systemic therapy with individuals

The first thing to say about systemic therapy with individuals is to ask the question what does it mean

to be to be systemic?

I approach being systemic as an overall perspective on the world that you can adopt whether you are seeing individuals, more than one person, or whole families in therapy. A systemic frame can also be applied beyond the therapy room across community and cultural domains such as working with organisations like schools and groups such as indigenous peoples. For example, in the 1990’s I was privileged to work in close collaboration with Aboriginal indigenous family therapist Colleen Brown concerning her work with members of the Stolen Generation using art dot paintings, which was taken to the family therapy community in Australia and New Zealand (Brown and Larner, 1992). As we noted in that article: “Family therapy provided the border where black and white cultures could meet and talk and listen to each other, where the dots could take on a new, shared meaning” (p.175).  

Today the word systemic can encompass diverse meanings where we consider persons in their wider context including culture, race, and gender. Thus, a family therapist today can be referred to as a systemic practitioner working across the spectrum of individuals, couples, families, communities, and organisations (e.g. supervision), particularly in addressing issues of cultural practice, power, race, racism, and misogyny.

Overall, a systemic or circular perspective concerns how we can see things from another point of view and introduce difference (Bateson, 1972) as part of a therapeutic dialogue or enquiry.

A systemic perspective in therapy also locates the therapist right there within the ecology of the work, which acknowledges the important contribution of the therapeutic relationship. As Peter Rober (2024) notes in his recent excellent book, a wealth of common factors research shows effective therapy has more to do with the quality of the therapeutic relationship than the use of any specific treatment approach. This includes the therapist’s capacity to be self-reflective, utilize client feedback, build a good working alliance, and foster safety, trust, and empathy. Whether a therapist is working with one person in the room (face to face or in a virtual space), couples, part-families or whole families, the therapeutic relationship is a central part of a systemic therapy approach. If family therapy can be described as a dialogue (Rober, 2017) it doesn’t matter whether that dialogue takes place with one, two or four people. Family therapy can be with an individual or a whole family; what matters is the systemic, dialogical or relational frame.

Also, for me to be systemic very much encompasses an integrative approach to family therapy.  As I have argued in a previous paper (Larner, 2003) to be systemic is to be integrative and vice-versa, in the sense of bringing together different conversations in therapy whether they occur between person(s) in the room, in dialogues with family members (such as parents or carers) inside or outside the therapy room or with various professionals and wider systems of care. The process of integration can also include the therapist’s inner conversations and reflections as therapy unfolds that can be fed back into the therapy conversation:

“The word “integrate” comes from the Latin integrare, to “make whole”, that is, to combine parts into a whole, which is also the meaning of “systemic”. In a spirit of hospitality, family therapy brings one part of the whole into conversation or dialogue with the other. As family therapists, we feel the desire to engage, to be curious, reflective and interested in how the other speaks and makes meaning, to learn their language while speaking our own. Family therapy is the wider understanding, the relational movement towards the other, whether at the level of the personal, the theoretical or the political. It opens up, not shuts down, borders” (p. 12).

 In this way, all therapeutic work whether with individuals or part or whole families, can be seen to fall under a systemic umbrella, and what this allows is an opportunity to be flexible and creative in drawing upon a range of psychological and relational therapies. In adopting an ethic of hospitality (Larner, 2003) family therapists collaborate with clients to ‘fine-tune’ a therapy approach that offers a best possible outcome for mitigating relational and psychological suffering. Thus, as a systemic family therapist, one can integrate ideas and practices from a range of therapy approaches, whether neuroscience, trauma work, attachment theory, schema therapy, psychoanalysis, and so on.

Regarding the latter, one can see even psychodynamic work with individuals from a systemic and social constructionist perspective (Larner, 1996) where the relationship between the therapist and client forms a therapeutic system that enacts the transference and countertransference. For those interested I have described this collaborative work in the therapeutic relationship as a ‘common ground’ between family therapy and psychoanalysis (Larner, 2000).

That said, the question of how to work with

individuals from a systemic perspective has been discussed at length in the family therapy literature

over several decades.

For example, The Network News section of the Australian and New Zealand Journal of Family Therapy in the early 1990’s discussed the place of individual therapy in family therapy. As one of the participants Wendy Bunston put it, the treatment system for family therapists can be the individual, couple, family, school, workplace and wider culture as well as the interface between therapist and client. What stays constant is the problem, which may require attention by moving across various perspectives and using different levels of expertise. Similarly, Wallace noted whether you work with individuals or families is less relevant than having “enough information to bring about change (p.162)”, and as Phillips commented, this may require both an individual and a family focus. In this pluralistic approach, therapy with an individual can assist work with family relationships where what matters is not the number of people in the room but how you work. Also, as Roger Lowe pointed out in the discussion family therapists can work systemically with individuals or families and should be flexible about deciding who to see in the client system.

Breunlin &Jacobsen (2014) draw a distinction between Whole Family Therapy (WFT) approaches that include all family members in therapy sessions and Relational Family Therapy (RFT), where therapists work with a subsystem or an individual using a systemic lens. They note that RFT has been favoured over WFT in the profession for the following reasons: sociological changes for families, the structure of training programs, realistic practice constraints such as time limitations and a reluctance to involve children in family therapy interviews. Nonetheless the authors note that using a hybrid of WFT and RFT is common practice especially with the recent advent of empirically supported family therapy approaches: “When practiced today, WFT is generally done in conjunction with RFT and individual therapy “(p.8).

I would hazard a guess that as for my own practice, many family therapists work between or across WFT and RFT approaches to combine them in a flexible fashion in response to the clinical requirements.  For example, while working in an RTF way with an individual using an integrative therapy approach, I will often see a family in a WFT approach for some sessions. There can be a lot of flexibility in combining individual and family sessions. For example, one can begin with a family interview and then have some form of individual therapy that may combine aspects of mindfulness, CBT, ACT etc., then have another family session. When family sessions are utilised may vary according to each case presentation. Some therapists might begin with an individual, part or whole family session.

And of course, the Bowen Family Systems Approach sees working with individuals in relation to a range of mental health issues such as trauma by addressing anxiety, self-regulation and self-differentiation can significantly impact family relationships (Mackay et. al. 2024; Mackay, 2012).

In my own psychological practice, I worked over four decades in a child and adolescent mental health service where I was obliged to utilise assessment protocols and evidence-based approaches like cognitive-behavioural therapy as part of my systemic work with young persons and their families (Larner, 2003). Especially for teenagers this would involve seeing the identified client in individual therapy and integrating this work with seeing their parents and families and consulting with other professionals and schools as part of an overall systemic approach.

Young persons and especially adolescents often require their own confidential therapy space where the systemic challenge is to bring what is said in individual sessions into the wider family conversation with their permission. I have described one way of approaching this with primary age children that incorporates (psychodynamic) play therapy sessions in a wider family therapy conversation from a social constructionist and systemic perspective (Larner, 1986). In brief, I would take play narratives and drawings over 3 individual sessions with a young person to a wider family interview and discuss their metaphorical significance in throwing light on the child’s presenting issues and the family concerns.

This is an integrative approach I still use, for example, I recently worked with a 12-year-old girl (Belinda) referred for help with her anxiety, and depression and not wanting to attend school, which was triggered by falling out with her best friend, and peer group. The work took place online during Covid where over several individual therapy sessions I invited Belinda to do a series of drawings that captured her current issues with friends, peers and the situation at school.  With her permission we discussed these drawings with her mother (and her father), which ultimately provided a strategy for her to go forward. For example, at one point in a family interview we discussed a drawing where Belinda feels panic after her friend threatens to harm her with a gun and the father asked: “How could you create a situation where you are less sensitive about what she is doing”, and her mother added: “So bullets don’t enter in your way to armour yourself ”. The discussion proceeded to how Belinda could see her ‘other friends’ as forming part of her ‘bullet proof’ vest. At one point Belinda reported she had been surfing with her father and I asked: “How can you surf the waves your friend has thrown at you?” This formed a theme for her next drawing. We collaboratively agreed that the regular use of an art book, as well as mindful breathing before going to school and surfing of course could be helpful strategies. What became clearer from the drawings and discussion was a psychodynamic hypothesis that under Belinda’s anxiety was a sense of anger, which added to her panic about attending school and confronting her friend. This was discussed with the family and appeared to make sense to all.

A month later the mother reported: “It was lovely to see her be able to express through her art something that has felt so confusing and unknown to her for a while now. She had a spring in her step last night and went off to school easily this morning. Am feeling more hopeful too”. I heard from the mother 18 months later that Belinda is doing “really well” with no issues since we met, “she has grown from strength to strength” and has repaired her relationship with her friend. Also, that she is considering writing about her experience for a school piece about ‘events that changed your life’.

In the individual therapy context, an integration occurs not just in the systemic conversations with family but also in the young person themselves as they reach for a therapeutic solution to their problems. There is also integration within parents in helping them to reflect on their parenting, understanding and management of the young person. And this was the case for this young person and their family.

Elsewhere I have argued that integrating a range of individual therapy approaches such as CBT, art therapy as part of an overall systemic therapy approach is best practice for working with common mental health presentations such as adolescent depression and suicidality (Larner, 2003). I describe this approach in the case of a teenage girl presenting with depression, self-harm and suicidal behaviour. I used her drawing of what it was like to have a ‘breakdown’ where she became suicidal as a platform for exploring and challenging her thoughts integrating CBT, art therapy and narrative therapy. Here:

“One way to give individual therapy a systemic context is to see it as a therapeutic space or container within which a young person’s thoughts and feelings can be held, explored, reconfigured and taken back to the family in conversation... In the context of an empathic and collaborative therapeutic relationship, cognitive therapy was interspersed with narrative and art therapy, while family therapy sessions occurred at various stages of treatment” (Larner, 2003, p.214).

This is just one example of how you can work with an individual systemically and the point is that you can evolve your own unique approach that utilises training and expertise acquired in your own therapy journey. The responsibility of the family therapist is to have at their disposal a range of therapeutic techniques that can be applied within an overall systemic perspective.

This might include approaches like mindfulness, schema therapy, anger management, narrative therapy externalising practices, parts therapy or attachment-based therapy approaches etc. The point is whatever individual therapy approach is applied can be part of an overall systemic perspective, framework or intervention.

For example, I recently attended a 2-day workshop with Bessel van der Kolk on The Body Keeps the Score: Trauma, Attachment and Neuroscience. The take home message for me as a family therapist was that if you are working with person(s) affected by trauma (and as der Kolk strongly argued trauma is highly likely to underlie a range of common mental health diagnoses), therapy approaches supported by scientific research include the following: neurofeedback, mindfulness, yoga, psychodrama, movement and dance therapy, Tai Chi, use of voice, theatre, EMDR, parts therapy or Internal Family Systems Therapy (which draws on systems thinking), and so on. This therapeutic work can be integrated as part of a systemic therapy approach. For example, der Kolk illustrated working systemically with the attachment relationship using a video of a refugee balancing on a ball in an institutional setting while talking with his mother in the room.

Take a moment now to reflect on how you integrate different therapy approaches in working with individuals and how this can be incorporated as part of an overall systemic therapy approach.

Glenn Larner

Clinical Psychologist and Clinical Family Therapist

References

Bessel van der Kolk on The Body Keeps the Score: Trauma, Attachment and Neuroscience. Two Day Workshop, Sydney, March 20-21, 2025.

Breunlin, D.C. & Jacobsen, E. (2014). Putting the “Family” Back Into Family Therapy. Family Process, 10:1-14.

Brown, C. and Larner, G. (1992). Every Dot Has a Meaning. Australian and New Zealand Journal of Family Therapy, 13,175-184.

Larner, G. (1996). Narrative Child Family Therapy. Family Process, 35:423-440. (U.S.).

Larner, G. (2000). Towards a common ground in psychoanalysis and family therapy: On

knowing not to know. Journal of Family Therapy, 22: 61-82.

Larner, G. (2003). Integrating family therapy in child and adolescent mental health practice: An ethic of hospitality. Australian and New Zealand Journal of Family Therapy, 24, 211 219.

Larner, G. (2022). Integrative dialogues in family therapy. Australian and New Zealand Journal of Family Therapy,43,54–69.

Mackay, L. (2012). Trauma and Bowen Family Systems Theory: Working with Adults Who were Abused as Children. Australian and New Zealand Journal of Family Therapy, 33: 232-241).

Mackay, L., Errington, L. and Brown, J. (2024). Special Issue: Bowen family systems theory editorial. Australian and New Zealand Journal of Family Therapy, 45: 131-134.

Rober, P. (2024). Becoming An Effective Family Therapist: Research, Practice and Case Stories. London and New York: Routledge.

Endnote: The case study has used fictional names and changed details to protect privacy and the client has given permission for its publication.

Photo Attributions:

Photo 1 - Canva Pro

Photo 2 - Glenn Larner

Photo 3 - Glenn Larner

Please note that this article is educational in nature and does not constitute professional or therapeutic advice or suggestion.