Systemic therapy (also: systemic family therapy ) is a psychotherapeutic procedure that focuses on the social context of mental disorders, in particular on interactions between members of the family and their social environment. In contrast to psychoanalysis , representatives of this direction of therapy emphasize the importance of implicit norms of coexistence for the creation and overcoming of mental disorders (family rules). However, other forms of therapy such as short-term cognitive therapy also take the 'systemic' aspect into account. According to its representatives, systemic therapy differs in that other members of the social environment relevant to the patient are included in the treatment. Since the end of 2018, systemic therapy has been included in the service catalog of the statutory health insurance in Germany.
History of theory
Family therapeutic thinking developed from 1950 through Nathan Ackerman . Ackerman began to involve the entire family when a child had a disorder. As a student of Ackerman, Salvador Minuchin developed structural family therapy . In structural family therapy, the distinction between familial subsystems (such as parent, child systems) is of great importance. As a student of Minuchin helped develop Jay Haley , the strategic family therapy . With the perverse triangle, Jay Haley described an often fundamentally dysfunctional (communication) structure in families, which found its way into family therapy as a (dysfunctional) triad and is still considered as a relevant disorder pattern today.
Virginia Satir was already working with family sculptures in the 1950s . In 1956, the effect of was in a research report double messages as paradoxical patterns of communication in interpersonal relationships and the history of science prominent " double bind " (Engl. " Double bind theory ") published. An important prerequisite for these developments was the preparatory work on the subject of cybernetics by Norbert Wiener . The new concept of family therapy then developed on this basis. The problem-solving approach of systemic therapy was developed in the 1950s at the Mental Research Institute (MRI) in Palo Alto, California by Don D. Jackson , Gregory Bateson , John Weakland and Richard Fisch. The Palo Alto Group emerged , from which many important family therapists were inspired.
The systemic family therapy originated with Mara Selvini Palazzoli and its Milanese group from 1971. 1973 published Iván Böszörményi-Nagy 's Invisible loyalties. Reciprocity in intergenerational family therapy , which is considered to be an early basic work of family therapy. Iván Böszörményi-Nagy is considered essential for the multi-generational perspective . From him the terms loyalty , parentification , balance ( the relationship accounts or justice ) and order in family therapeutic contexts come from.
The initial equation of family and system was formative in the founding phase of systemic therapy, but moved into the background from the 1980s ( constructivist turn ). In the course of time, the methodical approach and the underlying premises have differentiated, so that today several schools are differentiated from one another: structural and strategic family therapy, but also family therapy with several generations ( Milan model and Heidelberg school ), narrative approaches (according to Michael White or Harold A. . Goolishian ), family sculptures based on Virginia Satir , the solution-oriented approaches of the Milwaukee School .
Systemic therapy is currently based on three overarching lines of theory:
- Autopoiesis (Luhmann 1984 )
- Narrative approach
The Milan model
The Milanese model of the group led by Mara Selvini Palazzoli , Luigi Boscolo , Gianfranco Cecchin and Giuliana Prata represents an essential historical, but also practical, approach in (systemic) family therapy . They were continuously supported by Paul Watzlawick , who regularly traveled to Milan and the Discussed the results of the center for family therapy there with the therapists. The Milan group achieved success with schizophrenic family members and eating disorders in a short period of time .
A formative methodology and forerunner of the reflective team was the two-chamber method, in which the therapist and client sat in one room and were observed separately from the co-therapists. These follow the therapy through disposable discs or video transmission. Treating and observing therapists discuss the concept of the therapy session (hypothesis discussion). The actual therapist conducts the conversation. If necessary, the therapist and co-therapist (s) consult with you during short interruptions. At the end of the conversation, the team of therapists consults in order to find an optimal final intervention (e.g. a homework or an interpretation of the symptoms), which is communicated to the client immediately afterwards. The purpose of this intervention is to disturb the system (made up of family members and important other people) in their interaction patterns and, secondarily, to change the complained symptoms.
The Norwegian social psychiatrist Tom Andersen expanded the therapeutic setting to include the so-called Reflecting Team . At the end of a therapy session, the therapist and client (s) swap places with the co-therapist team (usually). Therapist and client (s) now observe how the co-therapist team reflects on what has happened so far from their point of view in a helpful and supportive way. The increased effort (several therapists) brings a greater variety of perspectives, fewer therapeutic errors and one-sidedness and is rewarded with high effectiveness.
Virginia Satir is considered the mother of systemic therapy . She has expanded and developed the systemic repertoire and methodology - through family sculpture , family reconstruction , parts party . In this way, biographical patterns and cross-generational problems can be discovered and worked on, or individual parts of the personality can be made visible and integrated at the Parts Party. Satir's work is regarded as a forerunner of systemic constellation work . The American Virginia Satir gave many seminars in Europe and not only influenced systemic psychotherapy, but was also a role model for neuro-linguistic programming (NLP) alongside Fritz Perls (gestalt therapy) and Milton H. Erickson (hypnotherapy ).
The work of Virginia Satir also provided inspiration for the “Innere Team” (1998), a model by the Hamburg psychologist Friedemann Schulz von Thun , to make people aware of parts of the personality and their characteristics. Schulz von Thun speaks of the “plurality of human inner life”. In the years from 1998 onwards, the model of the inner team was increasingly used for psychotherapy in order to systemically establish personality components or symptoms. As a setting, significant placeholders are often used as floor anchors, but the system board is also suitable .
The German psychoanalyst and pioneer of family therapy Helm Stierlin held the chair for basic psychoanalytic research and family therapy at Heidelberg University from 1974 to 1991. A group of young and committed therapists, the Heidelberg School , gathered around him and propagated the narrative approach, multi-generational perspective, genogram and couple therapy. Stierlin's employees included Arnold Retzer , Gunther Schmidt , Fritz B. Simon , Hans Rudi Fischer and Gunthard Weber .
Influenced by Michel Foucault (1980), the narrative approach often used in systemic therapy is traced back to Michael White (1990) and David Epston (1992). It is a post-structuralist postulate that individual and social phenomena result from linguistic traditions and subsequent manifestations of constructions of reality . The identity of the individual is thus formed as a narrative and, to that extent, understood as deconstructable or reconstructable.
Therapeutic dialogue and client autonomy
Harold A. Goolishian and Harlene Anderson (1988), who established the therapeutic dialogue and the autonomy of the client in systemic therapy, are also the leading figures of the narrative approach .
While the family constellation according to Hellinger is rejected by the systemic therapy as "too phenomenological" and "too directive", system constellations , if they correspond to the narrative-constructivist approach , are mainly used today in systemic therapy in the German-speaking area according to Insa Sparrer and Matthias Varga von Kibéd performed.
Insoo Kim Berg and Steve de Shazer designed the solution-focused short-term therapy in Milwaukee . Philosophically influenced by the Austrian philosopher Ludwig Wittgenstein , this approach assumes that problem and solution belong to two different worlds. The problem takes a back seat, as does the family as a system (with the family members as entities). Inspired by Milton H. Erickson , Steve de Shazer understands the entire "therapy event" as a process of development and detachment from the respective problem. Important instruments of solution-focused short-term therapy are problem scaling (between 1 and 10 depending on the degree of stress) and the intervention process, which is referred to as the miracle question ("If a miracle happened overnight, your problem had disappeared overnight, how would you find it [after waking up ] notice?").
The most important starting point of a systemic therapy has emerged as the most precise order clarification possible in the relationship between therapist and client / customer (the term patient is mostly rejected). Once the goals have been specified and are acceptable to clients / clients and therapists, the actual therapy can begin. If a therapy extends over several sessions, it is advisable to occasionally clarify the task again, as goals can change over the course of a therapy. The preferred form is seen as a few appointments per therapy with, if possible, longer intervals between the individual sessions, in which the clients / customers can try out any new findings from the sessions in their own life practice and / or do so-called homework. In this respect, the system therapeutic approach is characterized by economy, which focuses on the client's / customer's own initiative.
Common techniques, interventions, and methods include: A .:
- Circular questions that aim at the presumed point of view of third parties (including those present)
- Questions of scale to clarify differences and progress
- Positive connotations and elaboration of the positive aspects of problematic issues
- Reframing of facts in order to stimulate changes in meaning and interpretation
- Paradoxical Intervention , i. d. R. Prescribing the problematic behavior in order to change automatisms
- Metaphor work , parables and stories as a bypass technique for potential "resistance"
- Sculpture , representation of family relationships as a statue of people in the room
- Sociogram , the graphic representation of social relationships
- Reflecting team
- Homework of various and individually adapted types to be completed between meetings
In Germany, systemic therapy has been recognized as a scientific psychotherapy method since the end of 2008. The effectiveness of systemic therapy in the treatment of adults is confirmed in:
- mood disorders (ICD-10: F3 x ),
- Eating disorders (ICD-10: F50),
- psychological and social factors in somatic diseases (ICD-10: F54),
- Abuse and dependencies (substance-related and non-substance-related ) (ICD-10: F1 x , F55, F63),
- Schizophrenia and delusional disorders (ICD-10: F2 x ).
In the treatment of children and adolescents, the Scientific Advisory Board for Psychotherapy also found scientific recognition for the following areas of application:
- Affective disorders (ICD-10: F30 to F39) and stress disorders (ICD-10: F43),
- Eating disorders (ICD-10: F50) and other behavioral disorders with physical disorders (ICD-10: F5 x ),
- Behavioral disorders (ICD-10: F90 to F92, F94, F98) with onset in childhood and adolescence as well as tic disorders (ICD-10: F95),
- Personality and behavioral disorders (ICD-10: F60, F62, F68 to F69), impulse control disorders (ICD-10: F63), gender identity and sexual disorders (ICD-10: F64 to F66), addiction and abuse (ICD- 10: F1 x , F55), schizophrenia and delusional disorders (ICD-10: F20 - F29).
At its meeting on May 23, 2014, the chamber assembly of the Chamber of Psychotherapists in North Rhine-Westphalia decided to change the further training regulations. a. states that systemic therapy is "a scientifically recognized psychotherapeutic method according to § 11 PsychThG for the detection, healing and alleviation of disorders with disease value for which psychotherapy is indicated".
The approval as a health insurance benefit by the Federal Joint Committee is still being examined (as of 2018). A final report from IQWiG is available on the benefit assessment .
In November 2018 the Federal Joint Committee (G-BA) recognized the benefits in five disorder areas as sufficiently proven, in November 2019 systemic therapy (for adults) was included in the psychotherapy guideline as the fourth "guideline procedure" by resolution of the G-BA and will therefore be available in the future as a service from statutory health insurance (GKV). Systemic therapy for children and adolescents has not yet been assessed by the G-BA, but the relevant test has been announced.
After the constructivist (narrative) turn in systemic therapy in the 1980s, it was sometimes criticized that "systemic therapy is too linguistic-constructivist and neglects emotional and biographical moments."
There is no dedicated disorder theory in systemic therapy, since a diagnosis of “disorders” or even “mental illnesses” including traditional psychopathology concepts is for the most part explicitly rejected as inadequate. This is due to the theoretical proximity to solution-focused approaches. The systemic theory is in contrast to the basic orientations of the established psychotherapeutic care and the self-image of the German health system, which operates largely in a disorder-oriented manner and is theoretically mainly behavioristic or psychoanalytical. In systemic therapy, social or psychological abnormalities are not seen as "sick" or pathological, but as a basically understandable reaction to problems or demands that can occasionally be problematic themselves.
- Rudolf Klein, Andreas Kannicht: Introduction to the practice of systemic therapy and counseling . First edition, Carl-Auer Verlag, Heidelberg 2007, ISBN 978-3-89670-571-6 .
- Jürgen Kriz : Systems theory for psychotherapists, psychologists and doctors. An introduction. 3rd edition, Facultas, Vienna, Stuttgart 1999, ISBN 3-8252-2084-2 .
- Jürgen Kriz: Basic concepts of psychotherapy. 7th, revised and expanded edition. Beltz Verlag, Weinheim, Basel 2014, Section IV Systemic Therapy , pp. 243–301. ISBN 978-3-621-28097-6 .
- Holger Lindemann : The great metaphor treasure chest. Systemic work with language images. Volume 1: Basics and Methods. Vandenhoeck & Ruprecht, Göttingen, 2016, ISBN 978-3-525-40275-7 .
- Holger Lindemann: The great metaphor treasure chest. Systemic work with language images. Volume 2: The Systemic Hero's Journey. Vandenhoeck & Ruprecht, Göttingen, 2016, ISBN 978-3-525-40264-1 .
- Kurt Ludewig : Systemic Therapy , Klett-Cotta, Stuttgart 1992, 1997 4th edition, ISBN 3-608-91648-2 .
- Klaus Mücke: Problems are solutions. Systemic counseling and psychotherapy - a pragmatic approach. 3rd edition, Potsdam, 2003, ISBN 978-3-9806094-4-9 .
- Günter Schiepek : The basics of systemic therapy , Vandenhoeck & Ruprecht, 1999
- Arist von Schlippe , Jochen Schweitzer : Textbook of systemic therapy and advice I. Vandenhoeck & Ruprecht, Göttingen 2012, ISBN 978-3-525-40185-9 .
- Arist von Schlippe, Jochen Schweitzer: Textbook of systemic therapy and counseling II. Vandenhoeck & Ruprecht, 4th edition 2012. ISBN 978-3-525-46256-0 .
- Jochen Schweitzer and Gunthard Weber: Relationship as a metaphor. The family sculpture as a diagnostic, therapeutic and training technique. In: Familiendynamik, Issue 2 , April 1982, 7th year, pp 113-128.
- Kirsten von Sydow, Stefan Beher, Rüdiger Retzlaff: The effectiveness of systemic therapy / family therapy . Hogrefe-Verlag, Göttingen 2006, ISBN 3-8017-2037-3 .
- Kirsten von Sydow, Ulrike Borst [Hrsg.]: Systemic therapy in practice . Beltz, Weinheim, 2018, ISBN 978-3621285278 .
- Joop Willemse and Falko von Ameln: Theory and Practice of the Systemic Approach. The system theory of Watzlawick and Luhmann explained in an understandable way. Springer, Berlin, 2018. ISBN 978-3-6625-6644-2 .
- ↑ Hans-Ulrich Wittchen and Jürgen Hoyer (eds.): Clinical Psychology & Psychotherapy , 2nd edition, Berlin and Heidelberg 2011, p. 462.
- ↑ Scientific Advisory Board for Psychotherapy, December 14, 2008: Report on the scientific recognition of systemic therapy (PDF), p. 1.
- ↑ Christian Reimer, Jochen Eckert, Martin Hautzinger, Eberhard Wilke: Psychotherapie , 3rd edition, Heidelberg 2007, p. 293.
- ↑ Luc Isebaert, Kurzzeittherapie , Stuttgart 2005, p. 21.
- ↑ Scientific Advisory Board for Psychotherapy, December 14, 2008: Report on the scientific recognition of systemic therapy (PDF), p. 2.
- ↑ Systemic therapy: Recognition of the benefit and medical necessity as a psychotherapy method - Federal Joint Committee. Retrieved October 27, 2019 .
- ↑ Systemic therapy for adults becomes a health insurance benefit! , Report on the homepage of the Systemic Society (accessed on October 27, 2019)
- ^ Alan S. Gurman, David P. Kniskern: Handbook Of Family Therapy. New York 1991, p. 23.
- ^ Ackerman, Sobel (1950): Family diagnosis. An approach to the preschool child.
- ↑ Personal Lexicon of Psychotherapy (Eds. Stumm, Pritz, Gumhalter, Nemeskeri, Voracek). Vienna and New York 2005, p. 3.
- ↑ Jay Haley: The perverse triangle. In: J. Zuk & I. Nagy (Eds.), Family therapy and disturbed families. Palo Alto 1967, CA, Science and Behavior Books.
- ↑ A. Schindler, UJ Küstner, P.-M. Sack, R. Thomasius: Systemic therapy. In: Family and Addiction. Basics, therapy practice, prevention. (Ed. Thomasius, Küstner). Stuttgart 2005, p. 156.
- ↑ German: Invisible bonds, The dynamics of familial systems.
- ↑ Eric Lippmann: Drug addiction. Family therapy and prevention. Berlin and Heidelberg 1990, p. 94.
- ↑ G. Reich: Multi-Generation Family Therapy. In: Couple and Family Therapy (Ed. Wirsching, Scheib). Berlin and Heidelberg 2002, p. 252.
- ^ Dictionary of Psychotherapy (Ed. Gerhard Stumm, Alfred Pritz). Vienna and New York 2009, p. 195: "As a result of this constructivist turn , the term family therapy is increasingly being replaced by systemic therapy [...]."
- ↑ a b Arist von Schlippe, Jochen Schweitzer: Textbook of systemic therapy and counseling I. Basic knowledge. Göttingen 2016, p. 95.
- ↑ Self-organization in social systems often does not work if social hierarchies are too flat (see also politicization dilemma ) - cf. Stefan Kühl, 2001: Centralization through decentralization. Paradoxical Effects in Leadership Groups ( Memento from March 4, 2016 in the Internet Archive ) (PDF). In: Cologne Journal for Sociology and Social Psychology , vol. 53, issue 3, 2001, p. 485 f. The systemicists are subject to a blind spot in this regard - cf. Stefan Kühl, 2009: The blind spots of systemic counseling ( Memento from December 8, 2015 in the Internet Archive ) (PDF)
- ↑ In his statements (p. 95), Arist von Schlippe alludes to the political correctness (“gender correctness ”) of this approach within systemic therapy: “Rather ' across ' the two directions, because it is linked to the constructivist assumptions of systemic therapy but not related to the system concept, the narrative theory should be mentioned [...]. "
- ↑ Dagmar Kumbier: Constellation work with the inner team . 2nd Edition. Klett-Cotta, ISBN 3-608-89176-5 , p. 191 .
- ^ Stumm, Pritz: Personal Lexicon of Psychotherapy , Vienna, New York 2005, 458
- ^ Fritz B. Simon, Ulrich Clement, Helm Stierlin: The language of family therapy. A vocabulary. Stuttgart 2004, p. 232.
- ↑ Arist von Schlippe, Jochen Schweitzer: Textbook of systemic therapy and advice I. Basic knowledge. Göttingen 2016, p. 123: “As I said, social constructionism is closely related to the narrative approach. The narrative approach is not based on the concept of system, but its statements are quite compatible with systemic conceptions. In social systems we are dealing with the 'omnipresence of narratives' that characterize coexistence in a culture, with a stream of continuous, self-organizing generation of meaning. A person cannot be conceptualized independently of his or her social world, but can only be understood from the world of meanings, into which, like all other people, he is inevitably involved. Therapeutic change always means a change in self-narration. "
- ↑ E. Steiner, A. Brandl-Nebehay, L. Reiter: The story of family therapy to the systemic perspective. In: Couple and Family Therapy (Ed. Wirsching, Scheib). Berlin and Heidelberg 2002, p. 15.
- ↑ Cf. Ulrich Pfeifer-Schaupp: Systemic and person-centered approaches. Perspectives of the encounter (PDF), p. 4: “The founder Bert Hellinger calls his approach 'systemic-phenomenological' (Hellinger, 1994). [...] This approach is used by other systemicists e.g. Sometimes referred to as 'not systemic' and sharply criticized because of the sometimes dogmatic attitude of its founder and several of his representatives. "
- ↑ Federal Chamber of Psychotherapists, April 24, 2013: Systemic therapy as a service of the statutory health insurance
- ↑ Section B Number II Number 1 Further Training Regulations of the Chamber of Psychotherapists NRW , Ministerialblatt (MBl. NRW.) Edition 2014 No. 25 of September 5, 2014, pages 485 to 510
- ↑ https://www.aerztezeitung.de/politik_gesellschaft/article/968596/systemische-therapie-clinch-gba-regierung-will-tempo.html
- ↑ Press release of the Federal Chamber of Psychotherapists on the G-BA decision , accessed on November 27, 2018
- ↑ Press releases - Federal Joint Committee. Retrieved February 14, 2020 .
- ^ Dictionary of Psychotherapy (Ed. Gerhard Stumm, Alfred Pritz). Vienna and New York 2009, p. 195: "As a result of this constructivist turn, the term family therapy is increasingly being replaced by systemic therapy, since family meetings are only one of the possible settings for systemic therapy."
- ↑ Kurt Ludewig: Leitmotifs systemic therapy. Stuttgart 2002, p. 127 f.