milan
Milan Family Systems Therapy - Strategic Model - Modern
Key Terms:
Games (family games and dirty games)
Circular (circular causality and circular questioning)
Therapeutic Team
Key Leaders:
Psychoanalyst; All systemic therapist
Mara Selvini Palazzoli
Luigi Boscolo
Gianfranco Cecchin
Guiliana Prata
Overview of Theory:
Developed in Milan, Italy - hence the name
A very Structured approach. Works by trial and error, what works, what doesn’t work.
Model developed to address problem: of noticing that individuals would be treated in therapy, go home back to their families, then the individual would experience relapse.
Main Concepts:
Family is a self-regulating system through trial and error, the whole is larger than the sub of its parts.
What makes Milan Group unique:
Family Games, people are competing for power within the family which leads to alliances and subsets within the family. Not done initially but develops over time to gain the most control within the family. Looking to control the other family members' behaviors. Dirty games will begin to come up when there is a threat of change presented, keeping the family from changing. Families will use deceit or manipulation to gain power.
6 Stages to how the games develop:
There is a marital stalemate between the partners.
The child becomes an ally with the parent he/she perceives to be the “loser” in the stalemate.
The child develops a symptom in an attempt to both challenge the winner and demonstrate to the loser how to contend with the winner.
The loser does not understand the purpose of the symptom and sides with the winner in disapproving of the symptomatic behavior.
Now desperate, the misunderstood child continues the game and the symptom.
The game becomes stabilized as the family believes the child is crazy and develops methods of dealing with their crazy child. In this way the psychotic behavior is maintained.
Assumptions:
View of the Problem:
Problem Formation
The family's problems are maintained by homeostasis, resisting change and interventions that counter this tendency.
Patients developed symptoms to protect one or more family members so as to maintain the delicate network of extended family alliances (family’s “game,” rules).
Dysfunction occurs at points of natural transformation when system is unable to make leap to new way of functioning.
Goals of Therapy:
Expanded network of people involved in maintaining problems, but still focused on interrupting destructive family games.
Less problem-focused and more interested in changing beliefs about covert collusions.
Systemic flexibility and symptom reduction.
Role of the Therapist:
Neutrality: at first encouraged to not take sides. Seen as distance by clients.
Multipartiality: the willingness to honor all perspectives.
Therapeutic stance is primarily one of curiosity (esthetic).
The Milan team carefully avoided buying into any one description of the problem, including their own.
Irreverence: do not honor problem as a mighty foe/assume it has more power than it does. Its power is entirely dependent on its context.
Focuses on choice behind behaviors.
Assessment/Case Conceptualization:
Techniques/Interventions:
Unique by having more than one person “a team” working with a family or patient instead of the traditional 1:1 therapy. Only a few therapists are working with the family (female-male dyad) while others are observing from behind a one way mirror. Sessions were held monthly to give families time to react to interventions. Considered, (long-term) brief therapy - Total number of sessions usually limited to 10.
Each session was broken down into 5 parts:
Presession Team Discussion
Client is not included
The team gets on the same page and discuss plan and goals
Form initial hypothesis.
Session - Interview with the family
Finding out what the family believes their problem is and beginning to think about what the plan will look like for that.
Was the hypothesis validated or modified?
Intersession - Discussion of the interview amongst then team
Client is not included
Discussing the plan from stage 1 and the interview with the family and now synthesizing what the best plan will be for the family.
Forming an intervention
Intervention - Assign task at the end of session
What homework the family will take home to complete before the next session
Post session discussion
Come up with the plan for next session
Session breakdown with children:
Session 1: All family members invited to allow team to observe interactional patterns and fam. game; from this they develop their initial hypothesis of the role of the symptom.
Session 2: Again, all family members are present, and the focus is on the children; however, after this only the parents are invited back.
Session 3: In this session with parents only, the team prescribes the invariant prescription.
Session 4: Again, only the parents return, and they become the focus of treatment. By changing the parental unit, symptoms in the children were expected to be addressed.
Session 5: Therapist addresses the parents’ success/failure to address symptoms of patient.
Sessions 6 to 10: Team continues to monitor parents’ success with invariant prescription and the children’s response; additional interventions offered as needed to resolve presenting complaints.
Change:
Therapist helps to show what patterns are in place and help them establish a new strategy “game” in the family.
The group believed that by helping families see new ways of understanding their problem, they would find better ways of organizing themselves.
Getting families to see things differently (through reframing technique-positive connotation) rather than getting them to behave differently.
Change occurs through prescribing rituals and reframing opinions.
Change occurs when family finds a way out of its current epistemology (achieving new meanings).
Encourages self-correction.
Change Agent - Behavioral
Termination:
Definitions:
Hypothesising: where the family alliances lay?
Neutrality: Now referenced as “curiosity”. Therapist to remain curious, a state of “irreverence”. goal is for the therapist to remain an allie with the whole family. Can be done by accepting each member's perception of events.
Multipartiality: willing to honor all perspectives in the system.
Circularity (circular causality and circular questioning): understanding things from other people's perspectives.
Circular causality: Circularity is about seeing family problems as a loop where everyone’s actions affect everyone else, instead of looking for a single “cause.”
Circular questioning: helps for each member of the family to step outside of the perspective. What do you think another person would feel about it?
Positive Connotation is basically a fancy way of saying: “Let’s look at people’s actions in a good way, instead of blaming them.”
Here’s what that means step by step:
Blaming doesn’t help:
If you say, “You’re bad because you’re sad” (like calling someone depressed a problem), it makes people feel worse and less likely to change.
Look for the good intention:
Positive connotation is about saying, “Hmm, maybe there’s a good reason you’re acting this way.”
Example: If someone in a family is acting sad, the therapist might say, “They are staying sad to protect everyone else from getting hurt,” instead of saying, “You’re sad and that’s bad.”
Everyone has a part:
It’s not about blaming one person. Everyone in the family might be helping keep the problem going, even if they don’t mean to. Positive connotation points out everyone’s role in a kind way.
Different from reframing:
Reframing is like giving a new meaning to someone’s action. Sometimes it can blame a person, sometimes it can be positive.
Positive connotation is always positive and includes everyone, not just one person.
Family teamwork:
Therapists sometimes include everyone in the “good reasons” idea—even other therapists—so nobody feels blamed.
It’s like saying, “Thanks for everything you’ve done—even if it didn’t work—because it shows you care.”
In short:
Positive connotation is about finding the good intention in everyone’s behavior, pointing it out in a kind way, and helping the family see things differently without blaming anyone. It’s like turning a frown into a “hmm, that actually makes sense” moment.
Rituals are special “family exercises” that therapists use to help families see problems in a new, positive way. They are kind of like “fun rules” or “family challenges” in therapy.
Here’s the breakdown:
Exaggerate the positive:
This means doing something that makes the good side of a problem really obvious.
Example: If one family member always has a problem, the family might be asked to thank them for having it. Sounds weird, but it helps the family see the person’s actions as caring or protective, instead of just annoying.
Break family rules (in a safe way):
Some families have hidden “rules” they follow without thinking.
Example: If a family always puts the extended family first, they might be asked to hold a secret meeting just for themselves. Breaking the rule helps them notice the rules and patterns that control their behavior.
Therapy focus changed over time:
At first, the Milan team liked tricky or “paradoxical” exercises—like asking families to do the opposite of what seems normal.
Later, they focused more on what happens during the therapy session itself—talking, observing, and understanding patterns.
Different teams, different ideas:
Selvini Palazzoli & Prata: Focused on stopping destructive family games. They made a special technique called the invariant prescription for very serious problems.
Boscolo & Cecchin: Focused on how families think and believe. They looked at family beliefs and eventually inspired solution-focused and narrative therapies (ways of helping families change by telling stories or focusing on solutions).
In short:
Rituals are like “practice games” for families that either make the good side of a problem very obvious or shake up old family rules. These exercises help the family see things differently and open the door for change.
Invariant prescription: parents were to go out together without telling anyone else in the family of their whereabouts and to be mysterious about where they went. The goal was to strengthen the parental alliance and reinforce the boundary between generations.
Counterparadox: request that 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 becomes undeniable.