Casey O.

Skeide
June 13th, 2016
Therapy Outlines #3
MFT617A
Prof. Herb Grant

Milan Family Therapy

Assumptions
1.
2.
3.
4.

Much of the Milan therapy builds upon aspects of the MRI Family Therapy School of thought
Focus is upon family history throughout the generations and the power alliances that exist
Any dysfunction that occurs is maintained by a familys attempt to remedy
Resistance is inevitable
The theory's statement of dysfunction

1. Dysfunction comes not through general intention, but through good intentions in trying to solve a problem, thereby
exacerbating the dysfunction.
Unique concepts
1. Positive Connotation
1. Ritual
2. Neutrality
1. Boundaries
3. Circular Questioning
Interventions
1. Standard Format: Presession, Session, intersession, intervention and post session.
2. Utilization of Ritual or positive connotation to reframe a system as one that serves as a protective function
1. Rituals engages families in a series of actions that ran counter to or exaggerate the family rules of myths
3. Neutrality is crucial in creating an environment that is conducive to strengthening relationships so that the intergenerational boundaries are further solidified
4. Circular questioning became integral in shifting thought from linear causality towards reciprocity and
interdependence
The stance of the therapist
Therapist acts as an expert, with emphasis on being as neutral as possible to create distance.
Response
What I like most about this therapy is the underlying assumption that dysfunction occurs because of assumptive
intention. Basically, (my future dad-ness is coming through) what you get when you assume is making an ass out of
you and me. I initially thought that makes perfect sense because of this old dad parable, but underlying this
assumption is its intrinsic value as an assumption that the Milan team has acknowledged. This failed therapy
highlights the intricacies of dysfunction and the difficulties of making impactful, second order change. I totally see how
this therapy is useful for ritualized dysfunctions like bulimia or even something as severe as Stockholm syndrome. I
would love to see the data regarding all of their work and see what other therapies have come from their focus on
ritualization.

Casey O. Skeide
June 13th, 2016
Therapy Outlines #3
MFT617A
Prof. Herb Grant

Structural Family Therapy

Assumptions
1. A family exists as a structural system, with subsystems that have varying boundary types
2. Changing the structure, changes behavior
The theory's statement of dysfunction
1. Dysfunction occurs between the mitigation of boundary, resulting from the overall structure of the family
Unique concepts
1. Family Structure: consists of the relationships or the relations, which result in subsystems that are differentiated by
boundaries that vary due to differences like gender, generation, and function. These boundaries vary in their ability
to demarcate
2. Boundaries
1. Rigid - result in disengagement and subsequent isolation and independence
2. Clear - a normal sense of proximity in relation
3. Diffused - no boundary results in closeness, but results in lack of independence
3. Joining, enactment, and unbalancing
Interventions
1. Joining and Accommodating
1. Disarm defences and ease anxiety to build understanding
2. Enactment: to comment or to continue
1. Look at what they do, rather than what they say
3. Structural Mapping or Assessment
1. Must occur sooner, rather than later to avoid being inducted into the familys culture
4. Highlighting and Modifying interactions
5. Boundary Making
6. Challenging
7. Unbalancing
8. Raising Intensity
The stance of the therapist
Therapist joins the system as a facilitator to unbalance and restructure the family structure to create second order
change.
Response
My initial response to this therapy is, how does this even make sense to use? More than anything, the therapy
seems to be a conduit for which further dysfunction to occur purely because of the therapists insensitivity and
displacement from the relationship. As a portion of Strategic of Family therapy, the Milan school of thought brings to
light the often contradictory nature of systems and the power struggles that often appear because of
miscommunication. As a stand alone therapy, Milan Family therapy takes what seems like a 50/50 type risk of,
essentially, forcing the family to deal with issues that arise allowing for the problem to persist through reframing and
hopefully working themselves out through themselves. However, there are instances in which results have turned out
positive. Again, this therapy should be utilized with the caveat that: 1) its not practiced much because original results
were not deemed as effective as originally thought 2) though originally meant to be a relatively short therapeutic
process, may in actuality take longer than the suggested 10-12 sessions