Strategic - Milan Flashcards
Who was on the Milan team?
- Mara Selvini Palazzoli (founder, 1967)
- Gianfranco Cecchin
- Luigi Boscolo
- Giuliana Prata
Palazzoli was a prominent Italian psychoanalyst. She and her team of 8 other analysts read the works of Gregory Bateson and Jay Haley… and did lots of research. In 1980, they split, with ½ continuing research and the other doing training.
Who influenced the MIlan team?
The 4 Italians studied Gregory Bateson. Visited the MRI group, and invited Watzlawick (from MRI) for consultations.
Milan Family Therapy is a direct offshoot of the MRI Strategic model.
Summarize the focus of Milan Systemic Family Therapy
- Known as “long-term brief therapy”
- How client language shapes family dynamics
What are the assumptions of Milan Family Therapy?
- The problem is maintained by the family’s attempts to fix it (negative feedback loop)
- Therapy can be brief over a long period of time
- Clients resist change (seek homeostasis); People may be more interested in defeating the therapist than changing
- Therapist’s prescriptions can serve to “outwit” the family game
- Work with boundaries and power struggles
- Look at multiple generations
What is the primary goal of Milan Family Therapy?
To disrupt family games.
(Pay special attention to multigenerational interactions around symptoms.)
What is the role of the therapist in Milan Family Therapy?
- Therapist as expert
- Curious
- Neutral to each family member - don’t get sucked into the family game
- Adjusting boundaries/alliances
- Reframing behavior with positive motives
- Clarification of differences via circular questions
- Issuing change-focused directives knows as Rituals
What does assessment involve in Milan Family Therapy?
The therapist…
- Looks for dysfunctional patterns (that maintain the problem)
- Uncovers the family game
- Confirm or deny the preliminary hypothesis – which usually is that the problems of the identified patient serve a protective function for the family, by trying to empower the less-empowered parent (the family game)
- Take a systemic perspective on the problem
What are interventions in Milan Family Therapy?
Interventions are seen as means of hypothesis testing.
- RITUAL
– Odd/Even day - rituals that only apply every other day - POSTIIVE CONNOTATION
- INVARIANT PRESCRIPTION
– “Date” - parents spending time w/o kids - CIRCULAR QUESTIONS
- Paradoxical interventions
– Counter-paradox - Reflecting team
- Letters
- Prescribe the system
When is Milan Family Therapy terminated?
When the therapist decides
How long does Milan Family Therapy last?
Milan is usually 10-12 sessions, or fewer. Long lags may happen between clusters of sessions, though.
What are the mechanisms of change in Milan Family Therapy?
- The family develops a different game that does not include the symptoms
- Requires an incubation period - long periods of time between sessions
What are key concepts in Milan Family Therapy?
- Family games - including “dirty games” with lying, treachery, lack of integrity, etc.
- There is a nodal point of pathology
- Invariant prescriptions
- Rituals / prescriptive rituals
- Positive connotation
- “Difference that makes a difference”
- Circular questions
- Neutrality - not focusing on a stable hypothesis, but letting it evolve
- Hypothesizing, and using circular questions to test hypotheses
- Therapy team works on case together, discussing & advising
- Incubation period for change - requires long periods of time between sessions, even a year
What are Family Games, in Milan Family Therapy?
The family’s patterns that maintain the problem: Unacknowledged strategies that result in destructive interactions within families. Often, games are unspoken and used as attempts to control another’s behavior.
- Dirty games =
- Psychotic games =
What kind of therapy is Milan Family Therapy?
A Strategic and Systemic therapy modality
What is a Paradoxical Intervention, in Milan Family Therapy?
A Paradoxical Intervention is designed to alter the self-sustaining nature of a symptom by interrupting the reinforcing feedback loops that maintain it through engaging in opposite behavior. Seems counterintuitive - thus paradox.
Originated by Jay Haley.
Examples:
- The “Go Slow” prescription
- Prescribing the symptom - make the symptom worse so the therapist can understand dynamics better or so family can gain insight
The focus is ‘reframed’ from avoiding failure to recovering from failure, and from loss of control (unintentional error) to gaining control (intentional error). Avoidance of failure keeps him from discovering that failure is manageable. The intervention is repeated over several weeks, changing client’s experience of failure, and the paralysis dissipates.
Sex therapists rely on a similar dynamic when prohibiting couples with performance anxiety from having intercourse, directing them to focus instead on giving and receiving pleasure, replacing a vicious cycle of mounting anxiety with a virtuous circle of mounting arousal.
