Approaches / Relational and systemic
Family and systemic therapy
Approaches that look at problems in the context of relationships, family patterns and wider social settings.
Overview
Systemic therapy looks at how people's difficulties relate to the relationships and contexts around them. It can involve a family, a couple, a wider network or an individual.
Core ideas
A common idea is that problems are better understood in the patterns of communication and relationships in which they occur than as located only in one person. Practitioners often ask questions about differences, beliefs and what each person notices.
Schools within the field place different weight on structure, communication, meaning and narrative.
What a session can involve
Sessions often involve several family members, though not always. A therapist may ask each person for their view, explore patterns and invite members to try something different. Some services use a team or a reflecting conversation.
Formats and settings
Systemic therapy is offered in child and adolescent services, adult services, schools, community organisations and private practice. Formats include single-family, multi-family, couple and individual sessions.
How it relates to other approaches
Emotionally focused couple therapy draws on both systemic and attachment ideas. Some cognitive behavioural work also involves family members. Narrative and solution-focused approaches are sometimes grouped within systemic work.
Limits and open questions
Critics have raised concerns that some early models gave too little attention to power, gender, abuse and cultural difference. Joint sessions are not always suitable, for example where there is risk of harm.
NICE advises clinicians to consider anorexia-nervosa-focused family therapy for children and young people with anorexia nervosa in England and Wales. Guidance for other conditions and in other countries should be checked separately.
History
Family therapy developed in the 1950s and 1960s, influenced by Gregory Bateson's work on communication and by clinicians including Salvador Minuchin, Murray Bowen, Virginia Satir and, later, the Milan group. Later developments included narrative and postmodern approaches.
Key people
Salvador Minuchin, Murray Bowen, Virginia Satir, Jay Haley, Gregory Bateson and Mara Selvini Palazzoli were influential in the field's formation.
Sources and inspection notes
BACP, What is systemic therapy?
Supports: An introductory description of the approach from a UK professional body.
NICE, Eating disorders: recognition and treatment (NG69)
Supports: That the guideline says to consider anorexia-nervosa-focused family therapy for children and young people (England and Wales).
Supports: Historical overview naming several early contributors to family psychiatry and therapy; its broader theoretical arguments are not endorsed by this citation.