What is Milan Family Systems Therapy? Circularity, Therapeutic Teams, & Dirty Games | Model Review

hi guys welcome back to my channel if you're new welcome to my channel my name is Stephanie Tanya bouille Stefani for short and I'm a licensed marriage and family therapist in this video I'm going to be reviewing the Milan systemic family therapy model if you're curious stay tuned [Music] okay I thought it was about time that we get back into another model review a lot of you are back in school that have been sending me requests for certain models please keep those coming so I know which ones that you want to see and Milan is

one of the ones I've been getting requests for for a long time that I have not made a video for yet so let's Jump Right In so you guys know I like to start these model reviews with key buzzwords that you want to think about this is important because when you're looking at an exam sometimes these models can sound so similar but there will be certain words sometimes that can let you know which model they're referring to when it comes to Milan systemic family therapy the words you definitely want to look for is the word

games because they refer to family games as well as dirty games because their model is all about control Power influence within a family and you also want to look for the word circular so circular causality is definitely something that is a very systemic fake principle but circular questioning is something that's very specific to the Milan group you hear about a therapeutic team that's another buzzword that you might want to think about so I will be talking more about that when we get to the intervention section but I just wanted to give you those buzzwords to

think about in the beginning so that if you're taking an exam you know these are words that are more than likely going to be referring to the Milan systemic family therapy model Milan's systemic family therapy was developed by four psychiatrists specifically they were psychoanalysts and what you'll see in the late 60s is that you started seeing the break off of a lot of mental health clinicians breaking off from this concept of psychoanalysis or exclusively talk therapy which is very Insight based and starting to get a little bit more structured in their approach the Milan Group

which was developed in Milan Italy which is why it's called the Milan group they created their model in response to incorporating family interventions into anorexia nervosa schizophrenia a lot of times the family interventions were developed in response to mental illnesses that were not being successfully treated with psychoanalysis or other modalities that have been used up until that time we saw a lot of models including family therapy as a whole being the result of seeing that clients had a much higher likelihood of not relapsing after treatment for things like schizophrenia if the family was included so

the Milan group is no different in that they were trying to solve a problem that they were seeing in their work which is that people would be treated go home and then we started seeing a quicker relapse so the family started being incorporated into the work that's how the Milan group got started using systemic interventions with the whole family there were four psychiatrists that made up the original Associates of the Milan group selvini palazzoli boscolo sakin and Prada those four psychiatrists created the Milan approach to working with families key Concepts the main thing to remember

about the Milan systemic family approach is that they viewed the family as a self-regulating system rules form within a family over a process of trial and error so we try one thing within the family that doesn't work you try something else and over time we sort of stabilize this is a very key component of really all systemic models which is looking at groups as a whole the whole is larger than the sum of its parts which is what we are always considering whenever we're working with the family couple any sort of unit even an individual

we're always taking that into consideration so this concept of basically the family reaching a certain level of homeostasis or equilibrium after a process of trial and error is not unique to the Milan group but it is definitely a very important element of their model what is unique to the Milan group is this idea of a family game what I like about this is that it really puts in your mind an image it creates automatic visualization of how they view the family they believe that there are rules there are patterns that happen within the family game

where people are basically competing for power within the family these repeated patterns subconsciously lead to certain alliances within the family certain coalitions within the family so I think of it like The Hunger Games right you've got people who are in teams fighting for their family but think of it almost as people are fighting for their particular subset of the family so maybe you have a pair of like a mother and son and it's a family of four and they have a coalition and it seems like two of them have created this Alliance where dad knows

if the son says something he's never going to win when it comes to the mother choosing a side or maybe the little sister feels left out of the relationship between Mom and son so when we have these Alliance formed they're not done intentionally most of the time but through repeated patterns we start to see little subsystems within the family where people are aligning to get the most control of the family so the family game is definitely something unique to the Milan group that you want to definitely pay attention to and be familiar with ultimately each

member through the Milan view is looking to control the other family members Behavior so let's say if that's son and mom have an alliance then if there's a family vote for example and you've got two people automatically who are going to be on the same page that gives them a lot more control and influence than if it was each man for himself now let's talk about the view of the problem what is the maladaptive Behavior within these families at the Milan therapist is looking for so as we talk about the family game one of the

most important Concepts at the Milan group introduces to the field of family therapy is the idea of dirty games these are tactics that people within the family take on in order to avoid change this is particularly important because when a family comes into family therapy change is the goal right a family doesn't typically come into therapy so that things can just stay the same however we will see these things starting to happen these dirty games whenever any form of change is introduced whether that be a move whether that be coming of age or like I

said maybe that's even therapy as the source or threat for change some of those dirty games include things like maybe a child acting out or developing some form of psychosis as a way to manipulate the family and keep the family from changing these things are not done intentionally most of the time however they definitely do have an effect on the family that might have positive effects and we'll get to that a little bit later usually these dirty games involve some sort of Deceit ultimately fighting for power as usual I'm referencing my aatbs text which I

have links to in the description box there's no sponsorship but this is what I use to prepare for my exam and I use it as a reference point to help explain things to you all aatbs shared one of the examples at the Milan group commonly refers to when they talk about the dirty game of the child developing psychosis for example there are six stages that would lead to that specific dirty game of Deceit starts with a a marital impasse with the parents basically their relationship is in some sort of distress or maybe there's some form

of distance happening between the parents and keep in mind that a lot of these earlier models of family therapy only took into consideration the nuclear family so especially if you're seeing on your test a specific reference to families that fit that traditional nuclear style that might be an indication to you that we're talking about some of the classic models instead of the postmodern models like narrative therapy or solution focused therapy that we've talked about in other videos the second stage is that the child becomes aligned with one of the parents so like we were saying

earlier maybe you have a son who is aligning with their mother as they're recognizing some tension in the relationship between Mom and Dad they choose to align with Mom the child develops symptoms that they believe would challenge the parent they perceive to maybe be the winner of that impasse and this example will say the father is who that son perceives to be the winner and so they start doing things that will be challenging for that father and make the mother more heroic let's say the child starts acting out right they start crying and screaming and

saying things such as I want Mommy to tuck me in I only want to be with Mommy I want Mommy to feed me whatever the case may be doing things where their mother is going to be the winner they're going to get some sort of gain over that father right they're showing their favor towards mom but the next stage is because the mother does not fully understand that this child's tactic is to help them win this impasse in their marriage the mother starts to align with the Father the winner that the child perceives the winner

of that impasse and starts to reprimand that child's Behavior it doesn't make sense for her to align with problematic behavior that her child is expressing then next stage stage five is that in response to the mother and father not coming to help the child or not having a successful strategy of helping their mother win they continue to exhibit these behaviors because they don't feel understood those behaviors often are exacerbated now what started out as screaming and crying for bedtime has started to bleed over into having issues in school they know that their mom is the

only person who their teacher knows so mom's going to be called and she's the one dealing with these issues and so the child might have a misguided view on what it means for their mother to win and they're doing things that they think strategically could help her win this impasse in her marriage that is actually probably creating more stress and strain within the family then the last stage is that in response to this the family starts saying okay this child is off their rocker and we're going to have to learn how how to adjust and

work with them we see this a lot right and so what ends up happening is instead of there being actual changes for the parents what started all of this was issues within their relationship that started spilling over into family life now we have the family instead of addressing those issues just adjusting to this child's maladaptive behavior that repetition it does become the child's pattern and now this is who this child is by the time we see this kid they have been identified as the issue and family therapy refer to them as the identified patient so

parents are basically like hey fix this kid the therapist is automatically wondering okay what family processes support this Behavior but that is an example of some of the dirty games that the Milan group is referring to when they say that families will use deceit or manipulation in order to gain power in this instance the child was a acting out in an attempt to really help their parents marriage or help the parent that they've aligned with but in the end obviously that strategy is not successful and now the family is dealing with stronger stressors so what

are the goals of the Milan therapy approach the primary goal is to help people recognize their influence and power within the family and within their life recognize their sense of choice what we see a lot of times is people start to feel it in the family that things are just happening to them right but what's happening is that these repeated behaviors these alliances the dirty games that might be happening consciously or subconsciously are starting to just become the family Norm so the systemic therapist is helping them recognize the choices that they make that perpetuate the

maladaptive responses or outcomes that they're experiencing within the family so you start to show them the patterns that are happening and you help them start to acknowledge College recognize and practice new patterns they refer to this as a new family game helping them to recognize the rules of their previous game that was not working and help them establish a new strategy within the family so the Milan group really soars and are most well known I would say not for their conceptualization of the problem because a lot of this should sound familiar to you if you've

been watching some of the other model videos where I talk about the other models and how they view the problem this is very similar to a lot of those things but the reason why they're canonized and why we learn about them in our textbooks is because of their very structured process to dealing with these issues so here are two unique things about the Milan group and the way that they treat their patients they have the unique approach of a therapeutic team where we're accustomed to you have a client and a therapist they're like no let's

have more than one person working with this family or working with this patient so that is very unique to the Milan group okay so when you hear about a therapeutic team or you might see a scenario written out that includes a therapeutic team that might be an indication to you that they're talking about the Milan group another unique characteristic is that they break their sessions down into five parts the first part doesn't even include the client this is a pre-discussion that the team has a pre-session team discussion the team of therapists get on the same

page about the goals with this family the next stage is interview with the family this is where they can start to find out what the family believes their issues are what they're looking to address and they can start kind of making a plan for that then we move to another piece again that does not include the family they have the discussion of the family interview amongst the team so now they are talking about their original pre-session meeting what they talked about in that family interview and their synthesizing okay what is the best plan for working

with this family based on what we're seeing and what they're reporting then they have the conclusion of the interview and they always assign a task so they will always assign some form of homework for the family to take home and work on before the next session and to continue to be very strategic this is a very strategic model okay they will come up with their plan for the next session these are the five parts that happen with every session for the Milan group okay they have a very structured process that begins with a pre-teen discussion

then they meet with the family then they talk about the meeting with the family they conclude the conversation with the family and give them some homework and plan for the next session so this is a much more structured approach than what we typically see with psychoanalysis or typical talk based therapy another very unique element to the Milan group is that they have this therapeutic team but you only have one or two of the therapists actually working with the family each session the other members of the team watch in on the sessions when you have that

one-way mirror that we see a lot of times on crime or investigation shows that is what they use they have the rest of the team watch the session so they're not influencing it with questions or talking in checking in with the family they are just observing this is why they have so many breaks right they're having the pre-teen discussion then they're having a discussion about the interview because everyone is not a part of the interview and everyone is conceptualizing maybe there's something while you're talking with the clients maybe you're missing some body language or every

time you look down you don't realize that maybe this kid is sticking their tongue out but the people behind the mirror would be able to see those behaviors let you know what they're saying and what their hypotheses are as to why that might be happening it's also interesting when I imagine the Milan model one thing that's so interesting to me is that they could pull a person out of the room so let's say I'm sitting there working with the family and someone behind that mirror is like hmm no they should be asking about this and

they might say Stephanie come on can we talk to you over here so the family is aware that people are watching the session right they're talking with that therapist and saying hey I think maybe we should do this instead it's a very experimental way every single question every single session is like an experiment in and of itself and you're trying things just as they say in the beginning and the way they perceive the family right everything is done through trial and error that is how family rules are established and they're doing the exact same thing

and how they're working with the family they're trying different things out they're saying what's working and what it's not working and they're being very cognizant of the interventions that are going to help this family achieve the goals that both the therapeutic team as well as the family has outlined as you can see the Milan group is very science-based in their approach to working with families so it should come as no surprise that one of their main techniques that they use is hypothesizing they want to come up with the hypothesis specifically about where the family alliances

lie this is not always obvious and you can't always trust a client to tell you that or even be aware of where their alliances fall but they can watch things such as who sits by each other who finishes one another sentences who's the most understanding who is the most argumentative who sits in the corner quiet making faces at each other they're really really really paying attention to to where these alliances lie because that will really open the floor up to what rules exist within this family that maybe even the family is unaware of neutrality a

very very important element of the therapeutic relationship is that the therapist team tries to remain an ally to the whole family so whereas in some models we've seen that strategies could be leaning more towards certain family members who may not speak up for themselves or have a solid place in the family or some of the models like structural family therapy where you're trying to make sure the parents are at the top of the hierarchy and they have the most power and influence in the Milan approach they want to make sure that they're an ally to

everyone in the room which can be very hard to accomplish and there are a lot of critics that say that that's not actually possible when you're working with the family especially but that is a major goal of the Milan approach but one of the the ways that you can try to ensure that is by accepting each family member's perception of events so even if you've got four or five different retellings of something and how it happened and how it made a person feel and what that person said or did the therapist wants to let each

family member know that they accept their version of events and they believe that is what happened from your point of view and letting each family member have that same respect and making sure that you are promoting an acceptance of different perspectives within the room amongst the family members and that brings us to our last technique the most important one that is something you want to pay attention to a buzzword I mentioned which is circularity so the Milan group really really focuses on understanding things from other people's perspectives because when we are so set in one

person perspective and how we see things it really plays into those dirty games right we are trying to hone in on a very specific narrative and we're using power strategies based on only our own perception so things that might predominantly benefit us while possibly hurting others there are multiple ways of viewing circularity they talk about circularity in terms of the family's interactions with one another my favorite thing is how they talk about circularity in terms of the family and therapist relationship they are fully aware that the therapist's hypotheses about the family the way that the

therapist interacts with the family therapy in and of itself all of those things impact how the family acts and how the family acts therefore impacts the hypotheses that are being made about them so that lets you know that there is no such thing as a leads to B this is circular causality as well right so when we talk about circularity we're talking about circular causality but we're also talking about circular questioning when it comes to the Milan group and that is a very specific technique so circular questioning helps each member of the family to step

outside of their exclusive perspective so you might ask each person something about differences or about their view on things like who do you think is closest to Mom for example you may ask scaling questions on a scale of 1 to 10 how loud was Dad yelling last week or you might ask circular questions about the implications of things if we never moved how do you think the family would be today when you ask those questions you're giving each person opportunity to see things from another family member's point of view sometimes you'll ask the same question

to everyone or multiple people in the family just to see that there are very different views on the exact same situation so circular questions really helps people be able to step into the shoes of other people one of my favorite personal ways to use circular questions is by asking a person what they think another person would think about a situation so what do you think about XYZ like what do you think about the argument you guys had last week how do you think your Mom feels about it do you think your dad thought about it

the next day asking those questions so we can understand more about the perceptions that we have about even how other people think it's an infinite Loop it makes me think about the movie The Inception how you can go further and further and further down a rabbit hole of circular questions they're one of my absolute favorite techniques I obviously don't use the Milan approach because I don't have a therapeutic team we're not using one-way mirrors but some of the techniques like circular questioning and thinking about circularity those are things that have stayed with me since grad

school and I definitely use a lot in my practice so that is a summary of the Milan family system approach also known as Milan's systemic family therapy let me know what your thoughts are on this model was there anything surprising to you were there things that were jarring to you like what do you think about the idea of having a therapeutic team and having people watch the sessions that was always the most fascinating thing to me about their approach I really would love to know your ideas and also let me know any other models that

you would like me to cover I know a lot of you use these for school and some schools are actually using these videos in their syllabi so let me know what is helpful for you all thank you for watching again my name is Stephanie Yates Stephania for short please like this video subscribe to my channel share it with your cohort classmates Professor let people know about these videos they are free content that hopefully you guys can use to be as successful as possible in your grad program I thank you for watching this video all the

way until the end that really helps me with the YouTube algorithm so thank you thank you thank you [Music]