Family therapists talk as if the term "systemic" was all theirs. They talk as if it has just one meaning. They talk as if it is transparently clear what that one meaning is. A good general book to start with is: Donna Meadows (1993 / 2008) "Thinking in Systems". This is the start of a compendium of meanings that Nick continues to collect. See also Systemic Means Much More where Nick proposes tagging a suffix on to the words to denote the different meanings, e.g. [DICT]
System [DICT] A group of interacting, interrelated, or interdependent elements forming a complex whole. Click here for many more dictionary variations and some etymology. One etymological origin of the word "system" means something that has "set-up-ness". That is a cybernetic view of a grouping of things as if set up for a purpose, as there is when a person uses a rope and pulley system, or a mechanical system like a bicycle. A system often has feedback to keep it on track. With machines guided by modern computers, inanimate systems can now seem almost human even though they cannot have intentions like humans can. So this "set-up-ness" refers - at least in an "as if" way - to intention or as if there was some purpose or intelligent design behind or in the system. We can also analyse a human event or predicament and the factors that go to make it happen "as if" it were intentionally set up, even if it was certainly not intended by anyone - e.g. a plane crash or crowd disaster. We say it was "an act of God" when supernatural forces seemed to intend the collective human system event even if no humans purposely intended it.
More commonly system is used about impersonal things - machines, factories, offices, or sets of rules. When we talk of human systems we are also dealing with a definite mixture of intended and unintended-ness. And our subsequent assessment is in order to intentionally or consciously understand, stop or change the undesired and maybe unintended system functioning. The same concept applies to things and humans. The idea of a system blends across from the physical system to the system of rules or laws that a system follows or seems to follow even if the rules or laws are natural not intentional ones. Cybernetics is the study of how a system's functions are regulated by feedback. Humans are more capable of self-awareness and intentions but even they can make mistakes - eg solutions that actually keep the problem going as in this image of two sailors steadying a (steady) boat (from Watzlawick et al's (1974) book Change: principles of problem formation and problem resolution.
Systemic [MED] Of or relating to systems or a system. An illness that affects multiple organs, systems or tissues, or the entire body. A route of administration of medication so that the entire body is affected. Click here Dictionaries have until recently only included the term systemic for these medical uses. Medicine has forever worked on how the body and its systems work together in order to understand, diagnose and treat its malfunctions. Thus 'systemic therapy' means you give the patient pills to take rather than apply topical cream to just to the local skin lesion. It is more scientific and medically useful to know the whole-systemic causes, the disease diagnoses, behind a symptom rather than just focus on the presented complaint. Thus poor eyesight and circulation are real in themselves, but they are symptoms of diabetes affecting the whole system; so treating the diabetes is best.
Increasingly an internet search will find systemic therapy (or systemic psychotherapy) goes straight to the family therapy meaning. Click here for example. The analogue from physical illness is obvious enough. In family therapy we do not just focus on a presented symptom or individual (as would be typical in medicine, psychiatry and most psychotherapies - derived as they are from the biomedical model's search for the causal condition, diagnosis or meaning of the problem to treat). We work to understand our clients within their wider family and social system. It's worth remembering that Gregory Bateson - highly credited in family therapy as an originator - was already way ahead of us in the 1950s; he used the broadest system term, ecology, to mean that the whole world in general and in detail was a system. Describing "the ecology of mind" he likened it to the way flora and fauna try to keep their grip on the sides of a cliff.
There are many variations of this broad general meaning of system and systemic. It is interesting to distinguish systematic:
Systematic Arranged or conducted according to a system, plan, or organised method. Purposeful organisation So we would say "I searched the house systematically for my lost wallet" to contrast with a less organised approach to the predicament. Here "Nick is systematically exploring the many meanings of systemic" in contrast to those who didn't know there was a problem.
Systemic [ENDEM] Endemic Systemic can be used to mean that some system is riddled with something. So we might say that "corruption is systemic throughout the police force" or "the problem with the banks is systemic". The understanding is that the feature is part of the culture, hard for anyone to stop.
Systemic [ACT] Actively sustained These same examples could also imply a meaning that there are more active intentional self-perpetuating processes that will ensure that any attempts to change things will be resisted. Cybernetics calls this a homeostatic system. It follows that, say, when a business is planning for the future, they may need to do a systemic review and find systemic solutions.
Systemic [HOL] Holistic Often a general use of system or systemic is interchangeable with holistic or gestalt, meaning that the parts of something are intimately interconnected and explicable only by reference to the whole. In holistic medicine, the concern is to treat the whole person, taking into account mental and social factors, rather than just the symptoms of a disease. See below for Systemic [FUNC]. Interestingly a common gestalt quotation about systems is commonly used wrongly by pretty much everyone else. Thus "the whole is greater than the sum of the parts" was originally and repeatedly corrected by Kurt Koffka to "the whole is other than the sum of the parts" emphasising his view that the whole has an independent existence in a way that is more than just additive plus.
Meanings in the Helping Professions
Because we are working with people, we assume that it is human systems we are talking about, without specifying that it is.
Systemic [FUNC] Thinking further about the presented problem's functions. Like holistic medicine (above) a basic lesson a professional or a therapist learns is to step back from tackling a presented problem in order to look more widely at the function the problem or symptom might be playing for the person and others in their lives. That is a short step to bringing in the context and the others in the family system (see below). For examples, a headache may be a way of avoiding a social event; a difficult or worrying teenage behaviour keeping the parents pulling together and avoiding some other problem they might have; e.g. where two sailors steady a (steady) boat the viewer can see what the wider context is and what each participant could do differently.
Systemic [NC] Working (with human systems) to bring out, share and respect the often interconnecting views and stories of everyone involved while integrating a way forward. "Views and stories" is intended to include any and all other kinds of personal matters of intention - experiences, values, beliefs, feelings, complaints, wishes, plans etc. In contrast with more specific but usually unspecified meanings below, this is Nick's present best and more inclusive general definition of what it means to be systemic with human systems. See Child (2012) Systemic Means Much More, here. It applies to family therapy but also to work that is much wider than that - including for example effective committees and even good politics. It contains the original etymological and therapeutic intentionality of the word system to mean "set-up-ness", that of understanding things as if they were intended to function that way, and of actively finding other options and solutions. The definition emphasises the collaborative but doesn't exclude the directive. And it emphasises that, while past events carry influence and may need to be attended to in the present, the present here-and-now is primarily seen as a platform for seeking future solutions, what to do about it next. This is in contrast to approaches that primarily look backwards for the causes of the problems rather leaving the client and their solutions to follow without actively thinking about them.
Stereotypically, family therapy has an actual family group of people in the room. A core skill of a family therapist is indeed to know how to set this up and how to work with conjoint gatherings for therapeutic purposes. Note though that merely bringing people into a room together is not enough (under this definition) for systemic practice to happen. A waiting room, for example, may certainly be a lively human system in which lots of interaction may be happening too, but it is not a meeting with a greater intentional purpose than waiting for a train or an appointment.
And note that it is possible to do systemic things without bringing more than one (or indeed any) of the actual people into the room. We all have many "people" alive in our heads. Therapies of all kinds work with this inner community of selves, but systemic practice would characteristically do individual work in a way that most closely evokes the real people in the room interacting and going forward. A good way to understand this point is in Valeria Ugazio et al's (2012) lovely paper that shows that the "common sense" explanation of an individual person's predicament is largely done in monadic or dyadic terms even when they are given extra hints to think of other people in their lives. Systemic thinking works with triadic explanations (or more). For examples, a monadic explanation for Marco's surprising decision to drop out of university would be that "he feels it's not the right path for him"; a dyadic one would be that "he wants to move to Brazil to forget his ex-girlfriend"; and a fully linked triadic one that he "wants to get back at his mother, who has always tried to undermine the relationship between her son and his father, who is all too happy to have his son follow in his footsteps". So systemic thinking of this kind is ubiquitous, universally understood, found in every life and community and in novels, news and drama, yet it is rarely employed when ordinary people are faced with the kinds of life questions a therapist is faced with. Triadic thinking like this is arguably not employed much in other psychotherapies than systemic ones. The definition's use of "interconnecting" refers to this aspect of more developed systemic practice.
So, in summary, this definition does not qualify the wide range of ways in which the process happens and that systemic psychotherapists are especially interested in (see below). But it does refer to two core elements of present day systemic family therapy (see below):
To remember, contact or include others in the many social systems that an individual lives in (e.g. the individual client or patient's family, community, culture, other agencies etc)
To think and work with people always to create plenty of options for them, new ways of seeing things. We do this both
by understanding the power of the "boxes" that constrain us (labels, diagnoses, facts, truths, categories), and also by
keeping ourselves open to any and all other ways of seeing things "out of the box" in the service of finding as many options and ways forward as possible (aka therapy).
This means that, even when a client or therapist feels convinced of some fact or truth or advice, the systemic person will wonder "Who says so (and why)? How far will believing the fact or truth help or hinder us here?" Eg the "boxes" provided by labels like "personality disorder" or "ADHD" or "transference" or "enmeshed" may have some uses but they can also box everyone in too. This part of our systemic approach is therapeutically useful and it derives from social constructionism - the idea that parts or all of our human ideas are socially constructed rather than positively real. This practical reason may be why social constructionism is popular in family therapy rather than any theoretically thought through reason.
Systemic [CONT] Always considering the context of events, people, actions, events etc. For example, you could say that the reason why the same word can readily have several meanings is because the meaning is clear from the different contexts it is in (the sentence in which the word is embedded). Nick's definition above is more pragmatic as are many of the meanings here used by therapists. Therapy is a practical matter. The elements of Nick's definition can also be seen as elements of "context" - who else is involved or influential and how? This common assumption of context when being systemic is worth noting more explicitly here as one of its meanings.
So being systemic is always to consider context. To understand a person or a situation or the meaning of words or actions properly you need to understand their context ... what led up to this, what culture or community frames this, who else is watching or involved, who will do what next, with what aims? Cronen and Pearce's coordinated management of meaning (CMM) is a practical theory of many "nested" levels of context and communication in social systems, levels that feed up and down on each other. CMM itself comes from other fields of social science than therapy, and does not use the term systemic much. CMM intends to reflect the complex, rich and proactive lived experience of those involved. For family therapists, "meaning", "system" and "context" are inextricably interconnected. CMM and system mean much the same if you always think of people and things in context - people and their system/s.
The word systemic is not usually directly used to mean "taking context into account". But everyone would agree that attention to context is essential to all systemic thinking and working. So Nick adds "Systemic [CONT]" to the list for this wide if implicit meaning of systemic.
Systemic [MFACT] Multifactorial This is an application of the simpler definition of system to mean just that a presenting problem, e.g. high blood pressure, or ADHD, has several factors operating in a combined or multifactorial way. This is in contrast to the simplest cause of illness being one factor: e.g. a fall causing a fracture. Sometimes a multifactorial problem requires a multidisciplinary team approach, as in child and adolescent mental health services (CAMHS). A family systemic approach might both bring out and share the multiple factors and possible options for solutions, and also help everyone be economic and effective by focusing down on the one or two that might work best. This is the human systems equivalent of the doctor creating a differential diagnosis before zooming in on the best steps.
Systemic [COMP] Complicated When problems are complex (like CAMH ones for example), systemic might just mean that they are complicated.
Systemic [INCL] Simple inclusion of other people involved Even if a psychiatrist, for example, is not aiming to do anything therapeutic, her straightforward inclusion of others - other members of the family, of team colleagues, of links to the GP or other agencies along with their views and contributions - would often be welcomed as being more systemic. Or more systemic (than not doing it). Hopefully something good will come out of the exercise even it is no more sophisticated than a well run case conference. In our CAMHS service in Lanarkshire (click here) we preferred to keep the terms simpler still - we called this inclusion of and liaison with others, a "family systems approach". To work hard to build a good CAMHS team or a good "team of agencies" seemed to us "good basic practice". We were not implying any sophisticated or therapeutic skill or intent in it. We didn't, but it could be called systemic.
Sometimes even apparently sophisticated literature uses systemic in this way. For example, in this JMFT (2012) the article on the treatment of intimate partner violence considers that to be systemic simply because it includes the victims as well as the perpetrators in a programme of standard parallel activities like men's group work.
Systemic Practice [AFT] Applying systemic family therapy ideas and methods to other professions than family therapy itself That application of family-systems principles and approaches (like what our CAMH team did in Lanarkshire - where there were no family therapists in the team) has long been called systemic practice. Before family therapy became a profession in Britain (around 1990) everyone was a systemic practitioner! Many people in many helping professions can claim now to have done this: psychology, psychiatry, family doctors, counselling, couple counselling, nursing, social work, and many psychotherapies. This meaning is in AFT's strapline: "The Association for Family Therapy and Systemic Practice in the UK" - meaning that AFT aims to serve (the clients of) both those in the family therapy profession itself, and all other professions who are interested in applying those ideas. Nick played a key role in creating that strapline for AFT. His interest in promoting the systemic practice half of AFT's aims is reflected in articles like The Potential of Systemic Practice (for social work) and Family Therapy: The Rest of the Picture.
Systemic Practice [ORD] Ordinary good practice On this forallthat website and in Systemic Means Much More (click here), Nick is probably alone in trying to argue that applying many of the 95 basic elements of good FT amounts to what is ordinary good practice for any helping professional. (See Nick's FT: The Rest of the Picture - if the more recent field called "common factors in psychotherapy" had been coined then, that paper would have been famous for its contribution to it.
Special Family Therapy Meanings
Systemic [FT] To categorise a special type of family therapy This use of systemic begs the question of which of many uses of the word we mean. Family therapists will certainly mean to distinguish themselves from, say, more psychoanalytical or individually focused forms of individual, couple or family therapy or counselling. But these other approaches themselves will say they incorporate systemic ideas. One thing is certain: when someone uses systemic they intend to convey that they are definitely more systemic than someone else is!
Systemic [DIR] Directive models of family therapy In its earliest form family therapists were very confident and directive of families as their way to help them. Examples would be problem focused, structural or strategic approaches. Because they included members of the wider family (than the presented individual) the term systemic was validly used to describe that then. But for 20 years or more that kind of directive approach has been overtaken by approaches that would be described as "more systemic". This later meaning of systemic is used to criticise (systemic) directive approaches for their failure to genuinely respect and engage individuals and their views and stories.
Systemic [COLL] Collaborative or social constructionist therapies In explicit contrast with directive family therapy, there is now a range of theories and practices that emphasise a more careful inclusion of people's views as part of a more collaborative way to understand and solve their difficulties. In family therapy circles, this would be the most common meaning. Strangely, although the meaning here is about respect and inclusion of diverse views, the tone and context may often convey the most severe implied disapproval of any other less systemic approaches. You may end up feeling that, if you get it wrong (in usually unspecified ways), you won't pass your exam!
Systemic [REF] Reflective approaches Even more specifically than the collaborative constructionist meaning, the term systemic may mean that more specifically reflective methods are used in the collaborative therapeutic work. The language of a properly trained family therapist includes key phrases like: "I am curious about ... " to underline that you will never be more interventive and ask more directly about something, let alone actually make a suggestion or give advice to your client. Being more open and reflective does indeed feel and work much better with clients - it is more ethical. It also does usually bring out the client's own ideas and solutions that may well be surprising to the therapist. But an important disguised core skill in modern family therapy is in asking questions that are most likely to bring forward the kind of ideas from the client that a directive therapist might previously have produced for or imposed on the family.
Reflexive methods in systemic therapy originated from Scandinavia where the word has a clearer specific meaning than in English and its cultures. Typically, ordinary discussion - i.e. discussion that is not "systemic [REF]" - takes the form of actively engaging in talk about a topic with some mild or heated intention to agree and persuade each other of the best or truest account or conclusion to the matter. Part of the process is to manage the mechanics of the discussion - who gets to talk, who has the best rhetorical skill. So: some listen more, some get to speak by knowing how to interrupt, some speak long and loudly or bang the table or threaten to storm out, etc. A reflective discussion, in contrast, typically establishes 1. that each person takes their turn to say a few things, 2. there may well be a focus or question in the collective minds, 3. thoughts loosely hold to some relevance to that focus, or to what others have said so far, but 4. otherwise a person's thoughts do not have to be as linked together with each other in a logical or focused way, nor with what other people have said (as they would in a normal discussion). 5. The last phase might be to return the floor to the person who presented the initial case or viewpoint, to ask for their reflections on what had and had not been useful for their purpose.
There is a meditative creative quality to the atmosphere with reflective discussion, with pauses for listening and reflection and thinking instead of active debate. The way a person begins speaking is more like: "I found myself thinking about X and Y ... and I wondered if that was linked to Z and A ... ". If you wanted to reflect on any strong disagreement you have, a reflective way to do that might be to say: "When Bill talked about X, I found myself wanting to strongly disagree with what he was saying…" You would not interrupt Bill and start arguing with him, as you might do in ordinary discussion.
Just doing reflective discussion is therapeutic and creative in itself. It validates, attends to, respects and permits each person's views and thoughts however diverse or divergent from other people's. No one is being forced to agree. New plans and agreements might emerge more easily from the richer field of ideas that has been shared. If therapy is creating as many options for a client to choose from, then reflective methods based on systemic thinking are a good way to achieve that.
An interesting link to this is in James Surowiecki's book The Wisdom of Crowds. He shows how linked (but only indirectly interacting) large and diverse groups of people can come up with the truest answer to some kinds of problem given some kind of method of averaging their separate answers out. This is found in many situations such as betting, stock-markets, elections or opinion polls. Making big crowds of people to actively work together on this sort of thing, makes for a worse outcome not a better one. Thus the loose links of reflective discussion might seem to be more like this picture. And it then becomes important when we also so strongly believe in collaborative approaches being best to be very clear what we mean by collaboration - as in Systemic [COLL] here.
Systemic therapy or practice [VIRT] Whoever is actually included in the room or not, this is a way of exploring in discussion with them their interconnected wider family, and their cultural and other stories and systems, so to include the wider system in a virtual way. One way to understand this pro-active but only virtual inclusion of a wider system is described in Ugazio's paper (see above) on monadic or dyadic explanation as opposed to triadic Systemic Thinking. Another would be Internalised Other Interviewing.
Systemic therapy or practice [ACT] (i.e. active) Including family members in the work or room, but also actively working with wider family, community and agencies involved, so to include more actually the wider system (not necessarily all at the same appointment). Here the word systemic refers to the active (hence [ACT]) wider inclusion of systems - actual or imaginary / virtual - than just immediate family members. Indeed it allows work with individuals to be systemic too, taking the emphasis off the main image of family therapy being about the group of people in the interview room and eliminating the use of the word family.
Systemic Psychotherapy or Therapy [PROF] A name for the family therapy professionthat indicates the broader application (to individuals, couples and organisations too) and also ensures that it is better included in the psychotherapy sector (eg UKCP). In the UK the main home of family therapy has been in the NHS. But as the NHS funding and selection of what works (and gets funded) has got cut back, and as other cheaper professionals have learned a bit about systemic practice and other modalities, it has naturally led to a hard fought battles to label the real thing and protect it. This is understandable but not really a very good example of the original broad meanings of system or systemic!
Until more people learn this new rather in-house meaning, it probably confuses everyone else more than it clarifies. So it tends to mystify where forallthat is about demystification! As well as avoiding the word family, this use of systemic might also tend toward variations of terminology to avoid the term "therapy" with it's unhelpful medical kind of meaning of an active professional doing something to a passive patient. So the term systemic practice may be used as a suitable alternative to family therapy to denote that broader scope. (But that is a confusion with other meanings, above, of systemic practice). Those who use "systemic" instead of "family" and/or use "consultant" instead of "therapist" - for example, in their job title - may mean simply that the professional has this broader view of their work (than just "families" and just "therapy"). But the NHS focuses on conditions attached to individuals (aka diseases or illnesses) to be treated in ways that have a validated evidence base; so that is a challenge for systemic methods whether you call it therapy or not.
The trouble is that many attempts have failed over the years to find a better but still widely understood and acceptable term for family therapy. That is, our field is still most often known best as "family therapy" or perhaps "couple and family therapy", and the other meanings have been slowly built into the general understanding of the term. Thus has the diversity of family forms been successfully built up over the years so that the standard middle class "2+2" family is not taken as implied now. This is partly because society in general is so much less attached to the standard idea of a family.
Systemic Practitioner [QUAL] A qualification given to half-trained family therapists in the UK The main British family therapy organisation, AFT, rightly wanted to reward those who complete the demanding first two years of a British family therapy training. Unfortunately they chose the term Systemic Practitioner which is seriously confusing with the meaning of systemic practice used in AFT's own strap line. It may seem to be congruent since the strap line use means someone who is using family therapy ideas applied to their own non-family therapy job. But it is unlikely that two years of a family therapy training has been focused on how the nurse, or teacher, or social worker can apply systemic ideas to their job; it will usually have been half of a training to become a card-carrying family therapist. The trainee will be enthused but not usually trained to be a systemic practitioner [AFT]. Family therapy's fortress in the UK is in the NHS and CAMHS teams where nurses and social workers were only able - in the past, but not now - to avoid loss of move to another work setting by retraining for the family therapy posts their team colleagues created precisely to keep good workers in the team.
In addition, if systemic practice means ordinary good practice shared by many helping professions, should it be just the family therapy profession that decides what makes a systemic practitioner let alone gives them the qualification? Nick admits that his theoretical position is unrealistic since there can never be a new multi-professional field of ordinary good practice or common factors. The world loves specialisms - even systemic family therapy does even though it shouldn't.
By using this term AFT has in effect disqualified all the other systemic practitioners that AFT is meant to be encouraging according to the earlier meaning of systemic practice. If we got nit-picky about this we would now have to invent a new term for the AFT strap line to refer to helping professions who use the ideas used by half-trained and fully trained family therapists. I suggest it is simpler to find an alternative reward for half-trained family therapists, bearing in mind that there are no actual posts for a Systemic Practitioner [QUAL] ... although the NHS is always looking for cheaper family therapists and thinks that two years training is surely enough for their purposes.
Unclear meanings Sometimes it seems that the term systemic is being used in entirely different or just loose ways. For example Alan Gurman's excellent (2008) American hand book on couple therapy has section headings for models that don't seem to fit at all with this glossary. Among others he includes: Social Constructionist – 1. Narrative 2. Solution Focused Systemic – 1. Brief Strategic 2. Structural
In Britain at present, as indicated above, the word systemic is rather equated with collaborative social constructionist approaches. Narrative might be grudgingly classed as social constructionist (but maybe not systemic [INCL]), but the other three models probably wouldn't. Anything strategic or structural would tend to be classed as too linear and directive. Although they were systemic [DIR] in their time, they are now not considered 'systemic [COLL] enough' to warrant the name. In other words a whole different glossary may be needed for another continent, North America. And that rather underlines my overall point on this webpage ... that there are many meanings of systemic.
Systemic practice [SOC] A more sociological perspective If families and small human organisations are complex, then sociologically sized ones must be even more so. Thinking about change within larger social groups therefore gives rise, for example, to a Journal of Action Research and Systemic Practice.
Nick Child Jan 2015
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