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THE MILAN APPROACH TO FAMILY THERAPY: A CRITIQUE KATE TUCKER

INTRODUCTION

  "The essence of life is the progression of such changes as growth, self-duplication, and synthesis of complex relationships." (Odum 1983: 87)

 

Life occurs within the context of ecosystems, which include both the living and non-living elements of the environment (Odum 1983: 13). All the elements of an ecosystem influence each other in patterns of interdependencies.

An ecosystemic post-modernist, deconstructionist view, presupposes that there is no one culture, no one worldview or reality, and no one ‘correct’ model of psychology. It is particularly important to understand this point in the South African context, where so many cultural and ethnic groups live side by side in an ever-changing ecology of ideas.

If a critique is to be meaningful, it should be informed, and should take into account the ecology of the conceptual framework that is being subject to criticism and should be "consistent with the assumptions of that framework" (Becvar & Becvar 1998: 221). An attempt will be made therefore to enter into the ecology or framework of the Milan approach to family therapy in order to write this critique. However, consistent with a ecosystemic perspective, it should be born in mind that the underlying propositions of the culture in which one has been socialised have a fundamental influence on one’s view of reality, on one’s thought processes, perceptions and intellectual functioning. In other words, in order to write a truly meaningful critical evaluation of the Milan approach to family therapy, it is not possible to stand outside the theory and merely observe (as in the black box metaphor) (Becvar & Becvar 1998: 63). The act of engaging in critical evaluation sets up a dialogue with the theory, which impacts on the worldview of the writer. The process of interpretation of the theory in order to subject it to critical analysis impacts on the theory – the theory as interpreted is not necessarily the theory as intended by the originators of that theory. The way that the reality of the theory is observed partly determines what is seen and how that reality is understood (Zohar 1991: 28).

Honderich (1995:13) says that there is currently a "distinct vacuum in interpretative theory… critical as well as philosophical, ‘continental’ as well as ‘analytic’ – across the entire range of western debate." The Milan group contended that there is a "tyranny of linguistics" (Becvar & Becvar 1998: 239), which traps therapists and clients into linear ways of thinking. This writer sees the work of the Milan group as a dialogue or rather ‘multilogue’ that attempts to break free of the received view of the Western logical-positivist tradition, and traditional depth psychology. This writer sees the systemic approach of the Milan group as confronting the ‘tyranny of linguistics’ and the ‘discursive vacuum’.

 

EPISTEMOLOGY

The original Milan group (Palazzoli, Boscolo, Cecchin, Prata) has split up and the various members have gone their separate ways (Becvar & Becvar 1998: 239), splitting up in 1980 (Becvar & Becvar 1998: 245). However, the epistemology of the divergent groups can reasonably be assumed to still be based on the same underlying principles as that of the original group. Bearing this in mind, the discussion of the epistemology of the Milan group will be based on the broad principles of the original group.

There are several important elements of the Milan group’s approach that require discussion.

The systemic element

Bateson’s influence

"The Milan approach to family therapy has been called systemic in the tradition of Bateson’s circular epistemology." (Becvar & Becvar 1998: 239)

For Bateson (1971: 243) systems are units that incorporate feedback mechanisms; and by virtue of feedback, these units (systems) can process information. Such systems can be ecological, social, and individual. Individuals are contextually located. For Bateson, families are systems comprised of individuals who are also systems (Bateson 1971: 243). Most important for Bateson was the shift in focus from traditional linear thinking and the traditional perception of the individual mind to a way of understanding the mind as part of a circuit. This means that the concept of mind is considered within the context of all relevant completed circuits (Bateson 1971: 244). In this manner Bateson resolves the dichotomy between mind and body, as for him mind, body, action and the objects (or people) which are acted upon are all part of a circuit of mental activity. This means that for Bateson, behaviour that in the traditional paradigms is considered to be pathological or abnormal and intrapsychic, is in the circular paradigm, interpersonal and relational (Becvar & Becvar 1998: 22). The focus in Bateson’s paradigm has shifted from the inner workings of the individual mind to the consideration of relationships in context (Becvar & Becvar 1998: 22).

Bateson based his ideas on several sources, including the work of Ludwig von Bertalanffy, Norbert Wiener, Warren McCulloch, Alfred North Whitehead, and Bertrand Russell, as well as mathematics and engineering (Becvar & Becvar 1998: 18 f.) An important concept for Bateson was Russell’s paradox, based on his Theory of Logical Types (Becvar & Becvar 1998: 18). Essentially Russell’s paradox states that "most classes are not members of themselves, but some are" (Honderich 1995: 785). Russell’s Theory of Logical Types deals with the complexities of relations between the members of classes and the discontinuity that arises between different levels of abstraction, or between a class and the members of that class (Becvar & Becvar 1998: 18) (Honderich 1995: 785, 884). Bateson examined the paradoxical situations suggested by Russell’s paradox and the dislocated communication patterns that can exist in such situations. Based on this Bateson and his research group moved towards a position of seeing disorders, such as schizophrenia, in terms of communication patterns within individuals and within families, rather than in terms of biogenic or intrapsychic pathology (Becvar & Becvar 1998: 20).

Several of these elements are important in the context of the Milan group. Paradoxes, levels of meaning, the evolutionary nature of systems (even when apparently stuck) (Becvar & Becvar 1998: 240), patterns of information, feedback and recursiveness are all concepts that draw from Bateson’s work.

Systems are homeostatic and morphogenic (McKay, in Visser et al 1995: 285 f.); they strive simultaneously for balance and change. Macy (1991) suggests that systems are autonomous. Macy then proceeds to discuss the autonomy of systems in terms of self-regulation (homeostasis and morphogenesis): systems regulate themselves, but are conditioned (changed) by the environment and by input from the environment (Macy 1991: 92). The Milan group saw the world in terms of patterns of relationships and information, rather than in terms of matter and energy (Becvar & Becvar 1998: 240). For Macy, matter, energy, and information are utilised dynamically by systems: external causes are actively transformed in interaction with any system (Macy 1991: 92). Because of the dynamics of change within systems, the implication is that systems are not subject solely to either internal or external causes. This perspective is consistent with Bateson’s view that people’s behaviour and thought processes must be seen in terms of the total context of the relationship between people, actions, thoughts and external objects or people in relationship. The Milan group saw that families came to therapy with a paradoxical request: families wanted the stability of an unchanged system, but also wanted the problem member of the family to be cured (Becvar & Becvar 1998: 240). However, the Milan group saw the problem as being rooted in the family rather than in the individual. Consistent with a systems theoretical perspective, and consistent with Bateson’s circular or recursive patterns, the group believed that it was not possible to change the patterns of behaviour and communication in one part of the system (the identified patient) without affecting the family system as a whole (Becvar & Becvar 1998: 240) 4.3.

Feedback and equifinality/equipotentiality

Feedback is described as "the aspect of recursion involving self-correction" (Becvar & Becvar 1998: 64). Feedback is what keeps a system functioning the way it does. The Milan group took cognisance of the importance of recursiveness 3.1.1 and feedback. It was important that both theory and therapy be responsive to feedback in the therapy situation (Becvar & Becvar 1998: 240). Negative feedback is taken into account in the Milan Group’s approach to theory and therapy (Becvar & Becvar 1998: 247). The Milan Group’s awareness of what happened in the therapeutic situation led them to discard a linear way of thinking and suggesting interventions, and to move towards a more circular approach to instigation and intervention (Palazzoli et al 1989: 118). This demonstrates that feedback from therapy punctuated their epistemology and that changes in epistemology led to changes in clinical practices. This means that the system of the Milan Group itself changed: the ecology of ideas took on a different perspective. This is an example of feedback on a level of simple cybernetics: the system (the Milan Group) changed in response to information fed back into it from interaction between the group and the clients. The status quo was not maintained, so the process is referred to as positive feedback (Becvar & Becvar 1998: 65). A second-order cybernetic way of looking at feedback in this context is that the Milan Group was error-activated: information that differed from their original ideas was fed back into the system (the Group, in interaction with their clients), and the Group responded to this information in such a way that the difference (from their previous concepts) was accepted (Becvar & Becvar 1998: 66). It is important to note that this feedback still functioned to stabilise or correct the system: the Milan Group incorporated new ideas, changed their strategies and thinking into more circular patterns, and continued to function (until such time as the Group did in fact split up) as a family therapeutic group. Whether or not the members of the Milan Group analysed the feedback process in this manner is not known. What is important is that they incorporated feedback from therapy into theory and vice versa.

According to the principle of equifinality systems function according to characteristic, repetitive patterns of interaction (Becvar & Becvar 1998: 69). The goal of a system is its own survival (Palazzoli et al 1989: 159): a system, "as it is, is its own best explanation of itself" (Becvar & Becvar 1998: 69) (my italics). Family members tend to develop habits and ways of communicating and relating to each other, so that regardless of how a situation starts, the tendency is to end in a characteristic way. An example might be a wife’s complaint that her husband ‘always’ shouts at her when she does something he does not approve of, while the husband might react by saying that his wife ‘never’ considers the implications of her actions, but ‘only ever’ thinks of the immediate present. Whether the wife buys expensive Christmas presents for the children, or new curtains, with her annual bonus, the end result will be that the husband will shout at her for not thinking of putting some money aside as savings. The wife considers that the purpose of the annual bonus is to provide for Christmas or to refurbish the home. The husband perceives the wife as never thinking of the future: each reacts in a certain, characteristic way, which preserves the system and the communication patterns as they are. Complementary to the principle of equifinality is the principle of equipotentiality, which states that different endings can be reached from the same initial actions (Becvar & Becvar 1998: 69). To continue with the example: the husband might decide that the new curtains are actually an investment in the family home, and might praise his wife for her forethought and consideration in not spending her bonus on presents that the children will have forgotten about before the end of January. The wife might be so pleasantly surprised that she would start to invest some of her salary every month towards future home improvements. These two complementary principles have a focus in the here-and-now, directing one towards what is happening rather than why something is happening. What is important is the present functioning of the system, rather than the history of how the system came to be or to function in a certain way (Becvar & Becvar 1998: 69).

Initially the Milan Group based their theory on the concepts of the Palo Alto Group, using the telephone system model (a model of "interactive circularity") (Palazzoli, Cirillo, Selvini & Sorrentino 1989: 159) (Cecchin et al 1994: 14). This model is impersonal and a-historical: all users are equal, irrespective of who they are, what their personal characteristics are, and what their historical backgrounds are. What is important in a telephone system is rapid action and reaction (Palazzoli et al 1989: 160). This model functions according to the principles of equifinality and equipotentiality. However, for the Milan Group, the model proved to be inadequate. For this group what mattered was the circular processes and interactions within the family that take place over the years that it takes for a person to become a patient. For the Milan Group, the circularity that mattered is to be found "in the history, not in the instant" (Palazzoli et al 1989: 160) (original italics). Time or history, for the Milan Group was vitally important, and they saw time as being linked to process (Palazzoli et al 1989: 260). They found that the telephone system model to be simplistic and reductive (Palazzoli et al 1989: 160). For example, according to Palazzoli and colleagues (1989: 160) there are many factors that might cause a husband to become a wife-beater: provocative behaviour by the wife, education level, adherence to cultural norms, personality, motivations, expectations, and the rules of what the Milan Group calls the family game. This does not mean that they rejected the importance of the here-and-now in their theoretical or clinical work, but believed rather that the here-and-now should be integrated together with history into a multidimensional model (Palazzoli et al 1989: 160). For the Milan Group circularity is a process that entails a completion the various arcs of a circuit over a period of time, but that also takes into account the here-and-now, and incorporates individual, intermediate events.

It is important to note at this stage that the position assumed by the Milan Group is thus inconsistent with second order cybernetics, as it does have a historical perspective, in addition to a present oriented focus 6.

The strategic element

Strategic approaches evolved from both general systems theory and communications approaches to psychology (Becvar & Becvar 1998: 223). Strategic therapists build on the assumptions that ‘one cannot not communicate’ and ‘one cannot not behave’ (Becvar & Becvar 1998: 222). These assumptions form an important part of communication science.

In communication science there are many models to explain the process of communication, from the linear Shannon and Weaver model, through Osgood and Schramm’s circular model to Verderber’s transactional model (Steinberg 1997:17 ff.). Verderber’s transactional model is of relevance in this context, as it demonstrates not only that communication is an ongoing, circular process, verbal and non-verbal, but that it is a process by which the parties concerned negotiate meanings (Steinberg 1997: 19). According to Steinberg (1997: 19) the "creation of meaning is negotiated between the participants" (my italics). In postmodernist, cybernetic terms, this implies that meaning is not present prior to the communication encounter, but that meaning is created out of the encounter, according to the way that the encounter or relationship punctuates the realities of the parties. Strategic therapists add a further injunction to the two above, namely; ‘one cannot not manipulate’ (Becvar & Becvar 1998: 222). In a relationship each member tries to find ways of being in a position to define or control the relationship (Becvar & Becvar 1998: 222). Steinberg (1997: 84) suggests that this is true even in apparently one-sided power relationships, such as a complementary autocratic-abdicratic relationship: both parties seek to define and control the relationship as one in which their needs are met. The autocrat seeks to control and dominate, while the abdicrat seeks to be dominated, abdicating control to the dominant partner. Each seeks to define the relationship to meet their specific needs. Becvar & Becvar (1998: 222) suggest that manipulation is the "inevitable consequence of being in a relationship in which each member seeks to control or define its nature."

Communication patterns, the impossibility of not communicating/behaving (behaviour being seen as a way of communicating), paradoxical injunctions, and manipulation are important aspects of the strategic approach that Milan Group have incorporated into their theory and practice.

The Milan Group found it important to consider the history of their clients; for them it was necessary to know and understand the clients’ backgrounds and influences over time 3.1.2. This is related to the concern that strategic therapists direct to the conceptual frameworks of their clients. It is also related to Bateson’s 3.1.1 concept that body, mind, action, and person/object are all part of a circuit of relationship: the mind and its thoughts do not exist independently of the body or of the people, actions and relationships that form the system in which an individual functions. A problem is not a problem unless it is defined as such (Becvar & Becvar 1998: 224). How a person or family defines a specific behaviour as problematic reflects the way they think, as well as how they relate to each other’s worldviews (Becvar & Becvar 1998: 224). However, the clients are not necessarily aware that there is more than one way of looking at the behaviour that they have defined as problematic (Becvar & Becvar 1998: 224): they are not necessarily aware that people function in a multiverse rather than a universe. Strategic therapists believe it is important to reframe the problem in such a way that it is no longer perceived as problematic (Becvar & Becvar 1998: 224). The Milan Group saw that new meanings needed to be introduced into a family system in order to change behaviour and to reframe or re-write the perception of a given behaviour so that it was not longer seen as problematic (Becvar & Becvar 1998: 241). Meanings are defined by conceptual frameworks or worldviews (Becvar & Becvar 1998: 224). Therefore the Milan Group needed to be able to understand the worldviews of their clients, and to do this they considered it vitally important to understand the history of their clients (Palazzoli et al 1989: 160, 260, op cit.) 3.1.2. Verderber’s transactional model of communication states that meaning is created in a communication encounter (Steinberg 1997: 19, op cit.). The Milan Group did not regard their clients as phenomena ‘out there’, but rather as a therapeutic system of family plus therapist (Palazzoli et al 1989: 267). They used the therapeutic encounters to perturb the family system (Palazzoli et al 1989: 267) so as to create new meanings or thought connections that would lead to new patterns of thought and behaviour (Becvar & Becvar 1998: 240) (i.e. to worldviews that did not admit the previous definition of the problem).

It is crucial to note that the Milan Group recognised that the different family members each reacted in their own different ways to therapeutic inventions (Palazzoli et al 1989: 260). This acknowledgement lead them, in a recursive way, back to acknowledging the importance of history, which placed them in an epistemological dilemma: a cybernetic, systemic view stressing the importance of the here-and-now versus the need for history (Palazzoli et al 1989: 260). This led to their moving towards a multidimensional approach to both therapy and theory, and a determined effort not to become trapped in an ideological reification of systems theory (Palazzoli et al 1989: 261).

A significant way of avoiding this ideological or dogmatic trap was suggested by Cecchin and colleagues after the split up of the original Milan Group. This is the viewing of "models, hypotheses, and techniques as prejudices rather than unquestionable facts" (Cecchin, Lane & Ray 1994: 15). In terms of Verderber’s transactional model of communications, prejudices or beliefs are located within the process and the communicating system. This model stresses the importance of values, background, attitudes, and culture in the creation and negotiation of meaning (Steinberg 1995: 19). Thus, even though Cecchin and colleagues’ epistemological position post-dates the original Milan Group, it can be seen to have developed out of the strategic approach that was one of the jumping off points for the original group’s theoretical framework.

Cecchin and colleagues (1994: 15) take the epistemological standpoint that there is no one truth and therefore that therapists should be aware there is no one truth to discover. Perceiving a model, hypothesis, or technique as a prejudice or bias, and being aware of multiverses rather than a universe, allows therapists to engage in true dialogue with clients and other therapists, rather than forcing a bias on to others (Cecchin et al 1994: 15). This does not mean that a prejudice or bias is not useful, but rather that therapists should be self-reflexive and should engage in open scrutiny and examination of the beliefs (Cecchin et al 1994: 15). Further, Cecchin and colleagues (1994: 15) stress the fact that any belief that is worth holding should not only be examined in this way, but that it should be contextually relevant. A belief only makes sense in context, and taking it out of context stops dialogue and can lead to the system (the family plus the therapist (Palazzoli et al 1989: 267 op cit. 3.2).) becoming stuck (Cecchin et al 1994: 15). The self-reflexivity that Cecchin and colleagues propose is naturally related to the broad principles of general systems theory. Framing the beliefs of the therapist in terms of prejudices that could interrupt the communication process within the system of family plus therapist is consistent with a cybernetic viewpoint.

The linguistic element and indeterminacy

"The Milan group focused on overcoming the "tyranny of linguistics," which by its very nature keeps therapists and clients thinking in an intrapsychic, linear manner. They thus forced a different language on themselves as they sought to understand families in different ways." (Becvar & Becvar 1998: 239)

The Milan Group "forced" (Becvar & Becvar 1998: 239 op cit.) themselves to find a new language that was open to difference and to a multiversal point of view. Underpinning this "new language" (Becvar & Becvar 1998" 239 op cit.), which sought to free the therapeutic system from entrenched meanings that led to systems becoming stuck, is an epistemology that derives from a deconstructionist philosophy. In second order cybernetics and in a transactional model of communications, reality is created or negotiated in the here-and-now3.2 (Steinberg 1994: 19) (Becvar & Becvar 1998: 69). Husserl tried to achieve a theory of the relationship between a communicator’s words (written or spoken) and language in terms of differential signs (Honderich 1995: 201). Husserl also tried to systematise the here-and-now as presence: presence as ‘here’ and presence as ‘now’ being one and the same (Taylor 1992: 253). Deconstructionist philosopher Derrida coined the term différance in reaction to Husserl’s philosophy. For Derrida the present (time) and what is present (spatially) is always becoming: it never ‘is’, there is no ultimate point of existence in space-time (Taylor 1992: 253). In other words, and consistent with second order cybernetics and Verderber’s model, reality and meaning are always becoming or being created; they do not exist "out there" waiting to be discovered. Equally, reality and meaning are never ‘real’ or fixed in the past; the reality of the past is being created within people as they punctuate their present, becoming realities. Also prominent in Derrida’s work is his examination of language and how language "outwits philosophers" (Honderich 1995: 188). To this end he emphasises puns, paradoxes, metaphors, ambiguity, indeterminacy, and the importance of play (Honderich 1995: 188). The Milan Group also focussed on metaphor and paradox in their work and theory (Becvar & Becvar 1998), and their first major publication was Paradox and Counterparadox (Becvar & Becvar 1998: 239). Strategic therapists 3.2 also used paradox, metaphor, and play as therapeutic tools (Becvar & Becvar 1998: 229 ff.).

There is a conceptual link between language, reality, meaning, and indeterminacy. Derrida emphasised indeterminacy in his approach to language and meaning, as well as in his approach to reality (Taylor 1992: 253, op cit.) Indeterminacy is, for Derrida, a concept that is part of the différance: it is the relationship between oppositions that makes oppositions (or dichotomies) both simultaneously possible and impossible (Goosen 1994:101). Western traditional philosophy and psychology tends to be linear and dichotomous in its approach, characterised by oppositions (male-female, good-bad, right-wrong, people-God etc.) (Goosen 1994: 25). Hegel’s philosophy was an attempt to create a union of these dichotomies (Goosen 1994: 25) and to heal the fragmentation he perceived in modern life (Goosen 1994: 51). Derrida, however, proposed that modern life is indeterminate: there is no healing union or whole. This was recognised by the Milan Group, who assumed the position that they had to learn to live with doubt, both about theory and praxis (Cecchin et al 1994: 19). With some similarity to Russell’s paradox 3.1.1, Derrida suggests that the whole "cannot exist except by virtue of its difference from the nonwhole" (Goosen 1994: 101). Derrida’s view of indeterminacy or the différance suggests that if the whole is possible by virtue of the existence of something other than itself (non-whole), then it ceases to be a whole, because it depends on something outside itself. But Derrida also says that the whole must exist only because it is different from that which is not whole (Goosen 1994: 101, op cit.). Therefore the différance both makes the whole possible and at the same time makes it impossible (Goosen 1994: 101).

A systemic, cybernetic, post-modernist paradigm acknowledges the multiversal nature of realities as created within people, and that there is no reality that is not valid or meaningful for the person concerned (Maturana, in Becvar & Becvar 1998: 82). In other words, reality is indeterminate and non-deterministic. Reality cannot be said to exist as a construct ‘out there’ that makes rules that determine how people think: rather, people determine their own reality. However, that reality is always changing: the reality of one person changes over time depending on how the environment punctuates that person’s view of reality, as well as how that person adjusts to and reacts to that punctuation. Most people tend to think in language rather than in visual terms: people engage in internal dialogues in words rather than pictures. Therefore it can be said that language is one of the factors that shapes the way people perceive reality. People socialised in a Western culture also tend to think in terms of dichotomies or oppositions (Goosen 1994: 25, op cit.). Derrida’s concept of the différance, while it does not try to resolve these dichotomies, opens the way to different ways of looking at language and behaviour and their impact on behaviour. It is important in terms of Derrida’s philosophy to look in between the extremes (e.g. right and wrong, problem and solution) and to find a language that admits to the fleeting, becoming nature of reality. It s this writer’s opinion that the Milan Group’s concept of freeing people from the "tyranny of linguistics" (Becvar & Becvar 1998: 239, op cit.) is consistent with Derrida’s philosophy. However, there is a problem regarding indeterminacy concerning the definitions of ‘health’ and ‘dysfunction’. These words imply the pejorative meanings of good and bad, which are dichotomous, and therefore not consistent with a philosophy that attempts to look ‘in between’ extremes.

What the Milan Group’s approach then attempted to achieve was to help clients to reach a point where they could understand that there was more than one reality, and then to help them to re-write the language in which they conducted their own internal dialogues, according to their perception of reality and problems as defined by that reality (Becvar & Becvar 1998: 240). In other words, they tried to allow the family to look in between the dichotomies of right and wrong, problem and solution, by rephrasing the way in which perceived problems were stated or expressed (Becvar & Becvar 1998: 241). The Group did not just teach the clients this new language, they themselves consistently used it, contextualising problems in terms of social and family relationships (Becvar & Becvar 1998: 241, 240). They also placed mental phenomena in the greater context of social phenomena – moving problems from an intrapsychic locus to a social locus. This is also a use of language to re-write problems in terms of a different reality.

A further tenet of the theory of the Milan Group was to use the word ‘game’. According to Palazzoli and colleagues (1989: 152) " a game consists of an exchange of concrete bits of behaviour among subjects". The Milan Group found that the use of certain systemic terms was confusing, or limiting, being related to the biological origins of general systems theory (Palazzoli et al 1989: 152). However, by using the metaphor of games and game playing to describe to themselves how systems functioned, they found that the metaphors associated with games were better frames of reference for their research (Palazzoli et al 1989: 152). Game playing immediately evokes interhuman relations and interaction, which the Milan Group felt systemic terminology failed to do (Palazzoli et al 1989: 152). For the Milan Group, the metaphors of games and game playing were the point of entry into a new vocabulary, which related their theory to familiar, human reactions and interactions (Palazzoli et al 1989: 153).

Structure and organisation

"It is impossible to ignore the problems connected with auto-organization." (Palazzoli et al 1989: 264) (My italics)

Multiversal or multi-dimensional thinking and behaviour must, according to the Milan Group, take into account the fact that systems organise themselves (auto-organisation) in order to function optimally (Palazzoli et al 1989: 264). Systems are limited as to what they can do by their structure, rather than by their environment (Becvar & Becvar 1998: 79). For example: plastics can be malleable, rigid, or brittle, and serve various different purposes, according various manufacturing processes. Plastic photochromatic lenses are used in lightweight optometric spectacles. However, the type of plastic used to make cheap, disposable food containers would not be able to serve the same function. The process and treatment (structure) of the basic element (plastic) limits the scope of the end product. So it is with systems: they are limited by their structure. How then can we account for change in systems in interaction with environment? Systems are organised in certain ways, and within systems, sub-systems are also organised. Organisation is seen as the relationships between the parts of a system (Becvar & Becvar 1998: 77). The structure of a system refers to the identity of a system (a ball, a plastic box, a photochromatic lens, a family, a company) as well as to the relationships between the its parts (Becvar & Becvar 1998: 77). The environment of a system includes the system itself – the environment is both internal and external. When systems interact, the context is changed or modified, by virtue of that interaction (Becvar & Becvar 1998: 80). Based on this type of understanding of the functioning of systems, the Milan Group found it crucial to pay attention to individuals and their needs and goals, as well to the organisation of the families of which individuals were members (Palazzoli et al 1989: 264). People tend to weigh up the pros and cons of their actions and how these might affect their families (Palazzoli et al 1989: 264). For example: a husband will discuss a new job, which entails a higher salary and more prestige with his wife, bearing in mind that the family would have to relocate to a strange city or country, and how this move might negatively affect their children’s education and social lives. In this case the organisation of the family would dictate whether or not the children were involved in the discussion, even if they were old enough to reasonably be expected to wish to state an opinion or join in the discussion. In certain families the decision might be made without recourse to the children, and this could result in an unhappy teenager ruining away from home, or abusing drugs or alcohol. Other problems of organisation concern matters such as death. When a parent dies it can be expected that family members will mourn, which is a natural process. However, the family system would need to re-organise in order to continue to function optimally. For example: feuds could develop between children, or the father and the children as a united front, and an aunt, as to who should take over the maternal role in the case of the death of a mother (Palazzoli et al 1989: 264).

As the Milan Group felt it necessary to pay attention to the important factor of the organisation, and by implication, to the structure of systems, it can be said that their approach in this regard is consistent with a cybernetic viewpoint.

THERAPEUTIC INTERVENTIONS AND STRATEGIES

"The whole process of [Milan Group] therapy is carefully orchestrated to be consistent with the model on which it is built." (Becvar & Becvar 1998: 241)

For the sake of clarity a brief tabular summary of the Milan Group’s approach to the therapy process will be presented before therapeutic interventions and strategies are discussed. Figure One shows a traditional therapy setting where an observing team is involved, as was probably similar to the setting used by the Milan Group.

 

Table One: Summary of the Milan Group’s approach to the therapy process

Period

    Ten months, divided into ten sessions spaced at monthly intervals

Initial contact

    Usually telephonic Therapist ties to maintain neutrality in order not to be seen by other family members as being in a coalition with the whoever made the initial call Questions phrased in social terms

Calls between sessions

    Neutral stance of therapist maintained In case of emergency calls (e.g. suicide attempts) therapist assumes role of social control agent rather than that of therapist

Resources

    Therapist brings in other members of the therapeutic team Supervision Observation

Therapy session – five components

    Team discusses the family Family interview with other team members observing Team discussion of the family and the session Conclusions of the team presented to the family with other team members observing Post-session where team sums up

Termination

    Mutual agreement by therapist and family Respect for family’s decision to terminate Warning of possibly of relapse or doubt

(from Becvar & Becvar 1998: 241 ff.)

 

Figure One: Traditional family therapy setting with an observing team

 

famther.jpg (14510 bytes)

1 = Family therapy room

    2 = One-way mirror

    3 = Team room

    4 = Therapy team

    5 = Invisible boundary separating the team and the observing team

    6 = Observing team

(from Cecchin et al 1994: 17)

 

 

Paradox and counterparadox

The Milan Group used the word paradox as follows: " …the specific tactics and maneuvres which are in apparent opposition to the goals of therapy, but are actually designed to achieve them" (Rohrbaugh, in Palazzoli et al 1989: 3). Paradoxes are therefore, in this context, such strategies as: prescribing the symptom, positively appraising the symptom, attaching positive connotations to symptoms, encouraging symptoms, or expressing fears that certain symptoms might disappear to quickly, and so on (Palazzoli et al 1989: 3).

Families presented with a paradoxical request for both stability and change (Becvar & Becvar 1998: 240). Families would come to therapy complaining of a problem in one member, the identified patient, who in their opinion, needed to change, to ‘get better’. For the Milan Group, true to the tenets of general systems theory, and Bateson’s influence, change in one part of the system cannot occur without change in the system as a whole (Becvar & Becvar 1998: 240) 3.1.1. Therapists would thus place family members into a therapeutic double bind situation by not prescribing change, even though the context of therapy is a context where change is expected to take place (Becvar & Becvar 1998: 240).

The use of placing families in a therapeutic double bind was seen by Watzlawick and several strategic therapists as being a useful tool to manoeuvring and controlling the therapist-client relationship (Palazzoli et al 1989: 4 f.). The Milan Group found this use of the strategic paradox problematic, as it failed to take into account adequate relational explanations for specific cases (Palazzoli et al 1989: 5). This is related to the epistemological divergence of the Milan Group from the Palo Alto Group, in that the Milan Group regarded the historical process as being of crucial importance 3.1.2. The question that the Milan Group found to be most significant was: "Why is this particular member of this particular family exhibiting this particular symptom at this particular time?" (Palazzoli et al 1989: 6) (My italics). Instead of using the strategy of paradox or counterparadox as a means of controlling the therapeutic relationship, the Milan Group used it as an auxiliary technique, subordinate to their principal concern, which was to observe families (Palazzoli et al 1989: 6). Palazzoli and colleagues go so far as to state that the centre of their focus of interest was families and not therapy (Palazzoli et al 1989: 7). Further, the Milan Group began to experience the phenomenon that, as time went by, paradoxical interventions were less powerful over time, or produced short-lived results (Palazzoli et al 1989: 9). Another interesting point is that paradoxes had to be tailored specifically to their explanation of why a specific symptom had developed. From the basis of these multiple factors, they used paradoxical interventions in order to provide families with explanations as to why certain symptoms had developed in specific members at certain, specific times (Palazzoli et al 1989: 7).

Paradoxes were used in specific ways according to the development of the therapeutic process over time, according to the number of sessions 4.1 (Palazzoli et al 1989: 9 ff.) The Milan Group also stressed the fact that paradoxical interventions, irrespective of how specific they might be, and in what positive terms they might be couched, or even how ingenious they were, would not work unless there was a strong need for help from the family concerned (Palazzoli et al 1989: 10). In cases where the therapist’s prestige (for the family concerned) was weak, or where the family was not strongly motivated to request help, paradoxical interventions could lead to the clients breaking off their relationship with the therapist (Palazzoli et al 1989: 10).

 

Circular questioning

"The process of circular questioning is a fundamental concept in the Milan model." (Becvar & Becvar 1998: 243).

Circular questioning aimed at transforming families’ ways of thinking from linear, causal chains of thought into reciprocal, interdependent worldviews (Becvar & Becvar 1998: 243). Important to the concept of circular questioning is the idea that in any relationship, all parties concerned must co-evolve (Becvar & Becvar 1998: 243). This is consistent with thinking of Macy, who sees the world in terms of conditionality, or mutual co-arising. Conditionality, in Macy’s view, is a dynamic process inherent in the universe whereby everything is interrelated and is "mutually affecting" (Macy 1991: 40) (My italics). The Milan Group saw that many families presenting for therapy did not function according to the principle of mutual co-arising, or co-evolution, but rather one subsystem, coalition, or family member would be attempting to establish unilateral control over the family unit (Becvar & Becvar 1998: 243). Circular questioning, thus, was designed to punctuate relationships, re-defining them in such way as to show up reciprocity and promote co-evolution (Becvar & Becvar 1998: 243).

Not only did the Milan Group use circular questioning to devise hypotheses (not necessarily true ones) (Becvar & Becvar 1998: 243) regarding possible connections and differences between relationships in families, or which could lead to further questions, they used this technique to continue to develop their basic theory 3.2. Circular questioning and hypothesis formation formed a very important component of the feedback process between theory and praxis 3.1.2, namely, that of understanding what was going on in a family. At this point it is important to note the cybernetic consistency of the emphasis on ‘what?’ In cybernetics the crucial emphasis is ‘what?’ rather than ‘why?’ (Becvar & Becvar 1998: 247).

Neutrality and support

It was necessary, in fact essential, for the therapist to be seen as neutral, particularly in regard to the process of circular questioning, as this process promotes hypotheses that could lead to further questions (Becvar & Becvar 1998: 243). Lateral, non-linear thinking was necessary as well, for the therapist to be able to follow the openings or responses that revealed themselves from the questions. For the Milan Group neutrality did not mean standing apart, or taking no position regarding any particular family member, but rather being "multipositional" (Becvar & Becvar 1998: 243). The therapist had to be aligned to no one and to everyone in the family at the same time, as well as being non-judgemental and non-moral (Becvar & Becvar 1998: 243). Neutrality, and the ability to think openly and non-linearly were therefore closely related, not only to each other, but also to the therapeutic process and to the theory that underpinned it.

The Milan Group also believed that neutrality implied support – each family member had to be supported in a neutral or equal way. The theoretical construct underlying this concept was the view of a family as a whole, greater than the sum of its parts, rather than being seen as the sum of its independent parts or family members. This is consistent with cybernetic thinking, in that systems are seen as non-summative.

Neutrality and support together with the underlying principles of circular questioning allowed the families in therapy the necessary room and freedom to explore alternative ways of thinking and behaving (Becvar & Becvar 1998: 240).

Prescription of rituals

The Milan Group put themselves into the position of not being outsiders (Becvar & Becvar 1998: 244) of the family in therapy. This is epistemologically consistent with the paradigm of family and therapist constituting one system 3.2. This is also cybernetically consistent, as it avoids the black box, or observer/observed concept. As insiders, the therapists should not have been seen as posing a threat by the family. Being inside the system and being accepted as non-threatening can be seen as natural outcomes of the Milan Group’s dedication to neutrality and support 4.4.1. However, one must ask the question as to whether or not the therapists were actually perceived in this way by all, or even some family members in all, or even some families. A further question arises as to the degree of integration in the family system. However, cybernetically speaking, these questions do provide answers themselves: no matter how much or how little the system was perturbed by being punctuated by the presence of the therapist, some degree of re-organisation and adaptation must have taken place within the family in order to accommodate that perturbation.

Working from the base of being part of the family system, the Milan Group used to prescribe rituals that paradoxically appeared not to lead to change (Becvar & Becvar 1998: 244). Further, the Milan Group worked according to the principle of meta-therapy – prescriptions at multiple levels (Palazzoli et al 1989: 17). This is consistent with their multipositional approach 4.4.1, and therefore also consistent with a cybernetic paradigm.

Prescription of rituals had to be carried out very exactly and carefully (Becvar & Becvar 1998: 244). It is important to note at that this stage that prescribing rituals that apparently enforce the status quo in the family system is a paradoxical action. It is therefore also important to note again the problematic aspects of paradoxical interventions discovered by the Milan Group 4.3. Rituals were not intended as a permanent part of family life, but rather framed in terms of experiments (Becvar & Becvar 1998: 244). Consistent with the neutral support that the Group believed was crucial to the therapeutic process, if a ritual failed, or even if the family failed to carry it out, responsibility for failure was framed in terms of the therapist, rather than the family (Becvar & Becvar 1998: 244).

The main purpose of the prescription of ritual was to point the family game in a different direction to its current course (Palazzoli et al 1989: 17). Further, the Group believed that by prescribing rituals, they could "cut through the knots of a game even when [they] had not yet deciphered and reframed it" (Palazzoli et al 1989: 17). A point of confusion arises at this stage for this writer, in that the Milan Group also stated clearly that they needed to understand the history of families 3.1.2. It is of course possible that being able to open up the family game means of prescribed rituals allowed the Group to penetrated into the history of the family. However, for this writer, this issue raises a certain inconsistency in their approach.

Not only were rituals prescribed to be carried out away from the therapy room, but the whole process of therapy was in fact a ritual prescription in the ordered (ritualistic) way in which it was structured (Becvar & Becvar 1998: 242) (Palazzoli et al 1989: 17 ff.) 4.1.

Rituals needed to be tailored to specific circumstances, but included the following general outlines: secrecy, isolation, family talks or the reading of statements, keeping of notebooks, or parental outings framed as disappearances (Becvar & Becvar 1998: 245) (Palazzoli et al 1989).

The Milan Group placed great emphasis on the idea that prescriptions functioned at multiple levels (Palazzoli et al 1989: 17, 31). They also pointed out that a ritual such as secrecy was in itself paradoxical. If parents were told to attend a session or sessions without their children, and without telling the children or anybody else what had happened in therapy, the family was all aware of the following:

Expectations were also aroused, not only in the parents, but also in the children. Parents, even though adhering to the injunction to secrecy, and therefore while not actually saying anything about the session, would convey non-verbal messages to the family, thereby subtly introducing new patterns of communication into the family system (Palazzoli et al 1989: 31). That the Milan Group recognised these important points as part of the injunction ‘one cannot not manipulate’ 3.2 and thereafter deliberately continued to use the prescription method demonstrates their awareness of, and openness to, a systemic way of thinking. It is important to note the influence of communication science in the epistemology of the Milan Group 3.2 in this regard. What was crucial to the efficacy of the prescription method was the "hierarchical arrangement of communications on a nonverbal level" (Palazzoli et al 1989: 31). That systems are hierarchically arranged (Becvar & Becvar 1998: 77, op cit.) (McKay, in Visser et al 1995:284, op cit.) is not only a tenet of general systems theory, but also of the structural therapists, who interpret the hierarchy in terms of certain specific sub-systems within the family (Becvar & Becvar 1998: 189). These sub-systems are as follows: the spouse subsystem, the parental subsystem and the sibling subsystem (Becvar & Becvar 1998: 189). These subsystems, according to the structural therapists, function according to hierarchical rules (Becvar & Becvar 1998: 189). Communication in the form of negotiation of roles within and between the subsystems is a crucial factor (Becvar & Becvar 1998: 189).

Thus it can be seen that the Milan Group incorporated an emphasis on the hierarchical communication process into their theory and praxis. Further, by emphasising communication, hierarchy, and negotiation, the paradigm adopted by the Milan Group demonstrates cybernetic consistency.

Mental phenomena as social phenomena

"The members of the Milan group believed mental phenomena reflect social phenomena and what is called a mental problem is really a problem in social interaction" (Becvar & Becvar 1998: 240)

Therapy and theory were directed rather at patterns and interactions, instead of at the intrapsychic dynamics of individuals (Becvar & Becvar 1998: 240). Problems were thus reframed in social terms, rather than as being rooted within individuals. An example of this is discussed by Cecchin and colleagues (1994: 57 f.) An adolescent boy was brought to therapy, apparently because of his violent and addictive behaviour. The discussion between the members of the team, in the absence of the family, seemed entirely negative: the team had allowed themselves to become bogged down in the negative trap laid for them by the family (Cecchin et al 1994: 57). When the problem was reframed in a more positive, social light, it was possible to ‘write’ a story that, instead of condemning the adolescent boy as a violent, anti-social individual, connected the family. What the team did was to develop the therapeutic ‘myth’ or story that the adolescent boy was the embodiment of the family’s way of trying to keep the memories of his grandfather alive (Cecchin et al 1994: 58). No longer was the boy seen as an individual with an individual problem, but rather, he was seen as an integral part of the family’s way of relating to each other, and to the deceased grandfather (Cecchin et al 1994: 58). Part of the prescription in this family’s case was for the boy to find a way to help his relatives to stop, or at least deal with, their worries about him (Cecchin et al 1994: 58). Framing the prescription in relational terms, specific to the family concerned, is not only consistent with the Milan Group’s approach to prescribing 4.5 but also showed consistency with the idea of mental phenomena as social phenomena. The problem was reframed in social (relational) terms, as was the prescription – the boy had to involve himself in a specific way of relating to his mother, aunt, and grandmother (Cecchin et al 1994: 58).

If mental phenomena are reframed as social or relational phenomena, then the therapeutic techniques and interventions of the Milan Group should rest on this principle. This proposition will now be subjected to a brief analysis to test it.

Testing the principle of mental phenomena as social phenomena

The Milan Group saw families and therapists as a system 3.2. Systems are relational by definition 3.1.1. Framing problems as being within the family, its structure and its communication patterns, as well as prescribing rituals that changed those communication patterns, is consistent with the concept of mental phenomena as social phenomena, as well as being systemically consistent. Verderber’s transactional model of communication 3.2 allows for internal structure and functioning of systems (communicator/s and recipient/s) in the context of the communication encounter, where meaning is created and negotiated. Communication is a basic and essential social phenomenon: ‘one cannot not communicate’ (Steinberg 1997: 17 ff.). Communication, seen in the light of Verderber’s model, is a systemic or cybernetic concept. The method of circular questioning devised by the Milan Group can therefore be seen as a way of communicating within the therapeutic system (comprising family and therapist). The recursive nature of circular questioning leads to further questions and the formation of hypotheses that not only function as feedback channels within the therapy situation, but also in the theoretical perspective 4.4. The context of therapy can be seen as one of social change (Becvar & Becvar 1998: 240, op cit.). Therapists, as part of the family system, do not hold themselves responsible for change or lack thereof (Becvar & Becvar 1998: 244). Paradoxically, therapy has lead to a change in the Group’s own thinking (from linear to systemic) (Palazzoli et al 1989) and that of their clients (at least in some cases). Generally then, a recursive, relational pattern can be seen in the Milan Group’s approach to therapy, which is systemically consistent, and that is socially framed (i.e. framed in terms of relationships rather than individuals).

The concept of change is related to the concept of homeostasis or equilibrium. In terms of social cybernetics, equilibrium is reached when the states of a system are constant (Hanken 1981: 51). The states of a system are referred to as the "states related to the primary system, the actors ad the communication system" (Hanken 1981: 51). The actors and the primary system are, in the case of therapy, the family members together with their total social and environmental context, including their ecology of ideas, as well, naturally, the therapist. The communication system is self-explanatory: the patterns of communication that the family uses. In a homeostatic state the patterns of communication are fixed and maintain an existing level of functioning for the family. The system can be described as stuck. Therapeutic interventions, such as circular questioning, or the perturbation of the communication patterns of the family that can occur by ritual prescription, could be said to unbalance the equilibrium of the system. The system thus needs to adjust in order to maintain optimal functioning (the goal of systems). This brings about change. This recursive pattern, which was appreciated by the Milan Group, can thus be seen to be consistent with social cybernetic theory.

Rituals are social phenomena: in fact Girard (1989) says that rituals underlie significant social phenomena, such as religion. For example, Girard proposes the scapegoat myth as the origin of religion and culture.

Girard ‘s hypothetical event and ritual

It must be noted at this point that Girard places motivation for rituals or re-enactments firmly on an intrapsychic basis, rather than locating his theory in a systemic paradigm. The reason for introducing the discussion of Girard’s (linear/causal) version of how rituals arose is to present an alternative explanation of the social significance of ritual. Girard’s hypothesis and his theory of ritual are variations of the many possible ways that suggest a deep conceptual connection between ritual and social interaction.

Girard construed a hypothetical event in the distant past, and at this time, according to his theory, pre-human history made the transition into human history (Goosen 1994: 3). Girard’s event is based on mimetic desire (Krüger, le Roux, Lubbe & Goosen 1994: 104 f.) – two hominids both desired some object and started to fight over possession of it. Because the fight was caused by mimetic desire, rather than by the intrinsic value of the object that had triggered it, it became infectious and more people joined in, caught in a cycle of unconscious mimicry of the desires of those already involved. Eventually the fight became a full-scale battle (Goosen 1994: 4). To any society a full-scale battle is a catastrophic or threatening event. In Girard’s theory a threat to society is an important trigger of a scapegoating event (Girard 1989: 14, 43). It is at this stage that the scapegoat mechanism comes into focus, as according to Girard, during the course of the battle, all the combatants suddenly turned on one person, who was killed as a result. Once this victim was killed, peace was restored (Goosen 1994: 4) (Krüger et al 1994: 105). Interestingly, for Girard, the scapegoat is paradoxical, as the mechanism functions on two levels: the level of human emotions (desire and the conflict that results from it, and the level of resolution of conflict) but also, and simultaneously, by apparently resolving disasters in the physical world.

Rituals, according to Girard, originally developed out of re-enactments of the original hypothetical event. The concept of ritual functions as a safety valve – it allows people to release the negative energy of mimetic desire, instead of constantly bottling it up behind a screen of proscriptive law (Goosen 1994:10). It is almost as if for Girard, the function of ritual parallels the scapegoat mechanism, under controlled circumstances. Ritual allows for the crisis, allows for a release of mimetic desire, and then heals society or restores order to society (Goosen 1994: 10).

Rituals are ways that people relate to other people, and if Girard (though controversial and sometimes simplistic in his analysis of complex phenomena, such as religion and human relationships) has a valid point, then rituals are the most fundamental of social phenomena, and are related directly to mental phenomena. This supports the Milan Group’s emphasis on prescription of rituals as a way of reframing mental phenomena as social phenomena.

 

HEALTH AND DYSFUNCTION

Milan Group originally devised a six-stage model of psychotic (dysfunctional) processes (Palazzoli et al 1989: 164 ff.). More recent work by members of the Group shows a movement towards the development of a "more open cognitive and therapeutic spirit" (Palazzoli et al 1989: 220) and thereby an attitude of flexibility, which is less tied to dogma and theorising that the original model. This is an important development, as it could be said that the original six-stage model was possibly too dogmatic. Palazzoli and colleagues themselves express their concern with therapists tending to impose their own prejudices on families – in other words, it is possible for therapists to slip into the pitfall of trying to make families fit their models. This factor is a possible contributing factor towards the work of Cecchin and colleagues (Cecchin et al 1994), which deals with the pros and cons of the prejudices of therapists. The immediate problem with this approach is that by developing a model of dysfunction, the Milan Group is, in effect, labelling a state of being as being other than normal. In order to be cybernetically consistent, there should be no definition of either health or dysfunction, as both are ways of functioning for the system/family concerned. By labelling a family as dysfunctional, the Milan Group contradicted their philosophy (to be discussed in the next paragraph) of breaking the tyranny of linguistics" (Becvar & Becvar 1998: 239, op cit.)3.3

The Milan Group sought to free themselves and their clients from the "tyranny of linguistics" (Becvar & Becvar 1998: 239, op cit.)3.3. Part of the linguistic trap is that people tend to reify labels. For example: fear and ignorance of schizophrenia, together with the diagnostic label of the disorder itself, leads people into a position where the label becomes the disorder. A very important implication of this is that misinformation, misperceptions, ignorance, and fear of the unknown (in respect of the disorder) can also become one of the causal factors in the development and maintenance of disorders or dysfunctional family functioning. The Milan Group tied to break the concept of the label as the disorder by reframing the family problem in a recursive, circular way, rather than leaving families held in a linear mould. Ultimately, families might begin to question their own underlying beliefs, which process might lead to behavioural changes (Becvar & Becvar 1998: 242). If families could perceive problems in a different light, the problem as such ceased to be defined as a problem, or could at least cease to dominate the family’s functioning. The concept of reframing dysfunction in such a way that if it could not be perceived as health, it could cease to command the family’s functioning, was a basic tenet of the Milan Group’s approach.

Causality, seen cybernetically, is a paradox. Systems do what they do best in order to function as a result of the way in which they are structured (Becvar & Becvar 1998: 78). There is an overlap of function and of definition. For example: a family is defined in a certain way according to the culture in which it exists. That definition forms a boundary. However, "the boundary does not cause the family nor does the family cause the boundary" (Becvar & Becvar 1998: 78). The definition and the structure of the family both need each other in order to form a reality that is valid for that family within a certain context. A change of context, such as a second marriage, birth, death or divorce, will involve restructuring of the family, and therefore, and inseparably from that restructuring, redefinition of the family. Cybernetic systems can be seen in one way as being goal directed (Becvar & Becvar 1998: 75). They function in order to do what they do, which is to exist (Becvar & Becvar 1998: 75). Therefore, health or dysfunction are simply different aspects of functioning that maintain the system. When systems interact, the context is changed or modified, by virtue of that interaction (Becvar & Becvar 1998: 80). Therefore change can be seen a process of structural reorganisation as a result of internal pressures in relationship to perturbations or punctuations of environment (context) of the system (both internal and external environment) (Becvar & Becvar 1998: 78). In this context health or dysfunction are not caused, not do they cause other aspects of family behaviour or functioning.

Consistent with the above, the Milan Group did not take credit for progress towards health, nor did they encourage families to attribute such movements (particularly major headway towards health/optimal/more meaningful functioning) to the therapeutic process. Rather, the Milan Group saw changes as originating within families, and saw overt efforts to point out that therapeutic interventions and been instrumental in such changes as "disqualify[ing]the family" (Tomm, in Becvar & Becvar 1998: 245). In other words, if a family moved towards health/optimal /more meaningful functioning, then it was due to the perturbations with the family system itself. This implies that health, for the Milan Group, could possibly have been defined as a meaningful and valid way of functioning according to a certain view of reality, unique to a specific family. Conversely, by the same argument, dysfunction could be seen as functioning that is not valid in terms of a family’s worldview. Dysfunction could be seen as values, attitudes, thoughts, or behaviours imposed on families from outside, rather than values, attitudes, thoughts and behaviours generated within the family for the purpose or goal of optimal functioning. Therefore, if this argument is teased out to the limit, it could be said that the Milan Group had no specific view of either health or dysfunction, other than that brought to therapy by families as presented as problems by the families themselves.

  CYBERNETIC CONSISTENCY

"Man is not a passive receiver of stimuli coming from an external world, but in a very concrete sense creates his universe." (Von Bertalanffy, in Macy 1991: 81).

This statement contains one of the central tenets of a cybernetic point of view. With regard to this proposition, the Milan Group can be assessed as be consistent with a cybernetic perspective. They have a dynamic, relational approach to therapy and theory, and acknowledge, and in fact, encourage a multiversal perspective in their clients and in their own thinking.

Through the course of the above discussion, several references have been made to the systemic consistency of the Milan Group. These will briefly be summarised for the sake of clarity:

 

Table Two: Summary of points of cybernetic consistency of the Milan Group

Section

Points of cybernetic consistency

Bateson’s Influence 3.1.1

    Change in one part of the system affects the whole system Circular epistemology Patterns of information and relationships Importance of context
Feedback and Equifinality/Equipotentiality 3.1.2

    Importance of recursiveness and feedback Acknowledgement of negative feedback Original acknowledgement of principles of equifinality and equipotentiality, but later moved away from this model and took history into account
The Strategic Element 3.2

    Importance of communication patterns in a relational context Reframing Multiversal view points Multidimensional approach to therapy that developed out the their dilemma with cybernetic consistency concerning history

The Linguistic Element and Indeterminacy 3.3

    Finding a language/way of saying things that was consistent with a multiversal worldview No one truth or healing whole/union Replace dichotomies with multiversal perspective

 

Section

Points of cybernetic consistency
Structure and Organisation 3.4

    Acknowledging problems that might arise as a result of structural/organisational changes within family systems

Circular Questioning 4.4

    Recursive method that allows for feedback Principle of mutual co-arising or co-evolving Focus on ‘What?" rather than ‘Why?’
Neutrality and Support 4.4.1

    Principle of the non-summative nature of systems Room to find alternative ways of thinking and behaving
Prescription of rituals 4.5

    No black box metaphor – therapist and family as one system Metatherapy Multiple levels of functioning Perturbations of communication patterns in families Negotiation of meanings between subsystems
Mental Phenomena as Social Phenomena 4.6

    Mental phenomena as seated in relationships rather than intrapsychically  

Health and Dysfunction 5

    Freedom from labelling – ‘the map is not the territory’ Changes originating within families and not attributed to the therapeutic process

 

In footnotes to the above table, a few references have been made to some dimensions of the Milan Group’s approach that are not cybernetically consistent, so these will not be discussed again in detail.

Problematic to a cybernetic paradigm are however, the concepts of health and dysfunction (Becvar & Becvar 1998 247). According to second order cybernetics, systems function the way they function (Becvar & Becvar 1998: 247), and punctuating a difference as being healthy or not healthy is therefore inconsistent in cybernetic terms. Further, the Milan Group focused on breaking out of linguistic traps. For most people the term dysfunctional conveys the value judgement of ‘bad’, and equally, the term healthy implies a value judgement of ‘good’. Apart from being inconsistent cybernetically, these concepts, looked at in this way, are therefore also inconsistent with the Group’s expressed ideal of breaking out of linguistic traps.

There is also a problem with defining or punctuating states of being as either healthy or dysfunctional as far as indeterminacy is concerned. In terms of Derrida’s philosophy 3.3, health and dysfunction are dichotomous opposites. Therefore, to punctuate states of being as being either healthy or dysfunctional is to fail to look for the reality in between these opposites. However, in Derrida’s terms, health and dysfunction, as opposites, are brought into being by the existence of that which falls between them – the meaning of health is created by the meaning of dysfunction. It could then be said that it is necessary to have a concept of health in order to have a concept of dysfunction, or vice versa, and that the reality of both co-arises out of the creation or negotiation of their respective meanings. Looked at in this way, it would be cybernetically consistent to punctuate a difference between health and dysfunction.

Regarding the prescription of rituals 4.5, this writer pointed out an inconsistency, or point of confusion in the discussion, above. Rituals were designed to "cut through the knots of a game even when [they] had not yet deciphered and reframed it" (Palazzoli et al 1989: 17, op cit.). The Milan Group, were, however, also concerned with the history and background of their clients, which they needed to understand 3.1.2. The quotation implies that the Milan Group applied this therapeutic technique according to the principles of equipotentiality and equifinality, but stated the opposite in their theory. Connected to this point is the issue of history 3.1.2, which is clearly inconsistent with a cybernetic worldview.

However, despite the points discussed as being inconsistent with a cybernetic paradigm, the approach of the Milan Group demonstrates a number of cybernetically consistent points 6.1. Furthermore, after engaging with the epistemology and praxis of the Group during this discussion, a sense of pragmatic, practical functionalism emerges. If it is cybernetically consistent to say that systems do best what the do best in order to exist, and if the Group’s approach works in therapy, then it could be implied that this approach is a paradigm for a functional system.

Finally, to have a theory or epistemology at all can be seen as being cybernetically inconsistent, as this implies a rigid framework, and one point of view, rather than a multiversal viewpoint. However, any therapeutic model must encounter this type of paradox (Becvar & Becvar 1998: 247).

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