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CONTRASTING VISIONS FROM MILAN: FAMILY TYPOLOGY VS. SYSTEMIC EPISTEMOLOGY. by Vincenzo F. DiNicola, M.Phil., M.D., Dip.Psych., F.R.C.P.(C)" ABSTRACT

Two basic temperaments among family therapists reflect a tension in the field: the technocratic or technique-oriented temperament and the phenomenolo~ical temperament concerned with understanding the family. Two books are reviewed that highlight the tasks of different temperaments. Selvini Palazzo!i's current work is examined in a review of her book Family Games in which she attempts to crack the code of gamily interactions by discerning underlying patterns, formulating a typology of family games. Critiques of Selvini Palazzo!i's work are examined in the perspective of her essentially phenomenological therapeutic temperament. Boscolo's and Cecchin's book M..i.l.w.1 Systemic Family Therapy outlines an epistemology for systemic tools. In its emphasis on a method of interviewing as the Rosetta stone for family work. their approach exemplifies the technocratic therapeutic temperament. Boscolo and Cecchin call themselves systems consultants. de-emphasizing both "family" and "therapy"; this transformation of the therapeutic task is criticized. Techniques alone cannot unite the family therapy field and suggestions are offered on how to bring different temperaments together to focus on the therapeutic task.

Among family therapists, there are, I think, two kinds of therapeutic temperament.

These two

therapeutic temperaments reflect a tension about what is central to the activity of family therapy - - a broad concern about the family or an emphasis on therapy (DiNicola, 1990). If I am correct, then we must judge the achievement of therapy in part by the therapist's temperament, as this will determine the tasks of therapy. The first kind of therapeutic temperament, which emphasizes therapy, has been called technocratjc: spinning out technique and basing therapy on this kind of invention (Treacher, 1986). A good example is provided by the men of the original Milan team, Luigi Boscolo and Gianfranco Cecchin, who have concentrated on a method of interviewing as the

Mara Selvini Palazzoli, Stefano Cirillo, Matteo Selvini, Anna Maria Sorrentino Family Games: General Models of Psychotic Processes in the Family. Translated by V. Kleiber. New York: W.W. Norton, 1989, pp. xvii-28S Boscolo L., Cecchin G., Hoffman L., Penn P. Milan Systemic Family Therapy: Conversations j n Theru:y and Practice. New York: Basic Books 1987, pp .. xii-337

Rosetta stone for family work. In this constructivist approach, the therapist does not so much "uncover" or "unmask" the underlying problem as find the algorithms or rules for how the family constructs its world. Families construct their reality; therapists construct tools for finding their way around the construction site.

"Men become myths. not by what they know. or even by what they achieve, but by the tasks they set for themselves." Henry Kissinger (1973)

In this approach, traditional diagnosis and assessment are eschewed. What is sought in therapy is a new, liberating construction of family reality. Whatever the merits of such an approach, it has little to teach

*

..

This invited essay-review was written for Terapla Famlllare and appears by permission of the Editor. Dr. Maurizio Andolfi. Assistant Professor of Psychiatry. University of Ottawa; Director. Family Psychiatry Service, Royal Ottawa Hospital. 1145 Carling Avenue, Ottawa. Ontario. Canada KIZ 7K4

us about the nature of the family, but addresses family function and dysfunction, and therapy becomes a series of algorithms for dealing with a system. Circular questioning, for example, is an algorithm for generating information within a system. The emphasis on interviewing points to

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JoUTNJ1 ofStrategic and Systemic Therapies

where Boscolo and Cecchin believe the trouble to be:

strategic therapists. Jay Haley is paradigmatic of this

in the meanin~ constructed by the family system. In

approach. He works in the here and now, prescribing

their new book, they cite with approval Alexander

strategies aimed at behavioural change. Haley also

Blount's notion that the family therapy of the Milan

has a view of the family that appears reactionary and

Associates is "meaning driven" (Boscolo, et al.,

rigid. "We've had families with a kid who won't go

1987, p. 254). This makes them less concerned with

to school. But once the parents are in agreement. by

the family per se, and more interested in the family

God he'll do it." says Haley (Pines, 1982, p. 65).

as a system. As therapists, they become identified

With all due respect for his achievements, troubled

by their method. In fact. Boscolo and Cecchin now

children will not change simply by getting their

call themselves systems consultants (Boscolo, et aI.,

parents to agree on solutions. Relational problems

1987, p. 24), intentionalJy de-emphasizing "family

are not solved by the use of authority and power.

therapy."

There are serious reasons why parents have lost moral authority in the family and Western culture

This temperament has a long history in family therapy and has led to major gaps in family therapy's dialogue with mainstream psychiatry and other therapies. For example, what does family therapy . have to say about family problems such as incest or

will not move backward just to help parents regain their position. Furthermore, Haley has attitudes towards other approaches to psychiatric problems that were once stimulating and provocative to read (Haley, 1986), but are now boring and sterile.

separation and divorce, or about clinical problems such as anxiety and depression (DiNicola, 1989)1

The second kind of therapeutic temperament,

Very little, because the emphasis has been on a

characterized by the search for kl&m in its concern ;

method. not on relational problems. While many

about the family, we may accordingly call

thoughtful social scientists in the Western world are

phenomenolo2lcaJ. (I use this term in the European

preoccupied with the "decline of the family,"

philosophical tradition as applied to psychiatry by

therapists of this temperament seem to have little

Karl Jaspers, 1963, rather than in the American usage

interest in family sociology and nothing to say about

where

the evolution of the modem family. These larger

phenomenological therapist has before him, all the

concerns are now brought to the attention of family

time, the family's experience of pain and ways to deal

therapist by special interest groups such as feminists

with that experience.

(de Nichilo, 1987) and transcultural psychiatrists

understanding the natIIR of the family itself, rather

(DiNicola, 1985).

than only its function and dysfunction.

Although the work of the Milan Associates is more

In this kind of family work, the usual underlying

concerned with cognitive and perceptual processes, I

assumption is that the structure of the family or the

would group them with change-oriented family

hierarchical position of its members, or of the family

approaches such as the MRI school and other

in the community or in the larger society, is

Journal o/Stralegic and Systemic Therapies

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it

means

"descriptive.")

The

He is concerned with

Vol 9 #2, Summer 1990

problematic. Accordingly. therapeutically readjusting

we undergo or any results that are produced. The

the interplay of components in the system will make

books being considered here by two sides of the

the problem vanish. Although words carry meaning.

Milan team that went different ways since 1980 both

this approach mistrusts words (both the family's and

take stock of their respective evolution since then.

the therapist's) and interactions are analyzed to study

The book by Selvini Palazzoli and her new research

the underlying rules. What is uncovered depends on

team, reflecting one therapeutic temperament,

the therapist. Andolfi looks behind the family mask

attempts a typology of family games. The book by

to the family story or myth. Minuchin engages the

Boscolo and Cecchin and their American colleagues,

family directly and powerfully to make them enact

Lynn Hoffman and Peggy Penn, and reflecting

their dilemmas in front of him.

another therapeutic temperament, outlines an

For Selvini

Palazzoli, this reveals the coherence of a certain

epistemology for systemic tools.

ongoing family organization that she calls the family game.

When put into this perspective, it is

surprising to see how much diverse therapists like Andolfi, Minuchin and Selvini Palazzoli have in common.

A, Selyinj Palazzolj's New Book: A TypolQU of Family Games "My greatest problem was simply that I was never given the opportunity to reveal my 2ame. throw off

Selvini Palazzoli has displayed, at different times, both therapeutic temperaments, as part of her odyssey as a therapist, leading Lynn Hoffman to characterize

the mask and allow myself to be enveloped in a love that was reciprocated." --Ingmar Bergman (1988, p. 4, my emphasis)

her as "a discontinuous genius" (quoted in Simon, 1987). Her new book on family games, better than

In a fruitful coincidence, I happened to be reading two

anything else available, plots her progress through

fascinating books at the same time recently: E.a.mih

different kinds of therapy, where she is today and how

!lJmcs. and Ingmar Bergman's autobiography, IM

she got there. Selvini Palazzoli is now powerfully

Ma2ic Lantern. At numerous junctures, it was as if

involved with this second kind of therapy, concerned

these two books were talking to each other.

with family process in Ackerman's sense of the term

Bergman's book is painfully self-revealing, without

and only secondarily (even if brilliantly inventive)

actually being insightful. He went through many

with technique.

marriages and careers (writing, directing theater and

This makes her, in my mind,

indisputably a faInih: therapist.

film) -- all, one suspects, without knowing why. His final confrontation with his mother, full of

So different therapists set different tasks for themselves and we should accordingly measure their achievements against those tasks. In the end, like families, we may be more inspired and moved by the task the therapist tackles than by any actual changes

Vol 9 #2, Summer 1990

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recriminations and resentments, is just like his film work: esoteric, powerful and pathetic, but in the end we are cheated of any easy catharsis. This is just the kind of life Selvini Palazzoli excels in reading. Too bad she was not available for a consultation with the Journal of Strategic and Systemic Therapies

family of Fanny and Alexander or with the partners

Starvation (Selvini Palazzoli, et, 1974) and Paradox

in Scenes from a Marria&e. Bergman's most

and Counterparadox (Selvini Palazzoli, et al., 1978).

autobiographical films.

Think of the powerful

However, I think Selvini Palazzoli does something

images of relationships he has given us: the circus

very different than Haley with her analysis of power.

man who carries his degraded and naked wife over

With Haley, I never feel he touches pain or feelings,

rocks to shield her and dies in the effort ("In a burst

he just cleverly manipulates the system toward a

of unusuaHy profound misanthropy, I wrote a film

chosen goal.

that was baptized Sawdust and Iinsel," Bergman,

Palazzoli's

1988, p.176); the wife who mutilates her vagina

In the therapeutic world of Selvini Palazzoli, when

with the shard of a broken mirror (Cries and

two make a bond, it is not an alliance (for

Whispers); the divorced couple in bed again years

sQmething), but a coalition (against something or

later talking about the infidelities of their marriage

someone).

together (Scenes from a Marda2e). Bergman's life

therapy, Selvini Palazzoli has charted the territory of

and work is uniquely full of painful and poignant

the emotionally disenfranchised -- those who get left

family games.

out of family life.

In this new work with a new team, Selvini Palazzoli

This is the heart of her difficulty with terms. This is

attempts to crack the code of family interactions by

what generates opposition and critiques (see Rakoff,

discerning underlying patterns she calls family

1984; Anderson, et aI., 1986; Treacher, 1986;

games. This has great appeal because it suggests

Angelo, 1989).

that the messy interactions that we only glimpse

strategically manipulative and cybernetically chilling.

parts of in therapy have an underlying order or

I think she shows tremendous reserves of feeling,

meaning. This attempt to bring order to family

aimed fICst, however, not at the health of the family

interactions reminds me of Laing'S Kna1s. (1970). In

but at how the family has made a victim of the

fact, the whole enterprise seems to be one of making

identified patient and hurt other members. The

a typology of family games (although she does not

phrase that has generated the most misunderstanding

agree with this term), charting "a road·map to schizo-

is "positive connotation" which I understand as an

land" in the evocative phrase she once used to

effort to change the family organization and liberate

describe her new work (DiNicola, 1984).

the individual sufferers. But the critics say, if the

Many cases throughout Selvini

~

are about isolation and rejection.

More than anybody else in famity

Critics have seen her work as

symptom is connoted positively, why the elaborate In my reading of Family Games, I was struck by the influence of Haley in getting the parents in charge of the problem, not in Minuchin's structural sense

strategies? And now, why the reference to "dirty games" and the pejorative overtones of "imbroglio"

and "instigation"?

aimed at re-aligning appropriate boundaries, but in terms of power and authority. Haley's influence on

I have a different perspective on this controversy.

the Milan team has been deep, and is evident in ~

Some family therapists stress the resourcefulness of

JOUT1UIl ofStralegic aNl Systemic Tlwapiu

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Vol 9 #2, SlU1IIf/er 1990

families in order to empower them. This is also

prescriptions, I read in her work a creativity aimed

manipulative and strategic, since it is not the literal

not at technique but at theory, and not at therapy but

truth of their situation (see DiNicola, 1988). Now,

at the family itself.

Selvini Palazzoli has a different view of family life, one in which hidden games, dirty games, power games are going on. In these games, there are victims. This is also part of the territory. The question is: what is the value in working with these issues of power and manipulation within the family? For me, this is an empirical question, open to clinical testing. And it is clinically irrelevant that in the U.S., the National Alliance for the Mentally III does not like this message and wants to hear nice things about the families of schizophrenic patients (see Simon, 1987). The psychoeducational model may have its practical uses, but is in its own way part of the problem because it sheds no light on illness and family problems, it just sidesteps these issues (see Hunter, et aI., 1988). We must not yield to revisionism in the human sciences, responding to

interest groups by backing off our analysis of relational problems "with teeth." Freud also was seen as the bearer of bad news about human nature and he was also reviled for saying it. This should not deter our search for knowledge and for therapeutic

However, to some readers, this creativity is disconcerting. Many people feel that her professional audience just begins to understand and apply her work, when she suddenly announces a new approach. Others criticize her for not training therapists in her work. While this is only partially true, she has two answers to this (Selvini Palazzoli, personal communication, June 11, 1987).

First, her

colleagues Boscolo and Cecchin run training groups at their centre, based on work which Selvini PaIazzoli developed with them. Second, and more to the point, she feels that she is a researcher, and wants to work with people who are devoted to the systemic paradigm rather than looking for job training. And in a disarmingly frank aside, she says she does not want to be responsible to trainees while she is searching and experimenting. When I pointed out that by publishing her work, she influences many therapists who adopt her methods, she insists that she needs the intellectual freedom to explore and has never wanted to found a school with followers. In conversation with a leading European psychiatrist

tools.

who is an informed family therapist, another more Selvini Palazzoli's growth has been characterized by

palpable criticism was voiced. Yes, he said, there are

what she calls "U-Turns" -- abrupt changes in her

many creative solutions in her work, but what about

career, from medicine to psychiatry, from

continuity, what about an obligation to the families,

psychoanalysis to family therapy, from paradox to

and to the professional readers who follow her

family games (Barrows, 1982). Lynn Hoffman has

changes diligently?

called her a "discontinuous genius" (cited in Simon, 1987). This reflects a continual intellectual ferment and curiosity that is both admirable and unusual. Although to many she is known for her fascinating Vol 9 #2. Summer 1990

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In my reading, there are three compass points in Selvini Palazzoli's therapeutic odyssey. Each one produced a book with a key idea. Self-Starvation

Journal oJStrategic and Systemic Therapies

(Selvini Palazzoli, 1974) plotted her conversion to

orders given by their therapist" (Miller, 1986, p. 34).

family therapy and its brilliant application to The key is in Watzlawick's

When asked about Miller's critique, Selvini Palazzoli

statement about enlarging the context, to "ever wider

feels that in her new work she has side-stepped this

social units." This remains her best book because it

problem in therapy and moved towards a more

is the richest in scholarship, inventiveness and

positivistic notion of arriving at and speaking the

clinical possibilities. It is frequently cited with

"truth:"

anorexia nervosa.

respect by people in paediatrics and psychiatry who study eating disorders. It has already won a place in the history of medicine. Paradox and Counterparadox (Selvini Palazzoli, et al., 1978) was a window on a stunning and powerful research project that was incomplete. The key is in "positive connotation" that she called the royal road to entering the family's world.

Although it

established the "Milan approach," it also generated

"Regarding Miller's critique, I would say that after abandoning paradoxical interventions, in some ways we are approaching her way of thinking. We are no longer so fixated only on making the symptom disappear as in Palo Alto. But we are very interested allil (and not only) in understanding it, in the sense of connecting it with the type of relational organization . (game) enacted in the family, according to a diachronic temporal sequence that we call 'process' -- anorectic family process, psychotic family process, etc." (Selvini Palazzoli, personal communication, January 30, 1987, my translation).

much controversy. Systemic therapy resonates with the goals of modernism: uncertainty vs. certainty,

Famj1y Games is a continuation of Selvini

irony vs. fact, self-reference vs. objectivity, parody

Palazzoli's research project with anorectic and

vs. sombreness.

schizophrenic families. The key is in the "recurring

Nonetheless, Milan systemic

therapy of the Paradox and CQunterparadox phase sparked sharp critiques (Rakoff, 1984; Treacher, 1986), touching on questions of both technique and ethics. Alice Miller, a Swiss analyst concerned with manipulative techniques aimed at children by education, the family and therapy, perceives Selvini Palazzoli's work in this light: "A pedagogical, manipulative attitude ... could be pointed out behind a great many psychotherapeutic methods ... such as in the various forms of hypnosis or in the new directions in the family therapy (cf. Jay. Haley or M. Selvini-Palazzoli). Selvini PalazzoU's paradoxical method, for example, owes much of its success to the fact that patients are well-trained children. It should therefore come as no surprise if many people enthusiastically accept and carry out strict

JOU17I4l o/Strategic and Systemic Therapies

recognizable phenomena" she calls games: "We have striven to extract from the 'noise' of the psychotic family some recurring recognizable points. The brain can face something unexpected and unknown only if it moves among known and expected phenomena. Otherwise, if everything is unknown, how will the brain orient itself1" (Selvini Palazzoli, personal communication, July 16, 1989, my translation) What about the other members of the original Milan team, Boscolo and Cecchin, what has happened to their modernist approach? Did they abandon it, or pursue it? B. BoscoJo's and Cecchin's New Book: An EpistemolOJY for Systemic Tools

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Vol 982, Summer 1990

"While we were redimensioning the interventionism of the paradoxical phase in favor of prescriptions, another idea c~me to us' Could a certain manner of conductmg the se~sion be effective not only in yielding key information but also in inducing change per seT' --Selvini Palazzoli, et at, 1989, p. 12.

Their book has some excellent features, including a fine introductory chapter to take us from where the original Milan team left off to the current work of Boscolo and Cecchin.

In the construction of

therapeutic tools, they are creative and open-minded. For example, they cite Selvini Palazzoli's invariant

This quote traces the origin of the line of clinical work taken by Boscolo and Cecchin after they split from Selvini Palazzoli and Prata. Selvini Palazzoli et aI., call the work of Boscolo and Cecchin "the pragmatic neo-cognitivist approach" (1989, p. 12, footnote). This cognitive "manner of conducting the session" forms the heart of Boscolo's and Cecchin's current work.

prescription and use a version of it (p. 226). The rest of the book is in four parts, each with a title based on a family therapy. Each part has an introduction and detailed case consultation followed by conversations among the four authors about the case and other issues. Interestingly, the clinical cases begin with a family that was treated by all four members of the original Milan team and it is worth

This book is the first major statement in print from

reading first to see how they all started off and then

Boscolo and Cecchin since their split from their

follow the later changes of Boscolo and Cecchin.

Milan associates. They have appeared at many conferences and workshops, together and singly, stimulating family therapists with their consultation interviews. Both Boscolo and Cecchin and their followers (e.g., Karl Tomm in Canada) have made much of the systemic "epistemology" that informs their work. I have had the opportunity to hear each of them -- Cecchin on the future of family therapy (1984) and Boscolo at a workshop consultation to one of my families in treatment (1988). The only other papers of theirs I know of (since the team split) are their paper on training (Boscolo and Cecchin, 1982) and Cecchin's paper on curiosity (1988). In my own effort to address ethical problems in the use of strategic techniques, I concluded that their future questions are powerful and ethical ways to nudge families towards new, less constraining ways of being together (DiNicola, 1988).

Vol 9 #2, Summer 1990

While all four parts are intriguing and worth reading, two parts stood out for me.

Part three, "The

Anorectic Store," offers a good illustration of their work. It has plenty of examples of the actual process of therapy and then detailed discussion of the therapy by the authors.

Some typical interventions are

highlighted. Boscolo describes "time interventions" in families with rigid ideas about time that is imposed on their relationships. For example, if parents demand that a child act grown up at a certain age, they alternate two elements.

They might

suggest in one session that children should be detached from their parents and in the next session they will suggest slowing down because it is not yet time to separate. "By alternating these two elements, you introduce flexibility.

There is time for

separating, there is a time for not separating" (p. 250).

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Journal of Strategic and Systemic Therapies

sounds a lot like the analytic "blank screen" onto Part four, "The Girl Who Got Stuck to her Mother,"

which analysands project their inner world.

has an interesting elaboration of circular questioning with their use of "openings." An opening is a nodal

The same question can be posed to Milan systemic

event in the session which expresses the meaning

therapy

system in the family.

behaviourists put to psychoanalysis: are mere words

They use openings to

~

la Boscolo and Cecchin that the

introduce circular questions, future questions, and

enough for behaviour change?

Can a different

existential questions in order to perturb the system.

perspective, no matter how startling, different,

to disrupt the thinking pattern of the family by

unexpected, or true for that matter, be sufficient

suggesting new connections "and different

stimulus for family change? Behaviour therapy's

possibilities. Openings do not need to be completed.

critique of psychoanalysis was summed up in the

Openings add up, building new meanings and

slogan, "insight does not equal behaviour change."

connections as the session develops. For this reason,

The Milan interviewing approach provides

I prefer to think of circular questioning with the use

stimulating tools, but are they enough? In their

of openings as ~ because you do not come back

hands, these tools are necessary ingredients but are

to the same point, covering the same ground, since

they sufficient for systemic change? To adapt the

over time (if nothing else) the circular movement

slogan, "circular motion does not carry the system

carries you along a third dimension. This chapter

forward"

illustrates their ability to introduce novelty and modify the family's meanings and connections very

Boscolo and Cecchin call themselves systems

nicely. The elegance and coherence evident in these

consultants rather than family therapists now, but

cli~ical cases makes it all the more important to ask

there are a lot of ways to transform the therapeutic

some critical questions, outside the systemic

task to avoid responsibility. Here are some examples

framework because internal consistency is not the

of the ways in which their book avoids responsibility

only criterion for good hypotheses. Hypotheses also

and critical thought.

have to withstand comparisons and contrasts.

1. ~ In the introductory chapter many suggestions are

How does the Milan interviewing approach differ

made about how to deal with the family's protective

from the methods of psychoanalysis? Or better, what

responses, usually called resistance. (How does this

does it owe to the analytic tradition? Although it is

differ from the psychoanalytic notion of defense

conducted with a family or larger system. it is

mechanisms?)

interactional only insofar as the questions and

sessions with the family as 'consultations' and not

hopefully, the answers, are about relationships. One

therapy" and "just offer a few 'meetings' to the family

person speaks at a time and interactive sequences are

in order to decide what to do next" (p. 22). This is

not acted out, nor shaped behaviourally with

an interesting strategic reframing which has been

"structural" interventions. Furthermore, "neutrality"

used for a long time in consultation-liaison

For example, they "define the

psychiatry when consulting to medical and surgical Journal 0/StraJegic and Systemic T1Ierapks

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Vol

1)

#2, Swnmer 1990

patients who do not see themselves as psychiatric

within the system).

Having decided to work

patients. But it raises problems about the ethics of

authentically within the system as a psychiatrist, I

such statements. Even more interesting and left

find that the first solution lacks courage, the second

unexamined by Boscolo et al. Why has the term

lacks conviction.

family therapy become unacceptable to families? Is this a natural reaction on the part of families or have we done something in the past few decades to put

3.

At times, they display a disturbing lack of

sincerity in some interventions or basic ways of working. They avoid describing their work as family

families on their guard?

therapy, for both theoretical and strategic reasons. They show a contemptuous (not "critical" as

Discussing how to use a team, mostly with sound

this implies reasoned judgement) attitude toward

suggestions, they conclude that, "Sometimes, it

other functions of health care which they call "social

must be admitted, the consultants are imaginary" (p.

control."

The issue is not even superficially

25). How would the therapist feel if he discovered

examined and the proposed solution is facile: "there

that a family had an imaginary member (cf. the

is no problem as long as the therapist is clear about

couple with an imaginary child in Edward Albee's

which hat she is wearing, a 'therapist' hat or a 'social

Who's Afraid of Yir:&inia Woolf! (1965), or realized

control' one" (p. 24). This may work when you

after the session that the real goal of a consultation

have a private practice with middle-class clients who

was to declare someone incompetent? In the 1939

are not seriously disturbed (and are at least as healthy

play Gasli2ht, one spouse tried to get his partner

as you are), but many psychiatrists like myself,

committed to get rid of her.

working in large public hospitals have to wear many

common enough in clinical psychiatry for the

such "hats" simultaneously. I do not have the lUXUry

"Gaslight Syndrome" (Kutcher, 1982) to be named

of prescribing to myself an odd days/even days ritual

after it.

2.

This scenario is

whereby on odd days I will be a social controller and on even days I will be a therapist.

There are

workable answers to this problem, but they are not

To return to Boscolo and Cecchin: are they going to work with families or not? And if families are not the centre of the systemic therapist's concern, what is

provided by systemic family therapy.

family therapy all about? At present, no one method Family

therapy has

been avoiding

such

or school unites the field of family therapy. Some

confrontations with reality by pretending that you

leading voices, like Boscolo and Cecchin, now

can reframe the situation (which often means passing

question its focus on the family. Others like Selvini

the problem along to someone else) or by

Palazzoli are rediscovering the individual members of

complaining about the coercive nature of the mental

the family.

health care system (which means putting oneself

deconstryctin2itself?

Is family therapy a field that is

outside the system either by working in private practice or pretending to be an outsider, or rebel,

Vol 9 #2, Summer 1990

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Journal ofStrategic and Systemic Therapies

one approach to helping some families out of the

Conclusion

peculiar labyrinths they find themselves in. Each

What I conclude from these reflections is that

in

emphasis on technique cannot unite the family therapy field. Rather. a shared concern about the family in all its aspects will bring together a multidisciplinary group of researchers from fields like cultural anthropology. family history and sociology. and clinicians from child psychiatry and psychology. and social work conducting family therapy. to both

contribution has its value. to be tested and proven over time. Neither approach is a complete guide to the nature of family problems or to family therapy. And to return to my opening theme of two therapeutic temperaments: is it merely coincidental that Boscolo and Cecchin. the men of the original Milan team. decided to emphasize therapeutic techniques. while Selvini Palazzoli and Prata. the women of the team. pursued their concerns with

understand and treat family problems.

family processes?

If not. perhaps this reflects

What is the relationship between the Milan

something even deeper than therapeutic temperaments

interviewing approach of Boscolo and Cecchin and

- the different voices of men and women and their

the family games described by Selvini Palazzoli and

"images of relationship" as Gilligan (1982) calls

colleagues?

them.

To me it is quite clear: they are

contrasting visions of the therapeutic task based on different therapeutic temperaments. Viewed together. they form coherent parts of a systemic approach to family therapy. Here are some examples of circular questioning: asking who makes a family member most upset, Who can get a missing member to show uP. who first notices when the identified patient is beginning to display symptoms. etc. It is not far from such questions to constructing models of family games:

who instigates. who gets embroiled in

family intrigues. who plays dirty games. etc. For all the epistemological superstructure and revolutionary rhetoric. Milan interviewing techniques are simply tools:

ways of establishing rapport. getting

information. negotiating a therapeutic contract. What these tools lack as Boscolo et al. currently present them is a framework for their use: a blueprint or road-map. Selvini Palazzoli's "family games" are models of relationships that provide one possible road-map of family life. The invariant prescription is JOIU1IIJI o/StraJegic D1IIl Systemic Therapies

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Family therapy has achieved a degree of maturity that can allow us to differentiate. to tolerate ambivalence and diversity. and to ask self-critical questions. The time has come for family therapy to move beyond empire-building (institutes and schools), gurus ("Master" therapists). retreats (workshops). and venerating saints (St. Gregory) and sacred relics (the holy video. the blessed one-way mirror) in order to face real differences in ways of conducting therapy to meet valid diversities in family experiences. based on age and development, gender. sexual orientation, and other social and cultural variables: A healthy trend was evident in the Philadelphia "Trialogue" between Minuchin. Selvini Palazzoli and Whitaker (Alger. 1982) and the New York encounter between Andolfi and Cecchin on "Neutrality vs. Provocation" (Nichols. 1987).

In order to show that family

therapy actually produces change (outcome research). we have to return to fundamentals that have not been Vol 9 #2, Summer 1990

adequately addressed: family diagnosis and differential family therapeutics. That is: what are the different possibilities for cataloguing the nature of family problems and for their treatment and what can be shown to work for each different kind of problem? These questions should cut across temperamental differences among therapists to keep us focussed on the therapeutic task rather than on our chosen images of our therapeutic identities. To echo an age-old question - - if not now, when?

Cecchin, O. (1988). Hypothesizing, circularity, and neutrality revisited: An invitation to curiosity. Family Process. 26(4): 405-413. de Nichilo, M. (1987). Femminismo: Pomo dena discordia tra terapiste and terapisti familiari americani [Feminism: The apple of discord between female and male American famity therapists]. Terapia Familiare, 25: 23-34. DiNicola, V.F. (1984). Road-map to Schizo-land: Mara Selvini Palazzoli and the Milan model of systemic family therapy. Journal of Strateeic and Systemic Therapies. 3(2): 50-62.

References Albee, E. (1965). Who's Afraid of vireinia Woolf? Harmondsworth, Middlesex: Penguin. Alger, I. (1982). Continuing Education and Training. Trialogue - Philadelphia Child Ouidance Clinic. American Journal of Family Therapy. 10(2): 65-68. Anderson, C.M., Selvini Palazzoli, M. and DiNicola, V.F. (1987). Giochi psicotici; terapia 0 rieerca? [psychotic games: therapy or research?]. Terapja Familiare. 25: 35-47. Angelo, C. (1989) Recensione di I eiochj psicotici nella famjalia [Review of Family Gamesl. Terapja Faroiliare, 30: 61-63. Barrows, S.E. (1982). Interview with Mara Selvini Palazzoli and Oiuliana Prata. American Journal of Family Therapy. 10: 60-69. Bergman, I. (1988). The Maeic Lantern: An Autobjoeraphy Trans. by J. Tate. London: Hamish Hamilton. Boscolo, L. (1988). Systemic family therapy: The Milan approach to families and macro systems. Ottawa, Ontario, Canada, October 2()"21. Boscolo, L. and Cecchin, O. (1982). Training in systemic therapy at the Milan Centre. In R. Whiffen and J. Byng-Hall, eds., Family Therapy Supervision: Recent DeyelOllments in Practice. London: Academic Press, pp. 153-165.

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Cecchin, O. (1984). The future of family therapy. American Orthopsychiatric Association's Annual Meeting, Toronto, Ontario, Canada, April 10.

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DiNicola, V.F. (1985). Family therapy and transcultural psychiatry: An emerging synthesis. Transcultural Psychiatric Research Reyiew. 22(2 & 3): 81-113, 151·180. DiNicola, V.F. (1988). Saying it and meaning it: Forging an ethic for family therapy. Journal of Strateeic and Systemic Therapies. 7(4): 1-7. DiNicola, V.F. (1989). The child's predicament in families with a mood disorder: Research findings and family interventions. Psychiatric Clinics of North America, 1989: 12(4): 933949. DiNicola, V.F. (In 1990). Family therapy: A context for child psychiatry. In J.O. Simeon and H.B. Ferguson, eds., Treatment Strateeies in Child and Adolescent Psychiatry, New York: Plenum, pp. 199 - 219. Gilligan, C. (1982). In a Different voice: Psycholoaical Theory and Women's Deyelopment. Cambridge, MA: Harvard University Press. Haley, J. (1986). The Power Tactics of Jesus Christ and Other Essays. Second edition. Rockville, MD: Triangle Press. Hunter, D.E.K., Hoffnung, R.I. and Ferholt, J.B. (1988). Family therapy in trouble: Psychoeducation as solution and as problem. Family Process. 27(3): 327-338.

Journal ofSlralegic and Systemic Thi!rapiu

Jaspers, K. (1963). General PsychQpatholou. Trans. from the 7th German ed. by J. Hoenig and M.W. Hamilton. London: Manchester University Press. Kissinger, H. (1973). A World Restored: Metternich. CastJerea2b and the Problems of ~ Boston: Houghton Mifflin Co. Kutcher, S.P. (1982). The Gaslight Syndrome. Canadjan Journal of Psychjato', 27(3): 224-227. Laing, R.D. (1970). K.rul11. London: Tavistock Publications. Miller, A. (1986). Thou Shalt Not Be Aware: Society'S Betrayal of the Child. New York: New American Ubrary. Nichols, M.P. (1987). On the Circuit. The Fox and the Bear: Gianfranco Cecchin and Maurizio , Andolfi debate neutrality vs. provocation. ~ Family Therapy Networker. Jan-Feb: S9-62. Pines, M. (1982). Restoring law and order in the family: Therapist Jay Haley talks about disturbed power relationships in modem families. PsychoJo&y Today, November: 6069. Rakoff, V. (1984). The necessity for multiple models in family therapy. Journal of Family Therapy, 6: 199-210. Selvini Palazzoli, M. (1974). Self-Starvation: From Indiyidual to Family Therapy in the Treatment of Anorexia Neryosa. New York: 1ason Aronson. Selvini Palazzoli, M., Boscolo, L., Cecchin, G. and Prata, O. (1978). Paradox and CounteJ:paradox: A New Model in the Therapy of the Family in Schizophrenic Transaction. New York: Jason Aronson. Simon, R. (1987). Goodbye paradox, hello invariant prescription: An interview with Mara Selvini Palazzoli. The Family Therapy Networker. 11 (S): 16-2S. Treacher, A. (1986). Invisible patients, invisible families •• A critical exploration of some technocratic trends in family therapy. Journal of Family Ther'llY, 8 (3): 267-306.

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