Relational-multigenerational therapy

1. Introduction

Version followed: Maurizio Andolfi's multigenerational family therapy as set out in Multi-generational Family Therapy: Tools and Resources for the Therapist (Routledge, 2017; Italian original 2015), together with his "bottom-up" child-as-family-guide method (Andolfi 2011; Andolfi 2016 Springer chapter; Ackerman Institute workshop 2024). Earlier concepts (provocation and holding, trigenerational triangles, family myth, rituals, consultants) come from Andolfi et al. 1983, Andolfi, Angelo & De Nichilo 1989 and Andolfi & Haber 1994. For those books only the publisher descriptions, contents lists and reviews are drawn on. The earlier interactional techniques (directive and paradoxical tasks, prescribing the rules, metaphorical tasks, sculpting) are sourced to the contents list of Andolfi's Family Therapy: An Interactional Approach (1979). The metaphoric object is sourced to a confirmed citation of Angelo 1981 and a secondary article summary. The four-year Accademia training course is sourced to Andolfi 2018. The full texts of Behind the Family Mask, the 1979 book and Angelo 1981 are not drawn on. No manual, session count or certification is given. [source: Routledge and Taylor & Francis book pages; Lavoisier contents list; Sanvicente 2018 review; Andolfi 2011; Andolfi 2018]

What it is. An experiential, systemic-relational family therapy developed by the Italian psychiatrist Maurizio Andolfi and colleagues at the Accademia di Psicoterapia della Famiglia in Rome. The Accademia also teaches it, through a four-year training course. It draws on Bowen, Framo, Whitaker, Minuchin, Ackerman and Satir. Andolfi's sources describe it as a clinical approach and a stance, not a session-by-session manual. No session protocol, fidelity measure, certification or licensing scheme was found, and Andolfi's 2018 account of the Accademia mentions none. [source: Sanvicente 2018; Andolfi 2013 introduction; Andolfi 2018 introduction] [uncertain: no manual located]

How change happens. The presenting problem, often a child's symptom, is treated as a relational message. It points to unresolved wounds, losses and broken bonds across at least three generations. In Andolfi's 2011 paper, a child's problem is always a family problem, and the resources for change sit inside that problem. The therapist uses the symptomatic child as a guide into the family's history. Family-of-origin members and other consultants are brought in, and the knots are staged and lived through in session, not only talked about. The therapist's own person and emotional responses help build a "therapeutic system". Change shows in two ways: symptoms resolve, and emotional bonds in the family change in depth. Pain is treated as a force that can drive change. [source: Andolfi 2011; Andolfi 2016 abstract; Ackerman 2024; Sanvicente 2018]

2. Framework

Andolfi does not publish fixed phases or session counts. The sequence below comes from the phases his 2011 paper describes and the contents of the 2017 book (observation, assessment, therapeutic story, language, body, silence and touch). [source: Andolfi 2011; Routledge contents list] [synthesis: ordering and transition criteria]

Format. Conjoint sessions with whoever lives with the problem, opened out to grandparents, siblings, extended family and other significant people as therapy proceeds. In the Rome clinical service, two or more therapists work in co-therapy. A team of about five or six observes behind a one-way mirror and can be consulted during the session. The team works at least weekly. Home visits and joint work with local services and institutions are part of the model. Typical clinical groups include couples in crisis, hostile separations, child and adolescent problems, recently immigrated families, and families after a sudden death. Andolfi also runs single live consultations in front of trainees: a child-focused family session and a couple session in which godparents were invited as consultants. [source: Andolfi 2018 introduction; IACAPAP 2025 report]

Session count. Not specified in any source. Follow-up sessions after the end of treatment are explicitly part of the model. [uncertain]

Phase A: first contact and redefining the problem.

Goals: build cooperation, especially with the symptomatic child. Redefine the symptom as a relational opportunity, not a disorder. Make first links between the symptom and family relationships. Start the genogram. [source: Andolfi 2011; Ackerman 2024]
Move on when the family accepts a relational reading of the problem, at least tentatively, and the child is participating as a guide, not as the patient. [synthesis]

Phase B: multigenerational exploration (assessment and the therapeutic story).

Goals: observe family functioning across three generations and the life cycle. Explore triangles. Use bottom-up questions to the child about adversities the parents and grandparents went through. Build a shared "therapeutic story" that ties past trauma and broken bonds to present suffering. [source: Routledge contents list; Ackerman 2024; Andolfi, Angelo & De Nichilo 1989 contents list]
Move on when a working hypothesis links the symptom to a specific intergenerational knot (a loss, a cut-off, a secret, a migration) and the family is willing to involve the people concerned. [synthesis]

Phase C: bringing in the families of origin and other consultants.

Goals: invite grandparents, siblings or the parents' own families. In couple work, do this early, because family-of-origin conflicts are often central. Children can be used as consultants on the couple's impasse. Friends, godparents, co-workers or professional consultants can be added where relevant. [source: Andolfi 2011; IACAPAP 2025; Ashton 1999 review of Andolfi & Haber 1994]
Andolfi stresses careful timing and a well-prepared invitation before family-of-origin members or children join as consultants. [source: IACAPAP 2025]
Move on when the knot has been staged and spoken in the presence of those involved, for example a parent's disclosure of their own childhood fear to their child, and new relational moves appear. [synthesis, based on the Anita case in Andolfi 2011]

Phase D: impasse work (any time it is needed).

Goals: unblock stuck phases with children as consultants, extended family, or a professional consultant who adds new perspectives and uncertainty to the therapeutic system. [source: Andolfi 2011; Ashton 1999]

Phase E: ending, validation and follow-up.

Goals: children give feedback and can "grade" the adults' progress. Check the two outcome criteria: the symptom has resolved and emotional bonds have deeply changed. Both should hold at the end and again at follow-up. [source: Andolfi 2011; Ackerman 2024]
Andolfi's 1989 book has a chapter on "periods of separation", but its content is not drawn on. [uncertain]

3. Guiding principles

[source for this section: Andolfi 2011; Andolfi 2016 abstract; Andolfi 2018 introduction; Ackerman 2024; Sanvicente 2018 review; Andolfi, Angelo & De Nichilo 1989 description. One-line practical meanings are synthesis.]

The family is the frame; a child's problem is a family problem. Practically: do not see the referred child alone as the first move. Convene the family and read the symptom in context.
Look for resources, not labels. Practically: put off diagnostic labels such as ADHD. Ask what the symptom reveals and protects, and who in the wider network can help.
Resources lie inside the problem. Practically: treat the symptom as the entry point into the family's knots, not something to remove first.
Think in at least three generations. Practically: every presenting problem gets a genogram and questions about grandparents' and parents' adversities.
The child is a competent guide and co-therapist. Practically: speak to the child directly, admit what you do not know, and let the child teach you about the family.
From child protection to child respect. Practically: do not rescue the child or replace the parents. Andolfi warns against the therapist acting as the "good parents". Give the child a voice and return the parents to their role.
The family is the protagonist. Practically: techniques serve the family's own story. The therapist directs the drama but does not own it. [Andolfi & Angelo, in Andolfi 2013]
Techniques live inside a relationship. Practically: never apply a tool "like a medicine". Use it only when the alliance can hold it.
The therapist's person is the main instrument. Practically: notice your own emotional responses and use them openly to connect with each member. Be direct, authentic and empathic.
Provocation is therapeutic only with holding. Practically: challenge rigid patterns only from a warm, joined position, and stay with the family through what follows.
Be direct, clear, systematic and non-diplomatic. Practically: ask the question everyone avoids, in the room, to the person concerned.
Stage it, don't just talk about it. Practically: bring role inversions and conflicts into the session as live interaction so they can change there.
Pain is a force for change. Practically: don't hurry to soothe disclosures of grief, fear or guilt. Stay with them, since they carry the change.
Experiential, playful and humorous. Practically: get on the floor, use play, metaphor and "as if" language, and drop the serious adult role when it blocks contact.
The body, silence and touch are languages. Practically: read posture, movement and seating. Use silence on purpose. Allow and invite appropriate physical contact between family members.
Flexible expertise; consultants enlarge the system. Practically: when stuck, widen the system (family, friends, colleagues) instead of pushing harder alone.
Self-knowledge and an internal supervisor. Practically: know your own family history and biases, use team and co-therapy reflection, and work on your own family of origin in training.
Judge success on two criteria. Practically: check for symptom relief and for changed bonds, at the end and at follow-up.

4. Intervention inventory

Note on sources: the techniques are named, and illustrated with cases, in Andolfi 2011, the Ackerman 2024 workshop description, the IACAPAP 2025 report and the Andolfi 2018 introduction. They also appear in the contents lists of the 2017, 1989 and 1994 books and of Family Therapy: An Interactional Approach (1979). For the metaphoric object, a secondary article summary and a 1984 workshop record were also used. The step-by-step breakdowns are my operationalisation of those descriptions [synthesis]. All example language is illustrative unless quoted.

4.1 Convening the family and redefining the symptom relationally

Purpose / when: From the first contact, especially when a child is referred, to shift the problem from "inside the child" to the relationships. This is the core move of the first phase. [source: Andolfi 2011; Ackerman 2024]
Steps:
1. Invite everyone who lives with the child, or at least both parents and siblings. Grandparents can be invited early. [synthesis]
2. Let each person describe the problem. Note who speaks for whom and where people sit. [synthesis]
3. Turn to the child and ask what they think the problem is about and who worries most.
4. Offer a relational redefinition: the symptom as a message, a protection, or a sign of a family knot. Do not offer a diagnosis. [source: Andolfi 2011; Andolfi 1979 contents, ch. 2 on redefinition of the relationship, context and problem, including positive redefinition and amplification of the problem]
5. Hold off on labels, including ADHD, which Andolfi regards as overextended. Say the label can wait until the family has been understood. [source: Andolfi 2011]
Example language (illustrative): "Before we decide what is wrong with Marco, I'd like to understand what his fear is trying to say to all of you." / "Maybe his stomach aches are doing a job in this family. Let's find out which job."
Watch for: Parents who insist on an individual fix. Build the alliance before pushing the redefinition, and don't argue. It's working when parents start talking about their own worries and the child relaxes and joins in. [synthesis]

4.2 Engaging the child as guide and co-therapist

Purpose / when: Throughout therapy, so the symptomatic child acts as the "Ariadne's thread" that leads the therapist into and out of the family labyrinth (Andolfi's image, 2011). [source: Andolfi 2011; Andolfi 2016 abstract; Ackerman 2024]
Steps:
1. Address the child directly, early, at eye level. Sit on the floor if that helps. [source: Andolfi 2011]
2. Ask permission to ask a question. In one 2011 case the therapist asks the boys whether he may put a question to them. Admit you don't know the answer, so the child is the one who teaches you. [source: Andolfi 2011]
3. Treat the child's answers as expert information about the family, and check them with the adults.
4. Use the child as a bridge to the parents' own history (see 4.4) and between generations (see 4.6).
5. Protect the child's position: the child guides, but does not carry responsibility for fixing the parents. [synthesis]
Example language (illustrative): "Can I ask you something? I don't know this family yet, and I think you know it better than anyone here. Who in the house gets most worried when you're sad?"
Watch for: Parentification. If the child starts managing the adults, hand the responsibility back to the parents. Don't side with the child against the parents. Andolfi warns against the therapist acting as the "good parents". Signs it's working: the child moves from symptomatic withdrawal to lively participation, and the parents become curious. [source: Andolfi 2011; synthesis]

4.3 Genogram as map of the family world

Purpose / when: To start the therapeutic journey, map the three-generation family, locate losses, cut-offs, migrations, secrets and triangles, and see which generations or members need inviting. [source: Ackerman 2024; Routledge contents ch. 2, 4–5; Andolfi 2018 introduction]
Steps:
1. Draw the genogram with the family, during the session, on a board or large sheet. Include the children. [synthesis]
2. Cover at least three generations: dates, deaths, separations, illnesses, migrations, addictions, abuse, secrets. These categories are listed by Ackerman 2024.
3. Mark emotional closeness, distance and cut-offs, and life-cycle transitions happening now. [synthesis; life cycle from Routledge ch. 2]
4. Look for parallels between the child's symptom, timing or age and events in earlier generations.
5. Use the genogram to choose who to invite and what to ask (4.4–4.6).
Example language (illustrative): "Let's draw your family together, including the people who aren't here today and the ones who have died." / "Was anything happening in the family the year Sara started refusing school?"
Watch for: The genogram turning into a dry data form. Andolfi frames it as a way into the family's emotional world. Slow down when emotion rises at a name or a date. Don't push into secrets before there is enough trust. [synthesis]

4.4 Bottom-up intergenerational questions

Purpose / when: In the exploration phase, to use the child's voice to open the parents' and grandparents' unresolved adversities. Andolfi calls this the bottom-up approach. [source: Ackerman 2024]
Steps:
1. With the parents present, ask the child about events in the parents' or grandparents' lives: losses, hostile divorces, secrets, abuse, forced migration, addiction. [source: Ackerman 2024]
2. Ask what the child knows, imagines or senses, for example "what do you think Dad was like at your age?"
3. Turn to the parent concerned and ask whether the child is right. Invite the parent to tell the story to the child directly.
4. Link the story to the present symptom, tentatively.
Example language (illustrative): "Do you know what happened to Mum's dad? ... Mum, is she right? Would you tell her?"
Watch for: Children being drawn into adult material they shouldn't hold, such as details of abuse. Steer to what can be shared at the child's age, and see the adults alone if needed [synthesis]. A sign it's working is a parent speaking to the child about their own childhood for the first time, as in the Anita case, where the father's disclosure of his childhood fear came before the girl began sleeping alone. [source: Andolfi 2011]

4.5 Relational questions

Purpose / when: Throughout therapy, to link a person's traits or symptoms to relationships and their origins in the family history. Relational questioning is a chapter-level tool in the 2017 book. [source: Andolfi 2011; Routledge contents ch. 7; Taylor & Francis description]
Steps:
1. Take a trait or symptom, such as a mother's depression or a father's dependence on someone's mood.
2. Ask where and from whom it was learned. Andolfi's 2011 examples ask which family member the mother learned depression from, or where the father learned his dependence. [source: Andolfi 2011]
3. Ask about third parties: who notices, who reacts, who benefits, who is left out. [synthesis, a triadic extension]
4. Put the question to a different family member from the one it is about, often a child.
Example language (illustrative): "Who did you learn to be this sad from, in your own family?" / "Luca, when Mum is low, who does Dad turn to?"
Watch for: Questions that sound like blame. Keep the tone curious. It's working when answers bring up new names, generations and stories. [synthesis]

4.6 Three-generation sessions and the child as bridge to grandparents

Purpose / when: When the genogram or questions point to a knot in the parents' families of origin, and early in couple work. Grandparents and extended family are invited so that hidden family narratives can surface and be worked with. [source: Andolfi 2011; IACAPAP 2025; Andolfi, Angelo & De Nichilo 1989 contents ch. 2]
Steps:
1. Prepare the invitation with the parents. Explore their fears about bringing in their own parents. Framo read reluctance as a sign of the conflict itself (Andolfi 2013 introduction). [source; preparation steps are synthesis]
2. Frame the invitation as asking for the grandparents' help and expertise, not as blame. [synthesis, consistent with the consultant framing in Andolfi & Haber 1994]
3. In session, let the child mediate: ask the child to ask the grandparent, or ask the grandparent about the parent as a child.
4. Stage the old relationship, for example a parent and their own parent speaking directly about a loss or cut-off.
5. Close by acknowledging each generation's contribution.
Example language (illustrative): "We've asked you here because you know things about this family nobody else knows." / "Giulia, would you ask Grandma what your dad was like when he was eleven?"
Watch for: Grandparents who feel accused. Joining comes before any challenge. Watch for old conflicts escalating, and contain them by slowing down and turning back to the child [synthesis]. It's working when the parent is seen as someone's child, and when softening or repair happens across generations in the room. [source: Andolfi 2011]

4.7 Addressing parents as children (contextualising roles)

Purpose / when: To loosen rigid parental or marital positions by temporarily putting the parents in the position of children in their own families, often through the child. [source: Andolfi 2011]
Steps:
1. Send messages to the couple through the child. [source: Andolfi 2011]
2. Ask the parents about themselves as children, or how their own parents would see the current problem.
3. Link their present parenting to what they received or missed.
Example language (illustrative): "When you were Marco's age, who comforted you at night?"
Watch for: Losing parental authority. Afterwards, put the parents back in charge explicitly. [synthesis]

4.8 Children as consultants in couple therapy

Purpose / when: When a couple is stuck in a conflict or a cold wall. Children are invited to suggest how to "knock down the wall". Later they can grade the adults' progress. [source: Andolfi 2011; IACAPAP 2025]
Steps:
1. Prepare the couple first. Explain that the children are coming as consultants on the relationship, not as judges or messengers, and get both partners' agreement. Andolfi stresses careful timing and invitation. [source: IACAPAP 2025; agreement step is synthesis]
2. In session, tell the children you need their help, and ask what they notice and what would help their parents get closer.
3. Keep the children out of the parents' disputes. Ask for ideas, not for sides. [synthesis]
4. Late in therapy, ask the children to give the parents a mark for how they are doing. Keep the scoring flexible and non-labelling. [source: Andolfi 2011]
Example language (illustrative): "Your mum and dad have built a wall between them. You see it every day. Any ideas for how they could start taking it down?" / "If you gave them a mark out of ten for how they're getting on now, what would it be? What would make it one point higher?"
Watch for: Children who are frightened, or loyal to one parent. In hostile separations, check that consulting the child won't put them at risk of blame at home. If it might, don't use this technique, or keep it to safe topics [synthesis]. Signs it's working: the parents are moved by what the children say, and the children look relieved, not burdened.

4.9 Consultants from the client's network (family of origin, godparents, friends, co-workers)

Purpose / when: To widen the system's resources and break stuck patterns. Andolfi & Haber 1994 describe children, friends, co-workers and families of origin as consultants. In a 2025 live couple session Andolfi invited the couple's godparents as consultants. [source: Ashton 1999; IACAPAP 2025]
Steps:
1. With the family, find out who outside the household has a meaningful view of them: a godparent, an aunt, a friend, a co-worker. [synthesis]
2. Agree on a specific consultative question to put to them, then invite them with the family's consent.
3. In session, interview the consultant about their observations and their hopes for the family. Keep responsibility for the therapy with the therapist. [source: Ashton 1999]
4. Debrief with the family afterwards.
Example language (illustrative): "You've known them since their wedding. What did you see in them then that we might be missing now?"
Watch for: Consultants who take sides or break confidentiality. Agree beforehand what can be talked about. It's working when the family finds supportive voices and the impasse gives way. [synthesis]

4.10 Professional consultation to prevent or break impasse

Purpose / when: When the therapeutic system itself is stuck. A colleague or master therapist brings in new perspectives and uncertainty. A problematic referral can also be turned into a consultation. [source: Ashton 1999 on Andolfi & Haber 1994]
Steps:
1. Name the impasse with the family and offer a consultation. [synthesis]
2. The consultant runs or joins one session while the treating therapist stays present and responsible.
3. Integrate the consultant's view into the ongoing work. [synthesis]
Example language (illustrative): "I think the family and I have got stuck together. I'd like to invite a colleague to look at us with fresh eyes."
Watch for: The family feeling handed over. Make the continuity of the treating therapist explicit. [synthesis]

4.11 Provocation with holding (direct, non-diplomatic challenge)

Purpose / when: To unsettle rigid patterns, role inversions and avoidances once the therapist is joined with the family. The 1989 book argues provocation is therapeutic only together with a warm, holding position. [source: Andolfi, Angelo & De Nichilo 1989 description and ch. 3 title; Andolfi 2011]
Steps:
1. Make sure you are joined first: each member should feel seen by you. [source: 1989 description]
2. Name the avoided issue directly and clearly, without diplomatic softening. Ask the pointed question, for example whether a father has ever said to his son what he has just said to the therapist. Push gently for what has gone unsaid. [source: Andolfi 2011]
3. Stay emotionally present through the reaction, and show warmth and commitment (holding).
4. Turn the provocation into an exchange between family members. [synthesis]
Example language (illustrative): "You've just told me you're proud of him. Have you ever told him? ... Tell him now, here."
Watch for: A challenge given without an alliance, which feels like attack. If anger or shame rises, slow down, acknowledge it and reconnect before going further. It's working when the family moves from defensiveness into new, more honest interaction. [synthesis] [uncertain: the 1983 and 1989 detailed accounts of provocation]

4.12 Staging the problem in session

Purpose / when: To bring disorders, role inversions and distortions into the session as live interaction so they can change there, not be denied or minimised. [source: Andolfi 2011]
Steps:
1. When a pattern is described, such as a child sleeping in the parents' bed or a son protecting his mother, ask the family to show it here and now. [synthesis on how to elicit it]
2. Arrange the people involved to face each other and speak directly. Move chairs if needed (see 4.15).
3. Comment on what happens, and invite a different move.
Example language (illustrative): "Instead of telling me how it goes at home, show me. Dad, talk to Anna the way you would at bedtime."
Watch for: Escalation beyond safe limits. Stop and contain if conflict threatens anyone. [synthesis]

4.13 Play, metaphor and "as if" language

Purpose / when: With children, and whenever direct talk is blocked, to move meanings between people and situations. Andolfi gives examples of moving a girl's sadness onto her parents and of redirecting a boy's aggressive energy. Playing in therapy is a chapter in the 1989 book. [source: Andolfi 2011; 1989 contents ch. 4]
Steps:
1. Get down to the child's level and play, on the floor if it fits, as children do at home. [source: Andolfi 2011; "play with children" is a section of Andolfi 1979, ch. 3]
2. Introduce an "as if" frame, for example "as if this toy were the worry" or "as if Dad were the little boy". [synthesis on wording]
3. Use the frame to hand a feeling or role to someone else. Watch how the family takes it.
4. Use humour and lightness, and drop the serious adult role. [source: Andolfi 2011]
Example language (illustrative): "Let's pretend this sadness is something you can pass around. Who should hold it for a while, Mum or Dad?"
Watch for: Play that mocks or trivialises a serious matter. It's working when the family laughs together and emotion follows.

4.14 Subgroup sessions with a symbolic task

Purpose / when: To explore a theme within a subgroup. In a 2011 case Andolfi proposed a men-only session in which the boy and the adult men read newspapers together, a playful way to explore male dependence. [source: Andolfi 2011]
Steps: Identify the theme and the subgroup: men, sisters, the grandparent generation. Propose a session with a simple shared activity that carries the theme. Process it with the whole family afterwards. [synthesis beyond the single case]
Example language (illustrative): "Next time I'd like to meet only the men of the family, three generations of you."
Watch for: Excluded members feeling rejected. Explain the purpose to them and include them in the follow-up. [synthesis]

4.15 Reading and using body language and movement

Purpose / when: Throughout therapy. Symptoms, especially psychosomatic and behavioural ones, "speak" through the body, and posture, distance and movement in the room carry relational information. Body language, physical contact and movement are a chapter of the 2017 book. [source: Andolfi 2011; Routledge contents ch. 8; Taylor & Francis description]
Steps:
1. Notice how the family chooses seats, and who sits next to whom, who turns away and who mirrors whom. [synthesis]
2. Feed back an observation about the body in place of an interpretation.
3. Use movement: invite people to change places, to face each other, or to move closer or further apart, then ask what changed. [synthesis] [uncertain: the 2017 chapter's specific procedures]
Example language (illustrative): "I notice that every time Dad speaks, Sofia turns towards Mum. Sofia, would you sit next to Dad for a moment?"
Watch for: Comments on the body that feel exposing. Keep them descriptive and tentative. [synthesis]

4.16 Silence

Purpose / when: To give room to emotion, especially after a disclosure of grief, fear or guilt, and to connect without words. The 2017 book treats silence as one of two powerful ways to connect. [source: Routledge contents ch. 9; Taylor & Francis description]
Steps: After a painful disclosure, don't fill the space. Stay with the person and let the family see the emotion. Then invite a response from a family member, not from the therapist. [synthesis]
Example language (illustrative): (a pause), then "Who here understands what she is feeling right now?"
Watch for: Silence that feels like abandonment to an anxious client. Stay visibly engaged. [synthesis] [uncertain: the chapter content]

4.17 Physical contact and gestures of gratitude

Purpose / when: To seal emotional moments and repair bonds. In Andolfi's cases, children spontaneously hug or sit on a parent's lap after a disclosure, and the therapist invites gestures of gratitude, such as asking a child to thank his father. In the 2025 couple session Andolfi encouraged gratitude and appreciation between the partners. Touch is a chapter-level topic in the 2017 book. [source: Andolfi 2011; IACAPAP 2025; Routledge contents ch. 9]
Steps:
1. Allow spontaneous contact between family members, and name it.
2. Where it fits, invite a gesture or words of thanks between family members. [source: Andolfi 2011]
3. Any contact by the therapist should be culturally appropriate, non-sexual, brief, consented to and in the client's interest. Follow local ethics codes. [synthesis] [uncertain: Andolfi's own guidance on therapist touch]
Example language (illustrative): "Your dad just told you something he's never told anyone. Is there anything you'd like to say to him?"
Watch for: Pressured or performative gestures, and any touch with clients who have trauma or abuse histories. Never insist. [synthesis]

4.18 Constructing the therapeutic story and working with the family myth

Purpose / when: In the exploration and change phases, to weave the symptom, family history and the therapy's events into a shared narrative. That narrative links past trauma and broken bonds to present problems and opens new meanings. [source: Routledge contents ch. 6; 1989 contents ch. 1, 5, 8; Taylor & Francis description]
Steps:
1. Gather fragments from the genogram, questions and staged scenes. [synthesis]
2. Offer a provisional story that connects generations, then invite the family to correct and extend it.
3. Notice the family's own myth, its shared beliefs about who is what ("the strong one", "the fragile one"), and how the therapy can develop it. [synthesis] [uncertain: the 1989 chapters]
Example language (illustrative): "So the story might go like this: in this family, the women had to be strong because the men left early, and now Chiara is trying to be strong for everyone. Is that close?"
Watch for: A therapist-imposed story. It's working when the family takes over the story and tells it in their own words. [synthesis]

4.19 Family drama and therapeutic rituals

Purpose / when: Named as a chapter in the 1989 book. Experiential or ritual acts can mark transitions such as separations, mourning or changes of role. [source: 1989 contents ch. 6, 7] [uncertain: the content and steps. Do not treat any specific ritual as Andolfi's protocol]
Steps (synthesis only): Co-design any ritual with the family, for example a visit to a grave or a letter to an absent member. Ground it in their culture and meaning, and debrief it in session.
Watch for: Rituals imposed from outside the family's culture. [synthesis]

4.20 Directive tasks and paradoxical prescription of the family's rules (Andolfi's earlier interactional work)

Purpose / when: Version note: this comes from Andolfi's earlier interactional work, before the multigenerational model. Chapter 4 ("Tasks") of Family Therapy: An Interactional Approach (1979) discusses directiveness and classifies tasks as restructuring, countersystemic, contextual, displacing, system-restructuring, reinforcing and symptom-utilizing. It has a section on paradoxical tasks, covering prescribing the symptom and prescribing the rules, and a section on metaphorical tasks (see 4.21). The aim is to unbalance a rigid interactional pattern once the therapist has joined the family. [source: Andolfi 1979, contents list (Lavoisier)] [uncertain: only the contents list is drawn on. How Andolfi builds, frames and reviews each type of task is not confirmed]
Steps (synthesis, not Andolfi's protocol):
- Base any task on a pattern you have watched in session, not only on what the family reports. [synthesis]
- Ordinary directive task: give one clear, concrete task tied to that pattern: who does what, when and for how long. Review it at the start of the next session, including whether or not it was done. [synthesis]
- Prescribing a rule: name the unspoken rule the family seems to follow (for example "nobody disagrees with Mum in front of the children"). Ask them to keep it deliberately and openly for a set period, with a rationale that respects what the rule protects. Then explore what happened once the rule became visible. [synthesis]
- Use paradoxical prescription only with a solid alliance, a clear hypothesis, and supervision or team review. [synthesis]
Example language (illustrative): "It seems that in this family worries are kept away from Dad to protect him. Until we meet again, I'd like you to carry on doing that, but on purpose, and notice what it costs each of you."
Watch for: A prescription that feels like a trick or mockery, which damages trust. Never prescribe a symptom or rule that involves violence, self-harm, substance misuse or risk to a child. It's working when the family starts to question or talk about the rule instead of just acting it out. [synthesis]

4.21 Metaphoric objects (Rome group)

Purpose / when: A metaphoric object is a concrete object brought into the session to stand for a relationship, a family function or a shared family myth. The technique is associated with Claudio Angelo of the Rome group: Angelo, "The use of the metaphoric object in family therapy", American Journal of Family Therapy 9 (1981), 69–78. That citation was confirmed in a journal reference list. A later article that cites Angelo 1981 and Behind the Family Mask describes three uses in its summary. Metaphoric objects can enter the family's shared myths. They can carry messages that go beyond the family's literal story and point to missing parts of its central plot. They can also bring in new or fragmented information that may lead to revised myths and new interaction patterns. A 1984 workshop record describes Andolfi's tools as provocation, metaphor and humour, used to get behind the "defensive masks" of rigid families without provoking insurmountable resistance. It reports that the image of an "acoustic mask" came out of a consultation with an immigrant family whose child had elective mutism. [source: reference list and summary of DOI 10.1300/J287v04n03_04; DiNicola 1984 workshop record (Minkowska)] [uncertain: Angelo's and Andolfi's own step-by-step procedures]
Steps (synthesis, not a published protocol):
- From the family's own words and images (a phrase, a recurring complaint, a myth such as "the strong one"), choose an object that can stand for it, such as a rope, a mask, a heavy bag or a toy. [synthesis]
- Bring it in or pick it from the room. Say what it might stand for, tentatively, and hand it to the person who seems to hold that function. [synthesis]
- Ask the family to work with it: pass it on, put it down, decide who should carry it or where it belongs. Notice who moves and who resists. [synthesis]
- Use the object to say what is not being said. Come back to it in later sessions as the family's story changes. [synthesis]
Example language (illustrative): "This bag is heavy. I think it's a bit like the job Sara has taken on, keeping everyone calm. Sara, would you hold it for a moment? Who else in this family has carried a bag like this?"
Watch for: An object the family finds puzzling, childish or mocking. Let them reject or change it. It's working when family members start using the object, or its image, in their own talk. [synthesis]

4.22 Sculpting and the use of space

Purpose / when: To make relationships visible as positions in space when words go round in circles or are blocked. One chapter of Family Therapy: An Interactional Approach (1979), "Space and Action", covers nonverbal communication, mismatches between form and content, the meaning of space, sculpting and play with children. In the Accademia's training, trainees use sculpture to represent family knots. [source: Andolfi 1979 contents list; Andolfi 2018 introduction] [uncertain: the 1979 chapter text]
Steps (synthesis):
- Ask one member, often a child, to be the sculptor. They place each person in the room to show how close or distant people feel, and in what posture. [synthesis]
- Hold the sculpture still. Ask each person what they feel in their position and what they can see. [synthesis]
- Ask the sculptor, or another member, to show how they would like it to be. Then explore one move that would take the family a step towards that. [synthesis]
- Represent absent or dead members with chairs or objects. [synthesis]
Example language (illustrative): "Luca, you're the sculptor. Without words, put everyone where they are in this family right now. And where do you put yourself?"
Watch for: Someone placed in a humiliating or frightening position, and discomfort with touch. Keep postures and contact light, consented to and easy to stop. It's working when people are surprised by what they see and start talking about it. [synthesis]

4.23 Home visits and liaison with services

Purpose / when: When the family's suffering is tied to its living context, or when other services or institutions are involved. Home visits and work with local services and institutions are part of the Rome clinical model. [source: Andolfi 2018 introduction]
Steps: Agree on the visit's purpose with the family. Observe the home as a relational space. Coordinate with schools and social, health or legal services, keeping a clear role and consent for sharing information. [synthesis on steps]
Watch for: Blurred boundaries, and services pulling the therapist into a control role. [synthesis]

4.24 Co-therapy, observation team and in-session consultation

Purpose / when: As the standard set-up in the Rome service: two or more co-therapists, a team of about five or six behind a one-way mirror, and the option of consulting the team during the session. It helps the therapist avoid being absorbed by the family and builds an "internal supervisor". [source: Andolfi 2018 introduction]
Steps: Tell the family about the team and get consent. Agree the co-therapists' roles. Take mid-session breaks to consult. Bring the team's input back to the family. [synthesis on steps]
Watch for: Families who feel watched. Introduce the team as a resource. In solo practice, use peer consultation or recorded sessions as a substitute. [synthesis]

4.25 Child feedback, validation and follow-up

Purpose / when: At the end of therapy, to check change through the child's eyes and against the model's two criteria: the symptom has resolved, and emotional bonds have deeply changed. [source: Andolfi 2011; Ackerman 2024]
Steps:
1. Ask the children to give the adults feedback or a mark on what has changed. [source: Andolfi 2011]
2. Review the symptom and the relationships with the whole family.
3. Schedule follow-up sessions and check both criteria again. [source: Ackerman 2024; interval not specified, uncertain]
Example language (illustrative): "You've been our consultant all along. What's different at home now? What still needs work?"
Watch for: Symptom relief while relationships stay the same, which counts as incomplete by this model's standards.

4.26 Therapist use of self and personal family-of-origin work

Purpose / when: Continuously. The therapist's emotional responses are used to connect with each member, and training builds awareness of the therapist's own family history and biases so they neither absorb nor avoid families' pain. Trainees work on their own genogram, use sculpture (a spatial representation of family knots) and meet their families of origin directly or symbolically, in a group. [source: Andolfi 2016 abstract; Andolfi 2018 introduction; Sanvicente 2018]
Steps: Draw your own three-generation genogram. Notice which client families activate your own history. Disclose emotional responses briefly when it helps the family. Take the activation to supervision or co-therapy reflection. [synthesis on steps]
Example language (illustrative): "Listening to you, I felt a lump in my throat. I think this loss is still very present here."
Watch for: Disclosure that shifts the focus onto the therapist. Keep it short and in the service of the family. [synthesis]

5. Handling problems

The sources say little about problem management. Andolfi's general answers to impasse are to widen the system with consultants (children, family of origin, friends, colleagues), to combine provocation with holding, and to use team and co-therapy reflection. [source: Ashton 1999; 1989 description; Andolfi 2018 introduction] Everything else in this section is [synthesis] unless tagged.

Stuck therapy or repeating sessions. Name the impasse as belonging to the therapeutic system, not to the family. Bring in a new resource: the children as consultants (4.8), a family-of-origin member (4.6), a network member (4.9) or a professional consultant (4.10). [source: Andolfi 2011; Ashton 1999] Review the genogram for a generation or loss you haven't explored yet.
Parents who want only the child fixed or a diagnosis. Don't argue. Show interest in the child's symptom, then ask relational and bottom-up questions (4.4, 4.5) that make the parents' own story relevant. If a medical or neurodevelopmental assessment is clinically indicated, arrange it, and keep the family frame alongside it. Andolfi criticises over-diagnosis, but genuine conditions should not go unassessed. [synthesis]
Resistance to inviting the family of origin. Framo read such reluctance as a sign of the unresolved conflict itself (as Andolfi reports, 2013). Explore the fear, invite for a specific, limited purpose, and frame the guest as a helper. If a grandparent is unreachable or has died, bring them in symbolically through stories, photos or letters, though this is not documented in the sources. For migrant families, a remote video link may be possible. Andolfi's 2018 text lists migrant families as a clinical population but not this method.
Adolescent who refuses or stays silent. Use the adolescent as an expert or consultant, not a patient, and use humour and directness. Consider a subgroup session (4.14). Andolfi has a book on adolescents (Teen Voices). [uncertain]
Provocation backfires (anger, shame, dropout risk). Go back to holding: acknowledge the impact, show warmth, and re-join each person before going on. [source for principle: 1989 description] Phone the family if a session ended badly.
Overwhelm after a disclosure (grief, trauma). Slow down, use silence and presence (4.16), and let family members comfort each other (4.17). Shrink the next step. Grounding and pacing are needed with traumatised members.
Child burdened by the consultant role or by adult material. Take back the responsibility, reassure the child, and continue the topic with the adults alone. Never ask a child to report on a parent's hidden behaviour.
Hostile separation, custody dispute, domestic violence or abuse. Screen for violence and safeguarding concerns before any conjoint, three-generation or child-as-consultant session. Joint sessions may be unsafe. Meet subgroups separately and follow child-protection and reporting duties. Andolfi lists hostile separations as a clinical population (2018), but no specific safety protocol was found. [uncertain]
Suicide or self-harm risk in any member. Do a standard risk assessment and safety planning with the individual. Involve the family in safety planning, including lethal-means counselling (secure storage and removal). Don't use provocation while acute risk persists. Andolfi's 2018 introduction mentions work after sudden deaths, including suicide.
Non-attendance of key members. Work with whoever comes. Ask them to carry a specific invitation, and ask the child what would bring the absent person in.
Rupture with one member (feeling blamed or sidelined). Name it, apologise for your part, and give that person time and a voice. Co-therapy and the team help to spot one-sided alliances. [source for team function: Andolfi 2018]
Therapist's own family history activated. Use supervision and co-therapy, and revisit your own genogram. [source: Andolfi 2018; Sanvicente 2018]
Solo practice without a team or mirror. Use peer consultation, recorded sessions with consent, or a visiting co-therapist for key sessions. This adapts a team-based model and may change it. [uncertain]
Cultural fit. Physical contact, direct confrontation and inviting elders all carry different meanings across cultures. Ask the family how these are handled at home, and adjust. Andolfi has taught internationally, for example in Malaysia (IACAPAP 2025), but no cultural-adaptation guidance was found. [uncertain]
Training and authorisation. The sources mention no licensing, certification or fidelity scheme. Training is offered through the Accademia di Psicoterapia della Famiglia in Rome, as a four-year course with supervised co-therapy behind a one-way mirror and personal family-of-origin work (Andolfi 2018), and through workshops and live consultations, for example at the Ackerman Institute in 2024 and in Malaysia in 2025. Practise within your own professional licence. [source: Andolfi 2018 introduction for the four-year course] [uncertain: ministry recognition, detailed curriculum and any certificate title were not verified]

Sources

Sources: