Systemic Therapy | Doctors & Treatment Information

Systemic therapy and psychosomatics is an interactive and process-oriented form of diagnosis and treatment. It is used for circular, i.e., feedback-loop-related, disorders.

From the perspective of systemic therapy, natural psychosomatic interactions (i.e., between mind and body) occur through information, interaction, feedback, and self-regulation. At the same time, every medical treatment—whether intentionally or unintentionally—has an effect on a person’s conscious and unconscious experiences, as well as on their somatic (physical) processes and social behavior.

Systemic therapy and psychosomatics are also characterized by the fact that they

• social,
• psychological, or
• somatic

disorders and illnesses that affect the patient, family, and relationships. It thus integrates social relationships, the mind, and the body into a therapeutic approach involving the patient, family, and society; furthermore, it facilitates collaboration with social and medical institutions.

Systemic therapy does not aim solely at a linear (one-sided) diagnosis or treatment, such as that of the body. In addition to this, it also examines and activates the self-organization of the psyche and the body, including from an ecological perspective. Diagnostically, this is achieved through an environmental, family, and social-medical assessment.

Therapeutically, this is achieved through guided psychosomatic or somatopsychic stimuli and corresponding therapeutic interventions that have a retroactive effect. From an associative perspective, this is achieved by activating memories and developing stable psychological constructs.

In summary, systemic treatments within the framework of systemic therapy facilitate healing processes on both the psychosomatic and somatopsychic levels.

The application of systemic perspectives and intervention techniques to medical issues and healthcare structures is based on three principles:

• Integration of psychological and physical factors in diagnosis and therapy
• Collaboration between therapist, patient, and family
• Integration of specialists from medicine, psychology, education, and social therapy to form interdisciplinary (cross-disciplinary) teams for diagnosis and therapy

More than almost any other professional group, physicians are qualified to develop interdisciplinary working groups that practice patient-centered medicine. Thus, systemic therapy and medicine demonstrate a path through which collaboration between physicians and therapists with patients and their families can achieve competence, efficiency, and quality of life.

The term “cybernetics” was coined by Norbert Wiener. He derived the term from the Greek word for “helmsman” and used it to describe the feedback mechanism in his book *Man and the Human Machine: Cybernetics and Society* (1948). In German, the term “Regelungstechnik” (control engineering) can be used as a synonym for cybernetics.

The example of a thermostat illustrates the principle of a cybernetic system: A person sets a specific room temperature, which the thermostat compares with the actual temperature. If the values differ, the thermostat adjusts the room temperature to the desired level.

According to Ludwig von Bertalanffy, a cybernetic system is a “special system that differs from other systems in its principle of self-regulation.” As an open system, it has variable relationships among its components, which are influenced by unpredictable external factors. Through this adaptability, the system is able to balance itself through internal and external processes. This is referred to as dynamic equilibrium: some components are eliminated, others are added, and overall, a balance is maintained.

There is no such thing as objectivity

Open systems interact with their environment; they complement one another and alternate in their roles. In doing so, they retain their primary purpose. They remain true to themselves, so to speak. They can only change themselves (“black box”), even when influenced from the outside. This is the principle of self-organization. In cybernetics, Heinz von Foerster speaks of mutual influence (circularity) and reproducibility (recursivity, self-reference) in living systems.

Self-organization processes in living systems are thus circular and recursive. In a circular interaction, the controller is therefore also the one being influenced and the one undergoing change.

Example: A doctor assesses a patient neutrally on the one hand, but not entirely so on the other, because the patient influences the doctor—either unconsciously or consciously—through their social background, language, manner of expression, age, gender, and type of illness (e.g., histrionic personality disorder). At the same time, both parties influence each other through their projections. An objective observation is therefore not possible.

Objectivity is thus always also subjectivity. Heinz von Foerster therefore states that there is no such thing as objectivity, just as there is no such thing as real truth (see his book *Truth Is the Invention of a Liar*).

The circularity, recursiveness, and the associated dialogical laws of life can be most clearly expressed through the concepts of psyche and soma (the soul controls the body and vice versa). The term “systemic psychosomatics” therefore encompasses general medicine, psychiatry, psychosomatics, and psychotherapy. In this context, the terms “psychiatry” (“the study of mental illness”) and “psychotherapy” (“treatment of the mind”) cannot didactically convey the circular and recursive meaning of psyche and soma, even if they do so in terms of content. Nor does the term “psychosomatics” fully do justice to the interconnectedness of mind, brain, body, and environment.

To be precise, it is actually a form of “socio-psycho-neuro-immuno-bio-somato-physical medicine.”

When applied to individual medical specialties, the following classification emerges:

• Psychological Medicine: Psychiatry (including neuropsychology), Social Medicine (including sociology and family medicine)
• Somatic Medicine: Neurology (including neurophysiology and physical medicine), Internal Medicine (organ and hormonal medicine, immunology), Environmental Medicine (biological and physiological environment).

The Meaning and Purpose of a System in Systemic Therapy

Cybernetics and systemic therapy offer a way to understand the concepts of “meaning” and “life” of a system—and thus of a sick person—in a recursive manner:

The purpose (benefit) “of a complex system, such as a living being, is the system itself” (H. von Foerster). A purpose does not require a meaning (goal) separate from the system. The purpose is the meaning. For example, a small child plays, takes joy in it, and does not question itself. The meaning and purpose of its existence in that moment is its joy.

Niklas Luhmann takes this further in his social cybernetics by stating that the individual in social systems virtually “does not” exist; instead, it is their communication style and their communication that exist. (Quote: “Social systems consist only of communication, not of individuals, and as such create themselves.”) Accordingly, we exist because we inform, communicate, and understand (circularity). Because we do this, recursivity (self-reference) arises—that is, we learn from one another, develop ourselves, and pass on our knowledge and skills to the next generation. The goal of this process is our self-preservation as human beings.

In both psychological and somatic terms, however, Luhmann, von Foerster, Bertalaffny, Maturana, and others arrive at the same conclusion: Life (and thus therapy) succeeds through circularity and recursion.

Self-Organization and Self-Organizing Systems in Systemic Therapy

A self-organizing system defines its fundamental structure as a function of its experience with itself and its environment. This definition of the term “self-organization,” formulated by Farley and Clark in 1954, already has strong connections to contemporary topics, such as the cybernetics of neural networks.

The following is characteristic of self-organizing systems:

• The nature of a system influences its individual parts (interaction takes place).
• The parts of the system determine how they must respond to the system’s constraints.
• They act accordingly.

An example illustrates this clearly: A group influences individuals through language, the content of speech, activities, interests, and the intensity and nature of the relationships among its members. The individual group members “decide” how to respond to the group through emotions, the topics they choose for conversation, and their ideas. The individual and the group act accordingly. Self-organization manifests itself in many fields, such as biology, psychology, and sociology, etc.

People form a picture of their world interactively and through self-organization, and in doing so, experience emotions. This gives rise to constructs, which they rank hierarchically according to their significance and assign to structures. At the same time, these constructs belong, to some extent, to the past, because a constant recalibration of internal and external images is taking place.

Example: I observe a certain behavior in another person, which I interpret in a specific way and therefore infer a certain character trait about that person (formation of a construct). Further observations contribute to either supporting or revising my opinion.

Example of a construct: For a long time, the Earth was considered the center of the cosmos, around which all other celestial bodies revolve. This view arose from observations and interpretations.

The sum of these constructs, which are constantly being reformed, then gives people the subjective feeling that they have a coherent, realistic perception, a point of view, or a realistic perspective. However, this is not entirely correct: constructs are always a compromise between reality and assumed reality.

It’s about constructs, not truths

Diagnostically and therapeutically, systemic psychosomatics is therefore concerned with constructs, not truths, as is often assumed. Psychological and somatic processes are adaptive (i.e., they adapt). “They possess the ability of organisms and self-regulating systems to adapt to changing environmental conditions” (Surhone, Timpledon, Marseken, 2010). They are geared toward survival, as nature has demonstrated for millions of years.

Nature adheres to a strict but effective rule: it seeks to preserve what it needs in order to remain in balance. Unlike humans, with their perfectionist and thus destructive nature, it does not seek to disrupt that balance from time to time. From a homeostatic—and thus also medical—perspective, this raises the question of why we humans endanger the environment through our advanced technology and its byproducts, which, for example, contribute to global warming. From a cybernetic perspective, for example, it is ineffective how we weaken our immune system through air pollution, excessive use of disinfectants, and antibiotics. It is equally ineffective that we endanger our innate social abilities—such as consideration, helpfulness, and tolerance—through strictness, devaluation, and the pursuit of perfection.

Obviously, we rely on nature’s self-healing powers. In this case, however, it will likely be small and large-scale disasters that, as has happened time and again throughout human history, regulate us against our will. From a medical perspective, of course, we can always hope that a person—and thus a patient—will be aided by their capacity for circularity and recursion by embracing nature’s rules as part of nature itself.

Insights Are Constructs

According to Jean Piaget’s (2010) “evolutionary theory of knowledge,” reality and our cognitive apparatus adapt to one another because our senses, our brain, and our thinking have developed and adapted to this world over the course of evolution.

“What is perceived by our neural networks is therefore real” (J. Piaget, 2010), i.e., adapted to what we see.

Example: Rescuing a drowning person by no means proves that the person did not want to drown. Perhaps he wanted to take his own life. Thus, what is “real” is, at best, what we perceive and what aligns with our actions. We do not know whether it reflects reality. Only one thing matters to the rescuer: The other person was drowning. He rescued him. Thus, his so-called reality was reality because it made sense and “worked.” The background of the alleged drowning eludes his reality—or, rather, is irrelevant to the rescuer. Otherwise, he would no longer be able to rescue quickly and successfully.

A person’s insights, feelings, thoughts, and experiences are reflected dynamically—that is, shaped by constant, albeit very slight, changes—in the network of their brain’s organic perception and its synergistic processes. Thus, not only does insight change, but so does the reality we experience. Certainly, this changes in subjective experience. Forms of perception are therefore process-oriented and never static. Furthermore, perception is subjective.

Health Is Balance

Systemic therapy is about giving expression to all the senses and the emotional-cognitive perception (images and symbols) of a patient in order to connect with what moves them. Neuroscientist Wolf Singer comments on this (2005): “Insight occurs only where we observe, organize our thoughts, and form mental images. Everything beyond that does not exist for us, but is stored in the subconscious.” This means that our conscious perception always leads to particularly high activity in neural networks. This requires plasticity and a large number of new connections, which enable learning. This is the functional purpose of attention and consciousness.

Insight can therefore only occur where our consciousness allows it to take shape as constructs. In this respect, every therapeutic outcome is relative and impermanent. It is relative because most of what moves us is not—or cannot be—recognized. It is impermanent because new insights are constantly emerging that alter the old ones and thus put them into perspective. Ultimately, therefore, it is not the insights themselves that are therapeutically relevant. What is important is that the insights facilitate inner homeostasis—that is, a state of balance.

It is crucial that the constructs derived through insight be internally accepted by the individual. It is not necessarily crucial whether they correspond to so-called objective reality, which, in any case, no one knows in physical or epistemological terms.

Homeostasis thus means a balance of insights, not absolute truth. In this respect, the person who believes in their constructs is healthy. For they are at peace within themselves. Some people, however, are unwell because they constantly question the so-called truth. For they are not at peace within themselves.

Life and Its Symbols

Regardless of the complexity of human action, thought, and feeling, human life is shaped by fundamental rules: It involves interaction (the exchange of information) and synergy (the interplay of networks), whether mental, emotional, or ecological (biological, physical, social).

Memories of words, images, and the associated feelings and ideas interact with one another and develop neurogenic patterns. They also manifest as constructs and ideas. These shape the reality we experience and perceive. This also includes symbolic images that combine real images, ideas, and the feelings projected onto them.

On Symbols, Sketches, and Constructs

Humans may have been using these since the dawn of humanity, as ancient cave paintings demonstrate. They depicted a simplified reality as humans perceived it at that time. Through them, humans were able to “grasp,” store, assess, and symbolize life (the lion as a symbol of power, the horse as a symbol of strength, the sun as a symbol of fertility, etc.). [Rock engravings in Scandinavia (Bronze Age, approx. 4,000–3,000 years ago); sun symbol in Aspeberget (The most beautiful depiction of the sun in Scandinavia, found in Aspeberget, shows women with long braids. For the peoples of Scandinavia, the sun was a symbol of fertility and abundance).]

If one or more symbols (constructs) in our individual or collective imaginations are therapeutically altered—for example, through new symbolic images—the relationship between all other images or patterns and their neural connections to one another also changes. In this respect, images and ideas as constructs can contribute to healing just as much as soothing experiences in reality.

A very simple example of how images shape a society: At the time of N. Copernicus and G. Galileo, it was a challenge for society and its church to determine whether the Earth was the center of the cosmos or merely one planet among many. For the world of the 16th century, the discovery that the Earth was a planet orbiting the Sun initially posed no threat. However, the construct—the Earth as the center of the cosmos—was lost. At first, the Church tried to defend its constructs until the stronger influences of the Enlightenment prevailed. From that point on, people’s worldview—and thus their place in this world—underwent a fundamental change that continues to this day, simply because an image or a symbol changed.

The Earth at the Center of the Cosmos: The Geocentric Worldview in Schindel’s World Chronicle (c. 1493)

Symbolism can also be used therapeutically by altering images and ideas in our consciousness. This is achieved by disrupting “incorrect connections” (so-called “disruption”) and relying on the self-regulation of the body, the psyche, or social processes. However, this can also be achieved through positive ideas or constructs.

Every medical treatment, including systemic therapy, offers an opportunity to connect with oneself through somatic symptoms, psychological conflicts, and—above all—internalized symbols, images, and ideas.

For Viktor von Weizsäcker, the founder of psychosomatics, it was the somatic illness itself—with its symbolism, meaning, and the timing of its onset—that was key. Karl Jaspers, a psychiatrist and philosopher, emphasized in his philosophy of existence the human existence shaped by images and ideas (“Being I, Being Self, and the Search for Meaning”). For C.G. Jung, a psychiatrist and analyst, it was symbols and fairy tales that brought collective memories and imprints to light. For S. Freud, a neurologist and psychoanalyst, it was the constructs of transference fantasies and the patient’s memories. For the biophysicist H. von Foerster, it was the constructs of human cognition that reflect the human psyche. For the physician and surgeon Hans Kilian, it was the relationship between doctor and patient.

When symptoms, conflicts, and internalized images—that is, a person’s symbols and experiences—are carefully elucidated using analytical skills, this involves an interactive, and from a cybernetic perspective, synergistic approach in treatment.

Therapeutically, systemic therapy is therefore concerned with implementing treatments based on information and feedback as a central concept. In the sense of N. Luhmann, however, the feedback of self-reproducing processes does not occur without meaning (“social and psychological systems operate with meaning”). This means that a treatment without meaning (or purpose) cannot be effective for the patient or the therapeutic environment. Within the framework of systemic therapy, for example, the patient is willing to confide in the therapist, and the therapist is therefore willing to validate the patient. In a subsequent process, the patient is willing to allow certain aspects of their life to be questioned in a supportive manner, while the therapist is willing to challenge them in a therapeutic sense in order to set self-organizing and self-regulating processes in motion.

Disruption and Self-Organization in Systemic Therapy

If we assume that a person and their environment function as a self-sustaining (autopoietic) system and that change can be brought about through disruption, the natural question arises as to what form an intervention must take in order to disrupt the system and bring about change (ideally in the desired direction).

This is possible through a targeted “irritation or disruption of non-intact control loops” (a so-called disturbance) and, in turn, the activation of self-organizing healing processes.

This, in turn, is achieved through changing feedback: In response to a therapeutic irritation, the patient reacts differently than usual; this behavior triggers a different response from those around them, which in turn confirms, irritates, or corrects the patient, and so on. Interactive processes thus sustain, reinforce, or correct themselves even within a treatment setting.

In principle, however, in a treatment characterized by the process of self-organization, one lets things “flow,” allowing associations, ideas, and fantasies of all kinds to emerge, one “goes along with the patient” and discovers the patient’s “I” or “self,” which is ultimately the focus of psychosomatic treatment. For those who are at peace with themselves tend to recover more readily than those who are torn within.