The Key to Systemic Family Therapy

“Systemic.” What a word. On one hand, systemic can be used to describe a deep-seated, pervasive problem like racism. On the other, it can also be used to describe a medical condition—like an infection, or growth—that has infiltrated the entire body. Typically if we’re describing something as systemic, it’s gotten pretty big and pretty bad.

So I’m not terribly thrilled that the kind of work I do is called “systemic family therapy.” I’d prefer something with a brighter connotation, like “comprehensive happiness training” or “puppy dogs and rainbows.” But the truth is undeniable—to work from a systemic point of view is to assume that problems in the family are, indeed, deep-seated and pervasive. 

For those therapists who work from a different perspective, this stance may seem cynical and pessimistic at first. But once you take a closer look, you’ll start to see the inherent hope and optimism in systemic family therapy.

Think of the Family as a Body

To work from a systemic point of view is to understand that all families are systems, similar to the cardiovascular system of the human body. Like all systems, members of a family rely on—and react to—all other members of their family system. So if you’re a systemic family therapist, what you’re really doing is diagnosing and treating a body with many parts. You’re also relentlessly combating the notion that one faulty organ is the reason the entire body
is coughing.

Medical doctors work this way by definition. They have to look at the whole system. A cardiologist doesn’t only examine your heart. If she did, she’d miss crucial pieces of information and might even accidentally kill you. Imagine if your problem was that your heart wasn’t pumping enough blood to the rest of your body, so she focused all her treatment on that single organ. Well, if your veins and arteries had become accustomed to low blood pressure, then a stronger heart could cause higher blood flow to tear through the lining of those walls. The cardiologist can’t just consider the suffering heart. She has to consider the entire system.

That’s how systemic family therapy works. We often get calls from a concerned family member who believes that their husband, daughter, or brother is really suffering and in need of professional help. Our first instinct is to assume that if one person is suffering, then we likely have weak arteries and sluggish veins somewhere else in the body as well. So we like to suggest that the entire family come in for an EKG—which is a departure from therapies that focus their intervention on a single part of the system. 

Defining the Interaction Cycle

Our second order of business is to identify the interaction cycle. Instead of focusing on the member that the family wants us to focus on, we zoom our lens way out to see if we can identify chain reactions and circular events. 

For instance, if a younger brother is presenting with hyperactivity and school refusal, we don’t treat him with behavior charts and self-soothing skills. Instead, we see his behavior as necessary, at least for now, for the system to function as it does. We look to see what would happen to the entire body if the younger brother wasn’t symptomatic. 

What we might find in this case is that his acting out serves to protect his parents from addressing a marital problem that could lead to divorce, or distracts from his older sister’s struggle with anxiety. 

Then we draw circles. We start mapping the cycle, or “family dance” as some therapists like to say, to understand why the entire body is coughing—not just one part. As we listen to and observe the family, we see that things seem to go along okay until little brother detects marital tension in the house. 

His behavior problems immediately flare up, causing his parents to become upset and focus on him, which leads to shouting and fighting in the house. This triggers the older sister to comfort her parents and stick up for her brother, returning the family to normal until the next flare-up. When we think of it this way, then we’re able to identify what we always knew was there—a deep-seated, pervasive problem in the very culture of the family.

A Holistic Approach to Systemic Family Therapy

Some people might think this systemic approach is pretty pessimistic, but this is where the hope and optimism come in. If we can maintain our zoomed-out view, then we get to help everyone—not just the loudest problem. In the case of our example family, even though the initial call was made for the younger brother, everyone actually can benefit from systemic
family therapy. 

It’s possible that the older sister had no idea that her chronic anxiety was directly related to the heavy lift that her family role as mediator requires. It’s also possible that the parents were too afraid to address their tension for fear of splitting up, but being in the safety of a family therapist’s office finally allowed them to work through some things that have been building for a long time. 

By treating the systemic problem, we can resolve old injuries in the marriage, return the older sister to her rightful role as a child, and render little brother’s distraction tactics unnecessary. How cool is that? 

The Value of Interaction Cycles

A behavior chart never would have tackled the underlying issues at work in our sample family. The little brother would have just come up with some other clever tactic, the parents might have eventually divorced, and the sister would have been on anti-anxieties for most of her life.

The interaction cycle is the most important tool in systemic family therapy. Without it, we’re liable to use bandaids as our primary intervention, or worse, create problems that weren’t there in the first place. Learning how to map it is a worthwhile endeavor if you are a therapist interested in making tectonic shifts in family life. 

And best of all, letting families see the map, take it home, and post it on the fridge is a gift that keeps on giving. Once they see their maladaptive patterns, and have a little practice in your office with changing their responses, they get good at it on their own. 

Eventually, they don’t even need you for making necessary changes. Their love and devotion to one another, coupled with what you’ve taught them about systems, motivates them to take their own EKGs when the going gets tough. And isn’t that the change we wanted all along?