Transcending Therapy Models and Managing Complexity: Suggestions from Integrative Systemic Therapy

• Author: William P. Russell,Douglas C. Breunlin
• Published date: 01 September 2019
• Date: 01 September 2019
• DOI: http://doi.org/10.1111/famp.12482

Transcending Therapy Models and Managing

Complexity: Suggestions from Integrative Systemic

Therapy

WILLIAM P. RUSSELL*

DOUGLAS C. BREUNLIN*

Integrative Systemic Therapy (IST) is a metatheoretical perspective for the conduct of

individual, couple, and family therapy. Following a brief description of IST, this article

presents developments in IST and their implication for psychotherapy integration. The

nature of problem solving in IST is clarified, and the relationship between IST’ s essential

problem-solving tasks and its core decision-making process is defined. Particular attention

is paid to two dimensions of IST that have given it its name: integratio n and systems the-

ory. The advantages of a therapy that is client system-centered and not model-driven are

discussed, and a justification for “good enough” execution of interventions abstracted from

specific models is provided. A procedure for balancing pragmatic demands of therapy with

a commitment to account, as needed, for broader or deeper systemic issues is presented.

Keywords: Blueprint for Therapy; Constraint; Hypothesizing Metaframeworks;

Integrative; Integration; Metatheoretical; Metaframework; Planning Metaframeworks;

Problem Sequence; Solution Sequence; System; Systemic

Fam Proc 58:641–655, 2019

The fields of family therapy and couple therapy and, more broadly, the field of psy-

chotherapy offer clinicians an overwhelming body of knowledge about human func-

tioning, therapeutic principles, common factors, clinical models, evidence-based

treatments, and specific clinical competencies. Therapists are challenged to determine

how to absorb, manage, and utilize this vast and continually evolving body of knowledge.

This challenge is further complicated by the fact that clients present with a wide variety

of concerns—and often co-occurring concerns—that are maintained by any number of fac-

tors and frequently governed by complex networks of constraints.

In addition to deciding which treatment approaches to utilize in their practice and,

more specifically, which approaches to utilize with a particular case, therapists need to

guide the overall course of therapy. Therapists committed to a model of therapy str uggle

when the strategies of their model do not produce the desired results. When what they are

doing is not working, therapists are challenged to broaden their options for intervention.

One alternative is eclecticism; however, eclectic therapists lack a set of coherent principles

that organize therapy and guide decisions on the questions of what to do and when to do

it. Today, there is a growing movement toward integrative practice in which several ther-

apy approaches are systematically combined (Lebow, 1997; Lebow, 2014; Orlinskey &

*The Family Institute at Northwestern University, Evanston, IL.

Correspondence concerning this article should be addressed to William P. Russell, The Family Institute

at Northwestern University, 618 Library Pl., Evanston, IL 60201. E-mail: wrussell@family-institute.org.

641

Family Process, Vol. 58, No. 3, 2019 ©2019 Family Process Institute

doi: 10.1111/famp.12482