Table Of Content“This accessible and hugely engaging text sets out both to explain sys-
temic principles for professional practice and to support the develop-
ment of systemic thinking in practice. The book explores the different
ways in which we look at and understand families and their relation-
ships, and importantly, why we might look in the ways we do. The
authors follow the generations of a particular family system through-
out the text and with their lively writing style draw us into the family
members’ experiences – their loves, their challenges, their dreams, their
hurts and misunderstandings, and their successes. The authors invite us
into the safety of the therapeutic context with the family members and
clearly describe the unfolding of the therapeutic process, as they weave
together the intra-personal with the inter-personal, social and develop-
mental contexts of life. I strongly recommend this book as a practical
and foundational text for training in health and social care practice.
The sub-title of the book is ‘A Relational Compass’ – a strong metaphor
to guide us the reader through the complexities of family life and to help
make them more understandable, manageable and open to change.”
Arlene Vetere, PhD, Professor Emeritus of Family, VID Specialized
University, Norway
“This brilliant practice-orientated book provides a systemic compass
to help practitioners to stay on course, with clients and therapists
together confirming, debunking and changing their experience(s) of
reality. Exercises at the end of each chapter invite the reader to reflect
on their own practice and the personal contexts that contribute to their
responses during the therapeutic process. A fascinating exploration of
the different lenses needed to work systemically with a wide range of
families in diverse settings – highly recommended to anyone interested
in systemic practice!”
Eia Asen, Professor Dr. Anna Freud Centre, UK
“I would like to endorse Systemic Perspectives in Mental Health, Social
Work and Youth Care: A Relational Compass by Anke Savenije, Justine
van Lawick and Ellen Reijmers. This English translation will have spe-
cial relevance for mental health practitioners including psychiatrists,
doctors, psychologists, psychiatric nurses, family therapists and social
workers who seek to apply a systemic, contextual, and family-centred
practice framework. It draws on an ever-increasing evidence-based lit-
erature that acknowledges the value of applying a ‘systemic lens’ across
a range of psychiatric diagnoses and presenting issues. The dual the-
ory and practice focus of the book including useful homework exer-
cises will have appeal for both beginning and experienced practitioners
especially the detailed illustration of therapeutic work with the Dufour
family across several chapters as well as the inclusion of a wealth of
practice examples to illustrate the finer points of systemic therapy.
English language readers will appreciate the focus on context in ther-
apy conversations between therapists and clients and other systems
and the book provides a useful and easily understood map for systemic
practice across a range of settings for individuals, couples, parents,
families, groups and larger networks. The chapters on systemic work
with families presenting with ‘individual vulnerabilities’ and complex
mental health issues and the role of common factors in therapy change
will be especially useful. In summary this book will have wide appeal
for psychologists, therapists, social workers and counsellors in English
speaking countries who wish to learn more about applying a systemic
approach in a range of mental health contexts.”
Dr Glenn Larner, Senior Clinical Psychologist and Family Therapist,
Sydney, Australia, and Editor-in Chief of Australian and New Zealand
Journal of Family Therapy
Systemic Perspectives in Mental
Health, Social Work and Youth Care
Systemic Perspectives in Mental Health, Social Work and Youth Care
describes the theoretical foundations of a systemic framework, or ‘systemic
lens’, and how the counsellor, therapist, social worker or other health pro-
fessional can apply these ground principles in therapeutic meetings with
clients.
The book presents a wide variety of perspectives and interventions, multi-
ple examples and practical methods applicable to professionals with a range
of experience. A case study covering a diverse family of three generations
is presented throughout the book to clearly illustrate systemic perspectives,
concepts and practices. This accessible book will inform and enhance the
therapist’s practice and conversations with individuals, couples, parents,
groups or networks, even in the presence of psychopathology, multi-stressors
or complex networks.
This highly readable guide will be essential reading for systemic practi-
tioners of all backgrounds, as well as professionals looking to understand
systemic approaches, and for those working in social work, youth care or
mental health who want to enhance their current practice.
Anke Savenije is retired but worked as a psychologist, psychotherapist and
systemic therapist. She is the co-founder of The Amsterdam Institute of
Family Therapy, a centre for systemic therapy, training and supervision.
Justine van Lawick is a psychologist, psychotherapist and systemic therapist.
She is a co-founder of the Lorentzhuis, a centre for systemic therapy, training
and consultation in Haarlem, The Netherlands. She is a senior trainer in The
Netherlands and abroad.
Ellen Reijmers is a psychologist, psychotherapist and systemic therapist.
She is director and head of the psychotherapy training programme pro-
vided by the Interactie-Academie, a systemic training and therapy centre in
Antwerp, Belgium. She is editor in chief of the centre’s professional journal,
Systeemtheoretisch Bulletin, and a senior trainer and supervisor.
The Systemic Thinking and Practice Series
Series Editors: Charlotte Burck and Gwyn Daniel
This influential series was co-founded in 1989 by series editors David
Campbell and Ros Draper to promote innovative applications of systemic
theory to psychotherapy, teaching, supervision and organisational consul-
tation. In 2011, Charlotte Burck and Gwyn Daniel became series editors and
aim to present new theoretical developments and pioneering practice, to
make links with other theoretical approaches, and to promote the relevance
of systemic theory to contemporary social and psychological questions.
Recent titles in the series include:
Emotions and the Therapist: A Systemic-Dialogical Approach
By Paolo Bertrando
Creative Positions in Adult Mental Health: Outside In-Inside Out
Edited by Sue McNab and Karen Partridge
Ethical and Aesthetic Explorations of Systemic Practice:
New Critical Reflections
Pietro Barbetta, Maria Esther Cavagnis, Inga-Britt Krause and Umberta Telfener
Working Systemically with Refugee Couples and Families:
Exploring Trauma, Resilience and Culture
Shadi Shahnavaz
Psychotherapeutic Competencies: Techniques, Relationships, and
Epistemology in Systemic Practice
Laura Fruggeri, Francesca Balestra, and Elena Venturelli
Systemic Perspectives in Mental Health, Social Work
and Youth Care
Anke Savenije, Justine van Lawick, and Ellen Reijmers
Systemic Perspectives
in Mental Health, Social Work
and Youth Care
A Relational Compass
Anke Savenije, Justine van Lawick and
Ellen Reijmers
Designed cover image: Mila Van Goethem, The family, 2018
First published in English 2023
by Routledge
4 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
605 Third Avenue, New York, NY 10158
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2023 Anke Savenije, Justine van Lawick, and Ellen Reijmers
The right of Anke Savenije, Justine van Lawick, and Ellen Reijmers to be
identified as authors of this work has been asserted in accordance with
sections 77 and 78 of the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced
or utilised in any form or by any electronic, mechanical, or other means,
now known or hereafter invented, including photocopying and recording,
or in any information storage or retrieval system, without permission in
writing from the publishers.
Trademark notice: Product or corporate names may be trademarks
or registered trademarks, and are used only for identification and
explanation without intent to infringe.
Published in Dutch by Boom Uitgevers Amsterdam, 2018
British Library Cataloguing-in-Publication Data
Names: Savenije, Anke, author. | Lawick, Justine van, author. | Reijmers,
Ellen, author.
Title: Systemic perspectives in mental health, social work and youth care :
a relational compass / Anke Savenije, Justine van Lawick, and Ellen Reijmers.
Description: 1 Edition. | New York, NY : Routledge, 2023. | Series: The
systemic thinking and practice series | Includes bibliographical
references and index.
Identifiers: LCCN 2022031649 (print) | LCCN 2022031650 (ebook) | ISBN
9781032223117 (paperback) | ISBN 9781032223100 (hardback) | ISBN
9781003272038 (ebook)
Subjects: LCSH: Family counseling. | Family social work.
Classification: LCC HV697 .S33 2023 (print) | LCC HV697 (ebook) | DDC
362.82/53--dc23/eng/20221020
LC record available at https://lccn.loc.gov/2022031649
LC ebook record available at https://lccn.loc.gov/2022031650
ISBN: 978-1-032-22310-0 (hbk)
ISBN: 978-1-032-22311-7 (pbk)
ISBN: 978-1-003-27203-8 (ebk)
DOI: 10.4324/9781003272038
Typeset in Times
by KnowledgeWorks Global Ltd.
Contents
Preface viii
Series editors forward xii
1 Does ‘the family’ exist? 1
2 A systemic lens 13
3 The practitioner 28
4 Something needs to change 37
5 The start of the working alliance 43
6 Mapping 57
7 Positioning 69
8 Settings matter 79
9 Individual vulnerability in context 101
10 Multiple and complex problems 120
11 The systemic practitioner in action 137
12 Change: An epilogue 155
References 162
Index 176
Preface
This book is aimed at mental health and social care practitioners who work
with families, family members, partners, parents, adults or children, at
times with individual psychiatric diagnoses or embedded in complex net-
works, and who want guidelines to practice systemically. Systemic practice
means considering the context in which people live and in which problems
and symptoms occur. This includes both the context of immediate rela-
tionships and the influence of the socio-economic environment and cul-
ture. Conversations with multiple people such as family members, close
contacts or others may occur and is considered crucial in many treatment
programmes. Alternatively the practitioner may have conversations with
individuals and attend to significant others in the client’s life and the people
involved in the problems.
In conversations with individuals many professionals are unsure how
to bring to the fore people who are not physically present in the session
or they find talking with multiple people complicated. However every-
one in the room and absent influential others have their own ideas about
what is the matter and what needs to happen. And emotions can run high
for family members and others involved because their relationships mat-
ter. Keeping oversight, taking into account different perspectives, not
becoming overwhelmed by the severity of the problems or not becom-
ing stuck in the hectic pace of the conversation is for the professional a
challenge.
Systemic practitioners can choose from various perspectives and several
interventions. Given this broad spectrum of options we felt it crucial to for-
mulate global guidelines that can function as a common thread in systemic
work with individuals, couples, parents, groups or networks.
This book is practice orientated. But good practice requires a clear theo-
retical framework: a ‘systemic lens’. This lens consists of presumptions that
form the basis of systemic work and colour the practitioner’s perspective,
positioning and actions. A systemic lens implies a specific way of looking at
relationships and daily interactions, but also at problems in relationships,
the role of the practitioner and what is likely to effect change. The systemic
Preface ix
lens guides interventions. What this means for day-to-day practice is the
major focus of this book and illustrated with many practical examples and
applications, supported by various skills and techniques. As such the book
is a compass to help practitioners stay on course and adopt or maintain a
reflective position.
Structure
This book consists of 12 chapters. In Chapter 1 we describe the differ-
ent lenses that can be used when looking at families, illustrated with the
three-generational Dufour family. Examples from this family further
illustrate the history of systemic therapy in Chapter 2. The principles that
collectively form the ‘systemic lens’ are described: thinking in terms of con-
nections, attending to the difference between intention and effect, consider-
ing feedback, relational processes, polyphony and sources of support and
resilience. Chapter 3 focuses on how professionals too are influenced by the
contexts they live in and work in.
In Chapter 4 we look at what preceded seeking professional help, the
motivation of people to request professional input and what may be rea-
sons to involve family members or other people in the therapeutic process.
Again, this is illustrated with the Dufour family amongst other examples.
Chapter 5 pays attention to factors the practitioner knows about but are
generally not mentioned in conversations with clients, for example, that
the introduction starts much earlier than the actual therapy, the influence of
the referral and the significance of the space in which conversations take place.
In Chapter 6 we outline in practical terms how relationships, problems
and the problems’ contextual embedding can be systemically mapped.
Throughout the therapeutic process professionals assume a specific posi-
tioning. Three major positioning approaches in systemic practice are dis-
cussed in Chapter 7. Chapter 8 follows with an overview of the various
settings possible in systemic work: individual, with couples, parents, fami-
lies, groups and bigger networks. We consider possible reasons and implica-
tions of choosing a specific setting and how changes in setting, if carefully
chosen and prepared, can support the therapeutic process.
Chapters 9 and 10 focus on how systemic frameworks and positionings
can be sustained in difficult circumstances. This is first applied to the work
with people who present with mental health vulnerabilities or psychiatric
diagnoses in Chapter 9. Chapter 10 provides ideas about working systemi-
cally with families with multiple or complex problems.
Chapter 11 describes a wide variety of skills and techniques that support
the actions of systemic practitioners. And finally, in Chapter 12, we focus
on the important theme of change, including the common factors that con-
tribute to change in therapy and factors specific for systemic interventions.
Given that what effects change remains partly elusive, the professional has
