Systemic Therapy Approaches

By Team TherapyRoute

Systemic therapy works from a single starting point. Difficulties often arise from the patterns between people, rather than from one person alone.

It is not a single method. The word systemic points to the system a person belongs to: a family, a couple, the wider network of people around them. The name covers a family of related approaches that work with relationships, families and couples.¹

A quick word on the name

Several names describe the same broad field. The common ones are systemic therapy, systemic psychotherapy and systemic family therapy, and systems therapy and systemic counselling belong in the same group.

Other names come from outside English. The German systemische Therapie and the French thérapie systémique both name this field, and "systematic therapy" is a common misspelling of the word itself.

The shared goal runs across all of them. The work aims to change unhelpful family patterns, rather than treating one person in isolation.¹

The core idea: the problem lives in the pattern

Explanations of a problem are often linear. Linear here means one cause leading to one effect, with one person treated as the source.

Systemic therapy looks for circular patterns instead. Circular means the influence works in both directions, with each person's reaction becoming the next person's reason to react. A difficulty can then be held in place by the system's own response.¹

An anxious parent may check on a worried child again and again. The checking settles the child for a moment. Over time, though, it can keep the worry going rather than ease it. That is a circular pattern in ordinary life.

Families also settle into set patterns of relating. Those patterns hold steady, and past a certain point they resist change.²

One name, many schools

Systemic therapy grew into several schools. Each attends to a different feature of family life, yet the aim they share is the same: change the pattern rather than treat one member alone.

The table below lists the main approaches. For each school it gives the central idea, a signature technique, and the people linked to it.

Structural therapy is often described as the most influential of these approaches.¹ It has its own detailed page on TherapyRoute.

Strategic therapy targets the symptom-maintaining sequences that keep a problem going.¹ Those are the repeated exchanges around a symptom that end up sustaining it. The therapist works through directives, which are tasks set for the family to try, and through paradox, a directive that appears to work against the stated goal.

The Milan school reads the family as a whole and is known for circular questioning.¹ Bowen developed the genogram to map a family's history across several generations.¹ Solution-focused therapy was shaped by Steve de Shazer and Insoo Berg.¹ It builds on what already works, moving in small steps towards a goal rather than analysing the problem.

Psychoeducational family work is a special case. It teaches practical coping skills to families where a member lives with a serious psychiatric disorder. For that situation, it is seen as the most effective family-based approach.¹

Techniques you will actually meet

The schools overlap in practice. Several techniques appear across more than one of them, and the list below sets out the most common ones with the tradition each came from.

• Genogram. A family tree drawn together in the session, with notes on the relationships across the generations.¹ It comes from the Bowen tradition.
• Circular questioning. The therapist asks one person about the relationship between two others. The answers describe the pattern rather than fix blame on a single member. It comes from the Milan school.
• Joining and enactment.¹ The therapist first fits in with the family's own way of talking, which is the joining part. Members are then asked to speak to each other as they would at home, so the pattern can be watched rather than only described. This comes from structural therapy.
• Miracle, scaling and exception questions.¹ These questions come from solution-focused therapy and look for what already works. A miracle question asks what would be different if the problem were gone. A scaling question asks the family to rate where things stand, and an exception question asks about the times the problem is already absent.
• Re-authoring. The family builds a new, shared story that is less rigid than the old one.¹ This comes from narrative therapy.

Not only for families

Systemic thinking is not limited to whole-family sessions. It can guide work with one person, with a couple, or with a family.³

With one person, the therapist still traces the relationships around them, and the focus stays on the pattern rather than on the individual alone. That holds even when nobody else attends.

Modern integrative approaches blend ideas across the schools, rather than committing to a single model.³ The work is then shaped by the patterns that actually show up with each client.

With couples, a therapist often looks at both partners' families of origin.¹ That means the family each partner grew up in. They also look at what function a difficulty may be serving in the relationship.¹

Who it suits, and when individual work may fit better

Systemic therapy suits difficulties that arise between people rather than within one of them. Ongoing family conflict is a common example. Others are a child's behaviour understood in its setting, and difficulties between partners.

The evidence is strongest in one clear case. Family- and community-based interventions can help young people with serious antisocial behaviour.⁴ Their difficulties are shaped by family, friends, school and neighbourhood.⁴ Effective work has to operate in each of those settings.

Family therapy and individual therapy sit at opposite ends of a spectrum.¹ Each calls for a different kind of engagement from the people attending.

Joint sessions are not always the right starting point. If a partner or family member will not attend, joint work can be unbalanced.¹ Meeting only part of the system carries that risk.

A safety note

Meeting as a whole family is not always a safe first step. Where there is abuse, violence at home, or risk to a child, seeing everyone together can raise the risk for someone in the family.

In those situations, safety and individual support come first. A trained therapist weighs this carefully before arranging any joint session. The decision is not automatic.

Finding a systemic or family therapist

If this approach fits your situation, look for a therapist trained in systemic or family work. Ask about the training itself. Ask also about their experience with the kind of concern you are bringing.

Titles and training differ from country to country. There is no single global licence to look for, so the check has to be made therapist by therapist. A properly trained therapist will explain their background without hesitation.

You can search for a suitably trained therapist through the TherapyRoute directory.

Common questions

Is systemic therapy the same as family therapy?

They overlap closely. Systemic therapy is the broader field, and family therapy is its best-known form. Not all systemic work happens with a whole family.

Is it spelled "systematic therapy"?

No. The word is "systemic", and "systematic therapy" is a common slip for the same idea.

Does the whole family have to attend?

No. Systemic work can be done with one person, a couple, or a family.³ What fits best depends on the situation and on who is willing to attend.

This article is for general information and does not replace advice from a qualified professional.

References

1. [1] Sadock, B. J., Sadock, V. A., & Ruiz, P. (Eds.). (2017). Kaplan & Sadock's comprehensive textbook of psychiatry (10th ed.). Wolters Kluwer.
2. [2] Minuchin, S. (1974). Families and family therapy. Harvard University Press.
3. [3] Russell, W. P., Breunlin, D. C., & Sahebi, B. (2023). Integrative systemic therapy in practice. Routledge.
4. [4] Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D., & Cunningham, P. B. (2009). Multisystemic therapy for antisocial behavior in children and adolescents (2nd ed.). Guilford Press.