Ch. 4 Milan Systemic Family Therapy

Question 1

Where did systemic therapy originate?

Answer 1

• Milan, Italy

Question 2

Who were the major players in systemic therapy?

Answer 2

• Mara Selvini Palazzoli
• Luigi Boscolo
• Gianfranco Cecchin
• Guiliana Prata

Question 3

Which theory influenced systemic therapy the most?

Answer 3

• Bateson’s work with cybernetics

Question 4

How did the Milian group originally work with clients?

Answer 4

• Originally treated severely disturbed kids using traditional psychoanalytic methods
• became increasingly frustrated with the lack of progress in working with children alone
• Tried to apply traditional psychoanalytic models to families
• After reading Bateson, Boscolo, Cecchin, and Selvini Palazzoli broke from the original Milan group and formed the Center for the Study of the Family - worked with new systems model
• in early years, conceptualized family problems as being maintained by homeostasis, and devised paradoxical interventions to counter this tendency

Question 5

Milan Systemic FT: Theory of normal development and dysfunction

Therapists’ stance

Answer 5

• like MRI, Milan group adhered to a “non-normative” stance
• maintained a neutral stance toward therapy outcome, trusting that if families were helped to see new ways of understanding their problems, they would find better ways of organizing themselves, without reference to norms
• symptoms functioned to preserved family homeostasis and were maintained by interactional sequences.

Question 6

The original Milan Model

Answer 6

• first model was strongly influenced by MRI strategic methods
• families were seen by a male-female dyad and observed by other team members
• each session has 5 parts

Question 7

The original Milan Model: 5 parts to each session

Answer 7

1. Presession - the team formed an initial hypothesis
2. Session - the hypothesis was validated or modified
3. Intersession - the team met alone to form an intervention
4. Intervention - the therapists returned to deliver the intervention, either a positive connotation or a ritual, which was given in the form of a statement together with a prohibition against change, using paradox to counter resistance to change
5. Post-session discussion - team analysis of the session and formulation of a plan for the next session

Question 8

The original Milan Model: The 2 basic interventions

Answer 8

positive connotation and rituals

Question 9

The original Milan Model: length between session and amount of sessions

Answer 9

• Sessions were held one month apart to give families time to react to the interventions
• total number of sessions usually limited to 10

Question 10

The original Milan Model: positive connotation

Answer 10

• Milan group
• a complex paradoxical reframing technique that includes all family members and the system itself
• each family member’s contribution to the problem is reframed as an effort to solve problems and help meet the family’s needs.
• different from reframing in that reframing can be positive or negative and can be directed at one family member. Positive connotation addressed every family member’s part in the circular process that maintains the problem sequence.

Question 11

The original Milan Model: rituals

Answer 11

• interventions that enhance a positive connotation or require the family to either exaggerate or violate family rules
  ex: to exaggerate a positive connotation, family might be asked to thank the symptomatic family member for having the problem.
  ex: The family that maintains loyalty to an extended family to its own detriment might be asked to violate the family rule by holding secret meetings.

Question 12

The original Milan Model: the split

Answer 12

• 1979
• Selvini Palazzoli and Prata formed one group and focused on interrupting destructive family games in which disturbed families are involved.
• Boscolo and Cecchin stayed with the concepts of hypothesizing, circularity and neutrality and became interested in changing family belief systems (epistemologies) which eventually led to solution-focused and narrative therapies

Question 13

Selvini Palazzoli and Prata: What led to the development of symptoms?

Answer 13

• Power games in the family led to the development of symptoms in order to protect the family

Question 14

Selvini Palazzoli and Prata: the 6 stages of how psychotic games develop in families

Answer 14

1. There is a marital stalemate between the partners
2. The child becomes an ally with the parent he/she perceives to be the “loser” in the stalemate
3. The child develops a symptom in an attempt to both challenge the winner and demonstrate to the loser how to contend with the winner
4. The loser does not understand the purpose of the symptom and sides with the winner in disapproving of the symptomatic behavior
5. Now desperate, the misunderstood child continues the game and the symptom
6. The game becomes stabilized as the family believes the child is crazy and develops methods of dealing with their crazy child.

Question 15

Selvini Palazzoli and Prata: assessment and treatment

Answer 15

• before the 90s the goal was to help parents form a stable alliance and thereby alter the patterns of interactions among family members
• intervention = invariant prescription & was the same for all families:
• directed the parents in a secret coalition
• first parents met with the therapists without the knowledge of other family members and then began taking longer and longer secret trips so that eventually ther were away fro several days without telling the other famiy members
• asked to keep notes on family members reactions and share with the therapists

After the 90s - SP returned to long-term psychodynamic treatment models for individuals and families - understand the denial of family secrets and suffering over generations

Question 16

Boscolo and Cecchin: goal of therapy

Answer 16

• simply to introduce new information rather than set specific goals for change
• help clients see themselves in a relational context and and also understand the POV of other family members

Question 17

Boscolo and Cecchin: assessment and treatment

Answer 17

• hypothesizing, circularity, and neutrality (originated in the MRI group before the split)

Question 18

Boscolo and Cecchin: hypothesizing

Answer 18

• Milan systemic therapists
• A trial and error process by which the T makes initial suppositions about the presenting problem, then tests the supposition by asking questions or making an intervention based on that hypothesis.
• the original supposition is then revised according to the new information
• this cybernetic process makes use of information resulting from completed feedback loops
• believe that premises, values, or guiding principles might be unconscious - in forming hypotheses they look for a premise or myth that holds the behaviors attache to a problem. If the premise can be shifted, change might occur together with the change in beliefs

Question 19

Boscolo and Cecchin: Cirularity

Answer 19

• Milan group
• causality in families cannot be thought as a simple, cause and effect relationship (linear causality)
• events, behaviors, and interactions are seen in a more complex way, as mutually influencing each other (feedback loops)
• All elements of the problem coexist and are reciprocally reinforcing
• the problem could not be maintained if any one element were to be removed

Question 20

Boscolo and Cecchin: Circular questioning

Answer 20

• Milan Group
• interviewing and hypothesis validation technique
• Based on Bateson’s idea that people learn by perceiving differences
• Each family member comments on the behavior and interactions of two other members
• it is hoped that beliefs will become less rigid when members are exposed to different POVs
• explore aspects of family interactions such as the degree and time of the problem

Ex: mom asked to comment on how husband sees his relationship with his son.
“Did that occur before or after? How much? How often?”

Question 21

Boscolo and Cecchin: Neutrality (Curioristy) and Irreverence

Answer 21

• Milan systemic
• a technique and stance with the family in which the therapist withholds judgment, either positive or negative, in an effort to avoid becoming part of the family’s struggles
• the T is indifferent to treatment outcome, recognizing that his/her role is simple to perturb (have an impact on) the system

Question 22

Boscolo and Cecchin: odd day/even day ritual

Answer 22

• T gives a directive that on odd days one set of opinions would be true, but on even days, false
• the directives for the seventh day is to act spontaneously
• goal is to create a more flexible view of the family beliefs

Question 23

Logical connotation

Answer 23

• Milan systemic model
• grew as the use of paradox declined
• the T communicates that the development of a symptom is understandable, give the context
• there is no implication that the problem is useful, beneficent, or functional (positive connotation), only that people have gotten used to it and that habits are hard to change

Question 24

Second-order cybernetics

Answer 24

• a postmodern model that conceives of the T and family as one unit
• Objectivity is not possible
• the treatment unit is a meaning system to which the treating professional is an equal and active contributor
• the system does not create a problem; the problem creates a system