MILAN SYSTEMIC FAMILY THERAPY
THEORISTS: MARA SELVINI PALAZZOLI, LUIGI BOSCOLO, GIANFRANCO CECCHIN & GUILIANA PRATA
The Milan model, stemming from cybernetics, is referred to as “long-term brief therapy,” and was greatly influenced by both MRI and Strategic methods. Milan theorists believed that the identified patient’s problems served, and often existed, to maintain the family’s homeostasis.
Three tenets of Milan therapy are: hypothesizing, neutrality, and circularity.
- Disruption of “family games,” or family patterns that maintain the problem
- Encouragement of a change that will eliminate symptomatic patterns
- Achievement of healthy systemic functioning
- Considered the assessment tool in which the therapist observes and engages with the family system, observing all relational components of the family.
- Form of communication between members of the system as well as interactions between members of the system and the therapist.
- Circular questioning:
- Questions designed to allow each member of the system to explore the unique perspectives of the other members within the system or to include a member of the system who is not present due to death or unavailability.
- Neutrality (Curiosity)
- The therapist’s stance where all members of the system are given equal consideration and value.
- Invariant Prescription
- An intervention designed towards the couple in a family system to create clear boundaries and a stronger parental unit. The couple is directed to form a secret coalition in which they engage in secret activities or secret trips without the knowledge of other family members.
- Dirty Games
- A family’s hidden and/or unacknowledged power struggles.
- Odd day/even day ritual
- Therapist directs the client to follow a weekly schedule where on odd days, a certain set of rules are true and on even days, those rules are false.The rule for the 7th day is to be spontaneous.
- Positive Connotation (associated with Early Milan-style reframe)
- Aimed at the system as a whole, this technique assigns positive values to each family member’s behavior.
- Rituals (associated with Early Milan)
- An intervention used to enhance or exaggerate family rules and alter the underlying belief systems of the family, for instance, thanking the identified patient for having the problem.
- Directing the family to NOT change (in spite of the fact that their goals of treatment may be the opposite).
- Therapists utilize the following techniques:
- Hypothesizing (the Assessment)
- Circularity (the Technique)
- Neutrality (the Stance of the therapist)
- Families seen by male-female dyad and observed by team members
- Treatment often includes all people who might be part of maintaining a problem
- There are typically 10 sessions (one session per month)
- Five part session:
- Presession – team forms an initial hypothesis
- Session – hypothesis validated or modified
- Intersession – team meets alone to form an intervention
- Intervention – therapists returned to deliver intervention to client
- Post session discussion – team analysis of the session and formulation of plan for next session
STANCE OF THERAPIST
- Male-female co-therapists and therapy team
- Therapist is expert
- Therapist maintains a neutral position
- Therapist produces a hypothesis explaining the family’s behaviors and interactions
- Palazzoli and Prata worked together and focused on interrupting the damaging family games (“power games”).
- Their intervention is called the invariant prescription.
- Remember the four P’s (Palazzoli, Prata, Power games, Invariant prescription).
- Boscolo and Cecchin stuck by the concepts of hypothesizing, circularity, and neutrality, and focused on changing family belief systems. They abandoned the use of paradoxical interventions and moved toward as a systemic approach. Circular questioning was the only defined intervention.