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Milan Model: StrategicTherapy

By Alyssa Davie, Kimberly Young, & Adria Barnes
by

Alyssa Davie

on 30 October 2013

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Transcript of Milan Model: StrategicTherapy

Milan Model

Family Rituals:
A set of actions designed to change a family system's rules
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Mara Selvini
Palazzoli
Problematic Family Development
Assessment
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CASE STUDY
Colombia - Italy
The Milan Systemic Model
Neutrality:
Palazzoli and the Milan Associates: Luigi Boscolo, Gianfranco Cecchin and Guilianan Prata
Belief that by raising questions that forced families to examine themselves and exposed their hidden power games, family would reorganize itself


The Milan Model:
Interventions:
1990's
IT
A
LY

Original model was highly scripted
Like Haley, belief that families should have clear generational boundaries
Families were seen by female-male co-therapists
Observed by team members
Once a month for 10 sessions
Like MRI's: Be neutral; no expectations
Ask questions to help examine the structure and expose their family games
Begins with a preliminary hypothesis
Confirmed or disconfirmed in the first session
Based on assumption that problems serve as a protective function in the family
Questions designed to explore family's set of interconnected relationships
1980's
Strategic Therapy
-Read work of Bateson and Haley and MRI
-Focus on power struggles and boundaries in the family
Explored family histories over several generations (searching for evidence to confirm children's symptoms as necessary hypothesis)
Frequently concluded that patient developed symptoms to protect family and maintain alliances among family members
Did a lot of work with families with members with anorexia and schizophrenia
Powerful and provacitive interventions required a strong therapeutic alliance
Emphasis on neutrality came across as distance, causing families to react to interventions negatively and not return to therapy
Example: Tommy is 16 and has recently refused to go out of the house.
Milan would focus on the family's history and hidden power struggles, or family games, in which Tommy is embedded and has to stay home to help a family member "win"
ULTIMATE GOAL:

ACHIEVE A SYSTEMIC PERSPECTIVE OF THE PROBLEM
1. Presession
Team develops initial hypothesis about presenting problem
2. Session
Team members validate, modify, change hypothesis
3. Intercession
Entire team would meet alone to discuss hypothesis and decide on an intervention
4. Intervention
Treating therapists would deliver the intervention to the family
Positive connotation
Family ritual
5. Post-session discussion
Analyze family's reaction and plan for next session
Positive Connotation
Derived from MRI, reframing symptoms as serving a protective function
Therapist described as positive both the symptom of the identified patient and the symptomatic behaviors of the others
Is the therapist's explanation to the family that the symptom is meaningful in its context
Avoided the implication that family members benefitted from the patient's symptoms
By construing behavior as effective, the overall group and not specific family members
Team hypothesized how symptoms fit into family system
Therapist would deliver hypothesis to family and tell them that they should not try to change
Used to engage members in actions that exaggerated or ran counter to rigid family rules and myths
Used to dramatize positive connotations
Ex.Family members thaanking patient everyday for having
Odd and even days
Ex. Mom and Dad who are deadlocked over parental control each take turns having control based on the day of the week
Rigid sequence is interrupted forcing them to react to each other differently
Split around nature of therapy
Palazzoli maintained original model
Focus exposing "dirty games" of patients with anorexia and psychotic disorders
Power struggles originally between their parents into which these patients are pulled

Ultimately they wind up using their symptoms in an attempt to defeat one parent for the sake of another
Started using invariant prescription intervention
Used with every family
Parents are directed to mysteriously sneak away together
Palazzoli reinvented theory again
Moved from long term therapeutic approach to short term
Stopped using invariant prescription
New therapy revolved around understanding the denial of family secrets and suffering over generations
Boscolo and Checchin
Moved toward a collaborative type of therapy
Focused on understanding the family and their games
Did not take responsibility for family change, and instead create a partnership to get them to make their own changes and create their own new structure
Circular questions are designed to decenter clients by orienting them toward seeing themselves in a relational context from the perspectives of other family members
Other contributions:
Team approach
Teams behind one way mirrors
Papp (1980) brought the team directly into the therapy process by turning the observers into a "Greek Chorus" who reacted to events in the session
Teams might disagree with the therapist

Team would get together and discuss the family while the family watched
Functional Family Therapy:
Concerned with the function that family behavior is designed to achieve
Assumes that most family behaviors are attempts to become more or less intimate
Relabling (or reframing): help family members see each other's actions
Help family members set up contingency management programs to help them achieve the kind of intimacy they want
Blend strategic and behavioral therapies
Current Status
Research on strategic therapy has not been very rigorous
Mostly based on case report format
Only successful treatment outcomes
More focus on MRI group and Haley and Madanes

Developing Brief Strategic Therapy for adolescents with substance abuse and behavioral problems
Similar to Haley and Madanes rather than the Milan group
SCRIPT
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