The main concern of this paper is: Can the psychodynamic theoretical framework be expanded and integrated with the family systems orientation or are they mutually exclusive? It is assumed that the essence of family therapy lies in the therapist's commitment to all members of the family as his patients, rather than in any technical or strategic arrangement for and during the sessions. A further major concern is with the question of how to define the conceptual framework of multiperson system levels of motivations. I believe that such framework relies on the hierarchy of obligations and loyalties in any family. Ethical entanglements of our lives are a key dynamics. Furthermore, I suggest that pathology and resistance to change are codetermined on the system levels of loyalty and unconsciously collusive obligations, eg, for retaining the "sick" role. More specifically, while transference and transferred "parentification" of the therapist are "technically" required for success, nonetheless they may lead to self-defeating mechanisms through implicit disloyalty to one's family of origin.
Boszormenyi-Nagy I. Loyalty Implications of the Transference Model in Psychotherapy. Arch Gen Psychiatry. 1972;27(3):374–380. doi:10.1001/archpsyc.1972.01750270078012
Customize your JAMA Network experience by selecting one or more topics from the list below.