What Exactly is Systemic Therapy?

4 days ago
5 min read

Systemic Therapie - A Different Way of Looking at Problems

An approach that many are still unfamiliar with

Most people seeking psychotherapy have already heard of cognitive behavioral therapy or depth psychology-based therapy. Some have even undergone therapy using one of these two approaches in the past. Systemic therapy is still new to many—at least in this country.

It is the most recently recognized approach under German statutory health insurance. It has only been covered by health insurance for adults since 2020. Since 2024, it has also been covered for children and adolescents. Internationally, however, the systemic approach is one of the most widely used forms of therapy and counseling, alongside psychoanalysis and cognitive behavioral therapy.

In this article, I’d like to describe the approach behind systemic therapy and what it means for my practice.

People Exist in Relationships

The basic idea is simple, but it changes a great deal: People—and thus their problems and symptoms—always exist in relation to others. Psychological distress is rarely purely an individual matter. It arises within a broader context: from relationships, family patterns, professional contexts, roles, expectations, and life transitions.

Who we are, what sustains us, but also what causes us suffering, is connected to the systems in which we live. This explicitly does not mean, “It’s other peoples' fault.” Rather, it means, “Others matter.” This does not relieve anyone of the responsibility to address their own issues, but it changes the way we view them. In systemic therapy, we therefore sometimes speak of “index patients”: Their symptom indicates that something within the system as a whole has become unbalanced.

Good Resons for Problems

People are constantly trying to find balance with their environment. Much like a mobile that starts moving after being nudged and eventually settles back into balance. Social systems respond to external stimuli in a way that maintains their balance and sustains the whole.

Sometimes this comes at a high price. A symptom, a disturbance, or a problem can be part of this balance. From this perspective, what looks like a disturbance from the outside is often a solution in its own right. Sometimes a surprisingly clever one that protects the system. Just one that comes at a high cost.

There are usually good reasons for a symptom. It almost always made sense at one point and helped a family system, a couple, or a team establish stability. This perspective provides relief. An individual problem that is supposed to disappear becomes something that once had a purpose.

In systemic therapy, we are therefore particularly interested in the context in which the problem manifests, what keeps it alive there, and why it was once important. This last question, in particular, leads to an idea that is central to my understanding of psychotherapy: Today’s problems, according to a basic assumption of systemic thinking as articulated by Peter Senge, are often yesterday’s solutions.

Sometimes, by the time people come to therapy, they’re still right in the middle of the situation where the pattern is significant—and in those cases, it may not yet be the right moment for change. Often, however, the context has long since changed, but the pattern has remained.

Why It’s Not About “Getting Rid of” It

Many people come to me wanting to get rid of their symptoms. As quickly as possible. I understand that completely. Who wouldn’t want a quick way out of what’s weighing them down?

But a symptom that’s treated without understanding its function rarely disappears permanently. What the symptom was originally there to address often finds a new way to express itself and reappears in a different form elsewhere.

This leads to a certain understanding of change. A person cannot be transformed from the outside, and change is not something a therapist creates or prescribes.

What is possible is to provide impulses that set a system in motion. Out of this movement, new constellations can emerge that are more sustainable than the old ones. Sometimes this happens quickly; sometimes it takes longer.

What This Means in Practice

In systemic work, we engage in a dialogue with the problem. We don’t treat it as a flaw to be eliminated, but as something that has an important message. If this symptom could speak, what would it say? What would it need to be less persistent?

I’m also interested in the stories you tell yourself about yourself and the world. Which of these might be worth questioning because they’ve become painful or are fueling the problem? Sometimes it’s worth changing your perspective.

In systemic therapy, we don’t just look at the problem, but also at what’s already working, what’s going well, and what can stay exactly as it is. Systemic therapy is solution- and resource-oriented. It asks what is working, looks for exceptions, and seeks out moments when the problem is less severe.

A resource-oriented approach means two things: First, recognizing what a problem once served a purpose for. Second, the belief that people already possess the means to change within themselves.

My role is not to teach you a solution that I already know. Rather, it is to work with you to discover which solution is right for you and to rediscover resources that have long been there, so that you can put them to use.

Often, one aspect of this is already evident in the very fact that someone decides to start therapy in the first place. After all, anyone who takes that first step already carries within them a vision of what life without the problem might look like. Even when everything feels hopeless, there’s usually a part of them that knows: Things could be different. It is precisely this part that serves as a resource.

Systemic Therapy - An Approach, Not a Technique

Systemic therapy means establishing a relationship, providing impetus to set a process in motion, and being curious about what emerges. It means exploring how the world looks through the eyes of the other person—and always assuming that things could be very different. It means trusting people to take responsibility for themselves and the process—and assuming that they already possess much of what is needed to solve their problem.

As a therapist, I am not the expert on your life. I don’t know any better than you do what’s right for you. I can’t see inside you and determine from the outside which path you should take.

What I can do is listen carefully, ask good questions, and help you shed light on your blind spots. I can provide insights that can give rise to something new to replace old patterns. I am an expert in the process—in transition, in perseverance, and in growth.

Perhaps this approach resonates with you. Systemic therapy isn’t a path where you’re treated, but one we walk together. If you’re ready to develop a new relationship with your symptoms and to actively work on your problem, we can explore what that might look like for you together. Either at my practice in Frankfurt or during an initial online consultation.