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3 Creating a Context for Therapy

Campbell, David; Draper, Ros; Huffington, Clare Karnac Books ePub

In the original paper, Working with the Milan Method : Twenty Questions, Question 1 (What is the minimum needed in the work setting to work in this way?’) and Question 20 (‘How would you introduce this method to a traditional clinic?’) addressed issues about the treatment setting that we would now answer differently.

Our thinking in response to these questions has changed considerably over the past few years. If we were asked them now, we would ask a questionin return: ‘What do you need to understand about your work setting, in order to create a systemic approach?’ Instead of having an idea about a way of working and trying to create a setting for it, we would want to ask people about developing a way of working that is responsive to that setting, and arises from within that system. We might suggest that a person could ask his or her manager, What are your most important aims and objectives in running a service?’ and, ‘What kind of view of families is it important for the agency to maintain?’ and, lio w do you see family therapy fitting in?’ The answers to these questions will then create the beginnings of a way of working systemically in that context, and will have evolved through the relationship with the manager.

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8 Positive Connotation

Campbell, David; Draper, Ros; Huffington, Clare Karnac Books ePub

Although the idea of seeing family problems in a positive light was not a new one, the Milan team developed the technique in order to make their paradoxical interventions seem credible to the family. The intention, in using this technique, was strategic. Over the years we have had discussions about whether we really believe what we say when we tell a family that ‘Johnny is doing something helpful for the family by stealing from Woolworths’.

But this i s to miss the point. We believe that people do what they think is best, or what they think they must do in order to prevent something that at the time seems worse from happening. But, since the ‘problem’ behaviour is observed from another context, that is, a ‘problem’ context, it acquires a negative connotation. A positive connotation is no more true or false or right or wrong than a negative connotation; rather, it is a strategic statement aimed to introduce difference into the family belief system and, with it, the possibility of change.

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2 Theoretical Framework-How We View Families and Therapy Now

Campbell, David; Draper, Ros; Huffington, Clare Karnac Books ePub

Whereas we used to describe symptomatic behaviour as the individual’s response to the threat of changing relationships, the development of our thinking has led us to the notion that problems in families result from the experience of ‘bad fit’ between the beliefs and behaviours of family members.

Each family member carries inside him or her self a hierarchically organized set of beliefs, premisesor constructs. They derive from the different levels of feedback we get from our environment. The highest, most inclusive beliefs are those which come from interaction with cultural values: Trotect one’s family’, ‘Respect the rights of others’. Lower-level beliefs derive from feedback from the community, family, workplace, dyadic relationships, etc. The reader should refer to Cronen and Pearce (1985) and Cronen, Pearce and Tomm (1985) for a fuller discussion of this topic.

These beliefs combine to exert a contextual force to guide people towards specific actions or behaviours, and those actions or behaviour provide the feedback by which people support or reject the belief which guided that particular action. Thus belief and action are joined in a recursive relationship; and if they are experienced by the individual as a ‘good enough fif, the beliefs and behaviour will be maintained within certain limits.

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1 Introduction

Campbell, David; Draper, Ros; Huffington, Clare Karnac Books ePub

We published Working with the Milan Method : Twenty Questions in 1983 as a response to the way the Milan Approach had been described and discussed up to that time. Selvini et al attempted to clarify the major components which under-pinned the approach and described them in their paper, ‘Hypothesizing-Circularity-Neutrality’ (1980). Because we were being confronted with something new, we needed to differentiate these components and make them relevant and manageable for ourselves, as family therapists offering treatment to families. Looking back, we can see how at that time we were preoccupied with linking our systemic thinking to useful family therapy techniques.

We have discovered that people starting out as therapists use Working with the Milan Method : Twenty Questions as an introduction to the basic ideas behind the Milan Approach and as a handbook of therapy skills. It has served as a set of questions and explanations which prompt further questions and which people continue to ask us. But we now answer those questions in a different way : we have inevitably been affected by the feedback created by answering those Twenty Questions’, and the questions family therapists asked of us now represent different preoccupations and different working contexts.

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6 Interviewing

Campbell, David; Draper, Ros; Huffington, Clare Karnac Books ePub

In thinking about the aims or purposes of the interview, we are more interested now in addressing the question: 1i the purpose of the interview is family therapy what is the purpose of family therapy for this family in this particular setting?’ This might lead to a hypothesis about what relationship a therapist might need to make with a family in that setting, in order to create a therapeutic system. For example, Selvini (1988) has a view that in order to do family therapy with anorexics in her setting, everybody must attend or therapy cannot take place. This will differ with different sorts of families or different sorts of agencies where the issues can be more structural or more strategic. In order to create a therapeutic system a therapist will act much differently with a life-threatening illness or a statutory case, for example.

We may sound more eclectic in this book than we did in the original Twenty Questions because we entertain the idea that there are many different ways to approach families in order to bring about change. Rather than selling the Milan Approach, we are more interested in how people respond to feedback in order to connect their own thinking with their own work setting. We try to help people find a way of articulating some understanding, firstly, of their position in their own system; and then how in this position they represent an agent of change in that system, and need to spell out the losses and gains for that system implicit in any change. Appreciating the dilemmas for their colleagues’ and their own relationships in their professional system allows therapists to begin to reframe their own position when feeling ‘stuck’.

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