Case Report: Keeping the Milan approach legacy alive? Paradox and counterparadox working therapeutically with non-suicidal self-injury.

Abstract

Is it possible to maintain some of the precious wisdom of our ancestors, while embracing the post-modern revolution of family therapy and systemic thinking? This paper tries to offer an exploratory answer to this question. Milan Approach designed its interventions relying on the therapist's expert position, their moral neutrality and their ability to identify, as an external observer, the "family games" that were responsible for the identified patient's symptoms. Despite its success in offering a fresh perspective and some innovative therapeutic strategies to deal with a range of issues, including, but not limited to, eating disorders, the Milan Approach has undergone criticism, mainly due to its lack of reflexivity about social justice and elements of inequality that might have been at the foundation of problematic family dynamics. In the commendable attempt of purifying family therapy from elements of oppressive practice, post-Milan approaches have distanced themselves from their "ancestors" and showed increasing reluctance to use their tools. Particularly, counter-paradoxical interventions such as the invariable prescriptions have been progressively abandoned in favor of more collaborative tools. This paper, through the means of a clinical example, explores the usefulness of a counter-paradoxical intervention in a second-order family therapy, embracing a social-constructionist perspective while maintaining the importance of counter-paradox in allowing change. The paper discusses the underpinning principle, the delivery and the outcome of such intervention, and addresses potential criticism, indications for practice and scope for further research.