Class 4: Milan- Systemic FT

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What is unique to Milan FT?

therapeutic teams of 4



  • Families as systems composed of individuals, who are also systems.
  • Marks a shift in thinking from linear to circular. This is the foundation of the milan model

Key beliefs of Milan- Systemic FT

  • Understanding the family over time, and how they came to “need” the problem that they’re trying to solve in therapy
  • Therapist neutrality**
  • stressed importance of the **Prescription** or intervention remaining systemic and neutral. Helps everyone stay on course and put away emotions
  • first and second order change

Therapist neutrality

  • non directive. Gives positive connotations to families, engendering trust and respect for everyone involved
  • Idea that if every family member was asked at the end of session whose side the therapist was one, they would all respond “on my side”


  • stressed importance of the **Prescription** or intervention remaining systemic and neutral. Helps everyone stay on course and put away emotions
    • example: Grace acts in a way that isolates Olivia. Prescribe them to have a different relationship (Mom, you need to spend for time with Olivia this week).

first and second order change

  • 1- change that occurs w a specific behavior in the system
  • 2- change that occurs as a result of new rules and premises, leads to a permanent change in the system

How does change happen in Milan- Systems theory?

  • Change happens when the family sees their problems in a healthier way (e.g. its serving a purpose in the family)
  • Socratic**
  • Uses relationship centered questions to help reveal news ways of thinking/ embracing the problem
  • Therapist to assess the family members to see who is most willing to accept new ways of viewing problems

Interventions in Milan Theory

  • Positive connections
  • Circular questioning
  • Systemic hypothesizing
  • Therapeutic letter

Positive connections

  • intervention in Milan FT
  • similar to positive reframing but includes a systemic component. When a therapist reframes a situations, it helps establish a “good” and “bad” element to the family

Circular questioning

  • intervention in MT
  • interviewing method used to gain descriptive assessments and deliver interventions through questioning of the members. Helps to expand the family’s beliefs beyond the meaning that they currently hold. Often done by asking questions to individuals that probe how others view the situation

Systemic hypothesizing

  • intervention in Milan FT
  • way of confirming or disconfirming necessary info regarding how the family functions and how the therapist conceptualizes their functioning
  • Begins with initial phone call from family. Before first session, Milan team exhausts all possible hypotheses about the family’s symptoms and functioning based on this phone call
  • During session, the therapist is often summoned by the team who are observing the session thru a one-way mirror. One with the team, the therapist listens to the hypotheses developed by his/her colleagues and a new therapeutic direction may develop based on the consensus of the reflecting team

Therapeutic letter

  • intervention in Milan FT
  • sometimes written as both a summary and an intervention. Allows family to continue in therapeutic process while away from the session

The therapeutic process in Milan Therapy

  • Begins with intensive, 5 part interview pre-session, the session, the intersession, intervention, and postsession
  • During presession, team of four therapists formulates an initial hypothesis about the family’s presenting problem
  • Two members of the team meet with the family; the other two observe the session through a one way mirror. The two members with the family begin to modify, validate, or change their initial hypothesis through questioning
  • Following a roughly 40 minute session, the entire team meets to create an appropriate intervention, often by positively connoting the problem or prescribing a ritual with the intent of introducing change
  • Two therapists then return to family and deliver the intervention
  • The intervention can be the family to do nothing or to write a letter. Team has choices about how to implement the prescription. May read letter to the family or mail the letter out to the individual or the whole family
  • Instruct family to take the letter home and continue reading until their next appointment
  • Finally, team meets for the post session discussion to examine the family’s reactions and to prepare for the next session