Milan's school in systemic therapy

The Milan School in Psychology is a therapeutic approach developed by a group of Italian psychologists in the late 1950s and early 1960s. Milan's school focused on systemic therapy, in which interaction patterns are explored within the systems and ways in which these patterns affect individual behavior.

Content

• How the Milan School originated
• Milan's school and the concept of family play
• Milan school techniques and strategies
  • 1. Positive connotation
  • 2. Circular questioning
  • 3. Paradox
  • 4. REFRAMING OR REDEFINITION
  • 5. Neutral-question
  • 6. Prescription of tasks
  • 7. Direct intervention
• Conclusions
  • Bibliographic references

How the Milan School originated

This therapeutic approach was developed in Italy by a group of Italian psychiatrists and psychologists who were looking for new ways of addressing adolescents in adolescents.

The group of psychologists and psychiatrists developed by the School of Milan was composed of Mara Selvini Palazzoli, Luigi Boscolo, Gianfranco Cecchin, Giuliana Prata, Luigi Prata, Luigi Onnis and Giuseppe Napoleone. They began working together in 1958 at the San Raffaele hospital in Milan, Italy, where they specialized in the Treatment of eating disorders in adolescents.

In its early years, the group focused on individual therapy and hypnosis as a method to treat patients. However, they soon realized that these approaches were not enough to address eating disorders, since these disorders were the result of complex patterns of interaction and communication between the patient and his family.

These therapists then adopted an innovative approach in the treatment of these disorders, using a systemic approach instead of focusing exclusively on the individual and their pathologies. They started working with children with anorexia nervosa, putting particular interest in the mother-son dyad and including the mother in treatment, observing the need to then include the entire family context. Not satisfied with the results of his psychoanalytic work, during the years 1967 to 1971, he adopts the strategic systemic model of the MIR de Palo Alto, influenced by the ideas of Gregory Bateson, Jay Haley, Don Jackson and Milton Erickson.

Anorexia nervosa

In 1967 he founded the Institute for Family Study (Center for the Studio della Famiglia di Milano). Four years later, three more psychoanalyst psychiatrists, Luigi Boscolo, Gianfranco Cecchin and Giuliana Prata.

The starting point of the group had been its disappointment with psychoanalysis, for which they were looking for a scientific subtitle. Its members are They guided the general theory of systems and elaborated a theory of family relationships, helping with the notions of double bond and the paradox in its theoretical and practical aspects.

In response to this understanding, the group began to develop a systemic approach in the treatment of eating disorders. This approach was based on the idea that individuals could not be understood in isolation, but they should be considered in relation to the systems in which they lived, especially their families.

In the development of its systemic approach, the group of psychologists and psychiatrists of Milan introduced new therapeutic techniques. In particular, they developed the "circular reflection" technique, in which the therapist uses circular questions to explore interactions in the family system and discover behavior and communication patterns that may be contributing to the problem.

From the Milan group we can highlight their interest in studying families with typical psychotic disorders or anorexia nervosa. Milan's systemic therapy approach was the so -called "treatment demand analysis", through which the therapist prepares his first relational hypothesis on the role that the so -called patient identified in family functioning plays.

Milan's group became famous famous for the importance of their scientific productivity. Its components wrote in 1975 the book "Paradox and counterparage" ("Paradoso e counterparadosso") and the article "Hypotetization, circularity and neutrality: three guidelines for the conduct of the session", published in the prestigious magazine Family Process. Both would greatly influence "systemic family therapy".

The Milan group also developed its focus on brief therapy, which focused on address specific problems in a short period of time. This approach was based on the idea that the problems were more manageable if they were addressed early in the development process.

As the Milan School in Psychology developed, its systemic approach and its therapeutic techniques began to be used worldwide. The group continued working together and publishing research and articles on their approach for decades, until most of them died in the 2000s.

Milan's school and the concept of family play

A basic concept developed by Milan's team is that of "game", in the context of family therapy. The demand for treatment presented by the family and that the therapist has to analyze will be the "family game".

He Family game refers to a process in which a family members get involved in a structured game or activity while the therapist observes the interactions and communication patterns in the family. The therapist can ask questions and offer comments to help family members better understand their dynamics and work together to solve problems.

The family game It focuses on nonverbal communication and the observation of interaction patterns in the family. Through the game, family members can express emotions and feelings that could otherwise be difficult to verbalize. The therapist can see how family members relate to each other and can use this information to help the family identify problematic patterns and work together to change them.

The family game technique is based on the idea that families have their own language and their own form of communication, and that family problems can arise when communication patterns are unhealthy or dysfunctional. He Objective of the family game is to help families identify these problematic patterns and work together to change them.

Paul Maclean and Triuno brain theory

M. Selvini Palazzoli and his collaborators elaborate the concept of "game" as a metaphor thinking about expressions widely used such as "political game", "financial game", "play of powers", "team game", expressions that generate associations Immediate with group ideas, team, players, positions, command, soldier, attack, defense, strategies, tactics, moves, skill, turns alternation ... It would therefore be an intuitive and informal use of the Metaphor of the game, in order to produce associations, similarities and languages ​​suitable for framing in the most immediately intelligible way the phenomena that interest us. Likewise, they are terms of easy understanding for treated families, since they are part of their daily language.

With this family game, Each family member sends and receives verbal and analog messages from the other members. In short, each one tries to understand and tries to make others understand the rules that are allowed and what is not allowed in the family and in their "proposal" of family game.

They are implicit rules that have to do with the history of each of the family members, since these rules of the "game" are the ones that parents have brought from their families of origin, but they are also the rules that the couple itself itself It has been creating for their new family, rules of the family game that have been modified over the years and that, possibly, they have varied with their vital changes: birth of a son, emancipation, death.

Milan's school also focuses on Importance of change and evolution in therapy. Milan school therapists believe that families change and evolve over time, and that therapy must adapt and evolve with them.

Milan school techniques and strategies

The intervention techniques and strategies used by the Milan team are "prescriptions", "tasks" or "directives", and are taught to individuals and families with very specific and intentional purposes:

• Therapeutic purpose: The main objective of the therapy is to make the family behave differently, so that it has different subjective experiences thus.
• Diagnostic purpose: techniques are used to obtain information. The way in which the family reacts, and specifically each of its members, upon receiving a prescription is enlightening with respect to themselves and how they will respond to the desired changes.
• Relational purpose: It is used to intensify the relationship between the family and the therapist: by telling him what they should do, the therapist enters to participate in the action and acquires importance, because they have to do or not do what he tells them. If you should do something during the week, the therapist remains linked to their lives during all that period of time.

The Milan School uses a variety of intervention techniques in its therapeutic approach, which are designed to help families improve their communication and solve problems. These techniques include:

1. Positive connotation

Positive connotation refers to the positive evaluation that the therapist makes to the family, of a behavior that, in general, would be considered pathological or dysfunctional.

With this technique, the therapist Try to attribute positive motivations, Often in terms of "sacrifice for a greater good", which become a redefinition of the problem, avoiding any appearance of criticism or confrontation, at the same time that it can thus prevent family resistance, which will take the therapist's words as an understanding that What happens to them or a message that what they do is for a good reason and is understandable.

On the basis of this idea, the members of the Milan group determined that not only The behavior of the bearer of the symptom should be positively connoted, but also that of all family members, thus also fulfilling one of the previously commented premises of this group, which is that the therapist is neutral in relation to all family members.

2. Circular questioning

This technique implies asking specific questions to each family member to better understand your perspectives and communication patterns. For example, the therapist can ask "how do you think your brother perceives you when you talk to him?"

From a systemic perspective The therapist will ask the question including all its members, asking each of them as sees the interrelation of two other family members. This technique aims to gather, and at the same time transmit information within the family system. The information gathered helps formulate and legitimize hypotheses About the dynamic structure of the family.

Circular questions can be:

Descriptive

• The older brother can be asked: what does your father do while your mother lies to your little little brother?
• The son can ask: Who manages to calm your brother, your father or your mother better?

Reflective

• If her husband increased the discipline with the child, would better or worse results get?
• A father can be asked: Who do you think has more affected the fact that Maria consumes drugs again, her wife or son?
• To a father. Did your daughter stop eating before or after grandmother's death?

3. Paradox

The paradox has been defined in the logical-philosophical sphere as a reasoning that consists of use expressions or practices that contain a contradiction.

Milan's group devised this technique to break the established family game. The therapist, praising what is considered "symptomatic" or "sick", connoting it positively, manifesting his concern that he may disappear too soon, asks the patient or the family to continue doing exactly the same in a lapsus of fixed time fixed. With this prescription, which apparently opposes the objectives of the therapy, in reality they are trying to reach them.

For the family, this practice is shocking, since he is receiving a paradoxical message from his therapist, because, having told his members that he wants to help them change, at the same time he is asking them not to change. The message that the family receives is: "change", and, within the framework of the message, "do not change".

This technique It is used to challenge the limiting beliefs or behaviors of family members. For example, the therapist can suggest that encouraging a family member to continue their dysfunctional behavior could actually help him change.

4. REFRAMING OR REDEFINITION

The redefinition of the symptom implies reformulate the situation or problem in a positive or constructive way, with the intention of seeking and highlighting the family system resources. The attribution of the problem of negative causes to positive and even altruistic causes is changed, the symptom is not positively valued but its relationship with other more important behaviors, for which the system has, in reality, the solution. For example, the therapist can change the perception of a problem as a power struggle instead of as a power dispute, to reduce tension.

It is a cognitive technique that Avoid labels or markers who use the family when they define explain their problem and that same explanation is preventing change. It also helps the patient identified to download the tension a bit and change the perception of himself and the problem.

5. Neutral-question

This technique implies ask questions without issuing value judgments to promote reflection and self-discovery. For example, the therapist can ask "what do you think could be happening in your father's mind when he does that?"

6. Prescription of tasks

This technique implies assign tasks to family members to work to improve their communication o Solve specific problems.

They are tasks whose objective is to change the actions of some or some components of the family, mainly from the one related to the maintenance of the symptom. It is used to observe the ability to change the system and maintain the transformations already achieved, from paradoxical and ritualized interventions, previous.

For example, the therapist can assign to the family the task of practicing active listening during a family dinner. In disqualification conflicts in the couple, one of the spouses can be asked to ignore the disqualifications, the even days and, nevertheless, that they do pay attention to the odd days.

7. Direct intervention

This technique implies that The therapist offers suggestions or solutions to solve specific problems in family dynamics. For example, the therapist can suggest that the family establishes a weekly schedule to make sure everyone spends time together.

Conclusions

Milan's school in psychology is a Therapeutic approach that focuses on the system instead of focusing exclusively on the individual and their pathologies. Milan school therapists use techniques such as circular reflection to explore the communication and behavior patterns of the system in question, and believe that change in a part of the system can have an effect in other parts of the system and, therefore,, therefore , in the individual in question.

Milan's school has had a significant influence on the field of psychology and therapy. Its systemic approach has been adopted by many other therapists and has been used to treat a wide range of psychological disorders and problems. It has also contributed to the development of brief therapy and strategic therapy, in which specific techniques are used to address specific problems in a short period of time.

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