Chapter 12 Milan Systemic Model

Evolving Model Neutrality

- being connected and being avoid being caught in the coalitions and entanglements - remain connected, but avoid being caught in coalitions and entanglements

paradoxical letter

- bring the games out in the open -given to all family members including this who missed a session - cryptic statements= shared sadness and hurt and equating this with love (hidden or ambiguous) - relabeling = too soon to communicate feelings and relabel restrain feeling = distract each other and keep each other busy positive connotation = playing with minds, responsible for you might select a family member to focus your attention to, someone who has already decided on someone who has already to decide to take this role. This person should be responsible for starting fights -relabeling again -cryptic statement (silent crisis) -chaotic family (uncertain about the future) -paradoxical question

positive connotations (early Milan model)

- maintain cohesion in the family -reframed as helpful when its not helpful - can be viewed as voluntary to make changes Positive"- connotations reframe the problem as positive in maintain cohesion in the family

rituals

-prescribe rituals they are already performing , suggesting just to be helpful - they see this as voluntary and then could change - positive connotations - directive related to prescribed rituals

long brief therapy (early Milan Model)

-spacing of therapeutic session, five sessions apart extended to a year - they see the family together with one therapist and other therapist watching in a one way mirror - they do not let the let patient move up sessions - the idea is to help families recognize choices and assist members in exercising prerogative choosing and moving away from identified patient -structured sessions into 1.5 segments: pre session * first (telephone call, tone, problem, how intense), session (all met beforehand), intersession (modifying prescription, post session (reaction to the intervention). - never joined the family game

counter paradoxes (Early Milan Model)

-sympotomatic behavior in the family member helps maintain the balance & prescribe no changes -uncovering the families paradoxical patterns and to disrupt the repetitive unconnected games -warns about premature change? A. Counter paradoxes assuming that symptomatic behavior (IDP) helps maintain the balance in the family. Milan team prescribes no changes in attempt to uncover the family paradoxical patterns

Boscolo and cecchin (Post Milan Systemic)

-they worked on the Milan system for ten years and then they split up -viewed family system as the "meaning system" (rather than family system) - moved into a systemic direction and moved away from directives and strategic techniques - hypothesizing, neutrality, circular questioning takes every family member into account (unlike previous model focused on identified patient) - began reducing the use of paradoxes -goal of therapy is change not truth, proof (later model)

Boscolo and section Cecchin split

-treating unit as a meaning system * -therapist as an active contributor - the system does not create the problem, the problem creates the system - they cannot change the family through therapeutic intervention, but can perturbed the family, if family allows it (deconstruct old family assumption) - therapist do not always have to have the answers -circular questioning -neutrality -join family -permission to not be experts - do not issue directives, use neutrality from observing system to the family

Later Milan Model - Evolving Model,

Hypothesizing, neutrality and circular questioning A. Model was changed because IDP symptoms persisted B. Family Although seemingly stuck did not become differentiated 1) Utilized circular questioning a) Perceptions about family who is closer to father- son or daughter- scale of 1 - 10 b) Questioning family belief system c) Month long session become more flexible d on fed bate

Post Milan Systemic

Systemic not strategic A. Three guidelines for conducting a session 1) Hypothesizing - speculating and making assumptions about the family a) No true or false starting point b) Allows therapist to search for new information and identify patterns that sustain family behavior c) How does each family member contribute to systemic functioning d) How does the family organized around the symptom change not truth e) Circular questioning

paradoxes

no change is prescribed

Evolving model

no true or false, only starting point allow therapist to search new information change not truth

counter paradox

warns against premature change