Milan school of family therapy


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Milan school of family therapy and use of paradox

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  • Cybernetics is most applicable when the system being analysed is involved in a closed signal loop; that is, where action by the system causes some change in its environment and that change is fed to the system via information (feedback) that causes the system to adapt to these new conditions: the system's changes affect its behavior. This "circular causal" relationship is necessary and sufficient for a cybernetic perspective.[citation needed] System Dynamics, a related field, originated with applications of electrical engineering control theory to other kinds of simulation models (especially business systems) by Jay Forrester at MIT in the 1950s
  • Milan school of family therapy

    2. 2. “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)
    3. 3. 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.
    4. 4. Model based on complexity• Brief therapy- > problem oriented therapy -> behavioural oriented• Systemic approach emphasize on meaning ( Batesonian concept)-> Milan school
    5. 5. Contd…• Systematic search of difference in , – Behaviour – Individuals – Relationships Whats keeps family together?
    6. 6. PROPONENTSMara selvini Palazolli Luigi Boscolo Gianfranco Cecchin Guilana Prata
    7. 7. EARLY MILAN MODEL• Paradoxes• Counter paradoxes• Positive connotation• Long brief therapies• Team of therapists
    8. 8. Formulation…1. Families in schizophrenia transactions – games2. Family members unilaterally try to control each others behaviour3. Therapist to discover and interrupt these games
    9. 9. FEATURES• Structured:1. Presession- hypothesis2. Session – validate, modify, change3. Intersession - discussion4. Intervention • Positive connotation • rituals5. Post session discussion
    10. 10. 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.
    11. 11. FEATURES• Long gaps between sessions• Goal of therapy was altering the family belief system so as to end the symptom –maintaining interactional patterns
    12. 12. PROCESSES• Circular causality• Circular questioning.• Counter-paradox• Family games• Hypothesizing• Invariant prescription• Neutrality• feedback
    13. 13. period Ten months, divided into ten sessions spaced at monthly intervalsInitial 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 termsCalls 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 therapisResources Therapist brings in other members of the therapeutic team Supervision ObservatioTherapy 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 upTermination Mutual agreement by therapist and family Respect for family‟s decision to terminate Warning of possibly of relapse or doubt
    14. 14. PROCESSES• Odd days and even days• Positive connotation• Problem of the referring person• Rituals• Constancy in mission
    15. 15. INTERVENTION• Restructuring (+ve connotation)• The simple prescription (counter paradox, Meta communication)• Metaphoric prescription
    16. 16. Team split in 1980• Selvini Palazzoli and Prata • Cecchin and Boscolo have developed the strategic evolved a non-interventionist aspects of the original model style premised on social further by outlining the constructionism where the development of particular types therapist‟s use of circular of problem maintaining questioning opens up space interaction patterns that they for the client and therapist to referred to as family games. co-construct multiple new perspectives on the problem• stratergic therapy style-> situation highly directive)
    17. 17. 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 Importance of recursiveness and feedback AcknowledgementEquifinality/Equipotentiality 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 historyThe Linguistic Element and Finding a language/way of saying things that was consistent Indeterminacy with a multiversal worldview No one truth or healing whole/union Replace dichotomies with multiversal perspective
    18. 18. Section Points of cybernetic consistencyStructure 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 Mental phenomena as seated in relationships rather than Social Phenomena intrapsychically Health and Dysfunction Freedom from labelling – „the map is not the territory‟ Changes originating within families and not attributed to the therapeutic process
    19. 19. 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.
    20. 20. 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.
    21. 21. 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
    22. 22. When to prescribe?1. Presupposes an intense complementary relationship, with a high degree of survival value for the patient2. 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).
    23. 23. 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).
    24. 24. • Identify the family nodal point• Use different strategies• Used cautiously• Outcome not predictable
    25. 25. 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‟.
    26. 26. 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
    27. 27. THANK YOU
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