HE.S.T.A.F.T.A. - Scientific Society of Mental Health Professionals


**Book presentation: **

Systemic Research in Individual, Couple, and Family Therapy and Counseling , edited by Matthias Ochs , Maria Borcsa and Jochen Schweitzer (2020)

Valeria Pomini[1]

Translated from Greek by ** Kalliopi Dikaiou** , postgraduate psychology student.

[1] PhD, Clinical Psychologist - Psychotherapist, Family Therapy Unit, First Department of Psychiatry, Medical School, National & Kapodistrian University of Athens.

The book presents the state-of-the-art in systemic research. The cooperation between the editor of Springer international and the European Family Therapy Association – EFTA, which was initiated by the former President, **Maria Borcsa ** [1] and **Peter Stratton ** [2], resulted in the creation of a series of scientific books. The books aim to providing the international systemic community with the contributions of experienced therapists and researchers on contemporary issues of systemic therapy, research and training.

The first series volume, edited by Maria Borcsa and Peter Stratton, who are also the editors of the new Springer – EFTA series, was dedicated to the main themes presented at the 9th EFTA Conference which took place in Athens on September 2016 (Borcsa & Stratton, 2016).

This presentation concerns the fourth book of the series, which was published during the current year and was edited by **Matthias Ochs ** [3], **Maria Borcsa ** and **Jochen Schweitzer ** [4]. The book, _Systemic Research in Individual, Couple, and Family Therapy and Counseling, _ contains texts of internationally distinguished systemic researchers and therapists based on their presentations at the International Conference on Research in Systemic Therapy, organised in Heidelberg (Germany) in March 2017 (Ochs & Schweitzer, 2020). The conference was a valuable opportunity for learning, dialogue and sharing among 500 participants from 29 countries, predominantly European but also Asian and American (ibid.) I was given the honour of participating at the conference as a guest speaker, thus I had an unique opportunity to come in contact with the most contemporary topics and experiences in systemic research, presented by the most legitimate systemic – and not only – researchers from all over the world.

The book does not consist of the conference proceedings; it consists of the choice of main topics, as they were processed by the Authors after the conference, thus many texts include the feedback they received during the conference.

The work of the editors was complex: From the large amount of conference material, several topics presented by distinguished speakers were chosen and organised into four parts. The first part, _Innovations in Systemic Research Paradigms, _ focuses on the innovations in systemic research, specifically the change of paradigm that concerns aims, organisation, and methodology of research programs. This part offers the reader a plurality of research themes:

Günter Schiepek from Austria focused on the contribution of systemic research in the development of psychotherapy in general.  Schiepek described  a technical device for realizing real-time monitoring and feedback procedures is the Synergetic Navigation System (SNS), an Internet-based tool for the continuous assessment of change processes by self-related or interpersonal ratings of the included subjects. Continuous assessments create time series data which is the raw material for any further analysis. SNS is an internet-based, e-Mental Health technology that aims to study and understand the mechanisms of change – an essential part of every psychotherapeutic approach. The program helps to model the mechanisms and dynamics of therapeutic change and it can be used in various therapeutic settings or applied to a range of presenting problems. The science of complexity, which systemic theory like Synergetics belongs to, helps understanding the functioning of complex, self-organised systems like the brain, social networks as well as the mechanisms of therapy. Like the author highlights, internet programs might provide rapidly more legitimate and generalised results compared to traditional research methodologies, increasing the effectiveness of therapeutic interventions.

Wolfgang Tschacher, Fabian Ramseyerand, ** and ** Mario Pfammatter from Switzerland, provide a useful reflection on the definition of the term psychotherapy and the research questions that arise. They focused on a minimal model of psychotherapy and the " here and now " of the therapeutic relationship ( nowness ) (Stern, 2004), which they defined as a social present and analyzed through two tools that record the non-verbal synchronization between the patient and the therapist ( _SUSY, surrogate synchrony determination _ και το MEA, Motion Energy Analysis ). The aim of this methodology is the deeper study of the characteristics of the current moment during the therapeutic process and the connection with its effectiveness. A group of researchers from Finland, Germany and Spain ( Petra Nyman-Salonen, Berta Vall, AarnoLaitila, Maria Borcsa, Markku Penttonen, Anu Tourunen, Virpi-Liisa Kykyri, Jukka Kaartinen, Valeri Tsatsishvili ** and ** Jaakko Seikkula ) represents an excellent example of a transnational research initiative. The study focuses on the therapeutic process and on specific aspects of the therapeutic relationship in couple therapy, using a mixed study process of the therapeutic session. The qualitative analysis of the therapeutic dialogue is enriched by  the recording of the autonomic nervous system responses of the participants in the session (the couple members and the two therapists) by monitoring the Skin Conductance Responses – SCRs, by observing the non-verbal synchronization between all members, as well as by interviewing for the revocation of the internal dialogue through exposure to the recorded material of the session ( Inner Dialogue Captured by the Stimulated Recall Interview - SRI) . As the authors emphasize, this research process broadens the understanding of the therapeutic process and promotes practice-oriented research.  Peter Fraenkel from the USA presents the development of Collaborative Family Programs that enhance resilience and therapeutic engagement in marginalized communities, such as homeless families. The model presupposes close collaboration with other health, mental health and social services professionals, as well as the adoption of evaluation tools by the clients themselves. In this case, too, the research process and its results are directly linked to and supported by clinical practice.

Ashley Collette and Michael Ungar from Canada also focus on the mental resilience of individuals, families and communities, offering a useful overview of the concept of resilience, from the individual approach to the relational one and, even more broadly, to the community one. Indeed, resilience is not intended as an individual characteristic, but it is closely linked to the characteristics of the natural and cultural environment to which individuals, families and communities belong. Human resilience is therefore related to the ability of a dynamic and complex system (individual, family or community) to adapt effectively to the challenges of the physical and social environment. Research on resilience cannot isolate the individual from the environment and needs to consider the complexity of social ecology in order to understand in depth the factors that enhance or, conversely, hinder its development.

The second part of the book - _Methodological Considerations – _ delves into the subject and the concerns of the research methodology, emphasizing the innovations of the contemporary, international research activity.

Sheila McNamee from the USA, introduces the idea of ​​research action as a transforming practice, which cannot be non-relational. She refers a comment on the inaugural speech of President Donald Trump after his election in 2016. As she claims, such an awareness “ This shifts the focus and attention of our research from a proof-based rhetoric to a collaborative consideration of the implications and unintended consequences of what we study, how we study it, and what we ultimately do with our “results .”’ (p.122).

Eleftheria Tseliou focused on the contribution of qualitative research and more specifically of disc ourse analysis in the systemic approach. Her text is a useful and complete introduction to the concepts and methodologies of discourse analysis adapted to systemic family and couple psychotherapy. In fact, “ Discursive Psychology is not ‘ simply a methodological proposal for the analysis of talk and texts. It further constitutes a theoretical proposal for a radical re-conceptualization of psychological phenomena, in ways similar to the re-conceptualization of psychopathology and psychotherapy introduced by systemic family therapy. ” (p.128). The relevance of the two approaches, consists in offering a wide field of application of their methodology in the research of change processes in the context of systemic psychotherapy, of which the author offers interesting examples.

Jaakko Seikkula from Finland provides an overview of the " Open Dialogue " (OD) approach under the scope of their team's rich research activity, even defining continuous scientific research as the very basis of this approach. It is true that from the beginning of its development, the OD approach has evolved based on the feedback of the scientific data resulting from its evaluation, which in turn has fuelled new research needs and methodologies, making it a shining example of " practice-based research " and, at the same time, " practice based on scientific evidence ". Starting from the description of the methodology and results of the quantitative studies conducted in the context of psychiatric services in Western Lapland since the eighties - which fuelled the radical changes in the way of dealing with mental health problems in the community-, to the description of the qualitative studies conducted on the OD approach, particularly in the treatment of acute psychosis, the author describes and comments the short-term and long-term results of the approach, as emerged from the respective studies. The expansion of the OD at an international level coincides with the launch of multicentre international studies described in the text, such as the _Relational Mind, _ a program which studies the synchronization phenomena in human communication in the context of couple therapy – presented in more detail in the first part of the book.  The author's reflections on the research process and his critique of it raise central concerns that regard both clinicians and researchers.

Matthias Ochs, Lucie Hornová , and Andrea Goll-Kopka from Germany and the Czech Republic, reflect on similar issues regarding systemic research. They ask and comment on the question " What makes research systemic?" and examine what characterizes systemic research methodology and epistemology, based on the examples described in the book itself by the rest of the authors. This is a dense and important meta-commentary that emphasizes in the end – enriched by reflections also on other research examples – the importance of systemic research which directly involves clinicians/therapists, creating bridges of cooperation between professionals and academics, with the ultimate goal of improving the provision of mental health services.

The second part of the book concludes with a contribution by Eva Deslypere and Peter Rober from Belgium focusing on family secrets , providing an overview of clinical examples and research methods (for example, in assisted procreation), which also highlight the effective therapeutic approach to handling family secrets.

The third part “ Answering Clinical Issues Using Scientific Knowledge and Methods ” collects extremely useful topics of clinical and research interest, expanding the scope of contributions and applications of other approaches to the systemic clinical practice:

Eia Asen and Peter Fonagy from England present the well-known concept of reflective functioning (mentalization) and its application in family psychotherapy. They present a series of "playful" techniques that encourage and enhance the reflective function of family members as well as the therapist's ability to enhance a mentalizing loop . They also report the main results of studies evaluating treatment based on mentalization, mainly with adults diagnosed with personality disorders. Research studies on family therapy based on mentalization are developing and their results will be present in the future.

From a different epistemological approach, Corina Aguilar-Raab from Germany, presents the application of _mindfulness and compassion based therapy _ in relational contexts, such as families and couples, as well as the studies conducted on this approach.

Julika Zwack and Leslie Greenberg (from Germany and Canada respectively) analyse another popular therapeutic approach, Emotion Focused Therapy (EFT) and its influence on systemic practice.

Mona DeKoven Fishbane from the USA presents the contribution of neuroscience to couple therapy, referring to interpersonal neurobiology and the role of neuroscientists in tackling the vulnerability cycle in couple’s relationships.

The relational need perspective and the relational stress one are developed by **Lesley Verhofstadt, Gilbert Lemmens ** and Gaëlle Vanhee from Belgium, while the latest data on the treatment of domestic violence are presented by **Margreet Visser, Justine Van Lawick, Sandra Stith ** and Chelsea Spencer from the Netherlands and the USA.

Finally, the fourth part of the book ( Improving Therapy Quality by Feedback: Training and Publication ) offers the reader an interesting series of texts on both theoretical reflections on the importance of research activity in psychotherapy in general and the systemic approach in particular, as well as examples of studies and research tools.

A panorama of latest research activity in the systemic approach and the effectiveness of systemic interventions based on research methodology, with reference to the role of manuals in the formulation of therapeutic models ( manualized systemic therapy ) is presented by Alan Carr, Martin Pinquart , and Markus Haun from Ireland and Germany.

Paul Knekt, Olavi Lindfors, Erkki Heinonen, Timo Maljanen, Esa Virtala, and Tommi Härkänen from Finland write about the results of a comparative study of three psychotherapeutic approaches for anxiety disorders - solution focused therapy, short-term psychodynamic psychotherapy and long-term psychodynamic psychotherapy.

Peter Stratton, Alan Carr , and Luigi Schepisi (from England, Ireland and Italy respectively) discuss the usefulness of the SCORE scale for assessing therapeutic efficacy but also as a clinical tool that supports the therapeutic process.

Terje Tilden from Norway presents the development of a new "paradigm" that overturns the classical approach of evidence based practice by proposing a practice based evidence as a compass for evaluating psychotherapeutic efficacy, directly involving the patient in providing a feedback. As the author notes “ This approach implies in particular the possibility of studying session-to-session development of change, identifying change trajectories that may vary for different persons or groups with specific characteristics.” (p.391).

Petra Bauer and Marc Weinhardt from Germany describe a model of learning and training in systemic counseling based on therapeutic factors present in all therapeutic approaches ( common factors ), as well as the effective ways of their "transmission" from the trainer to the trainee.

The last part of the book closes with an interesting and illuminating dialogue between Maria Borcsa and Philip Messent with Jay Lebow, Reenee Singh and Glenn Larner , respectively editors, at the time, of three "historic" English-language journals: Family Process, Journal of Family Therapy, _ and the _ Australian and New Zealand Journal of Family Therapy . The dialogue aims to inform the reader about the trends and publishing policies of the three journals, the way of selection and review of the submitted works, the fields with incomplete coverage, as well as providing advice to authors who want to increase their chances of publishing their works.

The book is undoubtedly an essential tool not only for those engaged in or about to engage in systemic research, but also for therapists, teachers and trainees seeking a rich source of inspiration for the methods, goals and effectiveness of their present or future work. The book also highlights the richness and diversity of research activity in the systemic approach within the international psychotherapeutic and academic community, as I share the wish of Matthias Ochs and Jochen Schweitzer: “ it is generally recognized today that systemic therapy and consultation have a strong theoretical and empirical basis. However, their representation in the big research-active universities and powerful research institutions is still weak as of now. This may and we hope will change during the next 10 years. "(p.7).


Ochs, Μ., Borcsa, Μ., &Schweitzer, J. (2020). Systemic Research in Individual, Couple, and Family Therapy and Counseling. New York, NY: Springer International.

Stern, D. N. (2004). The present moment in psychotherapy and everyday life. New York, NY: Norton.

[1] Professor of Psychology, University of Applied Sciences Nordhausen, Nordhausen,Germany

[2] Emeritus Professor of Family Therapy, University of Leeds, Leeds, West Yorkshire, UK

[3] Professor of Psychology, Fulda University of Applied Sciences, Fulda, Germany

[4] Professor of Psychology, University Clinic of Heidelberg, Heidelberg, Germany


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