Embracing Systemic Integrative Practice: A Meta-Framework and Roadmap

As a systemic family therapist, psychologist, supervisor, and educator, I’ve long been interested in how we make decisions about what to do in therapy, especially when working in complex, high-needs situations. Many practitioners identify as integrative or eclectic, yet what that looks like in practice – and how we make those decisions with integrity and intention – isn’t always clearly taught in training programs or overtly considered in supervision. That’s one of the reasons I started thinking about and developing my ideas for a framework for Systemic Integrative Practice. 

I first began to organise my thinking on the topic out of necessity when working in a complex child and youth mental health service that challenged me to “do multiple things at once” and by sharing my ideas with my colleagues as part of our peer learning schedule (White, L. (2019) When School Refusal Has Nothing to do with School), then presenting at an AAFT conference (White, L. & Owen, K. (2019) What Matters in Contemporary Family Therapy: Things our Students have Taught Us. Australian Association of Family Therapy Conference), and then further developed my ideas as Guest Editor for a special edition of the Australian and New Zealand Journal of Family Therapy (ANZJFT) on the topic of integrative practice (White, L.  (2022).  Integrative practice in family therapy.  ANZJFT, 43, 3 - 8.), as well as authoring an article in the special edition (White, L. & Owen, K. (2022).  Systemic integrative practice: A meta-framework.  ANZJFT, 43, 33 – 53), and more recently at the IFTA Conference in Japan (White, L. & Owen K. (2024).  Integrative Practice in Systemic Group Supervision: Growing Competence, Confidence and Adaptability.  The International Family Therapy Association (IFTA) Congress).

Since the special edition, I’ve had the opportunity to facilitate masterclasses over the past couple of years on the topic of systemic integrative practice and further develop my thinking.  In this blog, I will share my current thinking – a meta framework for systemic integrative practice and a roadmap I've created for travelling an integrative road.  My goal has always been to create something that could support thoughtful, purposeful integrative practice that fits the demands of our current global context and era in time – something that could help practitioners ask not just what they’re doing in therapy, but why…and I’d love to hear your thoughts and ideas that come from reading this blog and thinking about your own integrative practice.

Why Integrative Practice?

“Human beings are complicated, each with their own thoughts, feelings, neurobiology, and actions, and each existing within complex relational, community, social contexts, and eras in time (Hawkins & Ryde, 2020; Nichols & Davis, 2017).”

White and Owen, 2022: 35 – 36

Not only are humans and the systems they exist in complicated, but what we’ve learned from the ACES (Adverse Childhood Experiences) study and the ACMS (Australian Childhood Maltreatment Study) is the prevalence of trauma that further increases complexity.  ACES include e.g., violence, abuse, neglect, witnessing violence at home, instability due to parental separation or incarceration of a parent.  In Australia, 1 in 5 children are exposed to 3 or more ACES, and 2/3 children will have experienced a potentially traumatic event by the age of 16.  These children then grow up to become adults and parents themselves, some of whom will seek support.

Understanding Systemic Integrative Therapeutic Practice

The Systemic Meta-Framework for Integrative Practice is a structured model for integrative psychotherapy that moves beyond eclecticism. It is rooted in the understanding that no single therapeutic model can address all the complexities of human behaviour and relationships. By integrating systemic principles with various therapeutic approaches, a more nuanced and adaptable framework for therapy is created that recognises the interconnectedness of individuals within their relational, social, cultural and ecosystemic contexts, emphasising the importance of considering these dynamics in therapeutic interventions.

The Systemic Meta-Framework for Integrative Practice organises diverse theories into a coherent clinical practice guide by using systemic thinking as the overarching frame and by structuring practice through distinct, layered key elements that guide decision-making and intervention decisions. The framework is designed to provide a map for a guided reasoning process, ensuring a necessary balance of coherence and flexibility in clinical work.  The framework does not prescribe the content of what should be integrated but serves as a process guide for professionals to organise their integrative practice systemically according to the individual needs of their clients.

And there’s an additional benefit of a systemic meta framework for the practitioner.  A systemic lens provides us with manoeuvrability because the helicopter view allows us to see the big picture and where we might land the helicopter to do a piece of work that is helpful.  The helicopter view also means that if we become stuck, reach an impasse, or face a change in client circumstances, we can take the helicopter back up and look for somewhere else to land.  A meta framework for systemic integrative practice allows even more options outside of systemic practice that can be thoughtfully considered i.e., we might land the helicopter on a different “continent” from systemic land… maybe CBT land or Expressive Therapies land.  As a therapist, having manoeuvrability increases therapist agency, and this is a possible antidote to compassion fatigue and burnout because you aren't left feeling stuck and helpless. Instead, you've always got options.

Core Principles of the Systemic Meta-Framework for Integrative Practice

1. Holistic Perspective: Considers the whole person, including their emotional, cognitive, physical, social and societal dimensions. This holistic approach ensures that therapy considers the full spectrum of a client's experiences and needs.

2. Contextual Awareness: Central to the meta framework is the recognition of the influence of social, cultural, relational and ecosystemic contexts. This principle underscores the importance of understanding and integrating these contexts into therapeutic work.

3. Flexibility and Adaptability: The meta framework encourages therapists to be flexible and adaptable, drawing from a diverse range of therapeutic models and techniques. This flexibility allows therapists to tailor their approach to the unique needs and circumstances of each client.

4. Collaboration and Empowerment: The meta framework fosters a collaborative relationship between therapist and client, empowering clients to actively participate in their therapeutic journey. This collaboration is respectful, enhances client engagement and promotes a sense of agency.

Eclectic vs. Integrative Therapy and the Importance of a Thoughtful, Intentional Approach

“Integration is different from eclecticism in the emphasis on the clinician’s ability to strategically, deliberately (Flaskas, 2014), and flexibly apply multiple therapeutic models and techniques, with each component having integrity (Boscolo & Bertrando, 2002), in ways that enhance the utility of each rather than being disjointed (Lebow, 2019). Integrative psychotherapeutic practice is the process of creating a broad, overarching framework as a guide to selecting and combining concepts and interventions.”

White and Owen, 2022: 35 - 36

Understanding the difference between eclectic and integrative therapy is essential for effective practice. While both approaches involve drawing from multiple therapeutic models, they differ significantly in their application and philosophy.

 Eclectic Therapy:  Eclectic therapy involves selecting techniques and interventions from various therapeutic models based on their perceived effectiveness for specific issues. This approach can be pragmatic and flexible, but may risk “therapeutic drift” or working from a “conceptual soup” without a coherent framework guiding the therapist's decisions.

Integrative Therapy:  Integrative therapy involves a thoughtful and intentional blending of therapeutic models within a cohesive framework. This approach ensures that interventions are not randomly selected but are part of a well-conceptualized plan tailored to the unique client.  The integration in the meta framework presented here is guided by a systemic understanding of the client's needs, context, and relational dynamics.

“Integrative theorists and supervisors believe that multiple lenses afford broader conceptual insights and more therapeutic degrees of freedom (Lebow, 1997b), but that there needs to be an underlying theoretical framework that allows clinicians to blend these “generic” ideas and actions with clear intent and purpose.” 

Lee and Everett, 2004: 19

The Meta-Framework for Systemic Integrative Practice: An Updated Snapshot of My Current Thinking (based on my initial thoughts, the 2022 article and special edition, conference presentations and my teaching, supervision and practice in recent years)

The framework is structured around six interrelated domains that are each consecutively nested in each other:

1. Way of Being (see Fife et al., 2014 & Davis et al., 2020) – This domain is the first and outermost layer.  It emphasises the therapist’s presence and relational stance above all else, taking an “I-thou” position.  This position is about seeing clients as human beings to connect with and not problems to solve. It includes how we show up in the therapy room and how we relate to clients from a place of respect, curiosity, and humility.  It’s for this reason that I’ve coupled “way of being” with a reminder about unconditional positive regard.  Unconditional positive regard is often assumed and taken for granted as a “basic”, but basics are not always basic, and there will be times when it is easy to hold this stance and times when it is difficult.   

   
   

   Especially when working in challenging, high emotion situations it’s important not to fall into the trap of conflating difficult and/or unacceptable behaviour with being an unacceptable person.  It will rob you of your curiosity.  Instead, actively separating the person from their behaviour, maintaining a vision of the person’s wholeness and mentalising their context across time and place will help maintain unconditional positive regard.

2.       Systemic Therapeutic Alliance with Awareness of Attachment and Neurobiology.   

The systemic alliance includes the bond, task, and goal components, and accounts for the complex interpersonal dimensions between the therapist and the system (individual, subsystem, whole family, and other treatment systems).  Building on the way of being, this layer incorporates the systemic therapeutic alliance bolstered by understandings of nervous system regulation, mentalisation, being PACEful (from Dyadic Developmental Therapy) to support co-regulation and relationship connection, and trauma-informed practice in building and maintaining safe and effective relationships with clients.  Incorporating awareness of neurobiology and attachment recognises that the therapist must facilitate a felt sense of safety by soothing survival circuits and providing corrective relational experiences to make helpful conversations and interventions possible, and these particular therapeutic approaches provide the tools to do just that. 

3. Systemic Assessment and Formulation – This involves developing a rich picture of the client's context, including their ecosystem and the impact of the climate emergency, their patterns, history, family life cycles stage(s), vertical and horizontal stressors,  meaning making, emotions, strengths, resources and resilience, family structures, interagency structures and processes, broader societal structures including structural oppression, and relationships…all informed by the systemic thinking practice of taking the helicopter view…only it’s now a helicopter that can enter the atmosphere and consider the earth as a whole.

4. Decision Making – This is where intentional choices about what to do in therapy happen – decisions about which techniques, interventions, or models to use – based on the systemic assessment formulation, an understanding client preferences for change, client resources and constraints, timing and staging of which “therapy” to use (e.g., individual, dyad, family, or stakeholders) and consideration of decolonizing therapy.  Embedding decolonising practices is essential to ensure Western models are not imposed to counter the harm of colonial legacies and build culturally safe, effective care (see e.g., Dudgeon and Walker, 2015).

   
   

   Another important consideration in decision-making is the self of the therapist.  Yes, that’s right – sometimes we need to focus on ourselves to be client-centred.  By this I mean we need to consider our “wobble points”, manage contagious anxiety and invitations to induction, and be aware of not privileging our theory of change preferences.

   
   

5. Intervention – Following decision making is intervention(s) and finding a way to choose an intervention, or sequence multiple interventions or offer multiple interventions at once as needed.  This is where the roadmap comes in.  The roadmap will be explained later in this blog.

The meta framework for integrative practice enables a diverse range of interventions drawn from different therapeutic approaches, including e.g., cognitive-behavioural therapy (CBT), dialectical behaviour therapy (DBT), psychodynamic therapy, play therapy, creative therapies, humanistic and experiential approaches, and systemic therapy.

For example: Cognitive-Behavioural Techniques: Address maladaptive thought patterns and behaviours, helping clients develop healthier coping mechanisms.   Systemic Interventions: Explore relational patterns and dynamics within the family system using tools like genograms, tracking and circular questioning.   Humanistic Approaches: Emphasize empathy, unconditional positive regard, and authenticity to foster self-exploration and growth.

6.      Review - Regular review and evaluation of the therapeutic process are integral.

Therapists and clients collaboratively assess progress, revisit goals and adjust interventions as needed. Ongoing review ensures therapy remains responsive to the client's evolving needs and circumstances.

Decision Making and Theory of Change in Integrative Practice

While all four domains are interconnected, a key domain for integrative practice is decision making.  This is a domain where the systemic formulation points to what is helpful and requires consideration of the theory of change to be effective.

One of the most powerful yet often overlooked aspects of effective therapy is how we conceptualize change. The way we believe change happens—the theory of change we operate from—shapes the interventions we choose, the conversations we have, and the way we measure progress.

In this meta framework, decision making is not about picking techniques off a shelf – it’s about grounding choices in a coherent understanding of the family system, our therapeutic goals, and the process of change.

I ask myself and encourage therapists to ask themself:

• What do I believe needs to shift in order for this client/family to experience meaningful change?

• Which theoretical framework helps me make sense of this?

• What interventions align with that theory of change and fit this client/family’s culture, needs, and preferences?

• How is neurobiology contributing to patterns? What Neurobiological intervention could help create space for change with a new belief and/or perturb a pattern? 

• How is neurobiology contributing to unhelpful and/or stuck stories? What Neurobiological intervention could open up space for change with a new story or meaning?

Meta Framework Decision Making Illustrations

1. The Client’s Theory of Change

“It will be important for therapists to consider the model of change with which they are currently working and consider what aspects of this model of change they are currently privileging. What is their overall aim during the process of therapy?”

Pote, Stratton, Cottrell, Boston, Shapiro, & Hanks, 2000: 12

Our clients don’t always talk about “theory,” but they usually come into therapy with an implicit sense of what will help. Some clients believe insight and reflection will lead to change – a meaning-making orientation. Others are more action-focused, seeking tools, strategies, or clear behavioural shifts – a behavioural orientation.

As therapists, we pay attention to these cues and adjust our approach accordingly.

Example: In the early stages of therapy, a father may be resistant to “talking about feelings,” and instead, he is seeking practical strategies for managing his son’s meltdowns. While holding a longer-term goal of helping the family explore emotional patterns, a beginning point could be parenting tools and routines to align with his action-oriented theory of change. Starting with where the client is at helps to build trust and create momentum.

Find out more about working with the clients/ theory of change in these blogs:

https://www.phoenixftacademy.com/post/tailoring-family-therapy-meeting-clients-where-they-are-to-shape-change-and-maximize-outcomes

https://www.phoenixftacademy.com/post/weaving-safety-into-the-system-trauma-neurobiology-and-systemic-family-therapy

And find out more about how understandings from neuroscience can support pathways of change in this downloadable.

Theory of Change and Neurobiology_DrLeonieWhite.pdf

Download PDF • 303KB

2. Client Context

The family’s broader social, cultural, and systemic context also shapes what is possible and appropriate. This includes intergenerational history, community resources, values, language, and beliefs about help and change.

Example: When working with a refugee family where trust in institutions is low, initial assumptions about pacing and engagement have to be considered. This means prioritising relational safety and consistency, taking care not to rush, and could involve drawing on narrative practices that honour cultural knowledge and story, rather than jumping into goal-setting or problem-solving.

3. Resources and Constraints

Every family brings their own mix of internal and external resources – as well as constraints. This might include time, energy, literacy levels, beliefs about problems and problem resolution, transport, financial stress, or emotional capacity.  As integrative therapists, we tailor our interventions accordingly.

Example: Imagine that you have a plan for a structured intervention using a genogram for family mapping and reflection tasks. But then it becomes clear that the family is navigating housing instability and financial hardship, and a shift to a more flexible, conversational, solution-focused approach with shorter sessions may be required. Or it may even be necessary to pause therapy while the family engages in housing services.

4. Timing and Staging

Just because an intervention is “good” doesn’t mean it’s the right fit for right now. Decision-making also includes careful attention to when to introduce certain ideas or techniques.  Evidence-based practice involves not just consideration of the research base but also clinician experience and client preferences.

Some interventions are best used early – like normalisation and joining – while others, like trauma exploration or meaning reconstruction, require deeper trust and more emotional regulation.

Example: Consider a young person experiencing high emotional dysregulation, deliberate self-harm and school refusal.  Starting with reflective practices regarding family patterns may exacerbate the difficulties the young person is experiencing and will not address the safety needs. Instead, early sessions could focus on nervous system regulation, family routines and connection, and relational co-regulation. Once the young person feels more anchored, the meanings they were making about their identity and relationships could be explored.

Pulling It All Together: A Case Illustration

Let’s consider a brief case example (fictional amalgamation with details changed to protect anonymity and confidentiality) to bring this decision-making process to life.

The family: A blended family of five – two parents (Jules and Sam) and three children aged 7, 10, and 14. Jules’s 14-year-old daughter, Mia, has been refusing to attend school and often withdraws to her room. There’s tension between Jules and Sam about parenting roles and discipline. Jules (Mia’s mum) and Sam (stepfather) are struggling with parenting differences and a communication breakdown. All members are feeling disconnected.

The starting point is to create safety and connection – drawing on, e.g. “way of being”, attachment, mentalisation and neurobiologically informed practices to build relationships and initially focus on co-regulation and helping the family feel safe and seen in the therapy space. This aligns with my ideas about change: that emotional safety and connection are prerequisites for behavioural change.

Formulation and Systemic assessment reveal intergenerational patterns of avoidance and shutdown in conflict, as well as role confusion in the blended family structure.  A genogram can be used with the parents to explore narratives of identity and belonging.

From a systemic lens, the presenting issues are part of broader dynamics: intergenerational patterns, family life cycle transitions, unclear family roles, attachment disruptions, and emotion avoidance.

A hypothesis is that building safety, clarifying roles, and supporting emotional expression could enable change.

The Family’s Theory of Change

Sam is action-oriented: “What can we do to fix this?”

Jules leans toward emotional reflection.

Mia is withdrawn but seems more comfortable externalising her struggles through metaphor and creative expression.

Given the tension in the family and the child's school refusal, parent sessions drawing on structural family therapy to clarify boundaries and roles and using tracking to explore patterns, could provide some safety and stabilisation in the family system. This could be further enhanced by supporting parents to define their I-Position working from a Bowen Family Systems lens to explore their parenting values and principles.   Additionally, narrative practices could be integrated to help Mia find her voice and externalise the problem ("the pull of isolation").  Clarifying roles and changing patterns could reduce family conflict, while narrative work could support Mia's identity and agency.

The work could involve building new patterns of connection between Mia and Sam, creating family rituals, and helping the parents become solid in their I-Position and aligned “enough” in their stepfamily parenting approach.

Choices regarding interventions to offer the family aren’t about allegiance to a single model, but rather about coherence with the systemic formulation and consideration of the theory of change.  And, timing is key:  goals would need to be adjusted in real time as new insights emerged.

The “Roadmap”

This "road" is a visual metaphor I've created to help illustrate systemic integrative practice... in practice.  If you’ve ever driven past roadworks, you’ll notice that in building a road, it has several “layers” and this is a great way of thinking about “travelling the road of therapy”. 

As we travel down the road, some layers will always stay the same for the whole journey – in my practice, these layers are “way of being” and “therapeutic alliance”.  These are always present, no matter what type of intervention I am offering.  Two other layers that stay the same for me are “attachment” and “systemic family therapy” – these are embodied in who I am, how I think and how I work and are also present no matter what type of intervention I am offering.  My top layer changes, though, providing flexibility – e.g., I might begin with psychoeducation but then place this on hold to respond to a crisis, or I may move from psychoeducation to skills building (cognitive and/or body-based) or to a block of work using creative art interventions.  Or I might dive straight into a Solution-Focused Brief Therapy approach if that fits for my client.

The layers on your “road” may be different from mine, but it’s always helpful for intentional practice to consider what our layers are and how they are helping or hindering client work.

In the case example above (Mia's family), for me, the bottom layers of way of being, therapeutic alliance, and attachment would always be foundational in travelling together with the family.  The next layer of the road would be the parent sessions, drawing on structural and strategic approaches.  The top layer, the “variety of flexibly time approaches” might look like putting supports in place to address self-harm, psychoeducation with parents about the family life cycle transition of the teenage years and the “teen brain”, combining expressive and narrative approaches with Mia, liaison with Mia’s school, skills development with Mia (body based and cognitive strategies for anxiety, interpersonal skills), and coaching parents in their I-position especially when they become wobbly in supporting Mia’s return to school.

Final Thoughts

Systemic Integrative Therapeutic Practice represents a powerful and flexible approach to family therapy, offering a comprehensive framework that considers the complexities of human behaviour and relationships. By integrating diverse therapeutic models and considering the broader layers of context, the systemic meta framework can enhance the effectiveness of therapy, allowing greater opportunities for meaningful change for clients.

Integrative practice is not about using “a bit of everything.” It's about purposeful integration facilitated through our way of being, and guided by systemic thinking, attachment and neurobiological awareness, and a commitment to co-creating change with families.  It’s about holding a systemic, relational lens while making flexible, intentional decisions – based on who this family is, how they experience change, and what is possible at this time.   Decision making is at the heart of this – and when done thoughtfully and collaboratively, it can help us offer more attuned, effective, and compassionate therapy.

To all the emerging therapists out there:

• Be curious about your choices.

• Ask yourself why this intervention, for this family, at this time? 

• And trust that developing your own integrative stance is a process – one that deepens over time with reflection, supervision, and practice.

Leonie

Dr Leonie White

Clinical Family Therapist and Psychologist

Director Phoenix Family Therapy Academy

Helping people grow, connect and thrive in life’s unique journey.

Please note - this article is educational in nature and does not constitute therapy advice. 

Please seek help from a professional if you require support. 

Photo Attributions:

All photos are from Canva Pro and Vecteezy Pro

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