Milan Systemic Model

Use of a Paradoxical Letter

1. Cryptic statement 2. relabeling 3. restraining 4. positive connotations 5. prescriptions 6. paradoxical questions

Therapeutic Interview Format

1. Pre-session 2. The session 3. The intersession- break during the session 4. The intervention (usually a prescription or a ritual) 5. The post-session- designed to evaluate the family's response to the interventions and plan the next session.

Two Distinguishing Characteristics

1. Spacing of sessions: "long brief treatment", i.e. 1 time per month, but could last a year, 2. Used a team of therapists. Often used a team of male and female therapists and a one way mirror.

The Invariant Prescription

A fixed sequence of directives a family must follow if the therapist is to help the family interrupt the family game. It is a universal prescription hoped to fit all families. It is intended to introduce a clear and stable boundary between generations.

Positives Connotations

A form of reframing the family's problem - in which symptoms are seen as positive or good because they help maintain the system's balance and facilitate cohesion and well being. The behavior is viewed as well intentioned and volitional. It is not the behavior, but the intention that is positive.The positive connotation has an inherent paradox - why does such a good thing require the symptomatic behavior?

Circular Questioning

A. probed differences in perceptions about relationships. B. investigated degrees of difference. C. studied now and then differences. D. sought family members' views of hypothetical or future differences. Asking each family member questions that help address a difference or define a relationship between two members.

Family Rituals

Carrying out the ritual calls for the performance of a task that challenges some rigid, covert family rule.

Circular Questioning

Designed to hypothesize - a continual interactive process of speculating. Neutrality - accepts each family member's perception - allied with all family members.

The Post-Milan Model

Emphasized the use of questioning techniques and meaning rather than focus on the family system. Karl Tomm introduced the idea of reflexive questioning. Circular questions constructed, not only for information, but also a technique to induce change.

normative-comparison questions

Have any of your friends recently dealt with the last child leaving home, so they would understand what you are going through now?

observer-perspective questions

How do you feel when your wife and teenage sone get into a quarrel?

future oriented questions

If the two of you got along better in the future, what would happen that is not happening now?

The Milan Model

Introduced the idea of "rules of the game" in families - tactics by which family members struggle to control each other's behavior.

systemic family therapy

Less emphasis on strategies to change behavior and more emphasis on examining thoughts.It is most consistent with Gregory Bateson's original ideas.

Ceremonial Acts

Proposed by the therapist, in a tentative way, as family experiments that are not expected to become a permanent part of the family life. These are not insisted on, but suggested as useful.

The Language of the Milan Group

The family's behavior is given a positive connotation - positive motives ascribed to behavior - carried out in the name of cohesion. Related to the identified patient's symptoms. Subsequent interventions, typically involved assigned rituals and were aimed at forcing behavior change in the system.

Problem

The identified problem is seen as serving the system in the best way possible, at the moment. The therapist must try to change the rules to change the behavior.

The Milan Model

The therapist's task is to help disrupt, expose, and ultimately interrupt the destructive "games" in which all family members participate.

The Milan Model

These therapists often began by "prescribing no change". They believed attitudes and behavior could not be confronted or challenged head on. Subsequently, they employed counter-paradoxes - therapeutic double-binds - such as warning against premature change.

unexpected counter-change questions

What does it feel like when you are not fighting?

embedded suggestion questions

What would happen if you told her when you felt angry instead of withdrawing?

distinction-clarifying questions

Which would be more important to you- showing up your boss's ignorance or helping him so that the project can be successful?

process-interrupting questions

You just seemed to get quiet and upset, and I wonder if you thought I was siding with your wife?

questions inducing hypotheses

You know how you become silent when you think your husband is angry with you? What would happen if next time you told him how you felt?

Reflective Questions

designed to move families to reflect on meaning: 1. future oriented questions 2. observer-perspective questions 3. unexpected counter-change questions 4. embedded suggestion questions 5. normative-comparison questions 6. distinction-clarifying questions 7. questions inducing hypotheses 8. process-interrupting questions