CASE REPORT article
Front. Child Adolesc. Psychiatry
Sec. Developmental Psychopathology and Mental Health
Volume 4 - 2025 | doi: 10.3389/frcha.2025.1657395
This article is part of the Research TopicNavigating Life Transitions and Family Dynamics in Eating Disorders and Non-suicidal Self-injuryView all articles
Keeping the Milan Approach legacy alive? Paradox and counterparadox working therapeutically with Non-Suicidal Self Injury, a single case study Authors: Ferdinando Salamino (corresponding author), Elisa Gusmini
Provisionally accepted
- 1University of Northampton, Northampton, United Kingdom
- 2University of Oxford, Oxford, United Kingdom
- 3Oxford Brookes University School of Social Sciences, Oxford, United Kingdom
- 4European Institute of Systemic-relational Therapies, Milan, Italy
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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 invariant 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.
Keywords: Family Therapy, systemic psychotherapy, child and adolescent mental health (CAMH), non-suicial self-injury, Milan approach, Social constructionism, Post-Milan systemic family therapy
Received: 01 Jul 2025; Accepted: 15 Aug 2025.
Copyright: © 2025 Salamino and Gusmini. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ferdinando Salamino, University of Northampton, Northampton, United Kingdom
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