Mental Research Institute [MRI]

1. Athlone Institute of Technology Counselling and PsychotherapyStrategic and Milan Approaches in Family Therapy

2. Mental Research Institute [MRI] In 1959 Don Jackson founded the MRI and this institute included; • Jay Haley • John Weakland • Paul Watzlawick and • Virginia Satir

3. MRI • The MRI model focused on presenting symptoms and was limited to 10 sessions • This approach was greatly influenced by Milton Erickson; ‘One of his guiding premises was that problems apparently residing in one person are frequently associated with the difficulties resulting from a family need to change and reorganize at key transitional stages…’ (Dallos and Draper 2000:44)

4. Axiom 1 • The 1st axiom (accepted principle) is that people are always communicating…..i.e. one cannot not communicate whether we communicate verbally or non-verbally • Communication also takes place whether it is not intentional, conscious or successful

5. Axiom 2 • All messages have report and command functions • The report or the content of a message conveys a message, while the command is a statement about the definition of the relationship e.g. ‘Mom, Sandy hit me!’ conveys information but also implies a command - ‘Do something about it’ Remember printed word does not include context and facial clues

6. Axiom 2 • In families, command messages are patterned as rules. • Jackson used the term family rulesas a description of regularity, not regulation. ‘Nobody ‘lays down rules’ as families are generally unaware of them. (Nichols and Schwartz 2004:152)

7. Axiom 2 • Rules of family interaction function to maintain family homeostasis. Jackson described homeostasis as a conservative function and is similar to the cybernetic concept of negative feedback

8. Communication theorists • Communication theorists are interested in circular causality and analyse patterns of communication rather than looking for a purpose for the behaviour • When the response to a family’s problem aggravates the problem, that chain is seen as a positive feedback loop (Sam’s example)

9. Positive feedback loop • Strategic therapists would surmise when positive feedback loops emerge in a system it can be indicative of change about to occur in a system • ‘…positive feedback amplifies innovations to accommodate to altered circumstances.’ (Nichols & Schwartz 2004:154)

10. First order change versus Second order change • First order change: occurs when a specific behaviour changes in the system • Second order change: occurs when the rules of the system changes. One means of doing so is to use technique of reframing

11. Haley and Hierarchy • In addition Haley believed that hierarchy in family was crucial to observe as he had worked with Minuchin and had engaged with structural concepts in that time • He stated that he found many inadequate parental hierarchies behind most problems. He stated ‘…an individual is most disturbed in direct proportion to the number of malfunctioning hierarchies in which he is embedded.’ (Haley 1976:117)

12. Interventions in strategic family therapy Interventions in strategic family therapy involve the following: • Conceptualisation/formulation of problem • Reframing • Giving directives and • Reviewing progress

13. Interventions in strategic family therapy 1 Giving directives may involve: • Addressing hierarchy incongruities by directing a subordinate Dad to take charge of a child and give Mum a well earned rest from the child’s misbehaviour (Carr 2000:86-90) • With adolescent conduct problems exist with a covert alliance between mother and child, Haley directed both parents to co-operate to treat the adolescent as a disobedient preadolescent until adolescent behaves more responsibly

14. Interventions in strategic family therapy 2 • In this context behaviour is reframed as been controllable rather than uncontrollable and an incongruent hierarchy is also being addressed • ‘Haley cautions against addressing marital discord directly,…’ (Carr 2000:90)

15. Overview of MRI approach Nichols and Schwartz 2004:153 would describe the approach as elegantly simple: • Identify the feedback loops that maintain problems • Determine the rules (or frames) that supports these interactions • Find a way to change the rules

16. Milan Systemic therapy • The Milan associates came together in 1971 and followed the basic MRI concepts but differed in that they saw the whole family • They were interested in ascertaining what the ‘family games’ were and then by positively connoting the behaviour they aspired to neutralise resistance

17. Milan Associates 1 • The group consisted of Selvini Palazzoli, Prata, Boscolo and Cecchin and they utilised Watzlawick as a consultant • Their background was psychoanalysis and psychiatry • In 1980 the group split, Palazzoli and Prata remained interested in research, and Boscolo and Cecchin moved towards training

18. Milan Associates 2 ‘…The women pursued their interest in the destructive games in which they believed severely disturbed families were caught up, the men grew increasingly less strategic and more interested in changing family belief systems through a process of asking questions.’ (Nichols & Schwartz 2004:151)

19. Milan Associates 3 • Training was the ‘death nail’ of knowledge as far as Palazzolli was concerned. She believed by taking ‘training money’ in training institutes one is expected to be consistent in approach and this stifled creativity and learning • Ironically she set up a training institute towards the end of her life

20. Milan model 1 • Cecchin and Boscolo would presume that the family are attempting to survive as a family – if a family are thought to be doing something ‘bizarre’ it is useful to ask the family how they think this behaviour contributes to the survival of the family • Cecchin also spoke of concept of INTENTION and EFFECT in a therapeutic context

21. Milan model 2 • Where a family keeps a secret – the INTENTION is not to hurt or split up the family – but the EFFECT maybe that the family feels cut off from each other and may undermine relationships

22. Milan model 3 • Boscolo and Cecchin were very interested and engaged with delivering seminars and with training therapists • In process of setting up a training programme they were taken aback when the trainees focused on and questioned the therapist and were not focused on the family!!!

23. Milan model 4 • This became a pattern in training groups and they were both very interested in the phenomenon & set up observation groups (of family) away from each other who came up with different stories/hunches (hypotheses) • At this time they met Maturana (biologist) who believed what we know is programmed and is triggered by the outside (constructivism). Maturana also believed human beings cannot be instructed to do anything

24. Milan model 5 • Boscolo and Cecchin felt they had found a useful theory – Therapy is about conversations that helps clients bring forth, out of its own store, new possibilities for itself • First therapists to look at 2nd order cybernetics and to look at language in context of therapy

25. Milan model 6 • Therapist reflexivity was also an idea they started to reflect upon • They moved away from giving interventions to the family, to the idea that the conversation was the intervention

26. Milan model 7 Utilises the format of a 5 part session: • The pre-session – formulate hypotheses • The session – validate, modify or change the hypothesis • The intersession – discussion on how to intervene and proceed with the family • The end of session – may include an end of session intervention • The post-session –team review the session and generate new ideas or hypotheses

27. Hypothesising, Circularity and Neutrality • Following visit to USA in late 70s where they were asked how they did what they did the seminal paper in 1980 ‘Hypothesising-circularity-neutrality: Three guidelines for the conductor of the session’ was written

28. Neutrality 1 • Therapist is neutral in respect of individuals – he/she doesn’t side with anyone in particular • He/she is not prejudiced about an idea, solution, hypothesis or definition of the problem • He/she is not on the side of change versus no change

29. Neutrality 2 • The team received considerable criticism about the concept of neutrality –seen as taking a cold, aloof position as well as not taking responsibility where necessary • Cecchin responded by writing paper in 1987 and introduced concept of curiosity

30. Curiosity ‘An interviewing position of impartiality, characterised by an openness not only to the validity of each member’s viewpoint, but also an openness to multiple possible constructions of clients’ situations and a respect for the integrity of the system and its way of operating. Cecchin offered curiosity as a social constructionist refinement of the therapeutic position of neutrality.’ (Carr 2000:145)

31. Hypothesising definition 1 ‘Developing a tentative systemic mini-theory about some aspect of a system, the validity of which is subsequently checked out through interviewing and observation. Information from interviewing and observation may lead to successive modifications and refinements of hypotheses…’ (Carr 2000:143)

32. Hypothesising definition 2 • ‘…consists of the elaboration, by the therapist and team, of speculations, guesses, assumptions and explanations about the family situation, on the basis of information about the family available at the stage of the therapy, as well as on the basis of normative assumptions and the therapist’s experience with other families.’ (Jones, E. 1994:14)

33. Hypothesising 2 • Caution about ‘falling in love’ with your hypothesis and believing them to be true and permanent • Construct more than one hypothesis and this will alleviate the likelihood to do so and will facilitate creativity

34. Hypothesising 3 ‘Hypothesizing is more to do with technique. Curiosity is a stance, whereas hypothesizing is what we do to try to maintain this stance.’ (Cecchin 1987:411)

35. Exercise • Individually utilise a case study & formulate 2-3 hypotheses in relation to the case (5 minutes) • Explore how you think these hypotheses may influence how you proceed with the case – What are you curious about? What questions would you be asking? Who would you be enquiring about? (5 minutes) • In pairs discuss and describe your cases, then process how you think the use of hypotheses may or may not influence your practice with this particular client/s (15 minutes)

36. Circularity • Being circular in one’s approach means to include everyone in the conversation, where one builds on what already has been discussed, and being circular means elaborating and developing questions in a way that introduces new information into the system • Circular questions accommodates this position

37. Circular Questions • Circular questions allows one to check out the validity of one’s hypothesis in relation to the family and the therapeutic system • Information gleaned from the circular questions are used to modify successive hypothesis • This is a recursive process

38. Types of Circular Questions Questions about sequence of events and interactions:What happened next? Questions about comparison: Who was the most worried, upset, active, inactive? Questions about agreement:Who would agree and who would disagree? Questions about explanation:What explanation would you give and/or do you think others would give for..? Questions about the future: Suppose X were to happen then how would things be different in 6 weeks/months?

39. Exercise Circular Questioning • Using the case you had been reflecting upon work in same pairs and utilise circulate questions to check out the validity of your hypotheses • Remember to modify your hypotheses as you gather more information • Each person role-plays for 10 minutes and then process for 7 minutes