THE MILAN FAMILY SYSTEMS

THERAPY
 Systemic Therapy :Introduction
• A system is a unit made up of a number of elements – which together constitute
more than the sum of the individual parts

• The elements have r/s with each other and also with other systems. This gives
rise to interactions that are d/t and greater than linear causal effects b/n two
single entities.

• Systemic Therapy considers interpersonal relationships (individuals) and the

systemic interrelationships within a group (e.g. a couple or family) in the
diagnosis and therapy of psychological problems and interpersonal conflicts.

• Every system has its own internal order which maintains itself and all of its
participants in a sort of equilibrium.

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 Systemic Therapy

• If the system (balance) is disturbed, whether in a family, e.g. through children maturing
to become adolescents and moving out of the parental home, or within a couple’s
relationship, e.g. through one member of the couple losing his/her job, the system
becomes out of balance and its position becomes threatened.

• As a buffer against the threat, at least one person develops symptoms for example
behavioral disorders, psychological disturbance or illness.

• The purpose of systemic therapy is to disturb (change) the interaction patterns within
the system (made up of family members and other significant persons) and as a
consequence to alter the undesired symptoms.

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 Systemic Therapy contd.

• The focus of systemic therapy is the “person in the environment” within the
context of a holistic bio-psycho-social concept of health, disturbance and social
problems.

• The general aim of systemic therapy is the inclusion of the excluded (isolated),
at risk, ill (displaying symptoms) and disabled persons by:

focusing not on the orientation of deficits (mistakes, faults, etc)

but on the person’s or system’s sources of strength, the capacity
to find solutions, the identification and establishment of access to
resources and the reinforcement of existing strengths in order to
assume responsibility for one’s own actions and also to achieve
goals or visions.

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 Violence from a Systemic Perspective

• Every system is susceptible to violence. Most systems are not structured on the
basis of equality, rather they are characterized by hierarchies, power
relationships, unequally shared resources (often financial) and knowledge, d/t
expectations of each other, and unrealizable wishes and disappointments.

• Thus, the equilibrium (the order) within the system become out of balance, a
member of the system usually develops symptoms such as psychological or
behavioral disorders as a means of buffering against this threat to restoring the
“old order”.

• In this context, violence is considered a behavioral disorder and the intention is

to restore the “old condition”. The “old condition”, the “old order” is the
situation of interpersonal neediness.

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 Significance of Violence contd.

• In a couple, one partner (e.g. husband) may be more powerful than the other (wife) by
virtue of his possession of greater financial resources or knowledge, or through
employment outside the home.

• This distribution of resources and the associated assignment of roles are initially desired
by both parties.

• A change, e.g. the second person’s (husband) entry into employment and the related
financial independence that this brings, alters the former (role) distribution. This makes
the wife uneasy.

• The wife wishes to restore the “old order” through the use of violence. This includes all
forms of violence: not only physical, but also verbal or economic violence.
• Depending on the personality structure of the husband, the wife may not be successful
here. Does the husband leave the r/s or remain in a violent r/s?

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The Milan Systemic Family
Therapy

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 History
• Milan Systemic Family Therapy is the extension of family systems therapy of
Bateson and Haley (strategic family therapy), Bowen (transgenerational)

▪ MSFT originated from a work of a team of four clinicians (psychiatrists -

Selvini-Palazzoli, L. Boscolo, G. Cecchin, and G. Prata) from Milan, Italy
(1980)

• MSFT emphasizes family relationships as an important factor in psychological

health; belief systems affecting relationships.

• MSFT tends to view change in terms of the systems of interaction b/n family
members.
• From this perspective, the family is viewed as a functioning unit within the
therapeutic process.

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 Basic assumption

• Person is best understood by looking at family interactions and relationships

• Focus on the family rather than the individual

• Mental health symptoms (in individual) result from maladaptive family patterns

• A person’s problematic behavior grows out of family interaction, as well as larger

cultural and societal systems

• If one person in the family changes, the rest of the unit must change to adapt

• Systemic family therapy is based on the premise that none of us lives in a vacuum
rather in a complex interactive relationships with other people

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 Principles to conduct a systematic interview
• Systemic family assessment focus on family r/s, family development, alliances;
and the process of communication b/n family members.
• Three fundamental principles necessary to conduct a systemic interview namely
hypothesizing, circularity, and neutrality

1. Hypotheses:
▪ The first principle of systemic assessment refers to Formulation of hypotheses by
the therapist about the family organizational patterns connects to the problem
▪ The therapist first gathers information about a family from intake data and
hypothesize a problem (e.g. a mother is too controlling of a father).
▪ Based on the information gathered from the family, the therapist modifies or alters
his or her hypotheses about the problem and about the family

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 Principles cont’d
• Systemic hypotheses connect the behaviors of all family members in a meaningful
manner. For example, a father shows little concern regarding his future.

• The less concern he shows, the more concern his wife shows: eventually, she directs him in
what to do. The more she directs him, the less he directs himself and vice versa.
2. Circularity - a technique for interviewing and hypothesis validation
➢ Refers to the ability of the therapist to conduct (questioning) the assessment on the basis
of obtaining information about relationships.

➢ Probing directly and indirectly; Reflexive question induce a family to reflect and therefore
think and act in a new way.

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 Principles cont’d
➢ Circular questions tend to explore r/s or differences, each family member
comments on the behavior and interactions of two other members

If the therapist wants to validate or invalidate the hypothesis that a family is

having trouble launching the eldest daughter, a useful circular question, directed
to other children in the family, could be, "What will be different in the family
when Hana leaves home !" how would you go about (deal) it ?

➢ Linear questions tend to explore individual characteristics or events (e.g.,

How long have you had high blood pressure'!)

3. Neutrality
• The third principle of systemic assessments refers to the ability of the therapist
to respond without judgment or blame to problems, change, persons, and
various descriptions of relationships.

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 Family development through a systemic lens
• In the systemic approach, families are viewed as self-regulating systems controlled by
rules established over time
• If the rules do not allow for a natural progression through various family life cycle stages or
for an accidental shift (e.g., chronic illness, divorce), a family member may develop a
symptom as a "solution" to helping the family progress along its evolutionary path.
• The symptom, or presenting problem, represents an interactional dilemma that is derived
from particular family beliefs.
• In this model, one of the therapist's goals is to offer the family an alternate "belief” or
"reality" about the problem, which may then allow the family to discover its own solutions.
• More specifically, the therapist aims first at understanding the family's reality surrounding the
problem and then at challenging this reality by introducing “new connections" b/n r/s, Beliefs,
and behaviors.

Second-order change
• It is change that alters the system itself. This type of change is a "change of change”.
▪ In second-order change, there are actual changes in the rules governing the system, and
therefore the system is transformed structurally and/or communicational. 13
• Systemic therapy focuses on facilitating second-order change.
 Family development through a systemic lens contd.

Concepts of change
▪ There are certain concepts regarding change. The two most salient concepts are:
1. The ability to alter one's perception of a problem.
It is essential that both family members and family therapists alter their perceptions of
a problem., enhances the ability for change.
• If a therapist agrees with the way a family views a problem, then nothing new will be
offered. How the therapist perceives and conceptualizes a particular problem determines
how he will intervenes
• Families and family members need assistance in moving from a linear perspective of the
problem (assessing individual characteristics) to a circular one (explore relationships or
differences) .

2. Solutions to problems change as the family's beliefs and interactional patterns change
Systemic therapy avoids the search for linear causes and seeks, instead, to provide
systemic explanations of problems and impasses (dead ends).
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 Family development….

Problem Formation
Problems develop in a family system b/c family hierarchies are flawed (no clear
boundaries) and/or a family member develops symptoms to control others in the family
system
Therapeutic Process
Therapists are generally more interested in what goes on b/n people rather than in
people, point out the family interaction patterns that the families may not have noticed

Interventions
Reassigning the role of "identified client" from one sibling to another. It is used to
disrupt/change the status quo and give power to previously disadvantaged family
members.

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 Therapeutic process/ techniques

Therapeutic strategies are closely related to the strategies used by the family to maintain
family dysfunctional patterns.
a. Directives
The therapist assigns therapeutic tasks to the family to practice b/n sessions with the goal of
breaking inappropriate sequences of behavior and realigning the family relationships.
b. Circular Questioning
It refers to interview questions directed by the therapist to family members in an effort to
learn more about differences b/n the family members or changes in family r/s.
It is also referred to as a triadic questionnaire, b/c a third party is asked to describe the
behavior and interactions of the first and second parties.

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 Therapeutic process/ techniques
c. Symptom Prescription
• Symptom prescription refers to strategies whereby the therapist uses powerful arguments
to encourage or instruct the client to perform their symptoms.
• For example, a couple requesting treatment for the reduction of marital fighting may be
instructed to continue the fight in order to resolve the underlying issues and eventually
have a more harmonious family life.

d. Relabeling or Reframing
▪ The therapist assigns a new and usually positive meaning to a situation in order to alter
its negative effects or consequences.
For example, the runaway behavior of an adolescent may be relabeled as an attempt to
gain autonomy.
e. Positive Connotation
Relabeling of family behavior in a positive light. For example, a nagging mother could be
relabeled as a concerned parent.

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