What is systemic practice?

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Family and Systemic Psychotherapy Research
Research has shown that systemic family and couple therapy is as effective—and in many cases more effective—than alternative interventions, often at a lower cost.

Systemic family therapy has been found to be effective for children's and adults' difficulties, both when individuals have acquired a mental health diagnosis and when there is more general or complex distress. It is effective across the lifecycle, spanning developmental stages from under fives to old age. Working therapeutically with individuals together with their families and/or significant others enables the use of individuals’ relationships as a resource, and reduces stress and difficulties for all family members. Family therapy has also been found to be particularly effective during severe and complex disorders requiring extensive treatment. Systemic family therapy can sometimes include relational work with individuals, psychoeducational approaches and multiple family groups.

Reviews of research (see below) list the following circumstances in which family therapy has been proven to be effective for children, adolescents and the important people in their lives:

 Problems in infancy; sleep, feeding and attachment
 Child abuse and neglect
 Child and adolescent conduct problems such as behavioural difficulties, attention deficit hyperactivity disorder (ADHD), and delinquency
 Emotional problems including anxiety, depression, grief, bipolar disorder, self harm and suicidality
 Body¬related problems including enuresis, encopresis, recurrent abdominal pain, medically unexplained symptoms and poorly controlled asthma and diabetes
 Drug abuse
 Eating disorders including anorexia, bulimia and obesity
 First episode psychosis

Reviews of research show effectiveness of family therapy for adults and families affected by:

 Relationship difficulties and distress
 Psychosexual problems
 Intimate partner violence
 Anxiety disorders
 Mood disorders and depression
 Alcohol and drug problems
 Schizophrenia
 Adjustment to chronic physical illness
Carr, Alan (2016) How and why do family and systemic therapies work ? Australia and New Zealand Journal of Family Therapy. 37(1) 37-55
Carr, Alan (2014) The evidence base for family therapy and systemic interventions for child¬focused problems, Journal of Family Therapy, 36(2) : 107¬157.
Carr, Alan (2014) The evidence¬base for couple therapy, family therapy and systemic interventions for adult¬focused problems. Journal of Family Therapy, 36 (2) pp.158¬194.
Retzlaff, R. et al (2013) The efficacy of systemic therapy for internalizing and other disorders of childhood and adolescence: A systematic review of 38 Randomized Trials. Family Process. 2013; 52(4): 619¬652. ).
Von Sydow, K., et al (2013). The efficacy of systemic therapy for childhood and adolescent externalizing disorders: A systematic review of 47 RCTs. Family Process, 52:576¬618.
Von Sydow, K., et al (2010). The efficacy of systemic therapy with adult patients: A meta¬content analysis of 38 randomised controlled trials. Family Process, 49:457¬485.

Many family therapists use their skills and understandings outside traditional ‘therapy’ settings. This work is often called ‘systemic practice’.

Professionals with ‘systemic family therapy’ trainings can be found working with families and other caring relationships in social care, schools, hospitals, hospices, organisational consultancies, substance misuse services, older adults services, youth offending projects, community outreach projects and more.

Some fully trained Family Therapists describe themselves as ‘systemic psychotherapists’ to emphasise their work in areas such as consultation, publication, research, supervision, training and a variety of direct forms of work with clients other than as part of a family.

The term ‘systemic practitioner’ refers to a person who has completed Family and Systemic Psychotherapy to intermediate level.

All share approaches to working respectfully and effectively with people in ways that consider their important relationships, across generations, and the different systems and contexts in which they live.

Systemic practice underpins many important developments in services and trainings in public, non-statutory and independent services in the UK.

See About AFT for further details of systemic practice in action.

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