Systemic Therapy in London & Online

What is Systemic Therapy?

Systemic Therapy Basics

A systemic therapist considers all the contexts that affect one or more individuals – couple relationships, nuclear family interactions, wider family interactions, culturally-based group memberships, and even socio-economic factors [1]. 

Systemic therapy can take the form of individual, one to one therapy, but also potentially involve numerous individuals in therapeutic work, for example family or group therapy. Although systemic therapists highlight the importance of numerous contexts (e.g. family, office, friends group, neighbourhood community, etc.) to which we belong, they don’t underestimate the value of an individual as an independent agent. 

Systemic Therapy and Maintenance of Issues

Psychological issues don’t exist in a vacuum. Much as they affect you and are affected by your responses, psychological issues also exist in a social universe where other people react to them and also act towards them. This is why systemic therapy offers a whole new insight into our struggles. Here’s an example of looking at depression from a systemic therapy perspective:

Let’s say that you’re struggling with depression and you decided to start systemic therapy. Your therapist will help you discuss your negative feelings as they occur in a variety of contexts (e.g. family, work, friends group, etc.) and what meaning and function the depression might have in these contexts. For instance, within a family, your difficult feelings may become a stronghold of your parents’ tendencies to patronise you and act towards you in a condescending manner. 

It happens that a person’s psychological issue, for instance depression, obtains a specific meaning within a family. For instance, even though your parents are naturally caring and encouraging towards you, they can inadvertently (e.g. unconsciously) contribute to your depression being maintained as this enables them to continue to help you and to care for you. In this scenario, their unconscious belief may be about seeing you as better off being dependent on them than independent. The exact opposite can also happen – your parents believing that you should be completely independent and that unless you’re able to be a go-getter, solving all your issues on your own, they will have all the right to reject you. 

In addition, within your work environment, depression can become a reason for your coworkers to start avoiding you, as a result of misunderstanding your feelings; they might believe that you’re trying to reduce your workload on purpose or that you’re trying to get more time off, whereas you’re simply not feeling well. And then, because they didn’t properly understand your issues, your coworkers might start spreading rumours or simply being detached from you. In a different scenario but within the same work context, depression can be a way for you to express your lack of satisfaction with your current role. The feelings of meaninglessness, lack of enthusiasm, and low energy may be the result of monotony of work and feeling a lack of opportunities to progress. 

In short, Systemic Therapy will help you better contextualise your feelings within the contexts of your life, understand how other people react to your feelings, but also how they are, inadvertently or otherwise, contributing to them. But how do systemic therapists come to such conclusions? This is what we’ll talk about in the  following sections.

Is systemic therapy only for families/groups?

No, individuals too can attend systemic therapy. Whereas group therapy with, for instance, family members, has its benefits, systemic therapy for individuals can also help you improve your well-being and gain new insights into the meaning behind the issues you are experiencing. Attending individual systemic therapy where you’re able to discuss your distress as it takes place within the important contexts you belong to (family, friends, work, etc), has the potential to bring change to yourself personally, as well as the systems you’re embedded into. The following systemic therapy techniques, which are used within group systemic therapy, can also be used within individual systemic therapy. 

Systemic Family Therapy Techniques

Circular questioning

One of the basic systemic therapy techniques, circular questioning [2], highlights the very essence of systemic therapy reasoning – within families (and other systems too), the feelings, behaviours, and beliefs of all members are interconnected in a circle, not in a linear causal pattern. This is why a systemic therapist will ask circular questions to see how you react to a certain event. A circular question, for instance, “Who, besides you, is the most affected by your issues?”, is about your relationships with others, and how the struggles you are experiencing are connected to other people.

Circular questions (e.g. “How do you imagine your partner feels when you tell them you have no time to speak to them because you’re busy?”), can also be used to explore our own thinking about others’ emotions, thoughts, and behaviours. One of the most important goals of circular questioning is to bring insight into what you think about other people and more specifically what you think about their thinking. A typical circular question “When you spend long periods feeling angry with each other, what do you think your husband thinks? Is he frustrated, sad, angry, anxious, or anything else?” is made with this goal in mind. 

We can also use them to see how an issue changes through time – “Compared to how people treated you before, how do they treat you now?” In this context, circular questioning allows you to explore your pessimism or optimism about the future, and your thinking about the past.

How Effective is Systemic Therapy?

According to research, systemic therapy is a very effective approach. A recent meta-analysis of the most important studies [4] on the effectiveness of systemic therapy up to 2020 showed that a great majority of people involved in systemic therapy experience an improvement in general mental well-being. Depending on the context and adherence to therapy, the success rate of systemic therapy can go well over 90%.

Does Online Systemic Therapy Work?

When is the right time to start systemic therapy?

The right time to start systemic therapy is as soon as you notice that the issues you’re experiencing are starting to affect you significantly, so that one or more spheres of your life (e.g. family, relationship, work, leisure, etc.), are affected. 

You should also consider starting systemic therapy when it becomes evident to you that the issues you’re experiencing are appearing mainly in the context of relationships with other people. For instance, if you have an anger management issue primarily because of the amount of frustration you experience in the relationship with your spouse, systemic therapy will help you better understand the viewpoint of the other person (and your own viewpoint) and what role anger plays in your relationships, and look at ways to make positive, sustainable changes. 

Moreover, individual systemic therapy can be an interesting alternative in case you’ve tried other individual therapeutic approaches but didn’t experience significant improvements because the context itself wasn’t addressed within your previous individual therapy.

What are the Advantages of Systemic Therapy?

• Systemic therapy helps you make meaningful changes by considering the various contexts in which your issues appear. The struggles you are experiencing exist in contexts such as family, work collective, neighbourhood community, etc., which is why learning more about the contextual meaning of your struggles can help you improve your well-being by prompting meaningful changes.
• It encourages deeper understanding of your struggles and what roles they have in your marriage, family, work group, etc; systemic therapy is the farthest away from pathologisation – the “problem” isn’t situated exclusively within you, but in various contexts and interactions you’re a part of. Systemic therapy can thus feel very normalising and validating, which can strongly contribute positively to your wellbeing.
• Systemic therapy is very flexible when it comes to the number of people involved. Namely, you can attend it individually, with your partner, family members, friends, etc. It can be couple or family therapy, but it can also be an individual therapy. The basic theory of systemic therapy remains the same whether it’s applied in the individual or group context – it will inevitably focus on your relationships and how your issues appear in the wider social context (e.g. family or spousal relationship). 
• Systemic therapy will likely not only improve your well-being, but has the potential to also improve the well-being of the people with whom you have close interactions. 
• Systemic therapy, whether in its individual or group form, will bring new insights to the way you think about your relationships, and will offer actionable steps to improve these relationships in the following ways:

• Improving communication – quite often we make our lives more complicated simply by communicating in a non-effective way. Our systemic therapists will help you to identify your communication problems and improve your communication with the help of, for instance, assertiveness training.
• Improving empathy – this goes for both empathising with yourself and other people as well. It’s not unusual that we lack understanding and patience for ourselves and other people. Systemic therapy will encourage deeper understanding of yours and others’ actions, leading to a crucial realisation that while most people do bad things, most people don’t necessarily want to or aren’t even aware they are acting in bad ways.

Bringing new insights to your thinking about the past – a lot of people carry a heavy baggage from the past. By reinterpreting past events and past relationship issues that are affecting you in the present, systemic therapy will open up a way for future changes.

What Issues can Systemic Therapy Help with?

Systemic therapy can be used to treat a variety of psychological issues. Keep in mind that within this approach a psychological struggle is not situated within an individual, but regarded as a product of the interactions within a certain social context (e.g. family):

• Depression
• Bipolar
• Eating disorders
• Substance use disorders
• Schizophrenia
• Anxiety disorders
• Trauma
• Child and adolescent mental well-being
• Parenting issues
• Physical health problems and psychosomatic issues

How long does Systemic Therapy Last?

Individual systemic therapy sessions will last usually 50 minutes. At times, a systemic therapy session could last up to 90 minutes, depending on context (i.e., individual therapy, couples or family/group therapy). It lasts in general between 6-20 sessions which means you’re likely to notice positive and significant changes in this timespan. 

More severe issues might need longer therapeutic work, but you’re likely to eventually see improvements if your issue is one that can be alleviated and worked through in therapy. We recommend regular check-ins with your therapist to discuss progress and the plan to move forward.

Common Concerns about Systemic Therapy

Systemic Therapy is too relativistic

It’s true that the individual nature of psychological issues is relativised to a certain extent within this approach. Although most modern individual therapies abstain from pathologising clients, they still consider the individual as the main protagonist of therapeutic improvements. 

Certain problems can appear even within well-functioning families. But even in this case systemic therapy is helpful because it can improve the collective understanding of the presenting issue. 

It’s too demanding for Family Members

When systemic therapy is practised with a family, some family members may find systemic therapy too demanding – they might think that they don’t have to go to therapy because they are not the ones who have any issues. This is exactly the sort of matter that can be discussed within a systemic therapy session. It’s possible that the family members who are most reticent about family therapy are the ones who, perhaps inadvertently, contribute most to issues. 

It’s too Unstructured

Compared to, say, CBT, systemic therapy might look a bit unstructured. However, systemic therapy can become more or less structured depending on your needs and the therapist you’re working with.  

Our systemic therapists work flexibly and integratively. This means they’re able to integrate principles and techniques of various therapy approaches (e.g., Systemic, CBT, Psychodynamic), to adapt the work to your unique situation. Thus they’ll be able to increase or decrease the structuredness of therapy (e.g. coming up with individual ‘homework’ or a list of tasks for each family member) if this is something that you want or that you and your therapist feel would be helpful to your situation.

Is Systemic Therapy the Right Choice?

Generally speaking, if you’re experiencing significant psychological issues that affect your functioning in one or more areas (i.e. social, intimate, professional), starting psychotherapy is likely to be a good choice. Systemic therapy can be used to better understand and tackle a variety of psychological issues, both as an individual or group approach. 

Is It the Right Choice for Individual Therapy?

Systemic therapy, as an individual approach, is likely to be beneficial to you if:

• You’re willing to consider psychological issues under a new light; we are living in increasingly individualistic cultures and the effect of contexts we live in (e.g. family, work, culture, etc.) can sometimes be ignored or their effect underestimated. This is why it can be beneficial to consider the importance of your relationships to other people and how they contribute to you as a person.
• You are ready to critically and objectively examine the role of other people in your life – systemic therapy requires a balanced approach to how you think about your relationships.  
• If you feel ready to try to change the contexts you’re living in. One of the basic ideas of systemic therapy is that there can be no profound changes to individuals without changes to broader systems. And while it can be a bit hard to change wider systems such as culture, you can likely start to bring some positive changes to your family or your office. 

Is it the Right Choice for Group or Couples Therapy?

• In case other people are attending therapy with you, the group’s acceptance of the principles of systemic therapy is crucial. If your family members (or, say, your partner) are not committed to improving your and their well-being, systemic therapy might not produce the desired outcome. 
• You want to improve your family as well – systemic therapy is not only about you, it’s about everyone involved; your well-being depends on the well-being of others. The therapeutic focus might not always be on you – but on your relationships with other people, how they react to your struggles and how you respond to theirs.
• Availability of everyone involved – once again, the following caveat too is only relevant if other people are attending therapy with you. Namely, it will take a certain amount of scheduling and planning to get everyone involved. The therapist will be helpful in this respect, but the effectiveness of systemic therapy still depends on the availability of your family.

How we like to Practise Systemic Therapy in London at Therapy Central?

Our systemic therapists are flexible and will pay great attention to tailor each session to your specific needs. Most of our systemic therapists are also trained in a variety of therapeutic approaches, and are able to offer therapy which is comprehensive and integrative. For instance, your systemic therapist can, for the most part, focus on the family dynamics and work with the group, in case you’re attending group systemic therapy. If you’re seeing the therapist with family members, your practitioner might sometimes decide to discuss certain topics on a one-on-one basis with each family member. 

Systemic therapy also has the individual form where the therapist works with only one client. Moreover, when relevant, the family therapist might introduce CBT-style homework such as behavioural experiments or journaling, or integrate elements of other approaches to suit your specific needs. 

The most important aspect of psychotherapy is how it helps you (and groups you belong to) make positive and sustainable changes. Psychotherapeutic integration is often helpful to reaching this goal.