Milan Systemic Approach – Flashcards
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Primary Contributors
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Mara Selvini Palazzoli, Guiliana Prata, Luigi Boscolo, Gianfranco Cecchin
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Classified under
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Classical school of family therapy, influenced by Bateson's systemic as well as Strategic's Paradoxical Intervention
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Historical Overview
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Was founded originally in 1971 by Palazzoli and her associates, approach started off as a close replica mirroring Bateson's strategic orientation, and later relying on strategic's use of paradoxical interventions. in the 1980's the group split (Boscolo and Cecchin, Palazzoli and Prata)
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Essential Themes of Therapy (Early Milan Group)
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Concept that family interactions are governed by a set of rules that may be adapted through the use of paradoxical interventions. Each family was seen by a therapist dyad (male and female team) while being observed by others. "Long term brief therapy" each session had 5 parts, sessions held one month apart. Treatment limited to 10 sessions over the course of a year. 2 basic interventions: positive connotation and ritual.
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Epistemology
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Family members have a limited view on what the problem is and by introducing a new way of thinking about the problem, the family can overcome the problem.
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Epistemological Error
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A set of beliefs that become incongruent with the reality, which becomes problematic. Not believing one is responsible for his or her behaviors.
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Games
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Unacknowledged strategies that result in destructive interactions within the family. Often unspoken and used as attempts to control another's behavior.
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Anological Message
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Process. Metaphorical or symbolic.
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Digital message
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The content, what is said or talked about.
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Metacommunication
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Communication about communication. Making sure to have intentional conversations with the family about what conversations just happened.
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Punctuation (different than structural)
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A manner in which individuals attribute their behavior as another's behavior. I only did this because you did that, I only nag you because you never offer to help me
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Time
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an important component of an assigned ritual- length of time, also to be practiced in between monthly sessions
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Positive Connotation
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assigning a positive motive or value to each family member's behavior whether behavior is positive or not, ex: depression - you are contemplative and can sit with your thoughts for a long period of time
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Ritual
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An intervention presented by the therapy team that is described in great detail instructing family members to carry out very specific behaviors at specific times of the day for a very distinct period of time. Providing consistency and clarity as they hypothesize problems within the family. Team reevaluates hypothesis depending on how it went
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Paradoxical Prescription
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Prescribing the symptom or asking the family not to change
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Neutrality or Irreverence
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Stance of therapist as being open to multiple hypothesis regarding the family's behavior, test the hypothesis each session and remain open to changing it as needed, goal is to be always open as a therapist to change.
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Counterparadox
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intervention used to unravel a family's double bind message by referring to their dysfunction as legitimate and necessary, instructing them not to change so they will want to change
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Learning process
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Before the first session the team hypothesizes, in the first session there is a lot of observing, then creating another hypothesis, changing it, having interventions happen, then changing and hypothesizing more. Like a wheel.
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Hypothesizing
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What keeps the family stuck? Always developing new hypothesis with new information
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team approach
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very involved with the family, dyad, observation happening with a one way mirror
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Assessment
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Based on primary principle of hypothesizing through the team approach, assessment is ongoing, based upon new information and the family's adjustment to it as it arose. Initial assessment is a phone call getting basic demographics and family overview, leads to pre-session where therapy team begins to develop a hypothesis which would be explored, validated, and readjusted during the session phases of each meeting
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Diagnosing
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Non-pathologizing, viewed problems families experience systemically
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Who is involved?
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Only the people directly involved with the problem, relatively few family members, more as needed as would be appropriate to the hypothesis
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Goals of Therapy
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open families to accommodating and adjusting new information and beliefs, to maintain healthy systemic functioning.
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Treatment Duration
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duration is limited to ten sessions one month apart.
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Therapy Structure
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1. Pre-session 2. Session 3. Intersession 4. Intervention a. positive connotation b. ritual c. use of paradox 5. post-session discussion
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Pre-session
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team meets without family to build hypothesis
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Session
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team meets with family to check hypothesis. validate or modify
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Intersession
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team meets privately to discuss and form an intervention
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Intervention
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therapist returns to deliver the intervention to the family, it could take the form of a positive connotation, or a prescription of a ritual, either were always given in the form of a statement leaning against change (use of paradox to address the family's natural resistance to change)
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Post-session discussion
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Team debriefs and makes plans for the following session
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Later Milan Group (Palazzoli and Prada)
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became more focused on interpreting the destructive family games which disturbed families through the use of invariant prescription
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Dirty Game (Later Milan Group Palazzoli and Prada)
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when parents would struggle for control, they triangulate their symptomatic child into their conflict who then works to defeat the parents by using their symptoms to gain even more control over the family
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Invariant Prescription
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interrupt the dirty game by parents introducing a secret and then taking a trip for three days, breaking pattern, showing they are a strong and healthy couple together
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Later Milan Group (Bascolo and Checchin)
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They moved away from paradoxical interventions and focused on exclusively introducing new information to the family, goal became to have families create a new epistemology, which allows for a new way of operating, a lot less directive and more process based
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Circular Questioning (Later Milan Group Boscolo and Checchin)
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Engaging in ongoing family dialogue by asking a third family member to react to the dialogue that occurred between two family members, then dialogue about that third party observation
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Early Phase Goals
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1. Form an initial hypothesis 2. Session conductor joins with the session 3. Gather information about the family problem and family rules to identify the presenting problem.
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Middle Phase Goals
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1. alter unproductive rules/games that support the presenting symptom 2.help family to identify more helpful meanings and distinctions in relation to the problem issue and games
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Late Phase Goals
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1. Address any new issues that arise in response to addressing the problem symptom 2. Develop and maintain new family game or interaction pattern that allows the family to accommodate or adjust to new information and beliefs without the emergence of symptoms in family members.
