Sometimes a problem seems to belong to one person: a teenager who stops going to school, a partner who drinks too much, a mother who is constantly exhausted. Systemic therapy invites a different view. It asks how the difficulty is connected with the relationships around it, and how those relationships can become part of the solution.
In this article I explain what systemic therapy is, how it works, what research says and how to find it.
The basic ideas
Systemic therapy grew out of family therapy and looks at people as part of systems: families, couples, friendships, workplaces, cultures. A few central ideas:
- Problems arise in context. A symptom often makes sense when we look at the relationships and situation around it.
- Patterns, more than causes. Instead of looking for one cause or one guilty person, systemic therapy looks at repeating patterns of interaction and how they keep a problem going.
- Everyone has a perspective. Each family member sees the situation differently, and all these views carry information.
- Resources and solutions. Systemic therapy focuses strongly on strengths, exceptions and what is already working.
- The client is the expert. The therapist brings curiosity and methods, and the client knows their own life best.
What happens in systemic therapy
Systemic therapy can take place with one person, a couple, a family or a group. Even in individual sessions, the important people in your life are present in the conversation.
Some typical methods:
- Circular questions: “What would your sister say if she saw you and your father arguing?” Such questions open new perspectives on relationships.
- The genogram: a family tree that shows relationships, patterns and important events across generations, often revealing themes such as migration, loss or unspoken rules.
- Working with figures (family board): placing figures or objects on a table to represent people and their relationships, which can make closeness and distance visible.
- Reframing: finding a new, often kinder meaning for a behaviour. For example, a child’s anger might be seen as an attempt to bring the parents back together.
- Solution-focused questions: “Imagine you wake up tomorrow and the problem is gone. What would be the first sign?”
A helpful question
Systemic therapists often ask: “Who is affected by this problem, and how?” The answer can show where change might begin.
What research says
Systemic therapy has been studied for many kinds of problems, and evidence has grown steadily. Health authorities have started to recognise this. In Germany, for example, the body that decides which treatments public health insurance pays for reviewed the evidence and added systemic therapy for adults in 2019 (Gemeinsamer Bundesausschuss, 2019).
Individual trials show how systemic ideas are being used. In a randomised trial with women with mild to moderate postpartum depression, CBT combined with systemic family therapy improved depression and sleep quality compared with usual care (Hou et al., 2014). Research also shows limits: in a large trial with young people after self-harm, systemic family therapy did not reduce repeated self-harm more than usual care (Cottrell et al., 2018). As with all forms of therapy, the method works best when it fits the person and their situation.
Research on couples also supports the systemic idea that problems and coping are shared. In couples facing cancer, coping together was linked with better emotional functioning and relationship quality (Ştefǎnuţ et al., 2020).
A short example
Imagine a family in which the teenage son has stopped going to school. In individual therapy, the focus might be on his anxiety. In systemic therapy, the therapist might also ask: What changed in the family before this started? How do the parents react, and how does he react to their reaction? What would happen at home if he went back to school tomorrow?
Perhaps it emerges that the parents have been arguing about a move abroad, and that the son’s staying home keeps the family together in an odd way. Seeing this pattern can open new options for everyone. The son’s anxiety is still taken seriously, and it becomes part of a larger picture.
Common questions
“Do my family members have to come?”
No. Systemic therapy is often done with one person. Family members can be included if it helps and if everyone agrees.
“Is it about finding out who is to blame?”
Systemic therapy avoids blame. It looks at patterns in which everyone plays a part, often with good intentions, and searches for ways forward that work for the whole system.
Who systemic therapy can suit
Systemic therapy may be a good fit if:
- your difficulties are closely connected with family, partnership or work relationships;
- several family members are affected and want to work together;
- you live between cultures and family expectations play a big role;
- you are facing a transition, such as separation, a new family, migration or illness;
- you prefer a resource-oriented approach that looks at strengths.
Do I need to bring my family?
This is one of the most common questions, and the answer is no. Systemic therapy is often done one to one. The therapist will still be curious about the people around you: who is close, who is distant, who carries which role, and what happens between you when things get tense. Sometimes a drawing of your family over several generations, called a genogram, helps to make patterns visible. If it would help, partners or relatives can join for one or a few sessions, but only if you want that. Many people find it a relief to look at their difficulties as part of a bigger picture, where nobody has to carry all the blame.
Systemic therapy can also be helpful when only one person comes. Talking about the people around you, even when they are not in the room, can change how you see a situation and what you choose to do next.
Finding systemic therapy
Systemic therapists work in private practices, counselling centres, family and youth services, and hospitals. Depending on the country, individual sessions may be covered by the health system or insurance, while couples and family sessions are often paid privately. You can read about other approaches in Cognitive behavioural therapy and Psychodynamic therapy, and about choosing in Which therapy is right for me?
More about therapy with me.
References
- Cottrell, D. J., Wright-Hughes, A., Collinson, M., Boston, P., Eisler, I., Fortune, S., Graham, E. H., Green, J., House, A. O., Kerfoot, M., Owens, D. W., Saloniki, E. C., Simic, M., Lambert, F., Rothwell, J., Tubeuf, S., & Farrin, A. J. (2018). Effectiveness of systemic family therapy versus treatment as usual for young people after self-harm: A pragmatic, phase 3, multicentre, randomised controlled trial. The Lancet. Psychiatry, 5(3), 203–216. https://doi.org/10.1016/s2215-0366(18)30058-0
- Gemeinsamer Bundesausschuss. (2019, November 22). Systemische Therapie für Erwachsene als weiteres Richtlinienverfahren aufgenommen [Press release]. https://www.g-ba.de/presse/pressemitteilungen/826/
- Hou, Y., Hu, P., Zhang, Y., Lu, Q., Wang, D., Yin, L., Chen, Y., & Zou, X. (2014). Cognitive behavioral therapy in combination with systemic family therapy improves mild to moderate postpartum depression. Revista Brasileira de Psiquiatria, 36(1), 47–52. https://doi.org/10.1590/1516-4446-2013-1170
- Ştefǎnuţ, A. M., Vintilǎ, M., & Tudorel, O. I. (2020). The relationship of dyadic coping with emotional functioning and quality of the relationship in couples facing cancer-A meta-analysis. Frontiers in Psychology, 11, 594015. https://doi.org/10.3389/fpsyg.2020.594015
This article is exploratory and meant for information and reflection. It cannot capture the full complexity of any individual situation, and your own experience may be different. It does not replace a diagnosis or treatment.
