Origins and evolution of the Milan model

The Milan group, founded in Milan by Mara Selvini-Palazzoli, Luigi Boscolo, Gianfranco Cecchin and Giuliana Prata, was initially made up of psychiatrists trained in psychoanalysis. Faced with the limits of that approach for treating disorders such as anorexia nervosa and schizophrenia, they began to bring the family into the therapeutic process.

Their initial collaboration, known as “the paradoxical period”, lasted until 1978, when the group split into two branches. On one side, Selvini-Palazzoli and Prata focused on the “invariant prescription”. On the other, Boscolo and Cecchin created the Milan Centre for Family Therapy, emphasising the premises underlying behaviours and the importance of neutrality.

The core concepts

1 — The family as a self-regulating system

In the Milan model, the family is seen as a system that seeks to maintain a balance, a homeostasis. Family rules and dynamics emerge through a process of trial and error, with each member gradually adjusting their behaviour to preserve a certain stability.

2 — The family game and alliances

One of the major contributions of the Milan model is the identification of the family game. This concept reveals how implicit alliances and power struggles structure family interactions. These alliances often form unconsciously and can prevent change by reinforcing certain dysfunctional behaviours.

For example, a child may side with a parent who is struggling in a conflict-ridden marital relationship, displaying symptoms in order to maintain a status quo and avoid a deeper imbalance.

3 — Unhealthy games and the function of the symptom

Unhealthy games are unconscious strategies put in place to avoid change. A family seeking therapeutic help often wants change but, unconsciously, sets up mechanisms that hinder the process. The symptomatic child then becomes the identified patient, serving as the focal point for the family’s underlying tensions.

The Milan model proposes to understand the function of the symptom: what role does it play in the family dynamic? By adopting this perspective, the therapist can bring to light how dysfunctional behaviours contribute to the homeostasis of the family system.

4 — Positive connotation

Positive connotation is an essential tool of the Milan model. Rather than judging a behaviour as problematic, the therapist seeks to understand what it allows the family to accomplish. By reframing the symptom in functional terms, they reduce resistance to change and encourage systemic transformation.

5 — The therapeutic team and neutrality

The Milan approach relies on the use of a therapeutic team. Part of the team works directly with the family, while the others observe through a one-way mirror. This method allows for greater distance and a finer analysis of the relational dynamics at play.

Another founding principle is neutrality. The therapist strives not to take sides in family conflicts, seeking to maintain a balanced stance that encourages each member to question their individual perspective.

6 — Circularity and circular questioning

Circularity is a fundamental concept of the Milan model. It rests on the idea that family behaviours influence one another in a continuous cycle, rather than following a linear cause-and-effect relationship.

Circular questioning is a technique that helps families step out of their fixed perspectives. The therapist asks questions that prompt each member to consider the perceptions and motivations of the others. For example:

• “What do you think your father feels when he sees this situation?”
• “How do you think your sister perceives this behaviour?”
• “If your mother had to describe this event, what would she say?”

By introducing these alternative perspectives, circular questioning fosters a more nuanced understanding of family dynamics and opens the way to change.

Conclusion

The Milan systemic approach remains an essential reference in family therapy. Its perspective on family games, the therapeutic team, positive connotation and neutrality offers powerful tools for practitioners.

By revealing these interconnections and introducing new understandings, the therapist helps the family move out of unhealthy games and build more balanced, fulfilling relationships. The full presentation of the model — in French — is in the video below.