Milan Systemic Family Therapy

Today's theory topic will focus on Milan Systemic Family Therapy. We have covered other theories before today that you can search for using the search bar at the top of this page. Other theories we have covered include: Play therapy, Person-Centered Therapy, Human Validation Process Model, Group Therapy, Systems Theory vs Postmodernism, Feminist Theory, General Systems Theory, CBT, Strategic, Structural, Narrative, Solution-Focused, and Extended Family Systems...

Milan systemic family therapy was developed by the psychiatrists Mara Selvini-Palazzoli, Luigi Boscolo, Gianfranco Cecchin, and Guiliana Prata who found that a family systems approach was more effective than psychoanalysis for treating a person with Anorexia Nervosa Schizophrenia, or other severe disorders.

Key Concepts: Milan systemic family therapy is based on the assumption that a family is “a self-regulating system which controls itself according to rules formed over a period of time through a process of trial and error” (Selvini-Palazzoli et al., 1978, p. 3). The “rules of the family game” consist of repetitive patterns of family interactions that are played out in unacknowledged alliances and coalitions and are used by family members to control each other’s behavior.

View of Maladaptive Behavior: Systemic family therapy proposes that “dirty games” (games involving deceit and power struggles) lead to symptoms that help protect a family    from change. For example, the development of psychosis in a child is the result of a “psychotic game” that involves six stages (Selvini-Palazzoli, 1986): 

(a) There is a marital impasse between the parents. 

(b) The child becomes allied with the parent he/she believes is the loser in the impasse. 

(c) The child develops symptoms to challenge the perceived winner and show the loser how to deal with the winner. 

(d) The loser doesn’t understand the purpose of the child’s symptoms and sides with the winner in disapproving of the child’s behavior. 

(e) The child feels misunderstood by his/her parents and continues exhibiting the symptoms to get his/her point across. 

(f) The family decides that the child is “crazy” and develops methods for dealing with the child that maintain his/her symptoms and stabilize the family.

Therapy Goals: The primary goal of therapy is to “help family members see their choices and to assist them in exercising their prerogative of choosing” (Gelcer, McCabe, & Smith-Resnick, 1990, p. 22). To achieve this goal, systemic therapists use techniques that help family members understand their relationships and problems in alternative ways, which allows them to work together to make new choices and identify new solutions (i.e., to “play a different game”).

Two distinguishing characteristics of Milan systemic family therapy are its use of a therapeutic team and the division of each therapy session into five parts: a pre-session team discussion, the interview with the family, discussion of the interview by team members, conclusion of the interview with a prescription (task) given to the family, and a post-session team discussion of the family’s reactions to the prescription and formulation of a plan for the next session. During each session, one or two members of the team meet with the family, while the remaining members observe sessions behind a one-way mirror. Team conferences are frequent, and an observer may call a therapist out of the session for a “strategy conference” to share his/her observations and make suggestions. Specific strategies include the following:

Hypothesizing: Hypothesizing is a continuous process that begins during the initial contact with the family and involves collecting information that can be used to derive or revise hypotheses about family functioning that are then used to identify appropriate interventions. Hypotheses focus on alliances and coalitions within the family, family myths and premises, and family communication patterns (Boscolo et al., 1987).

Neutrality: Throughout therapy, each team member remains an ally of the entire family rather than becoming recruited into family coalitions or alliances. Neutrality involves showing interest in and accepting each family member’s perceptions of the family’s problems.

Circularity: Circularity refers to the circular sequence of interactions between family members and between the therapist and the family. For example, with regard to the latter, the therapist’s hypotheses about the family lead to questions that he/she asks family members, and their responses lead to revised hypotheses and new questions. Circular questions are a common type of question and are asked of each family member to introduce new information into the system by helping members recognize differences and similarities in their perceptions. There are several types of circular questions: For example, some questions are aimed at identifying differences in each family member’s perceptions about relationships (“Which family member is closest to Dad?”); others at identifying degrees of difference in perceptions (“On a scale from 1 to 10, how bad was the arguing this week?”); and others at helping family members reflect on the consequences or implications of different situations (“If the youngest child hadn’t been born, what would Mom and Dad’s marriage be like?”)