The Milan approach focuses on viewing problems systemically and seeing how symptoms maintain family homeostasis. The therapist aims to help the family recognize how problems serve certain functions for the family system through circular questioning and other indirect interventions. Key techniques include hypothesizing family dynamics based on initial information, maintaining neutrality, and reframing problems and behaviors in a positive light to facilitate change in how the family views and interacts with each other. The goal is for the whole family to change their patterns rather than blaming individuals.
Describe the family life cycle
Distinguish the shift from linear to circular thinking.
Describe the influence of Bateson
Describe the core concepts of systemic therapy: phase 1 & 2
Dr. Murray Bowen, a pioneer in the field of marriage and family therapy, offered 8 interlocking concepts as a way to think about relationship functioning, especially in one's extended family, nuclear family, and couples' relationships. This is a model that assumes that problems can come from too much togetherness. It assumes that if one feels secure in one's ability to remain separate, one can go the distance in one's effort to remain connected to important people in one's life.
Describe the family life cycle
Distinguish the shift from linear to circular thinking.
Describe the influence of Bateson
Describe the core concepts of systemic therapy: phase 1 & 2
Dr. Murray Bowen, a pioneer in the field of marriage and family therapy, offered 8 interlocking concepts as a way to think about relationship functioning, especially in one's extended family, nuclear family, and couples' relationships. This is a model that assumes that problems can come from too much togetherness. It assumes that if one feels secure in one's ability to remain separate, one can go the distance in one's effort to remain connected to important people in one's life.
Family, family as system, crisis, crisis intervention, adaptive qualities, family therapy and approaches, stages of family therapy, 12 family strengths by Otto
General Family Systems Theory & Structural Family TherapyJane Gilgun
Ever wondered what general system theory has to do with circular causality and structural family therapy? These slides represent the most clarity I could come up with regarding these important ideas.
10 week lecture series on introducing counselling students to basics of research. Lecture series is based on Sanders & Wilkins (2010) First Steps in Practitioner Research PCCS books
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Couples presenting to the infertility clinic- Do they really have infertility...
Lecture 5 social constructionist family therapy: Milan school
1. Lecture 5: Introduction to Social
Constructionist Model: Milan School
Systemic Comparative
Kevin Standish
Newham College University Centre
2. Learning Outcomes
1. Identify the background influences
2. Describe the core concepts of Milan Family
Therapy (MFT)
3. Conceptualisation of problems in MFT
4. Therapeutic goals in MFT
5. Therapist role in MFT
6. MFT interventions
7. Evaluation of MFT
4. Core systemic influences
• Gregory Bateson’s circular epistemology.
• Greatly influenced by the works of the Mental
Research Institute (MRI) & brief therapy
• Pragmatics of Human Communication by
Watzlawick, Beavin, and Jackson (1967). Strategic
therapy
• Key publication: Paradox and Counterparadox
(1978) : understanding the family over time and
trying to determine how the family came to “need”
the problem they were attempting to resolve.
5. 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.
6. Founders of Milan Family therapy
Mara Selvini Palazzoli
Gianfranco Cecchin
Lynn Hoffman
Guilana Prata
Luigi Boscolo
Peggy Penn
7. Major Theorist: Mara Selvini Palazzoli
• Specialized in eating disorders but became frustrated
with lack of results
• Led group of psychiatrists who formed Center for the
Study of the Family in Milan, Italy
• Described families as engaging in series of games
– Families stabilize around disturbed behavior to try & benefit
from them
– Therapists meet with families & then parents separately to
give invariant or variant prescription to produce firm
boundary between generations
8. Team split in 1980
• 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.
•
strategic therapy
highly directive)
style->
• Cecchin and Boscolo have
evolved
a
noninterventionist
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
10. Core concepts/assumptions
• The principal assumption is that the
presenting symptom serves a function of
helping to maintain the family system’s
homeostasis.
• “a self-regulating system which controls itself
according to the rules formed over a period of
time through a process of trial and error”
(Selvini Palazzoli, Boscolo, Cecchin, & Prata,
1978, p. 3)
11. Premises of the Theory: Systemic
• Therapist will take systemic view of problem
maintenance & strategic orientation to change
• Symptoms serve a purpose
• Concentrate on consequences of family
communication patterns & conflict between competing
hierarchies
• Therapeutic neutrality — keeps therapist from being
drawn into coalitions & disputes & gives therapist time
to assess family dynamics
12. PRINCIPLES
• 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
• 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’.
14. 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.
• In second-order cybernetics, the therapist becomes part
of the system being observed rather than being an
outsider observing a family system.
16. Problem Conceptualisation
• symptom serves a function of helping to
maintain the family system’s homeostasis
• entire system is caught up in “family games”
whose purpose is to control individual family
members’ behaviour in response to flaws
within the family hierarchy
• The games are played through
unacknowledged alliances and coalitions.
17. Problem Conceptualisation
• Family members become symptomatic in an
attempt to either deal with isolation or retaliate
against family members for the hurt they are
experiencing (Campbell, 1999).
• The symptom or problem that developed within
the family was not viewed as coincidental.
• the symptomatic family member has taken his or
her attempt to control too far and the result is a
symptom or diagnosis
18. The problem of the referring person
• Failure to examine the problem of the
referring person resulted in unsuccessful
therapies.
• The referring persons is suspected of being a
homeostatic member of the family (eg.,
doctors who have been treating the family for
years and have formed a friendship with
them, young "supportive"-type psychiatrists
or psychologists, or social workers acting as
liaison between the patient and the family)
19. The problem of the referring person
• They argued that taking information about, and
potentially from, the referring person was a key way
to understand how the family presented for
assistance, and how therapy might progress.
• Without this understanding, the referring person
could become a 'grave problem' for the therapy,
given that s/he may hold a pivotal role in stabilising
the family or, in other ways, do some of the family's
emotional work for them.
• Palazzoli, Mara S.; Boscolo, Luigi; Cecchin,
Gianfranco; Prata, Guiliana The problem of the
referring person. Journal of Marital and Family
Therapy, Vol 6(1), Jan 1980, 3-9
20. In the Milan approach, change occurs when the family
is able to see their problems in a more systemic and
healthy way (i.e., recognize that their problem may be
serving a purpose).
4. THERAPEUTIC GOALS IN MFT
21. Change
• relationship-centered questions reveals new ways
of thinking.
• the family must face the reality of the
relationships experienced by each individual
family member.
• There is a shift in how the family views their
problems: no longer ascribe blame individual
family member—rather, see their problems as
family problems
• every family member must change, as opposed to
only the symptomatic family member, resulting in
second-order change: purposefully changing the
rules of their system.
22. Formulation…
1. Families in “problem saturated” transactions
– games
2. Family members unilaterally try to control
each others behaviour
3. Therapist to discover and interrupt these
games
23. The therapist’s role, simply stated, is to be
curious and creative
5. THERAPIST ROLE IN MFT
24. Role of the Therapist
• observe the patterns of family interactions
and uses techniques for making therapeutic
interventions
• Both expert & co-creator of evolving family
system
• Is neutral – does not overtly challenge or
change families; argues against change
• Takes a non-blaming stance, gives directives,
uses circular questioning & other indirect
forms of intervention
25. Role of the Therapist
• Stresses positive connotations of behavior
• the therapist uses curiosity to help
navigate the questions, which allows the
therapist to be observant for openings.
• The opening conceives a space for the
therapist to help the family to see their
problems in a new way.
27. Session Structure
1.
2.
3.
4.
Presession- hypothesis from telephone call
Phase 1: Joining and Building Rapport
Phase 2: Understanding the Presenting Issue
Phase 3: Assessment of Family Dynamics – validate,
modify, change hypothesis
5. Intersession – discussion with reflecting team
6. Phase 4: Goals generally are NOT set. Trust the system
to resolve itself
7. Phase 5: Amplifying Change / Intervention: Positive
connotation and rituals
8. Phase 6: Termination
9. Post session discussion
There is a reflecting team behind a one way mirror.
28. Positive connotation
• Similar to positive reframing; however, it
includes a systemic component.
• reframe problem as one that preserves family
homeostasis
• the therapist can help the family begin to
realize the homeostatic need for the
behaviours.
• The symptomatic family member is seen in a
more favorable light, and the symptom may
actually be welcomed
29. Treatment Techniques
• Hypothesizing — prepares team members to
treat family
• Circular questioning — focuses attention on
family connections by addressing differences
in perception
• Neutrality- is an attempt for the therapist to
see each person’s point of view. This later
changed to curiosity (Cecchin 1987)
30. Hypothesizing
• Systemic hypothesizing is the Milan therapist’s
way of confirming or disconfirming necessary
information regarding how the family functions
and how the therapist conceptualizes their
functioning.
• Hypothesizing begins with the initial telephone
call from the family.
• Prior to the first session, the Milan team exhausts
all possible hypotheses about the family’s symptoms and functioning based on the telephone
conversation.
31. Hypothesizing
• reflecting team members inform the therapist halfway
through the session of the new developed hypothesis.
• A new therapeutic direction may develop based on the
consensus of the reflecting team
• As the session comes to a close, the team arrives at a final
neutral hypothesis : the most systemic and powerful
hypothesis for the family.
• The final hypothesis not ascribe blame to any single family
member; often results in a prescription or ritual developed
by the
• reflecting team.
• Later, after the family leaves, the reflecting team and
therapist discuss how the family reacted to the intervention
and plan for the next session.
• In some cases, a therapeutic letter is written
32. Circular Questioning
• Circular questioning is an interviewing method
used to gain descriptive assessments and deliver
interventions through questioning of the family
members
• Circular questioning is to expand the family’s
beliefs beyond the meanings that they currently
hold.
• This is often done by asking questions to
individuals that probe how others view the
situation.
33. Circular Questioning
• Meaning formulation is an important component
of this approach to develop context. “Without
context, there is no meaning” (Campbell, 2003, p.
19).
• to examine their belief systems and the Meanings
that they attached to their behaviours.
• based on inquiries about the differences within
the relationships of family members and their
perceptions
34. Circular Questioning
• The therapist continually searches for patterns,
feedback loops, differences in beliefs among
family members (called openings), and the
covert rules that support family interactions.
• openings allow a place during the session to
begin questioning, , and exploring differences
35.
36. Karl Tomm 3 papers
1. (1987) Interventive Interviewing: Part
1. Strategizing as a Fourth Guideline
for the Therapist
2. (1987) Interventive Interviewing: Part
11. Reflexive Questioning as a Means
to Enable Self-Healing
3. (1988) Interventive Interviewing: Part
111. Intending to Ask Lineal, Circular,
Strategic,or Reflexive Questions?
37. Neutrality/Curiosity
• neutrality was that if every family member were
asked at the end of a session, ‘Whose side was the
therapist on during the session?’ they would all say,
‘My side’”
• neutrality has been misunderstood and challenged as
implying cold or aloof (Cecchin, 1987)
• A curious therapist allows all family members a voice
• Therefore, adhering to neutrality, the curious
therapist is more likely to be open to numerous
hypotheses about the system and invite the family
members to explore those hypotheses, increasing
the number of options for change
38. Treatment Techniques
•
Rituals:
–
–
–
Engage family in actions that run counter to, or exaggerate,
rigid family rules & myths
Occur daily at mealtime, bedtime & during chores
Include 5 components essential to family health:
•
–
–
Membership; Belief expression; Identity; Healing; Celebration
Purpose - change cognitions or meaning of behavior
Therapist should be specific in what is to be done, who is
to do it & how it is to be done
39. PARADOX
•
" …the specific tactics and manoeuvres which are in apparent
opposition to the goals of therapy, but are actually designed
to achieve them
• “. . . 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”
40. PARADOX: When to prescribe?
1. Presupposes an intense complementary relationship, with a
high degree of survival value for the family
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 (i) and (ii).
41. Process & Outcome
• Symptom resolution in 10 or fewer sessions
• Family dynamics change
– Systemic connection becomes clear
– Member stops being scapegoat
– Games change
• Old epistemology is discarded & more
productive behaviors emerge
• Process of growth continues
42. Unique Aspects of Systemic Theory
• Flexibility makes it applicable to treating a
variety of families
• Therapists work in teams
– Some in room, some behind one-way mirror
– Papp’s “Greek chorus”
• Concentration on one problem over short
period of time
43. 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
44. 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.
46. Comparison with Other Theories:
Systemic
• European bias toward nonintervention makes it not
widely used anywhere besides Europe
• Controversial view of schizophrenia
– Palazzoli believed it resulted from child’s attempt to take
sides in stalemated relationship between parents
• Tailor interventions to specifics of family
– Therapists responsible for creating innovative treatment
plans
– Limited generalisation of specific interventions
47. Evaluation
• Post-Milan therapists also moved away from
desiring particular outcomes from therapy and
instead saw their role as merely to “poke the
system” (jar the system, perturb the system),
which left families responsible for the outcome.
• Milan family therapy has been shown to be
effective with families dealing with various
childhood disorders, including oppositional
defiant disorder, attention deficit disorder,
autism, childhood depression, and anxiety.
• Additionally, couples with marital/relational
issues find benefits, as do families with a member
involved in drugs or alcohol.
48. Evaluation
• Families seeking answers to the past or desiring
an analysis of why their problems have developed
will not benefit as much because the Milan family
therapist does not pathologize.
• Milan family therapy might not be as culturally
sensitive as necessary: today you need to
incorporate sensitivity to cultural, racial, and
sexual orientation differences into a hypothesis
formulation
49. Readings
• Selvini et al (1998) Hypothesizing, Circularity, Neutrality,
Three guidelines for the conductor of the session. (Required
reading)
• Ceccin (1993) Hypothesizing, Circularity and Neutrality
Revisited an invitation to curiosity (required reading).
• Dallos, R. & Draper, R. (2010) chap 1 & 2
• Metcalf, L. (2011) Chap 9
• Burnham & Harris (1992) Systemic family therapy the Milan
approach
• Tomm (1995) Circular interviewing: A multifaceted clinical
tool.
• Tomm,K.(1987) Interventive_interviewing part 1. Strategizing
as a fourth guideline for the therapist
• Advanced reading
• Brown (2010) The Milan Principles extinction, evolution or
emergence
Editor's Notes
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