Systemic therapy or family therapy is a psychotherapeutic procedure that acts by involving the entire social environment in order to treat mental disorders or complaints. This distinct form of therapy is based on the assumption that the development and progression of mental illness can only occur within the context of social interactions. Systemic therapy is historically derived from family therapy and is now extended to other social systems such as professional work groups. Since social systems are always in a state of flux, systemic therapy is also undergoing constant development. Basically, there are the following forms of therapy:
- Systemic individual therapy
- Systemic couple therapy
- Systemic family therapy
- Systemic group therapy
The procedure is used on an outpatient and inpatient basis.
Indications (areas of application)
The spectrum of psychological and psychosomatic disorders that can be treated with systemic family therapy is very large. The focus is on disorders that can be traced back to specific relationship structures. In addition, supporting resource development for coping in cases of severe mental or physical illness plays a major role. Here are some examples:
- Affective psychotic disorders
- Anxiety disorders and obsessive-compulsive disorders*
- Chronic severe diseases – e.g. cancer.
- Chronic partnership or marital conflicts
- Dementia
- Depressive disorders* and depression
- Eating disorders*
- Generational conflicts
- Personality disorders*
- Schizophrenia* – non-organic psychosis leading to multiform disorders of personality, perception, thinking and control of reality.
- Sexual dysfunction
- Disorders in children and adolescents – e.g. school phobias or separation anxiety.
- Substance disorders (dependence, abuse)* .
IQWiG found evidence of benefit for adults for the indications highlighted above.
The procedure
Systemic therapy assumes that it is not the therapy of the isolated person or patient that leads to success, but only the treatment of the complete system, including the subsystems and all relationships among the members. The focus is on existing behavioral patterns, special and general contexts, rules, boundaries as well as the system’s own dynamics. In addition to the system, individual behavior and experience patterns also play an important role. The ill person, as a symptom bearer, reveals the disturbances in the system. The individual symptoms are understood as the result of disease-producing and disease-maintaining relationship patterns to important attachment figures or family members. The goals of systemic therapy are:
- Strengthening the self-esteem and autonomy of each member of the system.
- Strengthening the cohesion
- Improving exchange and communication
- Pointing out and changing damaging relationship patterns
- Healing of psychological and psychosomatic problems and disorders.
- Resolution of conflicts – for example, generational conflicts or separation conflicts.
To achieve a pattern change or break the previous interaction circle, different techniques are used. Here, for example, circular questioning techniques (behavioral cycles are shown and questioned) or family sculpture techniques (a member creates a model of the family or the system with figures) are available. Of importance are hypothetical questions (what if?) in the absence of the other person, resource- and solution-oriented questions, and reinterpreting symptoms (refraiming) to provide a different perspective. Another well-known technique is the paradoxical intervention in the form of symptom prescription: the members of the system are now supposed to hold the usual argument at a certain time in a certain situation every evening. This usually leads to breaking the usual pattern of behavior. All these techniques and more are successfully applied in systemic therapy. The psychotherapeutic method can also be applied in the so-called multi-person setting in order to discuss and change relationships that are significant for the illness, for example in the family.In addition to classical therapy, the systemic concept can be applied in a variety of ways:
- Systemic counseling – e.g. for work, leisure and education with the aim of expanding the possibilities of perception and action.
- Systemic coaching – individual process consulting, for example, in situations of tension in the professional environment.
- Systemic organizational consulting and development – here the focus is on the organization of a group, taking into account the individual members of the team.
- Systemic supervision – this application refers to professional work and development of teams, groups, leaders and organizations.
- Systemic family medicine – not only the disease of the patient is treated but also the consequences on the other members of the families.
Systemic therapy provides a specific framework for action for a variety of mental and psychosomatic disorders or problems. Individual solution strategies are effectively developed and applied based on the understanding of social systems. In addition to treating disorders, the focus is also on professional systems management. The Extended Evaluation Committee has included systemic therapy for adults in the catalog of services provided by panel physicians as of July 1, 2020.
