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The unraveling of a treatment paradigm: a followup study of the Milan approach to family therapy.

A 2-year followup study was conducted to determine the efficacy and degree of satisfaction with Milan-style family therapy with families refractory to other treatment interventions. Fourteen families and 5 couples who received Milan-style family therapy participated in the study. Family outcome was found to be improved in 56% of parents and 89% of identified child-patients at followup. Improved self-outcome at followup was reported by 56% of fathers, 67% of mothers, and 78% of identified child-patients. A substantial percentage of fathers (68%) and mothers (59%) reported that at least one family member sought further therapy posttreatment. Factors associated with either parent's positive perception of the treatment in general included the time interval between sessions, experiencing the treatment as brief rather than long, and positive feelings for the group behind the mirror. Mothers who reported liking the treatment reported better family outcome. For mothers, disliking the treatment was related to family members seeking further treatment. The more negative the mothers' and fathers' spontaneous comments about therapy were, the more likely that a family member would seek further alternative psychotherapy. The outcome results are explained in terms of the treatment families' negative reactions to some aspects of the therapist's stance and to the group behind the one-way mirror, as in Milan-style therapy. The importance of modifying Milan-type therapy to foster a positive attitude toward the treatment procedures and the therapist's interventions is discussed.