Milan Systemic

Question 1

Theorists of Milan Systemic:

Answer 1

1. Selvini-Palazzoli
2. Prata
3. Boscolo
4. Cecchin

Question 2

Major Concepts of Milan Systemic:

Answer 2

1. The family is viewed as a system that is constantly evolving.
2. Hypothesis
3. Circularity
4. Neutrality
5. Double bind
6. Invariant Prescription
7. Homeostasis
8. Attend to beliefs rather than behavior
9. Positive connotation

Question 3

Theory of Dysfunction in Milan Systemic:

Answer 3

1. Family members are caught up in an unacknowledged “dirty game”, power alliances, covert function of symptoms. Double bind.
2. Problems maintained by behavioral sequences, misguided solutions.
3. Problems exist when the family’s old epistemology (belief) does not fit its current pattern of behavior.

Question 4

Theory of Change in Milan Systemic:

Answer 4

Helping the family develop an alternative epistemology (belief) by creating an environment in which new information is introduced into the family system.

See things differently (cognitively) leads to behaving differently, without a need for reference to norms.

Question 5

Stages of Therapy in Milan Systemic:

Answer 5

Entire family is seen.

1. Pre-session (initial hypothesis)
2. Session Interview (validate or modify hypothesis)
3. Intersession (team meets to discuss hypothesis and arrive at intervention)
4. Intervention - positive connotation, ritual (exposing the family to a different way of viewing their problem)
   (5. Conclusion, therapist presents prescription or comments.)
5. Post session, team and therapist discuss family’s reaction to the prescription and comments.

Sessions spaced 1 month apart

Therapy is brief, usually 10 sessions.

Question 6

Stance of Therapist in Milan Systemic:

Answer 6

1. Male-female co-therapists and therapy team
2. Neutral, avoid taking sides
3. Focuses on ways to think differently, outwit resistance
4. Generates hypothesis regarding why the family behaves as it does

Question 7

Methods/Techniques of Milan Systemic:

Answer 7

1. Hypothesizing
2. Circularity
3. Neutrality
4. Invariant prescription
5. Rituals
6. Paradoxical prescription
7. Positive connotation

Question 8

Diagnosis/Assessment in Milan Systemic:

Answer 8

1. Data gathered before meeting becomes basis for what will become the formulation of an initial hypothesis.
2. Hypothesis eventually leads to choices for therapeutic interventions.
3. Circularity, looking for information within and between system components, is the ability to acquire authentic information from the family.

Question 9

Describe the Milan Systemic split:

Answer 9

Pazzoli and Prata - abandoned brief strategic in favor of long-term therapy with more focus on insight for the individual patient, understanding denial of family secrets and suffering over generations. Interrupt destructive family games.

Boscolo and Cecchin - moved away from strategically manipulating and toward collaborating to form systemic hypotheses about their problems. Therapy became research, trusting self-examination would prompt families to change unproductive patterns and belief systems (epistemologies) rather than setting specific goals. Hypothesizing (curious assessment), circularity (technique) and neutrality (therapist stance, not invested in any particular outcome).

Question 10

What is positive connotation?

Answer 10

Milan Systemic

Similar to MRI reframe, help clients see symptoms as serving a protective function to preserve harmony; the problem is logical and meaningful in context (not saying family members benefit from the symptoms).

Avoids linear causality and blame by assigning a positive motive or value to each family member’s behavior.

Evolved to the logical connotation - people are used to the problem and it is hard to break habits.

Question 11

What are rituals?

Answer 11

Milan Systemic

Engage families in a series of actions that violate or exaggerate rigid family rules and myths.

Dramatize positive connotations. (Ex. Express gratitude for symptom)

Question 12

What is invariant prescription?

Answer 12

Pazzoli and Prata

Parents directed to develop a secret coalition and secretly go out together.

Goal to strengthen the parental alliance and reinforce the boundary between generations.

Question 13

What is circular questioning?

Answer 13

Boscolo and Cecchin

Therapy interview technique that shifts clients from thinking about individuals and linear causality and toward reciprocality and interdependence.

Therapist stance as curious rather than strategic.

Question 14

What is the difference between positive connotation and reframe interventions?

Answer 14

Reframing (MRI) can be positive or negative and is usually directed toward one family member to ascribe meaning to a behavior.

Positive connotation (Milan Systemic) always addresses every family member’s part in the ‘circular’ process that maintains the problematic interactions. Emphasis on avoiding family members feeling blamed for their problems.

Question 15

How do Selvini Palazzoli and Prata hypothesize about the development of family power/psychotic games?

Answer 15

1. Marital stalemate between partners.
2. Child becomes an ally with parent perceived as the “loser” of the stalemate.
3. Child develops a symptom in an attempt to challenge the winner and demonstrate to the loser how to contend with the winner.
4. Loser does not understand purpose of the symptom and sides with the winner in disapproving of symptomatic behavior.
5. Misunderstood child continues the game and symptom.
6. Game becomes stabilized as family believes child is crazy and develops pattern of dealing with the child.

Question 16

What are the roles of hypothesizing in Boscolo/Cecchin?

Answer 16

1. Assessment tool that brings families into the investigation and provides new information about how the family system operates.
2. Systemic and encompasses all relational components of the family.
3. Guides circular questioning.
4. All hypotheses are considered equally valid.

Question 17

What is the odd day/even day ritual?

Answer 17

Milan Systemic, Boscolo and Cecchin

Therapist gives a directive that on odd days one set of opinions would be true and on even days false. The directive for the seventh day is to act spontaneously.

Encourages irreverence and openness to multiple epistemologies.