to overcome her primary attachment to her mother by shifting her base love object from her mother to her father. In this process, she may project her jealousy with her mother onto her mother, and at the same time, became frightened by her heightened sexual impulses, while her father is distancing from her (Lidz, 1968). Lidz views the desexualization of the parent-child relationship before puberty as one of the family’s most critical tasks. Helen’s and Alice’s families failed to negotiate that task. In Helen’s case, her parents failed to establish firm, generational boundaries and left, instead, a schism between them which Helen felt and filled. She was, therefore, unable to come to terms with the reality that her parents had prerogatives which she did not have. In such a case the therapist may begin rejuncture by asking the parents: “Do you understand why vour daughter wanted to kill herself?* Why don’t you know? Why can’t ;o; talk with each other? I want to teach you to share-to trust each other”. To the daughter, one might say, “In my mind, you’re a very devoted daughter. You really care about your mother”. The therapist would then work to build understanding of Helen’s mother’s own victimization and that of her father, in order to free Helen of the need to and in order to rebuild Helen’s deny her parents’ neglect and abuse; relationship with them on grounds of mutual respect. The therapist would encourage the parents to establish generational boundaries and to learn to nurture and to protect their child appropriately. Helen, in turn, would be helped to repay her loyalty obligations to her parents in adaptive ways; rather than to commit suicide in order to avoid holding her parents accountable.
‘I’he authors, as family concepts in their work.
therapists, have found great application In order to touch on deep and sometimes
for these invisible
326
SUSAN E. LCTZ AKD JOHN P. ILIED\Vi\\r
loyalties, it was found that a thorough, multigenerational history taking is a must. One of the authors has found the use of a simple projective technique to be especially helpful in unearthing a multigenerational, structurally oriented history (Medway and Geddes, 1977). As the intensive history is acquired, family patterns emerge which can help the identified patient to lift the load from her shoulders. Often these patterns surface fully months later as repressed family information is divulged. In helping the family to own these patterns, there again is an opportunity to enlist their support of each other in working together to understand what has gone wrong in their ability to be trustworthy to each other. What mandates of loyalty to other generations are pathologically binding them and preventing them from fulfilling their present obligations? How can they find a way to be (Boszormenyi-Nagy, more trustworthy now ? In the “dialectic relationship” 1973) that exists, what do they owe their child, their parents and vice versa? During these history-taking sessions, the main goal, therefore, would not be to gather facts, but rather to engage the family members in “facing the ledger of merits and obligations” (Boszormenyi-Nagy, 1976). During the initial individual family sessions utilized for this purpose, the therapist has many opportunities to display “multidirectional partiality: a therapist’s deep regard for the importance of all family members’ equitable investment into the trustworthiness of their relationships” (BoszormenyiNagy, 1979). This partiality is shown by listening to each family member’s views and by demonstrating a willingness to consider any member’s entitlements or indebtedness. This necessitates the therapist’s working through their countertransference toward the victimizer. It also includes the therapist’s siding with someone temporarily rather than remaining neutral. In this way, the focus in treatment begins to move from the very first session to the multitude of problems which are not owned solely by the identified patient. The authors have found in their practice with troubled families that a viewpoint which includes an ethical framework is essential to work toward balanced interpersonal fairness (Boszormenyi-Nagy, 1979). Needs are indeed reciprocal. Relationships are not one-dimensional. Treatment, in order to be successful, cannot be either. Other advantages of this technique soon become evident. By considering “the mutuality of fairness from both sides”, therapists choose when to align themselves with each family member (Boszormenyi-Nagy, 1976). They are also viewed as trustworthy by the beleagured parent and, at the same time, by the acting out adolescent. Stierlin (1977) refers to this technique as “involved impartiality”. He feels the countertransference in families is a “deviation from this therapeutic position”. Boszormenyi-Nagy believes that a failure to implement this
F.4MILY
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technique in the direction of the therapist siding with the child against the parents might be related to the therapist’s memory of his own suffering and the intrinsic exoneration of his own parents at the expense of the patient’s parents (Boszormenyi-Nagy, 1976). It is the therapist’s responsibility to make each family member accountable, including family members who are absent. Therapeutic efforts are focuses on aimed toward balancing merits. In other words, the therapist balancing the ledger among family members and between generations. Finally, but equally as important as a thorough history taking, is an analysis of the present structure of a family: What dyadic and triadic alliances helping members to play out the loyal themes? Where is the collusion between members to maintain this structure? IV’h! and how did this particular structure come to be?
SOnlE
P.1RTING
THOCGHTS
It is the authors’ experience that viewing a family within the contextual framework is extremely helpful in understanding many enigmatic situations. In the diagnostic-evaluation process, we have found this viewpoint to be crucial in assessing and understanding family dynamics. This approach helps troubled families to view themselves from a new perspective. Problematic behavior which previously was seen as negative and vindictive now is understood to be positive and loyal. This framework appeals to the compassion of family members and helps them to begin forgiving one another, rather than condemning one another. As a result, each family member wants to participate in the therapeutic process. In the therapeutic working through, the family inevitably responds to the opportunity for redemption, vindication and a fresh start in life. The authors have found that it is a moving experience to be a part of this process.
REFERENCES and Boszormenyi-Nagy, I. and Spark, G. (1973). I n~vsrhl~ Lo~~tclties. New York: lIarper Row. Boszormenyi-Nagy, I. (I 979). Contextual therapy : therapeutic leverages in mobilizing trust. In The ;Ime7ic_nn F’umi!\~. Philadelphia. Pennsylvania: Smith, Kline and French Co. Boszormenvi-Nagy, I. (1976). Behavioral change through family change. In I\%har .\Iakrs &ha&v Change Pvssihle. New York: Brunncr 1Iazel. Ericson, E. (1963). Childhood and So&t),. New York: \V. \V. Norton. Lidz, T. (1968). The Person. New York: Basic Books. bledway, J, and Geddes, nl. (1977). The symbolic drawing of the family life space. Family Process 16, 219-228. Stierlin, H. (1977). Psychoanalysis and Family Themp_v. New York: Jason Aronson.
of ;ldolescence
Contextual
1984, 7, 319-327
family therapy with the victims of incest
SUSAN
E. LUTZ*
AND
JO.AN P. MEDWAJ
The authors apply the concepts of Boszormenyi-Nagy’s contextual family therapy to the family treatment of victims of incest. Intergenerational bonds of loyalty and indebtedness are stressed, as is the therapist’s goal of increasing mutual empathy between the victim and the victimizer. Case examples are provided.
INTRODUCTION
Why will a devoted child run away from home and abuse drugs while she is trying to please her parents who are urging her to cease this behavior? Why, despite the interventions of a skilled therapist, despite the threat of court custody, and despite the additional urging of her siblings, will she persist? Often adolescents who have experienced incestuous relationships exhibit these symptoms. The broadest definition of incest will be used in this paper. It is the authors’ belief that incest can be viewed on a continuum of intensity of sexual involvement beginning with intense inappropriate sexual gazes, remarks or gestures and ending with vaginal or anal intercourse. The amount of intensity on the continuum is not as significant as the emotional havoc wrought by the destruction of generational boundaries. The different schools of therapy have varying views of the interpretation of these symptoms and the preferred manner of treatment in such a situation. Transactional analysis therapists would explain that she is playing out her life script. Bowenian therapists might postulate that her behavior is understandable according to the multi-generational transmission process-or the family projection process. Interactional family therapists would state that these symptoms are formed, selected and maintained as a function of the relational context in which they are found. Virginia Satir views symptoms in a child as indicative of dysfunction in the marital relationship. Although there are
l 4x05 Jenifer Street N.W., Washington D.C. 2ooi5, U.S.A. Joan Medway, LCSW is Director of Social Services at the Psychiatric Institute of Montgomery County and has a private practice of psychotherapy. Susan Lutz, LCSW is a clinical social worker in the private practice of psychotherapy.
014e1971/84/040319
+ 09 $03.00/0
@I 1984 The .4ssociation for the Psychiatric
3’9
Study of Adolescents
320
SUSAN E. LUTZ AND JOHN I’. MEDWA\r
various approaches to family therapy of the incest victim, most family therapists, including the authors, would agree that it is important to view and to treat the symptom bearer within the context of her family system. A closely related theory is that of Boszormenyi-Nagi, who believes that filial loyalty best explains her behavior. How, in this family, is running away and abusing drugs an act of loyalty? Is her acting out behavior an example of filial loyalty in that she is diverting attention from her parent’s dysfunctional marital relationship? To whom is this child being loyal by acting out?
LOYALTY:
THE TIE THAT
BINDS
At this juncture, a closer examination of the concept of loyalty might be helpful. The French root for loyalty is “loi” or law. Families have their own unwritten laws in the form of expectations for family members (Boszormenyi-Nagy, 1973). Internalization of these expectations provides direction and meaning to the family members’ daily activities. Thus, every family has a set of unwritten rules and expects each member to be loyal to the family by conforming to these rules. A family’s expectations are not necessarily constructive and, in fact, are often destructive, mandating co-operation in an incestuous relationship, maintenance of continued psychoses, criminal acting out or even suicide. Therefore, family expectations often explain many puzzling family situations that therapists confront every day. As is true in other groups, the most basic family loyalty commitment is the commitment to maintenance of the family group (Boszormenyi-Nagy, 197-j). Even incestuous behavior which appears to be disruptive to the family group may, in essence, be a successful manoeuvre to bind a family together. The daughter, who is a victim of incest, may feel she is being loyal to her father by participating in an incestuous relationship with him. She can be viewed as the family member who is the most loyal-the most caring-and the member who is working hardest to keep the family together. There are different types of loyalty. The bonds of loyalty can be viewed as being vertical or horizontal in nature. Vertical loyalty commitments are owed to either a previous or subsequent generation. The father who sexually abuses his daughter is not meeting his vertical loyalty commitment to her. Horizontal loyalty commitments are owed to one’s mate and siblings of peers in general (Boszormenyi-Nagy, 1973). The mother in this same family may not be able to meet her horizontal loyalty commitment to her husband. He, therefore, has inappropriately turned to his daughter to meet his needs. Often loyalty bonds conflict with each other, and a person feels torn with split loyalty (Boszormenyi-Nagy, 1979). This split loyalty is often due to a conflict between vertical and horizontal loyalty; however, this split loyalty
FAMILY
THERAPY
AND INCEST VICTIMS
32’
may be due to other loyalty conflicts. The adolescent girl who is a victim of incest may experience a loyalty conflict between her loyalty commitment to her family and her loyalty commitment to herself to separate and individuate. The following case example and subsequent analysis illustrate how these concepts of loyalty and trust can be applied to better understand family dynamics. A Is-year-old girl named Alice was hospitalized due to depression, frequent runaway behavior, truancy, declining school performance and drug abuse. The family consisted of the mother, the father, the identified patient and three brothers: a brain-damaged g-year-old who was institutionalized; a 6-year-old and a j-year-old. As a child, Alice had consistently been a “good girl” who caused her parents few problems and who asked for very little. Her brother, on the other hand, presented an extremely difficult management problem which the parents tried to handle at home for several years. His need for constant supervision by this parents left little time for Alice or her other brothers. This family had had an extraordinary number of pressures on it: the special needs of a brain-damaged child, the father’s excessive drinking and financial strains. The mother often felt overwhelmed by the demands of her husband and her children. She parentified Alice by expecting her to do the cooking and laundry and to provide child care for her younger brothers. When Alice was IO years old, her father began an incestuous relationship with her which continued for 5 years. Alice’s father told her to keep their “secret” or else the family would break up. Neither her mother nor her brothers were aware of this. When Alice was 13 years old, her father left the family for a short period with no explanation. Alice felt extremely guilty and thought she was somehow to blame for his leaving. He returned home after a month and Alice made every effort to be the good, co-operative daughter so he would not leave again. Not long after this, the mother’s level of functioning declined. She often became hysterical with her children and told Alice that she could no longer cope with their needs and found their demands intolerable. Subsequently, Alice ran away from home several times and began abusing drugs. So, what are the loyalty issues in this case example? Alice’s mother was parentified as a child. Out of loyalty to her mother, she accepted this role. She developed a caretaking relational style by the time she became a young adult, and was drawn to a man who wanted her to take care of him. When they were married, she parented her husband out of loyalty to him and out of
322
SUSAN
E. LUTZ
AND JOHN P. MEDWAY
loyalty to her family of origin. However, she eventually found that she could not cope with the parenting needs of her four children and her husband, so she parentified her only daughter, just as her mother had done. As a loyal child, Alice accepted this parental role, including meeting her father’s emotional and sexual needs. During Alice’s early childhood, her parents had many difficulties. Their marriage was turbulent and, at times, violent. They had a child with very special needs which added to the pressures they were experiencing. The father’s drinking habits conflicted with his ability to support the family financially. The patient sensed that her parents were experiencing a lot of difficulty in coping and, rather than trouble them with her problems, she withdrew into a silent compliance in a gesture of loyalty. When Alice became an adolescent, she found her mother’s need for her to assume a parental role for her mother and her brothers conflicted with her need to begin separating from the family. She withdrew into a depression and continued as a parent to the family who needed her. Alice’s father became untrustworthy to Alice when: (I) he violated the generational boundary by having an incestuous relationship with her; (2) he drank excessively and did not meet his loyalty obligations to the family and (3) he left the family. The measure of Alice’s loyalty and indebtedness to her father was diminished by the magnitude of his lack of trustworthiness. A R/IATTER OF TRUST
As can be seen in the case of Alice’s father, these concepts of loyalty and disloyalty are based on trustworthiness. The more one’s environment is worthy of trust, the more that person feels indebted or loyal to her family (Boszormenyi-Nagy, 1973). The converse is also true. The less one’s environment is worthy of trust, the less one feels indebted or loyal to one’s family. It can be seen, then, that trust is a cornerstone of this theory. Ericson states that trust is the first developmental task that a person must accomplish. If a person fails to do this, that person will face a life full of mistrust (Ericson, 1963). Boszormenyi-Nagy emphasizes that the development of trust in the family is the family’s single most important task. Similarly, if the family fails to develop trust among its members, their lives are apt to be full of mistrust. The amount of trust established depends upon the degree of reliability of each family member to every other family member and their ethical sense of fairness and reciprocity in their relationships with each other. The disregard of one’s obligations to one’s children will create a void-an imbalance in the relationship with those children-which will then create a sense of mistrust on the child’s part. A father may be acting out his sexual
FAMILY
THERAPY
AND INCEST VICTIMS
323
abuse on his child due to his unmet emotional and sexual needs from his marriage. Nevertheless, he is failing to meet his present duties. Boszormenyi-Nagy (1973) portrays the indebtedness and entitlements in reciprocal relationships between the important people on a balance sheet which he calls a ledger. This ledger is an unwritten accounting of past and present obligations and is based on the fairness of, and the amount of reciprocity in, family relationships. On the plus side of the ledger, a person feels entitled due to credits or merits in the family. On the minus side of the ledger, a person feels indebted due to debits or obligations to the family. It is important to be aware of the family’s ledger because it determines the behavior of family members.
VICTIMIZERS
AS VICTIMS
For instance, the mother who acts out her neglect is doing so on the basis of her perception of her family ledger. She may see herself as a lienholder due to the injustice of her having been neglected as a child, therefore giving her the right to neglect her own child. As most therapists know, the neglector was often neglected; the abuser, abused. It is a well known fact that incestuous activity often occurs throughout the generations in many families. Often a parent’s or spouse’s actions go beyond mere neglect-to cruelty: such as physical, emotional or sexual abuse. The victim is then owed a great debt. The victimizer has lost his or her trustworthiness in the victim’s eyes. In such a case, the victim may not be able to face the reality of the cruelty which has been perpetrated. Often, the victim sacrifices herself to avoid facing that reality as did Alice in her self-destructive behavior. The case of Helen T. also illustrates this point. Helen T. is a rq-year-old attractive blond female who was hospitalized for a suicide attempt after being raped by her father. Helen is the eldest of two daughters in an intact, nuclear middle class family. Her mother, an attractive, intelligent, young-looking woman was herself the victim of childhood molestation. She married an abusive, disdainful man who helped her to maintain her self-hatred. When Helen reached adolescence, her mother, unhappv in her disintegrating marital relationship, ignored her husband’s inappropriate sexual behavior in front of their daughters and delegated all management of Helen’s behavior to him. This occurred at a critical time in Helen’s life when she was struggling with her own feelings of attraction to her father. Her father warned Helen not to reveal the incestuous activity to her family and she complied. Helen then began to evidence insomnia, loss of appetite, difficulty in concentrating and an inability to get along with male authoritv figures in school. She became
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more and more seclusive and withdrawn-finally overdosing sleeping pills in an almost successful suicide attempt. In our practice, as well as in the practice family would be assisted to:
of most family
on her aunt’!
therapists,
the
(I)
Identify and express their feelings and understand how their feeling: have distorted their perception of reality and their communicatior with each other; (2) learn more adaptive behavior and more effective communication skill! and (3) restructure their relationships in order to strengthen intergenerationa boundaries and encourage healthy role assumption by each farnil! member. In Boszormenyi-Nagy’s contextual therapy, he would go one step furthe in achieving his goal of rejuncture. Rejucture is the facilitation of the development of mutually merited trust between family member (Boszormenyi-Nagy, 1979). To achieve rejuncture, the victim would bc helped to learn to trust the victimizer. In fact, in this treatment modeI, the primary goal would be building trust among all family members. This i: significant because there is little hope for the person who cannot trust he family. To her, the whole world appears untrustworthy. Boszormenyi-Nagy would build this trust by helping the victim: (I)
(2)
to build a relationship of understanding in which the victimizer has the opportunity to partially undo past abuses or repay the victim b; becoming more trustworthy and to understand the victimizer’s own past victimization.
If steps (a) and (b) are achieved,
then the victim
would
be helped:
(3) to repay the victimizer in appropriate, healthy ways for whateve loyalty obligations the victim feels she has to the victimizer. Therapists may have more difficulty with this concept than any other, du to their sense of injustice to the victim. However, it is important to remembe the reciprocal nature of establishing a rejuncture. In this way, the essential trustworthiness of the world is affirmed, for i one’s primary relationships are not reciprocal, not trustworthy, and made o fragile matter, then one’s view of the world will match those qualities. ‘Ih redemption of the victimizer in contextual therapy carries with it tremendou health-producing effects. It frees the victim to assume a new role-whils allowing the victimizer to balance the scales of justice. Premature death of the victimizer may present tremendous problems fo accomplishing this process. It robs the victim of the precious opportunity t
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confront, to understand and to do acts to free herself. However, this process can still be attempted by investigating with relatives of the deceased to reconstruct the victimizer’s own victimization-for it has almost always occurred. The victim is robbed of the opportunity to thoroughly work with the victimizer, but a partial working through is nevertheless possible. In Helen’s case, she was victimized by her mother who abdicated parenting responsibilities to her father, and by her father who failed to maintain generational boundaries and sexually abused her. For Helen, the sexual seduction, in fact, may have meant to her “My father really turns to me. He needs me”. In the Oedipal transition, a young woman traditionally is viewed as having to overcome her primary attachment to her mother by shifting her base love object from her mother to her father. In this process, she may project her jealousy with her mother onto her mother, and at the same time, became frightened by her heightened sexual impulses, while her father is distancing from her (Lidz, 1968). Lidz views the desexualization of the parent-child relationship before puberty as one of the family’s most critical tasks. Helen’s and Alice’s families failed to negotiate that task. In Helen’s case, her parents failed to establish firm, generational boundaries and left, instead, a schism between them which Helen felt and filled. She was, therefore, unable to come to terms with the reality that her parents had prerogatives which she did not have. In such a case the therapist may begin rejuncture by asking the parents: “Do you understand why vour daughter wanted to kill herself?* Why don’t you know? Why can’t ;o; talk with each other? I want to teach you to share-to trust each other”. To the daughter, one might say, “In my mind, you’re a very devoted daughter. You really care about your mother”. The therapist would then work to build understanding of Helen’s mother’s own victimization and that of her father, in order to free Helen of the need to and in order to rebuild Helen’s deny her parents’ neglect and abuse; relationship with them on grounds of mutual respect. The therapist would encourage the parents to establish generational boundaries and to learn to nurture and to protect their child appropriately. Helen, in turn, would be helped to repay her loyalty obligations to her parents in adaptive ways; rather than to commit suicide in order to avoid holding her parents accountable.
‘I’he authors, as family concepts in their work.
therapists, have found great application In order to touch on deep and sometimes
for these invisible
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loyalties, it was found that a thorough, multigenerational history taking is a must. One of the authors has found the use of a simple projective technique to be especially helpful in unearthing a multigenerational, structurally oriented history (Medway and Geddes, 1977). As the intensive history is acquired, family patterns emerge which can help the identified patient to lift the load from her shoulders. Often these patterns surface fully months later as repressed family information is divulged. In helping the family to own these patterns, there again is an opportunity to enlist their support of each other in working together to understand what has gone wrong in their ability to be trustworthy to each other. What mandates of loyalty to other generations are pathologically binding them and preventing them from fulfilling their present obligations? How can they find a way to be (Boszormenyi-Nagy, more trustworthy now ? In the “dialectic relationship” 1973) that exists, what do they owe their child, their parents and vice versa? During these history-taking sessions, the main goal, therefore, would not be to gather facts, but rather to engage the family members in “facing the ledger of merits and obligations” (Boszormenyi-Nagy, 1976). During the initial individual family sessions utilized for this purpose, the therapist has many opportunities to display “multidirectional partiality: a therapist’s deep regard for the importance of all family members’ equitable investment into the trustworthiness of their relationships” (BoszormenyiNagy, 1979). This partiality is shown by listening to each family member’s views and by demonstrating a willingness to consider any member’s entitlements or indebtedness. This necessitates the therapist’s working through their countertransference toward the victimizer. It also includes the therapist’s siding with someone temporarily rather than remaining neutral. In this way, the focus in treatment begins to move from the very first session to the multitude of problems which are not owned solely by the identified patient. The authors have found in their practice with troubled families that a viewpoint which includes an ethical framework is essential to work toward balanced interpersonal fairness (Boszormenyi-Nagy, 1979). Needs are indeed reciprocal. Relationships are not one-dimensional. Treatment, in order to be successful, cannot be either. Other advantages of this technique soon become evident. By considering “the mutuality of fairness from both sides”, therapists choose when to align themselves with each family member (Boszormenyi-Nagy, 1976). They are also viewed as trustworthy by the beleagured parent and, at the same time, by the acting out adolescent. Stierlin (1977) refers to this technique as “involved impartiality”. He feels the countertransference in families is a “deviation from this therapeutic position”. Boszormenyi-Nagy believes that a failure to implement this
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technique in the direction of the therapist siding with the child against the parents might be related to the therapist’s memory of his own suffering and the intrinsic exoneration of his own parents at the expense of the patient’s parents (Boszormenyi-Nagy, 1976). It is the therapist’s responsibility to make each family member accountable, including family members who are absent. Therapeutic efforts are focuses on aimed toward balancing merits. In other words, the therapist balancing the ledger among family members and between generations. Finally, but equally as important as a thorough history taking, is an analysis of the present structure of a family: What dyadic and triadic alliances helping members to play out the loyal themes? Where is the collusion between members to maintain this structure? IV’h! and how did this particular structure come to be?
SOnlE
P.1RTING
THOCGHTS
It is the authors’ experience that viewing a family within the contextual framework is extremely helpful in understanding many enigmatic situations. In the diagnostic-evaluation process, we have found this viewpoint to be crucial in assessing and understanding family dynamics. This approach helps troubled families to view themselves from a new perspective. Problematic behavior which previously was seen as negative and vindictive now is understood to be positive and loyal. This framework appeals to the compassion of family members and helps them to begin forgiving one another, rather than condemning one another. As a result, each family member wants to participate in the therapeutic process. In the therapeutic working through, the family inevitably responds to the opportunity for redemption, vindication and a fresh start in life. The authors have found that it is a moving experience to be a part of this process.
REFERENCES and Boszormenyi-Nagy, I. and Spark, G. (1973). I n~vsrhl~ Lo~~tclties. New York: lIarper Row. Boszormenyi-Nagy, I. (I 979). Contextual therapy : therapeutic leverages in mobilizing trust. In The ;Ime7ic_nn F’umi!\~. Philadelphia. Pennsylvania: Smith, Kline and French Co. Boszormenvi-Nagy, I. (1976). Behavioral change through family change. In I\%har .\Iakrs &ha&v Change Pvssihle. New York: Brunncr 1Iazel. Ericson, E. (1963). Childhood and So&t),. New York: \V. \V. Norton. Lidz, T. (1968). The Person. New York: Basic Books. bledway, J, and Geddes, nl. (1977). The symbolic drawing of the family life space. Family Process 16, 219-228. Stierlin, H. (1977). Psychoanalysis and Family Themp_v. New York: Jason Aronson.