MRI VS. MILAN

Assessment process for Milan

Assess interactional sequence but those aren't Milan's words, "FAMILY GAMES" is the term for interactional sequences. Milan asks circular questions to assess interactional sequences.

Goals for MRI

Create family homeostasis the is problem free or at least does not involve facing the same problem over and over again. Help the family define clear and concrete goals. Perturb the system to break the process patterns that making them stuck

Highly structured, long term brief therapy (one session per month/10 times)

MILAN

Communication Axioms

MRI

Double bind

MRI

First and second order change

MRI

Interactional sequence

MRI

Interrupt interactional sequence

MRI

Observation team

MRI

Positive & negative feedback loops

MRI

Prescribing the behavior

MRI--

Maneuverability

MRI: A therapist's freedom to use personal judgment in defining the therapist relationship.

More of the same solutions

MRI: Solutions that perpetuate the problem. The solution to the problem is the problem.

Therapeutic double bind

MRI: To undo a double bind message in a family or relationship. In a therapeutic double bind, no matter what you do, you do something different, something that moves in a new direction.

Danger of improvement or restraining

MRI: Warning to slow down therapeutic process...(a way to get around client resistance) trying to defuse resistance...no tug aware...we want it to be all the client working!

Reframing

MRI: finding an alternative yet equally plausible explanation for the same set of facts. The key is identifying the client current worldview and finding equally viable frame for the problem behavior from the client's perspective.

Dangers of improvement

MRI: restraining...go slow...

Maneuverability

MRI: therapist's freedom to use personal judgment in defining the therapist relationship. Will take on either an expert role or a one down stance depending on what's most helpful for the family. They may be more emotionally distant or engaged depending. They can be bad guy, expert, distant, emotionally engaged, whatever is needed.

Role of therapist for MRI

Maneuverability (will take an either one up or one down position)

Circular questioning

Milan

Family games

Milan

Invariant prescriptions

Milan

Positive connotation

Milan

Ritual

Milan

Neutrality

Milan (& MRI?)

Positive connotation

Milan (a milan style reframe): Therapist use positive connotation to respect both the family's fear of change and their request for change. They interpret the behavior of each member of the family positively, as having an underlying benevolent motivation. Perhaps the most important outcome of positive connotation is the effect it has on the therapist, enabling the therapist to view members of the system less judgmentally and with greater hope.

Types of circular questioning

Milan: 1) Behavior sequence questions, 2) Behavioral difference questions, 3) Comparison and ranking questions, 4) before and after questions, 5) Hypothetical circular questions

Rituals

Milan: Behavioral prescriptions (called rituals). Rituals were behavioral assignments given to the family that address the double binding communication and designed to help the family shift meanings associated with the problem.

Before and after questions

Milan: Can be useful in assessing how the event affected the family dynamics.

Irreverence

Milan: Captures the therapist's relationship to the problem (not client)

Hypothesizing

Milan: Hypothesizing for conceptualization and hypothesizing as an intervention. When therapists deliver hypothesis to the family, the purpose is to create " a news of difference" and shift how they think about the problem, thus creating new possibilities for change...

Counter paradox

Milan: Messages that request the family not change even though they have come in for change, often this has the effect of amplifying the problem behavior to such a degree that the family spontaneously gives it up because its absurdity because undeniable.

Circular questions

Milan: Such questions help 1) assess, 2) make overt the overcall dynamics and interactive patterns in the system, thereby reframing the problem for all participants without the therapist having to verbally provide a reframe. These questions allow families to view their problem in the context of the broader interaction pattern, thus opening new options for relating.

Behavioral difference questions

Milan: Therapists use behavioral different questions when clients start labeling people and assuming that a particular behavior is part of the person's inherent personality.

Hypothetical circular questions

Milan: Used to offer a scenario and have family members describe who each is likely to respond.

Comparison and ranking questions

Milan: Useful for reducing labeling and other rigid descriptions in the family

Invariant prescriptions

Milan: intervention that is not varied across families that severed covert coalitions between parent and child; parent/child dat example.

Role of therapist for Milan

Neutrality. A stance of curiosity.

Role of past for Milan

Not important

Role of the past for MRI

Not interested in the past. the focus is on the presenting problem and assessing their interactional patterns.

Optimal fam. functioning for Milan

Not prescribed (pm) fam. functioning

Philosophical school for Milan

PM and systemic???

Problem vs. growth for Milan

Problem

MRI growth or problem focused?

Problem focused: The goal of the therapist is solely resolving the presenting problem with the therapist imposing no other goals or agenda.

MRI's philosophical school

Systemic

Optimal family functioning for MRI

There is no "healthy family functioning" that the therapists use to define therapeutic goals. Flexibility is what characterizes healthy systems. Systemic therapists do not have a theory of health that a family should look like at the end of therapy. Instead, it is believed that the family system will reorganize itself from within to find a "functional", symptom-free, interactional pattern in response to the perturbations/disruptions intro ducted by therapist.

Behavior sequence questions

Use these questions to trace the entire sequence of behaviors that constitute the problem. The therapist follows the sequence of interactions until homeostasis is restored.

Goals of treatment for Milan

aim to shift family interactions by shifting family's epistemology and view of problems. Symptom reduction and means of new interactional patterns (family games)

what changed in the split?

at first Milan was very MRI (interested in process/international sequences, etc) but then became much more pm and interested in facilitating and constraining beliefs.

Milan mode

behavior (1st phase), beliefs (2nd phase)

Main mode for MRI

behavior (?)

Homeostatic dance

how A responds to B and B in return responds to A (MRI)

Assessment process for MRI

interested in identifying interactional cycle and the meanings that the clients have from that. 1) whats the problem, 2) attempted solutions, 3) Goals. Goal setting for MRI is huge/concrete.