von Sydow Kirsten, Beher Stefan, Retzlaff Rüdiger
Medical School Hamburg (MSH), Department for Psychology, Hamburg, Germany; Helm Stierlin Institut e. V., Heidelberg.
Dtsch Arztebl Int. 2024 Nov 15;121(23):783-792. doi: 10.3238/arztebl.m2024.0194.
Systemic therapy (ST) was approved as a further psychotherapy approach in line with the German Psychotherapy Directive's requirements in 2020 for adults and in 2024 for children and adolescents, and is thus covered by statutory health insurance.
Selective literature review on the theoretical foundations and clinical practice of ST, including recent meta-analyses of its efficacy.
The theoretical foundations of ST include systems and communication theory, moderate constructivism, the multigenera - tional perspective, and, in some manuals, the attachment perspective. Structural-strategic family therapy and the solution-focused therapy approach are key elements of its clinical practice. ST is mostly provided in individual or multi-person settings. Important interventions include solution-focused and circular questions, positive reframing, genograms, sculptures, tasks, and prescriptions. Several disorder-specific ST manuals have been developed. The efficacy of ST has been evaluated in 7 recent meta-analyses: ST has been found effective against various disorders, both in adults (affective disorders, anxiety/obsessive-compulsive disorders, substance use disorders, eating disorders, schizophrenia/psychotic disorders) and in children and adolescents (anxiety/obsessive-compulsive disorders, hyperkinetic disorders, substance use disorders, eating disorders, and mixed disorders). For example, in the treatment of depression in adults, ST was shown to be superior to no add-on treatment (Hedges g: 1.09, 95% confidence interval [0.78; 1.40]).
ST broadens the scope of treatment options for mental disorders, with a specific focus on their social context.
系统治疗（ST）于2020年被批准为符合德国心理治疗指令要求的针对成年人的进一步心理治疗方法，并于2024年被批准用于儿童和青少年，因此被法定健康保险所覆盖。
对系统治疗的理论基础和临床实践进行选择性文献综述，包括其疗效的近期荟萃分析。
系统治疗的理论基础包括系统与沟通理论、适度建构主义、多代视角，并且在一些手册中还包括依恋视角。结构-策略性家庭治疗和聚焦解决治疗方法是其临床实践的关键要素。系统治疗大多在个体或多人环境中提供。重要干预措施包括聚焦解决问题和循环提问、积极重新构建、家谱图、雕塑、任务和处方。已经开发了几本针对特定障碍的系统治疗手册。近期的7项荟萃分析评估了系统治疗的疗效：已发现系统治疗对各种障碍有效，在成年人（情感障碍、焦虑/强迫症、物质使用障碍、饮食障碍、精神分裂症/精神病性障碍）和儿童及青少年（焦虑/强迫症、多动障碍、物质使用障碍、饮食障碍和混合性障碍）中均有效。例如，在治疗成年人抑郁症方面，系统治疗被证明优于无附加治疗（赫奇斯g值：1.09，95%置信区间[0.78；1.40]）。
系统治疗拓宽了精神障碍的治疗选择范围，特别关注其社会背景。
