Breakingtheparadoxwithanumberof

smallerparadoxesthatareboundtogether
byabroaderparadox,andtherapy.

Whatis(Milan)systemictherapy?

AngusCornwell
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HPSC3023MajorEssay

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Preface

Thishasnotbeenaneasypapertoresearchinthetimeperiodallowed.Ithas
beenevenmoredifficulttowrite.

Theprocesshasbeenpersonallyinvolved.Ielectedtowriteonthissubjectasthe
Milanschoolisstillrelevantinanumberofmethodologicalregardstothe
contentofHPSC3023,butalsoasanopportunitytobetterunderstandmyfather
oneoftheoriginalsystemictherapycoconspirators.Inaddition,Iamveryfond
ofDr.BoscoloandhiswifeDr.Pereira,andgratefulfortheirhospitalitywhileI
wastravelling.Themythologicalcharactersofsystemictherapy,Boscoloand
Checcin,wereoftenthelifeofchildhoodstories.Ihaveattemptedtobeas
impersonalaspossible.Thisisacaveatforthereader.

OnewayIhavedecidedtoshowrespecttothegroupsimmenselycomplexbody
oftheorywasbynotassumingtheshowy,ambitiousvoiceofahighlevelcritic,
butratherretainingthepositionandthevocabularyofanundergraduate
PhilosophyofSciencestudentwith,aboveall,loyaltytohistoricalfactsand
engagementoftheleastcontentiousextrapolationsthereupon.

Theapparentlackofprecarious(interesting)generalisationsaboutthebroader
influenceofsystemictherapywhichisundeniablystillinfluentialinfieldwork,
thoughlesssothanatthetimeofitsinceptionintheearly1970smayappearat
oddswiththecharacteristicallysystemicobjectiontoconceptualisationof
discreteentitiesinavacuum.Whilethisisessentiallyahistoryofideas,
particularlyinlieuofsuchgeneralisations,itisappropriatetoincorporateafter
thefactcriticismoftheMilanmodel,justasitissotodiscussthedominant
paradigmoftherapythatthegroupsworkrespondedto.Thus,theMilangroup
maybethoughtofasthefocus,ratherthanthesoletopicofthispaper.

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Thesystemictherapymovement(alsoknownastheconstructivisttherapy
movement)beganinMilan,1betweenfourItalianpsychiatristsdevisinganovel
therapeuticmethod,elaboratingonthecybernetictheoryofGregoryBateson.2
Dr.Palazzoliandherteamhadpreviouslyworkedontherapeuticapproachesin
dealingwithanorecticgirlstheeffectivenessofwhichwasunclear3and,
frustratedyeteagertoexpandonthemethodologicalframeworkshehad
developed,in1971sheledagroupofthreeotherdoctorsofapsychoanalytic
persuasion4Boscolo,CecchinandPratainresearching(Bleurean)
schitzophreniccommunicationpatterns.5

Theoriginalgroupwascontemporaneouswiththeheydayofpostmodern
thought,whichofferedagapingentryforanew,experimentaland
interdisciplinaryapproach,mirroringtrendsinliterarycriticismandphilosophy.
Awindfallfrompostmodernthoughtontherapywasthepossibilityof
describingtherapeuticphenomenainalternativemodes.Whilethereisno
suggestionthatacompetitivescramblewasinitiatedintheearly1970stoseek
new,alternativemodesofexpression,originalityinthisnewintellectual
atmospherewascelebratedinthehopeitwouldleadtoacredibleand
ultimately,whenelaborated,moredescriptiveandinstructivemeansof
accessingthestufforessenceoftherapytheeffectivenessofwhich,forthe
Milangroupspurposes,wasalreadyevident.Itmustbestressedthatwhat
pragmatictherapistswhoseprincipalconcernwastoexplaintheusefulnessofa
styleofworkingthattheyfelthadalreadybeenvalidatedintheirownparticular,
apt,rehearsedpracticeanticipatedfromanopen,egalitarianapproachinaslew
ofcoexisting,nonexclusivemeansofdescription(psychoanalytic,constructivist,
etc.),wasanultimatelysuperior,empiricallyadequateaccountofthesubstance

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oftherapy.Theprimaryobjectiveofsystemicresearchwastojustifyaswellas
demystifyacollectionofmethods,informedbyanewtherapeuticframework,
thatweredeemedtobeeffective,andthendevelopthemfurther.

Theliteraturethathasarisenfromfortyyearsofresearchinandteachingofa
therapeuticparadigmthatrejectsthelanguageandgeometryofitslineageis
dense,complexandesoteric.Fortunately,theproblemofidentifyingthe
dominantmodeofthegroupisremarkablystraightforwardatthislevel:while
thereishealthydebateatitsperipheries,andanoteworthysplitbetweenits
founders,Systemictherapyasamovementhasbeenresolutelyloyaltosomekey
conceptsthatwillbediscussedinthispaper.Somuchso,thatithasbeenargued
thatthesystemicmovementconstitutedaformofItalianorpanEuropean
nationalismduringtheColdWar.6

CriticaltothesplitoftheoriginalMilanteamwasthewaningfaithofBoscoloand
Cecchinintheusefulnessofpathogenicconceptsinrealtherapy.7Althoughthey
wouldnotdiscounttheimportanceoftheseconceptsaltogether,theysaw
orthodoxpsychiatryascouchedinaCartesianlanguagethatilluminatedcertain
arcsofundesirableinteraction,butfailedtoaccountforthesocialstructurein
whichitwasinterpretedandreinforced,andthereforerequiredimprovement.8
Forsimplicity,whereanytentionarises,thispaperrevertstotheviewsofthe
dominanttraditionofsystemictherapyasitwascarriedonbyBoscoloandthe
lateCecchinwho,astheirinterestsdivergedfromthemoreacademicallyfocused
women,foundedtheeminentCentroMilanesedeTerapiadellaFamiglia,with
teachingcollegesacrosstheworld.

PalazzoliandPratacontinuedresearchalongmoreconventionallines,searching
foraonesizefitsallunitarylawofsuccessfulintervention.9BoscoloandCecchin
werereluctanttomakesuchambitiousclaimsaboutanyonetherapeutic
method.Oneofthestrengthsofthetheirmethodologywasitsflexibilitywith
respecttointerpretationsandindividualinterventions.10Thishasenableditto

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coexistwithmanytherapeuticstylesthathaveariseninthelastfortyyears,and
tothatitowesitssomelongevity.

Fundamentally,thegroupwascriticalofwhattheysawastheinadequate
analogicalgeometryofwesternpsychiatry:tothem,orthodoxpsychiatric
thoughtwasstiflinglylinearortwodimensional.11Theybelievedthatthe
characterisationofmentalillnessasadiscreteentity,containedwithinthe
individualsufferer,hadhamperedpriorattemptstoilluminatemental
phenomena,andthisexplainedtheineffectivenessoftherapywhereithad
failed.12ABatesoneancyberneticanalogywasdesirableasitimpliedthe
sequentialengagementofdifferentpartsofaninconceivablycomplexbut
reduciblesocialcircuitry,andadmittedfeedbackacriticalconstructfor
systemictherapy;logicalredundanciesthatthesystemicpractitionerwas
trainedtoperceiveandforgeintotherapeutictools.13

Batesonandhisresearchgroupmovedtowardsapositionof
seeing disorders, such as schizophrenia, in terms of
communication patterns within individuals and within
families, rather than in terms of biogenic or intrapsychic
pathology.14(Becvar&Becvar,1998)

AccordingtoBoscoloandCecchin,thenotionofdifferenceiscircular.15Where
inescapablelinguisticconventionsframeitasbeingapropertyofadiscrete
thing,itimpliesarelativerelationship.BorrowingatermfromShands,they
termedthisthetyrannyoflinguisticconditioning.16

Onethingsystemictherapyclaimedtoprovidewasaresponsiveandreflexive
newframefortheunderstandingofmentalillness:itofferedanewrelativity,
accountingforthesubjectivemeaningandimpactoftheseconditions.Itseemed
fallacious,forexample,topathologiseschitzophrenicbehaviouroutsideofthe
sociosemanticsphereoftheaffectedparties.17Inthismodel,thenotionof
alleviatingsymptomswithoutaddressingthestructureinwhichtheywere
problematisedwasincoherent.Whereafamilysoughthelpwithoneormore
memberswhoweresufferingfrom(inflicting)mentalillness,Boscoloand

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Cecchinfeltthatinfacttheywerereallyseekinghelpincopingwithdysfunction
intheirfamilysystem.18

AccordingtotheMilangroup,thislogicalleapwastheprincipalparadoxfaced,
indifferentforms,byfamilieswhopresentedtotherapy.Theobjectofsystemic
therapywastoisolatethisandothersuchparadoxes,andillustratetheirillogic
tothesubjectsusingaseriesofcounterparadoxesanobliquewayofguiding
thefamilytochange,withoutprescribingitdirectly.19Thesecounterparadoxes
oftenreframedapparentlypathogenicbehaviour,andinsomecasesencouraged
itredirectingitintopositiveoutletsorstiflingitscontraryimpetus.20These
interventionsweretypicallyleftoffieldand,astheMilangroupconsidered
familiestobecomplexandthereforenotmeaningfullyreduciblebeyonda
cyberneticunderstanding,interventionswerenecessarilytailoredtoindividual
cases.Thecombinationofthesetwofactorsaffordingthegroupamystical
authoritywhichtheyusedwarily,asinthefollowingcase:

Afamilythathadbeenreferredtotherapyasayoungsonanonlychild
regularlytruanted.Inthecourseoftherapyitwasdiscoveredthattheboys
grandmotherhadrecentlydiedandhewasspendinghisdayswithhisremaining
grandmother.Afteracourseoftherapy,BoscoloandCecchinexplainedtothe
familythatinsteadofattendingclass,theboywasattendingtheschoolofthe
grandmotherlearninghowtobeagrandmotherasheunderstoodshewould
soonbegone,too.21

Inreframingthesonsnegativebehaviour,thetherapistshadsucceededin
disarmingthefamilysmismatchofpurposes.Whatevertheactualtruthofthe
statement,orthemagnitudeoftheresidualproblemoftruancy,thetherapists
hadmadeanopeningintoconciliationoftheindividualsneeds.

AquestionthatwasconstantlyposedtotheMilangroupbywouldbesystemic
practitionerswashowthegrouphitupontheirexactinterventions.22In1985,
BoscoloandCecchinpublishedapaperthatexplicatedthreetenetsoftheirstyle
oftherapy.Intwentypages,Hypothesising,Circularity,Neutralityattemptedto

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demystifytheMilanesemethods.23Thepaperdescribedthegroupselaborate
useofonewayscreens,videotechnologyandteamsthatmonitoredeachother
andchallengedeachothershypotheses.Onananecdotallevel,itexpoundedthe
necessityofescapingorthodox,linearthought.

Thepaperwentontoarguethatmaintainingtheappearanceofabsolute
impartialityamongstthepartiesintherapywasofparamountimportance.Tobe
effectivethetherapistmustnotbeseenasanymorecriticalofonefamily
memberthananyothertheymustresistconstantoverturesfromanyparty
seekingtoformanalliance.24CircularquestioningtheMilangroupsarchetypal
interviewingtechnique(primarily,askingfamilymemberstoexplainhowthey
feelabouttherelationshipsofothersinthepresenceofallparties)wasbalanced
precariouslywiththepriorityofimpartiality.25Askilledtherapistwould
sacrificeneither.

Typically,familytherapywassoughtinconsultationwithareferringphysician,
afteroneormorefamilymembershavebeendiagnosedusingconventional
tools.26Thisissignificantasitshowsactiveintegrationofanorthodox
therapeuticschedulealbeitperhapsasavalidreadingofaffairs.

InMilaninthe1970s,theimmediatefamilyofthesuffererwasdeemedthemost
importantimpactedsystem,andprobablyalsothemostreceptivetogroup
therapy.Whileintheliteraturesystemicfamilytherapywasnevercarriedout
ongroupsotherthanthoseboundbydomestic,filialormaritalties,nonfamily
membersweresometimesdrawnin.27

Atroublingaspectofthegroupsliteratureisthetendencytoengagecomplex,
jargonloadedtheoryand,inremovingitfromthecontextofitsintendeddomain,
createconfusingareaswhereareaderwouldreasonablyexpecttheanalogythat
isdeployedtheappropriatedtheorytoextendbeyondtheauthorsintended
limitswithrespecttotherapy.Outsideoftheexplicitcontentofthechapters,the
meaningoftheseanalogiesisambiguousitisunclearexactlywhat,andhow

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much,theauthorsaretryingtosay.Insomecasesitisunclearwhatpointiseven
beingmade.

ThereisnobetterexamplethantheevocationofRussellsParadoxthroughout
ParadossoeContraparadosso.28RussellsParadoxreferstoacontradictionin
logicalsettheorywhereinaclassofsetsthatarenotmembersofthemselves
necessarilyincludesthismetaclassitself(therebysimultaneouslyrequiring,and
excludingitfromtheset).29InParadossoeContraparadosso,itisusedtodescribe
thelogicalleapmadebyfamilieswhopresenttotherapywantinghelpbut
havinghomeostaticexpectationsimplicitlynotwantingtochange.30The
paradoxledRusselltoproposeatheoryoflogicaltypesforlogicalsettheory,in
whichinferencesaboutagivensetwereonlyvalidinthelevelofabstractionthat
pertainedtotheparametersofthatset.31Thistheoryoflogicaltypesisthen
takenoncemoreinParadossoeContraparadossotorelatethelogicaldistinction
betweenperceptionsandactions.32

Gettingacquaintedwithsystemicliterature,itbecomesevidentthatthese
borrowedtheoriesarenotpriortothesystemicmethod,butweresimply
resonantwithPalazzolliandhergroupastheyelucidated(indicatedorimplied)
somephenomenonthatcamefromexperienceintherapyandhadnotpreviously
beenarticulatedorwasdifficulttorelatetoexperienceoutsideoftherapy.The
MilangrouphadpracticedtherapyandthenreadBateson,andinhisworkhad
foundnewlanguagethatcouldbettercharacterisepreviouslyinaccessible
phenomenathathadbeenobservedintheirowntherapy.Thismetalanguage
wasappropriatedfromageneraltheorythataddressedaperceivedlimitationin
phenomenology,whichhappenedtobethesamelimitationthatwasbeing
encounteredatthemarginsoftherapynamelythatofdiscretesemioticsina
continuousandinfinitelyinterconnectedworld.

Becauseoftheambiguitythatsurroundedtheirappropriatedtheory,itis
impossibletodecryptsystemicliteraturewithoutaninterpreterwith
appreciationofunwrittensubtexts,orelsebybeingsointimatelyinvolvedinreal

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therapythatthesamerelationshipofaweishadwiththetheoriesthatwere
resonantfortheMilangroupatthetimetheywrote.

TheMilangroupbelievedthattheycoulduseaBatesoneanframeworktotalk
abouttherapy,notjustconductitacyberneticallyframedmetatherapy.33Itis
abingeonsuchreductiveideasthatlittleRealistBarbaraHeldwarnscanherald
adeparturefromreality.34Thegroupsgroundinginrealtherapyandregardfor
irreverence,wherebytherapistsarediscouragedfrombeingtoofixeduponany
onetheoryisaninbuiltdefenceagainstsuchaflight.Systemictherapystood
outsideitselfasaselfcriticalmeasure,andtoacknowledgeitsepistemological
lineage.35Nevertheless,Heldchargesconstructivisttherapywiththeantirealist
insistencethatweallmakeratherthandiscoverreality.36

In1990,Boscolo,BertrandoetalpublishedapapercalledLanguageandChange,
abouttheusefulnessofambiguousorunfalsifiablestatementsinencouraging
subjectsoftherapytofindtheirownmeaningandpromoteintrospection.37
Whileitisconceivablethatreflectionwouldaidasubjectindiscoveringhisor
herownlogicalinconsistencies,thepaperofferslittletodemonstratethe
effectivenessofthetechniqueinquestionandleavesthereaderwonderingto
whatextentdeploymentissimplyincidentaltothesuccessoftherapy.Innot
observingscholarlyprotocol,thislackofrigourexemplifiespsychotherapy
exposingitselftocriticismfromthepsychiatricestablishment.

Onthesurface,aproblemforthegroupsresearchparticularlyinto
schizophreniaandpsychopathyappearstobehowaviabletherapycouldclaim
todealsystemicallywithseriousorganicmentalillness.Firstly,foranyanti
psychiatricconvictionsthesystemicviewentailedwithrespecttolabelling,the
Milangroupdidnotsharethelibertarianideologicalunderpinningsofsuch
thinkersasSzasz,whoemphasisedtheimportanceofpersonalresponsibilityin
fosteringsociallyacceptablebehavour.38Furthermore,psychotherapywasable
tododgethissortofcriticismsolongasitdidnotdenyaplacefororthodoxy,
andinsteadclaimedtocoexistwithandcomplementit.Theresultingproblemis
whether,andhowmuch,thisdeferencediminishestheclaimtherapyholdsover

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efficacyindealingwithpsychiatricproblems.Iftheterritoryoffamilytherapyis
notthepathologyoftheindividual,butratherthecircuitryofinteractionsina
socialgroupthatleadtodysfunction,thenthispaperpositsthatsystemictheory
mustrelyonpsychosomaticmedicine,andthusanonsystemicframework,to
solveproblemsthatarebeyonditsscope.Thus,whiletheconversemayalsobe
true,psychiatrycandothingsthatsystemictherapycannot.

Drawingonsystemstheory,Milanesethoughtofferedalensforseeing
therapeuticphenomenathatsoughttoextendtheopticsofconvention.Onthis
basis,itclaimedtobeastartingpointforbettermethodologythatattendedto
anunclosableyettamabledualisticdisjunctionbetweenthewaythingswere
thoughtofandthewaythingsare.

Systemictherapyhasbeeneffectiveovermanythousandsofcases,andaslongas
theCentroMilanesedeTerapiadellaFamigliacontinuesteaching,itcontinuesto
bepracticed.Butissystemictheoryjustanartifactofitstimeaseriesof
reactionstophenomenologicalproblemsintherapyordoesithaveenduring
relevance?InthepostMilanera,39itisunclearhowviableitwouldbetoextend
suchanobscureandcounterintuitiveresearchprogramme.Yetinofferingan
alternativetoDSMstylepathology,itmaybeanepistemicprecedentformore
effectivetherapyatthemarginswhereorthodoxpsychiatryisblindtoits
assumptions.

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Finalwordcount(ex.introduction,quotations,bibliography):2,420

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1 Becvar,D.S.&Becvar,R.J.,(7thed.,2009)FamilyTherapy:asystemic
integration.Firstpublished1988.PearsonEducation,Boston.pp.217225
2 Tucker,K.(2000)TheMilanApproachtoFamilyTherapy:acritiquein
PrioryFamilyTherapyOnline.<URL:http://priory.com/psych/milan.htm>
Accessed5/4/11.
3 Tomm,K.(1983)OnePerspectiveontheMilanSystemicApproach:PartI.
overviewofdevelopment,theoryandpracticeintheJournalofMaritaland
FamilyTherapy.Vol.10[2],1984.p.113125
4 Ibid.pp.114
5 Palazzoli,M.,Boscolo,L.Cecchin,G.,Prata,G.(1978)Paradossoe
Contraparadosso.Englishtranslation.JasonAronson,NewYork.pp.18
6 Cornwell,M.(2009)ConcludingaddresstotheSiminarioResindenziale2009
oftheCMTF.<URL:http://www.cmtf.it/pdf/albero_locandina.pdf>,
Accessed16/5/11
7 Tomm,K.(1983)OnePerspectiveontheMilanSystemicApproach:PartI.
overviewofdevelopment,theoryandpracticeintheJournalofMaritaland
FamilyTherapy.Vol.10[2],1984.pp.113125
8 Ibid.
9 Ibid.
10 Selvini,M.P.etal(1980)HypothesisingCircularityNeutrality:three
guidelinesfortheconductorofthesessioninFamilyProcess.Vol19[1],Mar
1980.pp.312
11 Palazzoli,M.,Boscolo,L.Cecchin,G.,Prata,G.(1978)Paradossoe
Contraparadosso.Englishtranslation.JasonAronson,NewYork.pp.18
12 Tomm,K.(1983)OnePerspectiveontheMilanSystemicApproach:PartI.
overviewofdevelopment,theoryandpracticeintheJournalofMaritaland
FamilyTherapy.Vol.10[2],1984.p.113125
13 Boscolo,L.,Bertrando,P.(1993)TheTimesofTime:anewperspectivein
Systemictherapyandconsultation.W.W.Norton&Company,London.p.85
14 Becvar,D.S.&Becvar,R.J.,(7thed.,2009)FamilyTherapy:asystemic
integration.Firstpublished1988.PearsonEducation,Boston.p.20
15 Ibid.
16 Palazzoli,M.,Boscolo,L.Cecchin,G.,Prata,G.(1978)Paradossoe
Contraparadosso.Englishtranslation.JasonAronson,NewYork.pp.5154
17 Ibid.pp.2124
18 Ibid.pp.18
19 Palazzoli,M.,Boscolo,L.Cecchin,G.,Prata,G.(1978)Paradossoe
Contraparadosso.Englishtranslation.JasonAronson,NewYork.pp.157
162
20 Ibid.pp.157162
21 Kolko,D.J.,Milan,M.A.(1983)Reframingandparadoxicalinstructionto
overcome"resistance"inthetreatmentofdelinquentyouths:Amultiple
baselineanalysisintheJournalofConsultingandClinicalPsychology.Vol
51(5),Oct1983.pp.655660
22 Selvini,M.P.etal(1980)HypothesisingCircularityNeutrality:three
guidelinesfortheconductorofthesessioninFamilyProcess.Vol19[1],Mar
1980.pp.312

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23 Ibid.
24 Ibid.
25 Tomm,K.(1983)OnePerspectiveontheMilanSystemicApproach:PartI.
overviewofdevelopment,theoryandpracticeintheJournalofMaritaland
FamilyTherapy.Vol.10[2],1984.p.113125
26 Palazzoli,M.,Boscolo,L.Cecchin,G.,Prata,G.(1978)Paradossoe
Contraparadosso.Englishtranslation.JasonAronson,NewYork.pp.18,
183n1
27 BoscoloL.&Bertrando,P.(1996)SystemicTherapywithIndividuals.
KarnacBooks,London.pp.91133
28 Palazzoli,M.,Boscolo,L.Cecchin,G.,Prata,G.(1978)Paradossoe
Contraparadosso.Englishtranslation.JasonAronson,NewYork.pp.78
29 Landini,G.(1998)Russellshiddensubstitutionaltheory.OxfordUniversity
Press,NewYork.
30 Tomm,K.(1983)OnePerspectiveontheMilanSystemicApproach:PartI.
overviewofdevelopment,theoryandpracticeintheJournalofMaritaland
FamilyTherapy.Vol.10[2],1984.p.113125
31 Landini,G.(1998)Russellshiddensubstitutionaltheory.OxfordUniversity
Press,NewYork.
32 Palazzoli,M.,Boscolo,L.Cecchin,G.,Prata,G.(1978)Paradossoe
Contraparadosso.Englishtranslation.JasonAronson,NewYork.pp.78
33 Ibid.pp.321
34 Held,B.(1995)BacktoReality:acritiqueofpostmoderntheoryin
psychotherapy.W.W.Norton&Company,London.pp.2954,236n3
35 Cecchin,G.,Lane,G.,Ray,W.A.(1993)FromStrategizingto
Nonintervention:towardirreverenceinsystemicpracticeintheJournalof
MaritalandFamilyTherapy.Vol.19[2],1993.pp.125136.
36 Held,B.(1995)BacktoReality:acritiqueofpostmoderntheoryin
psychotherapy.W.W.Norton&Company,London.p.ix.
37 Boscolo,L.,Bertrando,P.,etal(1990)LanguageandChange:theuseof
keywordsintherapy.pp.114
38 Szasz,T.(1983)PrimaryValuesandMajorContentions.EditedbyVatz,R.E.
&Weinburg,L.S.PrometheusBooks,NewYork.
39 Rhodes,P.(2008)AmplifyingDeviationsinFamilyInteractions:guidelines
fortraineesinPostMilanfamilytherapyintheAustralianandNewZealand
JournalofFamilyTherapy.Vol.29[1],Mar2008.pp.3536

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