Contextual therapy originated from the work of Ivan Boszormenyi-Nagy, who was a prominent pioneer in the family therapy movement. Contextual therapy has not been as popular with training therapists in recent decades. The waning in popularity is not because the theory is not effective or robust, but the theory and approach has been criticized for being possibly too intellectual. This chapter attempts to provide historical information on the development of contextual family therapy and the recent evolution of the model as it pertains to restoration therapy. It discusses the concepts of contextual family therapy: entitlement; loyalty; parentification; revolving slate; and ledger of merits. The contextual therapy approach is historically an integrative process of four dimensions of reality: facts, individual psychology, systemic interactions, and relational ethics. The main conceptualization of the contextual family therapy is that the present dynamic is typically a continuation of past loyalties, injustices, and entitlements.
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In the field of family therapy, there is a need for working with families struggling with medical problems. The collaboration of both medicine and psychology in addressing the particular familial and individual issues that occur in dealing with illness have led to the medical family therapy (MedFT) model. MedFT represents a meta framework that encompasses overarching principles within which any mode of psychotherapy can be practiced. What sets MedFT apart from other family therapy theories is the routine collaboration with medical professionals as well as seeing illness as part of the systems. Collaboration is a primary aspect; medical family therapists need to have an understanding of the medical system to embrace a multidisciplinary team approach with physicians and other healthcare providers. The hope is that the MedFT therapist will aid the family, along with the medical staff, traverse illness and journey united together in coping with the effects of illness.