MILAN SCHOOL OF FAMILY THERAPY &PARADOX

PRESENTER: Dr Virupaksha

“Life is not just happiness there is something called marriage”

-ANONYMOUS

 "The essence of life is the progression of such changes as growth, self-duplication, and synthesis of complex relationships."

(Odum 1983: 87)

Model based on complexity

• System theory – von Bertalanffy(1967)• ‘pattern which connects’ –Bateson (1979)• cybernetics• Double bind hypothesis – Bateson 1950s• Family homeostasis hypothesis – Jackson

( 1957) –> conjoint FT ( similarity to homeopathy) -> paradoxical intervention -> strategic approach.

Model based on complexity

• Brief therapy- > problem oriented therapy -> behavioural oriented

• Systemic approach emphasize on meaning ( Batesonian concept)-> Milan school

Contd…

• Systematic search of difference in ,– Behaviour– Individuals– Relationships

Whats keeps family together?

PROPONENTS

Mara selvini Palazolli Luigi Boscolo Gianfranco Cecchin Guilana Prata

EARLY MILAN MODEL

• Paradoxes • Counter paradoxes• Positive connotation• Long brief therapies• Team of therapists

Formulation…

1. Families in schizophrenia transactions – games

2. Family members unilaterally try to control each others behaviour

3. Therapist to discover and interrupt these games

FEATURES

• Structured:

1. Presession- hypothesis

2. Session – validate, modify, change

3. Intersession - discussion

4. Intervention• Positive connotation• rituals

5. Post session discussion

Milan school- salient features

• Five part therapy sessions.• The use of co-therapy and a team behind a screen.• Commitment to the guidelines of hypothesizing.• Circularity and neutrality & circular questioning.• End of session interventions involving positive

connotation and the prescription of rituals, some of which were apparently paradoxical.

FEATURES

• Long gaps between sessions

• Goal of therapy was altering the family belief system so as to end the symptom –maintaining interactional patterns

PROCESSES

• Circular causality • Circular questioning.• Counter-paradox• Family games• Hypothesizing• Invariant prescription• Neutrality• feedback

period Ten months, divided into ten sessions spaced at monthly intervals

Initial contact Usually telephonic Therapist ties to maintain neutrality in order not to be seen by other family members as being in a coalition with the whoever made the initial call Questions phrased in social terms

Calls between sessions Neutral stance of therapist maintained In case of emergency calls (e.g. suicide attempts) therapist assumes role of social control agent rather than that of therapis

Resources Therapist brings in other members of the therapeutic team Supervision Observatio

Therapy session – five components Team discusses the family Family interview with other team members observing Team discussion of the family and the session Conclusions of the team presented to the family with other team members observing Post-session where team sums up

Termination Mutual agreement by therapist and family Respect for family’s decision to terminate Warning of possibly of relapse or doubt

PROCESSES

• Odd days and even days• Positive connotation• Problem of the referring person• Rituals• Constancy in mission

INTERVENTION

• Restructuring (+ve connotation)

• The simple prescription

(counter paradox, Meta communication)

• Metaphoric prescription

Team split in 1980• Cecchin and Boscolo have

evolved a non-interventionist style premised on social constructionism where the therapist’s use of circular questioning opens up space for the client and therapist to co-construct multiple new perspectives on the problem situation

• Selvini Palazzoli and Prata developed the strategic aspects of the original model further by outlining the development of particular types of problem maintaining interaction patterns that they referred to as family games.

• stratergic therapy style-> highly directive)

Section Points of cybernetic consistency

Bateson’s Influence Change in one part of the system affects the whole system Circular epistemology Patterns of information and

relationships Importance of context

Feedback and Equifinality/Equipotentiality

Importance of recursiveness and feedback Acknowledgement of negative feedback Original acknowledgement of principles of equifinality and equipotentiality, but later moved away from

this model and took history into account

The Strategic Element Importance of communication patterns in a relational context Reframing Multiversal view points Multidimensional approach

to therapy that developed out the their dilemma with cybernetic consistency concerning history

The Linguistic Element and Indeterminacy

Finding a language/way of saying things that was consistent with a multiversal worldview No one truth or healing

whole/union Replace dichotomies with multiversal perspective

Section Points of cybernetic consistency

Structure and Organisation Acknowledging problems that might arise as a result of structural/organisational changes within family systems

Circular Questioning Recursive method that allows for feedback Principle of mutual co-arising or co-evolving Focus on ‘What?" rather than ‘Why?’

Neutrality and Support Principle of the non-summative nature of systems Room to find alternative ways of thinking and behaving

Prescription of rituals No black box metaphor – therapist and family as one system Metatherapy Multiple levels of functioning Perturbations of

communication patterns in families Negotiation of meanings between subsystems

Mental Phenomena as Social Phenomena

Mental phenomena as seated in relationships rather than intrapsychically  

Health and Dysfunction Freedom from labelling – ‘the map is not the territory’ Changes originating within families and not attributed to the therapeutic

process

SUMMARY

• Each family system develops a unique set of relationships, patterns of interactions and belief systems

• In healthy families these are sufficiently flexible to promote adaptation to the changing demands of the family lifecycle and the wider ecological system.

• Unhealthy families hold belief systems that are not sufficiently flexible to promote adaptation.

SUMMARY

• Circular questions asked from positions of curiosity and irreverence (neutrality) to bring forth the family’s construction of the problem.

• Challenging the family belief system that underpins problem maintaining interaction patterns.

• Circular questioning within sessions and end of session interventions are used to promote change.

PARADOX

•  " …the specific tactics and maneuvres which are in apparent opposition to the goals of therapy, but are actually designed to achieve them" (Rohrbaugh, in Palazzoli et al 1989: 3)

• “. . . paradox not only can invade interaction and affect our behaviour and our sanity, but also it challenges our belief in the consistency, and therefore the ultimate soundness of our universe”

-Hugh Jenkins 1980

When to prescribe?

1. Presupposes an intense complementary relationship, with a high degree of survival value for the patient

2. Within this context an injunction is given which is structured so that it• (i) reinforces the behaviour that the patient expects to be changed• (ii) implies that this reinforcement is a vehicle of change, and• (iii) creates a paradox by telling the patient to change by remaining unchanged.

3. The therapeutic situation prevents the patient from withdrawing or revealing the paradox by commenting on it, by virtue of (1) and (2).

STRATEGIES

•  Prescribing the symptom• Positively appraising the symptom• Attaching positive connotations to symptoms,• Encouraging symptoms• Expressing fears that certain symptoms might

disappear to quickly,(Palazzoli et al 1989: 3).

• Identify the family nodal point• Use different strategies• Used cautiously• Outcome not predictable

PRINCIPLE

• Double bind - ability to communicate different, and often conflicting, messages simultaneously

• While all relationships are governed by ‘rules’ they frequently lack rules to change the rules about how members deal with each other

(Jackson, 1965) • Therapist takes charge of symptom and prescribes

• The person(s) no longer do(es) it because he ‘cannot help it’, but ‘because my therapist told me to’.

References

• FAMILY THERAPY Concepts, Process and Practice Second Edition .Alan Carr John Wiley & Sons Ltd, 2006.

• The Milan Approach to Family Therapy. Guido L burbatti, Laura Formenti.Jason Aronson Inc.1988

• Mastering family therapy: journeys of growth and transformation  By Salvador Minuchin, Wai-Yung Lee, George M. Simon

• ‘Paradox: a pivotal point in therapy’

Hugh Jenkins, 1980, JFT

THANK YOU