Milan systemic and post-Milan therapy

Domain V · Systemic, relational, group & community · Mara Selvini Palazzoli, Luigi Boscolo, Gianfranco Cecchin · 1971 · Milan, Italy

What it is

A school of family therapy, not a single protocol. A psychoanalytically trained group in Milan turned to Bateson's cybernetics and the Palo Alto (MRI) communication work and began treating families "in schizophrenic transaction" and families of young people with self-starvation as systems with…

Format

• Format (A, classic).
• Five-part session, described as highly ritualised. The five parts are: (1) presession, where the team builds hypotheses from the referral data and previous sessions; (2) session/interview, about an hour, in which the therapist tests hypotheses by circular questioning while the team may call the…

Who practises it, and how they are trained or regulated

• Format (B, post-Milan). Same team/mirror structure in training and clinic settings, but more flexible. Teams may join the room, use reflecting-team conversations (Andersen) where the family hears the team, see individuals and couples, and vary the interval. Often there is no end-of-session prescription, only a summary or reflection, or nothing.
• How change happens. Classic Milan (A): symptoms are part of a family game that maintains the system's balance. The team positively connotes that game, then uses counter-paradox (prescribing no change, prescribing the symptom) or rituals to make the game impossible to continue unchanged. Post-Milan (B): change comes when beliefs and meanings change, because circular questions bring forward new information…
• No licensing. No certification is required to use the methods. Training is offered by systemic training institutes, notably CMTF (Milan) and the Scuola Mara Selvini Palazzoli (Milan).

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Novices can freeze from over-planning every question. Keep the relationship first.
• Curiosity turns into intrusiveness when it ignores distress. Pace it to the family.
• Sudden drop-out after the referrer withdraws or objects. Repeated re-referral to new services.
• Whether it was done, partly done or forgotten, and by whom. Each is information about the system.
• A family asking about or addressing the team is useful material. Note who is curious and who is anxious.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.