Milan school of family therapy and use of paradox

1. MILAN SCHOOL OF FAMILY
THERAPY &
PARADOX
PRESENTER: Dr Virupaksha

2. “Life is not just happiness there is something
called marriage”
-ANONYMOUS
"The essence of life is the progression of
such changes as growth, self-
duplication, and synthesis of complex
relationships."
(Odum 1983: 87)

3. 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.

4. Model based on complexity
• Brief therapy- > problem oriented therapy ->
behavioural oriented
• Systemic approach emphasize on meaning (
Batesonian concept)-> Milan school

5. Contd…
• Systematic search of difference in ,
– Behaviour
– Individuals
– Relationships
Whats keeps family together?

6. PROPONENTS
Mara selvini Palazolli Luigi Boscolo Gianfranco Cecchin Guilana Prata

7. EARLY MILAN MODEL
• Paradoxes
• Counter paradoxes
• Positive connotation
• Long brief therapies
• Team of therapists

8. Formulation…
1. Families in schizophrenia transactions – games
2. Family members unilaterally try to control each
others behaviour
3. Therapist to discover and interrupt these
games

9. FEATURES
• Structured:
1. Presession- hypothesis
2. Session – validate, modify, change
3. Intersession - discussion
4. Intervention
• Positive connotation
• rituals
5. Post session discussion

10. 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.

11. FEATURES
• Long gaps between sessions
• Goal of therapy was altering the family belief system
so as to end the symptom –maintaining interactional
patterns

12. PROCESSES
• Circular causality
• Circular questioning.
• Counter-paradox
• Family games
• Hypothesizing
• Invariant prescription
• Neutrality
• feedback

14. 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

15. PROCESSES
• Odd days and even days
• Positive connotation
• Problem of the referring person
• Rituals
• Constancy in mission

16. INTERVENTION
• Restructuring (+ve connotation)
• The simple prescription
(counter paradox, Meta communication)
• Metaphoric prescription

17. Team split in 1980
• Selvini Palazzoli and Prata • Cecchin and Boscolo have
developed the strategic evolved a non-interventionist
aspects of the original model style premised on social
further by outlining the constructionism where the
development of particular types therapist‟s use of circular
of problem maintaining questioning opens up space
interaction patterns that they for the client and therapist to
referred to as family games. co-construct multiple new
perspectives on the problem
• stratergic therapy style-> situation
highly directive)

18. Section Points of cybernetic consistency
Bateson‟s Influence Change in one part of the system affects the whole system
Circular epistemology Patterns of information and
relationships Importance of context
Feedback and Importance of recursiveness and feedback Acknowledgement
Equifinality/Equipotentiality of negative feedback Original acknowledgement of principles
of equifinality and equipotentiality, but later moved away from
this model and took history into account
The Strategic Element Importance of communication patterns in a relational context
Reframing Multiversal view points Multidimensional approach
to therapy that developed out the their dilemma with
cybernetic consistency concerning history
The Linguistic Element and Finding a language/way of saying things that was consistent
Indeterminacy with a multiversal worldview No one truth or healing
whole/union Replace dichotomies with multiversal perspective

19. Section Points of cybernetic consistency
Structure and Organisation Acknowledging problems that might arise as a result of
structural/organisational changes within family systems
Circular Questioning Recursive method that allows for feedback Principle of mutual
co-arising or co-evolving Focus on „What?" rather than „Why?‟
Neutrality and Support Principle of the non-summative nature of systems Room to find
alternative ways of thinking and behaving
Prescription of rituals No black box metaphor – therapist and family as one system
Metatherapy Multiple levels of functioning Perturbations of
communication patterns in families Negotiation of meanings
between subsystems
Mental Phenomena as Mental phenomena as seated in relationships rather than
Social Phenomena intrapsychically
Health and Dysfunction Freedom from labelling – „the map is not the territory‟ Changes
originating within families and not attributed to the therapeutic
process

20. SUMMARY
• Each family system develops a unique set of
relationships, patterns of interactions and belief
systems
• In healthy families these are sufficiently flexible to
promote adaptation to the changing demands of the
family lifecycle and the wider ecological system.
• Unhealthy families hold belief systems that are not
sufficiently flexible to promote adaptation.

21. 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.

22. PARADOX
• " …the specific tactics and maneuvres which are in apparent
opposition to the goals of therapy, but are actually designed to
achieve them" (Rohrbaugh, in Palazzoli et al 1989: 3)
• “. . . 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”
-Hugh Jenkins 1980

23. When to prescribe?
1. Presupposes an intense complementary relationship, with a high
degree of survival value for the patient
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 (1) and (2).

24. STRATEGIES
• Prescribing the symptom
• Positively appraising the symptom
• Attaching positive connotations to symptoms,
• Encouraging symptoms
• Expressing fears that certain symptoms might
disappear to quickly,(Palazzoli et al 1989: 3).

25. • Identify the family nodal point
• Use different strategies
• Used cautiously
• Outcome not predictable

26. PRINCIPLE
• 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
(Jackson, 1965)
• 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‟.

27. References
• FAMILY THERAPY Concepts, Process and
Practice Second Edition .Alan Carr John Wiley & Sons Ltd, 2006.
• The Milan Approach to Family Therapy. Guido L
burbatti, Laura Formenti.Jason Aronson Inc.1988
• Mastering family therapy: journeys of growth
and transformation By Salvador Minuchin, Wai-Yung Lee,
George M. Simon
• ‘Paradox: a pivotal point in therapy’
Hugh Jenkins, 1980, JFT

28. THANK YOU