Systemic Therapy: What is it and who can it help?

Updated: 26/11/24

Written by Dr Sara Tookey, Clinical Psychologist​​

 

 

Systemic Therapy: Healing Through Relationship Understanding

 

Systemic therapy views psychological issues within the context of relationships, families, and wider social systems. Rather than focusing solely on the individual, this approach considers how relationship patterns, family dynamics, and societal influences contribute to both challenges and solutions.

 

What is Systemic Therapy?

 

Systemic therapy explores how:

 

• People are influenced by their relationships

• Problems exist between people rather than within individuals

• Changes in one part of a system affect the whole

• Solutions emerge through understanding patterns and connections

 

 

The Science Behind Systemic Therapy

 

Research demonstrates systemic therapy's effectiveness through:

• Improved family functioning (Carr, 2019)

• Enhanced relationship satisfaction (Stratton et al., 2015)

• Better treatment outcomes for individual issues when families are involved (Crane & Christenson, 2014)

• Long-term maintenance of therapeutic gains (von Sydow et al., 2013)

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Key Concepts

 

1.  Circular Causality:

In systemic therapy, we understand that events and behaviours exist within a complex web of relationships and influences. Rather than seeking a single cause for problems, this approach recognizes that family members and relationships continuously influence each other in circular patterns. For example, a child's behavior affects parental responses, which in turn influences the child's future actions, creating ongoing cycles of interaction that maintain certain dynamics within the family system.

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2.  Multiple Perspectives:

The systemic approach acknowledges that each person's experience and viewpoint within a family or relationship system is valid and meaningful. There is no single "truth" about a situation; instead, different perspectives offer valuable insights into how the system functions. Understanding these various viewpoints within their cultural and social context helps create a richer, more nuanced picture of relationship dynamics and potential paths for change.

 

3.  Resources and Solutions:

Rather than focusing primarily on problems, systemic therapy emphasises identifying and building upon existing strengths and successful coping strategies within the family or relationship system. This approach recognises that every system has inherent resources and capabilities that can be activated for positive change. Through collaborative problem-solving, therapists work with families to discover and enhance these existing competencies, helping them develop new solutions based on their unique strengths and experiences.

 

 

Who Can Benefit?

 

Systemic therapy helps with:

 

• Family conflicts

• Couple relationships

• Parenting challenges

• Child and adolescent issues

• Life transitions

• Cultural adaptation

• Grief and loss

• Identity issues

 

 

What to Expect in Sessions

 

Session Structure

1. Exploring multiple perspectives

2. Mapping relationship patterns

3. Identifying strengths and resources

4. Developing new ways of relating

5. Practicing changes between sessions

 

Common Techniques

 

Circular Questioning

• A method that helps family members understand how their behaviors and beliefs influence each other. These questions explore relationships, differences, and changes over time, revealing patterns and connections within the family system. For example, "How does your brother react when your parents disagree?" or "What changes in the family when Mom works late?"

 

Genograms

• Visual maps of family relationships across generations, similar to a family tree but including relationship patterns, important life events, and family dynamics. Genograms help identify multigenerational patterns, alliances, and potential sources of support or conflict.

 

Sculpting

• A powerful experiential technique where family members physically arrange themselves or objects to represent their relationships and emotional dynamics. This provides insights into family structure, hierarchies, and emotional distances that might be difficult to express in words.

 

Reframing

• The process of offering alternative perspectives on behaviors or situations, helping families view challenges in more constructive ways. For example, a teenager's "rebellion" might be reframed as "developing independence" or "learning to express needs."

 

Externalisation

• A narrative therapy technique that separates people from their problems, viewing the issue as external to the person or family. This creates space between the problem and identity, making it easier to work together against the problem rather than seeing family members as the problem.

 

Reflecting Teams

• A collaborative approach where a team of therapists observes the session and shares their observations and ideas, offering multiple perspectives and possibilities for the family to consider. This creates a rich dialogue and opens new ways of understanding their situation.

 

Solution-Focused Questions

• Questions that help families identify exceptions to problems, past successes, and preferred futures. Examples include the miracle question ("If the problem disappeared overnight, what would be different?") and scaling questions that explore progress and goals.

 

 

The Evidence Base

 

Research Findings

 

Meta-analyses show effectiveness for improving:

• Couple relationship problems (Carr, 2019)

• Child behavioural issues (Carr, 2014)

• Eating disorders (Lock et al., 2015)

• Depression in context (Crane et al., 2013)

• Addiction treatment (Rowe, 2012)

 

Specific Outcomes

 

Research Studies demonstrate:

• Improved communication patterns

• Enhanced problem-solving abilities

• Better emotional regulation in families

• Increased relationship satisfaction

• Sustained positive changes

 

 

Key Therapeutic Elements

 

1. Systemic Assessment

• Relationship mapping

• Pattern identification

• Resource recognition

• Context understanding

 

2. Intervention Strategies

• Challenging unhelpful patterns

• Developing new perspectives

• Enhancing communication

• Strengthening relationships

 

3. Change Process

• Small changes lead to larger shifts

• Focus on interactions rather than individuals

• Building on existing strengths

• Creating sustainable solutions

 

 

Different Types of Systemic Therapy

 

Approaches Include:

• Structural Family Therapy

• Strategic Family Therapy

• Narrative Therapy

• Solution-Focused Brief Therapy

• Milan Systemic Family Therapy

• Emotionally Focused Therapy (EFT)

 

 

Special Considerations

 

When to Consider Systemic Therapy

• Relationship difficulties

• Family conflicts

• Parenting challenges

• Life transitions affecting multiple family members

• Cultural or intergenerational issues

 

Important Factors

• Willingness of family members to participate

• Commitment to exploring patterns

• Openness to multiple perspectives

• Readiness for change

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