Development of Family Therapy and Systemic Therapy

Contemp Fam Ther (2013) 35:349363
DOI 10.1007/s10591-013-9267-1
ORIGINAL PAPER
Development of Family Therapy and Systemic Therapy

in Germany
Rudiger Retzlaff
Published online: 16 April 2013

Springer Science+Business Media New York 2013
Abstract The roots of systemic therapy in Germany date back to the sixties. Systemic
therapy is one of the most widely applied forms of psychotherapy and counseling in
Germany. The majority of therapists and counselors in child guidance centers, couples
therapy counseling centers and youth protective services have been trained in systemic
therapy. A high number of clinical psychologists, social workers and medical doctors have
received training in this model of therapy. In the beginning, multigenerational, experiential, as well as structural-strategic and Milan systemic approaches were popular. Today, the
post-modern systems concepts, solution-oriented and narrative approaches and self-organization theory appear to be predominant. Some centers provide research and training in
behavioral and psychodynamic family and couples therapy. However, systemic approaches
are clearly leading the field with over 10,000 people who have received systemic training
and about 150 training institutes across the country. The critical attitude shared by many
leading figures towards empirical research has limited its success in university programs.
In addition, training is usually provided in the form of post-graduate courses rather than at
academic institutions. Currently, three journals and one online-journal publish articles on
various systemic topics. Many publishing houses have a series of books on systemic
therapy and one publishing house specializes exclusively on systems oriented books. In
2008, systemic therapy gained recognition as an evidence-based treatment. Four years
later, the appropriate authorities have not initiated the process of assessing it as a treatment
paid for by public health insurances. In consequence, systemic therapy is not available on a
large scale in the public outpatient psychotherapy system. Some additional remarks are
provided on the history and current situation of systemic therapy in Austria and
Switzerland.
Keywords
Family therapy Systemic therapy Germany History
R. Retzlaff (&)
Director of the Clinic of Marital and Family Therapy, Institute for Collaborative Psychosomatic
Research and Family Therapy, Heidelberg University Hospital, Bergheimer Str. 54, 69115 Heidelberg,
Germany
e-mail: Ruediger_Retzlaff@med.uni-heidelberg.de
URL: http://www.med.uni-heidelberg.de/psycho/pfam; http://www.ruediger-retzlaff.de
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A Brief Overview of the History of Family Therapy in Germany

The 1960s
Similar to the USA, psychoanalysts played an important role in the development of family
therapy in Germany. Many people hold the view that it was introduced in our country by
Helm Stierlin. Yet in 1963, Horst-Eberhard Richter, who worked at Gieen University
Hospital, published a book on family therapy from a psychoanalytical perspective (Richter
1963). He did not become interested in systems concepts and did not pursue family therapy
to a larger extent (Richter 1970). Rather, Richter became involved in group therapy and the
application of ideas from psychotherapy to political affairs and social politics. In 1965,
Eckhard Sperling, a child and adolescent psychiatrist from Gottingen University Hospital
presented his work on the family dynamic of adolescent anorexic patients for the first time
(Sperling 1965). He later founded a psychodynamic-systemic integrative model (Sperling
et al. 1982).
Experiential approaches to family therapy were quite compatible to views held by
many humanistic therapists. In the late 1960s, Gerd Muller, who originally had done
research on behavioral parent training programs at the Max Planck Institute of Psychiatry
in Munich, became interested in family therapy (Muller and Moskau 1983). Together
with Gaby Muller, a Canadian social worker raised in a Czech-German-Jewish family in
Prague, who had survived a number of concentration camps as a young girl, he started to
invite Virginia Satir and the Duhls for workshops. He founded the first formal family
therapy training institute in 1974 in Germany in Munich, which stills exists today.
Around the same time, Martin Kirschenbaum and Carol Gammar started to teach family
therapy in various cities across the country and continued to do so for many years. Maria
Bosch, who had received her family therapy training from Satir, Kempler and
McClendon, also invited Satir and the Duhls for conferences and workshops. She
founded her highly successful family therapy institute in Weinheim in 1974 (Bosch
1983). However, in 1985 she withdrew and started to teach at her new training center in
Weinheim.
The 1970s
In the early seventies, a group of behavior therapistsLudwig Schindler, Kurt Hahlweg,
and Dirk Revenstorfconducted research on behavioral couple therapy at the Max Planck
Institute of Psychiatry in Munich (Schindler et al. 1980). Hahlweg had spent a year at the
Department of Psychology and Neuropsychiatric Institute in Los Angeles and worked until
his retirement at the University of Braunschweig. There he conducted research on
behavioral couple therapy, expressed emotion, and behavioral family therapy approaches
in the treatment of severe mental disorders such as psychosis and bipolar disorder (Hahlweg et al. 2000).
The key event for the development of systemic family therapy in Germany was the
foundation of the Department of Psychoanalysis and Family Therapy by Helm Stierlin in
1974. He had accepted the position as the first and to this day only university chair of
family therapy in the entire country. Since 1957, Stierlin had worked in the USA, mostly in
Chestnut Lodge/Maryland. After an interlude from 1963 to 1965 in Switzerland and study
periods in New Zealand and Australia, Helm Stierlin became a member of the National
Institute of Mental Health, where he worked together with Lyman Wynne and Margaret
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Singer. He was invited to Heidelberg by psychoanalysts, but differentiated quickly by

quoting in his introductory lecture at the University of Heidelberg Haleys work on his
understanding of psychoanalysis (Duss-von-Werdt 1991; Stierlin 2001).
Stierlin attracted a group of highly talented young people. All of them were to become
the leading group of systemic therapists in the country in the subsequent years. Throughout
the years, a number of brilliant and successful people worked in his department for some
time. Characteristic for Stierlins style of leadership was the encouragement of individuality of his team members. His first team consisted of the late Ingeborg Rucker-EmdenJonasch, Fritz Simon, Gunthard Weber, and Michael Wirsching. Wirsching later moved to
Gieen, and then to University Medical School in Freiburg where he now teaches as
professor of psychosomatic medicine. For a long time, he was the only disciple of Stierlin
who held a regular chair as university professor. Gunther Schmidt and Bernhard Trenkle,
two former students of Stierlin, joined his group and were later replaced by Arnold Retzer,
Andrea Ebbecke-Nohlen and Jochen Schweitzer. Schweitzer had been an intern for a year
at the Cambridge Guidance Center at Harvard Medical School. All members of the
Department of Psychoanalytical Basic Research and Family Therapy published extensively, particularly on family therapy for clients with anorexia nervosa, psychosis, and
family dynamics in general (Stierlin 1978; Stierlin and Simon 1984). Stierlin attracted high
numbers of students to his lectures. Additionally, he and his wife Satuila Stierlin invited
most of the leading family therapists from the USA and Europe to Heidelberg. Originally
starting as psychoanalysts, under the influence of the Milan group, Stierlin and his
department shifted away from psychodynamic concepts to Milan style systemic therapy. In
1983, Stierlin and his associates founded a private training institute, Internationale
Gesellschaft fur systemische Therapie (i.e. IGST: International Society of Systemic
Therapy). This institute started a highly successful postgraduate training in systemic
therapy and a series of large international conferences. For many years, members of the
Milan group and Boscolo and Cecchin in particular came to Heidelberg to teach at the
IGST. While the IGST was a key to disseminating systemic therapy in Germany, training
activities withdrew energy from university matters. As a result, Stierlin invested less time
on internal university politics, which was to have serious consequences for the future of his
department.
In subsequent years, Gunther Schmidt and Bernhard Trenkle, who had briefly been
affiliated with the department of Helm Stierlin, became interested in the work of Milton H.
Erickson and founded their own Ericksonian training institutes. Hypnosystemic therapy
is an integration of systemic therapy, hypnotherapy and self-organization theory. It has
become a mainstream form of systemic therapy in Germany, which is also widely applied
for use with individuals in therapy (Schmidt 2004). While systemic therapy in Germany
has been shaped by postmodern approaches, Trenkle remains, apart from the author, the
trainer with the strongest affiliation to strategic concepts of Haley and Madanes. Another
influential hypnosystemic therapist, with a strong experiential touch, is Nemetschek
(2006). He trained with Satir and M. H. Erickson and later founded a training institute in
Munich in 1978.
One of the first trainees at the Weinheim Institute was Hans Jellouschek, who founded
with his late wife the Family Treatment Center at the Center for Psychotherapy in Stuttgart.
As a close friend of Rosmarie Welter-Enderlin, he developed a humanistic-systemic form
of couple therapy and published more than sixteen extremely popular books on couple
therapy. This made him the most influential couple therapist in the country (Jellouschek
2005; Welter-Enderlin and Jellouschek 2002).
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The 1980s
In the 1980s, during the aftermath of what is called the second cybernetics, the systemic
field moved away from structural-strategic, multigenerational, and experiential approaches.
In accordance with ideas by Dell, Maturana, and Varela. Nicolas Luhmann presented a
sociological systems theory in 1984 which continues to be highly influential in Germany.
Distinguishing between the three classes of autopoietic systems: organismic life, consciousness, and communication, which are intertwined yet independent, Luhmann maintained that systems can neither be predicted nor be influenced in a directive, linear way.
In 1985, Manfred Vogt who had trained in Heidelberg, started to offer solution-oriented
therapy at his training institute in Bremen. In the subsequent years, Steve de Shazer, was
regularly invited as a trainer by him, well as by Gunther Schmidt in Heidelberg.
In 1987, Marie-Luise Conen founded her training Institute in West-Berlin. She had
studied at Temple in Philadelphia and participated, together with the author of this article
in the last training with Boscolo and Cecchin at the IGST. Over time, she invited a large
number of American, British, and Italian pioneers to teach at her institute. Based in
structural and Milan systemic approaches, she published a large number of articles and
books on families in poverty, systemic therapy within residential centers for children and
adolescents, and home-based family therapy. Conen has to be credited for first establishing
home-based family therapy in Berlin. After changes in social legislation throughout the
country, it is now routinely offered by most Child Guidance Centers and by many youth
protective services (Conen 2002).
The 1990s
When Stierlin retired in 1991, there were plans to close his department and integrate it into
the Psychiatric and the Psychosomatic University Hospital. At this time, Jochen Schweitzer
moved to the Department of Medical Psychology at Heidelberg University Hospital. In the
department of family therapy, he was succeeded by the author, who continued to run the
outpatient clinic and courses in systemic family therapy from 1995 forward. Since that
year, the Clinic of Marital and Family Therapy has provided systemic therapy, especially
for families with medical concerns (Retzlaff 2010). The author received post-graduate
training in MFT at the institute of Kirschenbaum, with supervision from the MRI group.
He also had training at the Philadelphia Child Guidance Clinic, as well as from Boscolo
and Cecchin. He has worked with Hans Jellouschek and Roland Weber in Stuttgart and
trained with Fritz Simon, Gunther Schmidt, Gunthard Weber, Ingeborg Rucker-EmbdenJonasch, Welter Enderlin, and Hunter Beaumont. After intensive lobbying by Gunthard
Weber and others, in an unprecedented move, the state secretary of science and education
insisted that a new professor of family therapy must be hired, overruling the autonomy of
the university for the first time in decades. He strongly urged the university medical school
to maintain the department of family therapy and to appoint a family therapist as the chair.
In 1998, Cierpka, the successor of Sperling at Gottingen University Hospital, who had had
been trained as a psychoanalyst in Ulm, became the new chair of the renamed department,
with the long name, Institute for Collaborative Research and Family Therapy. Cierpka
became known by the German version of the family assessment device, a handbook of
family diagnostics (Cierpka et al. 2005) and for his work on family therapy with eating
disorders. Cierpka and the author share an interest in family systems medicine and together
published a textbook on this topic (Cierpka et al. 2001). In the subsequent years, the
department has been highly successful with a series of high-profile, highly visible
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programs such as the German version of Second Step, parent-infant therapy according to
the model developed by Papousek, and an early intervention program for high risk families
with infants. In 2000, Astrid Riehl-Emde, a psychodynamic and systemic couple therapist
who had worked with Jorg Willi in Zurich, joined the department and started projects on
marital therapy with elderly couples.
In 1992, Kurt Ludewig founded a systemic institute in Hamburg and published one of
the first textbooks on systemic therapy. Two years later in 1994, Jurgen Kriz, from the
University of Osnabruck, applied post-Milan ideas and Rogerian concepts to the practice of
systemic therapy. All of these changes resulted in a strong bias towards cognitive and
verbal phenomena in systemic therapy. It also brought extreme skepticism towards any
form of empirical research, which was considered to be an epistemological error. This view
is still held by the majority of leaders in systemic therapy in the country and as a consequence, it makes it rather difficult to succeed in the academic field.
In 1996, von Schlippe from the University of Osnabruck and Schweitzer, published a
successful textbook on systemic therapy, which is virtually read by anyone interested in
systemic therapy. This textbook received 10 editions and has been translated into a variety
of languages (von Schlippe and Schweitzer 2012). It describes all systemic approaches,
particularly solution-oriented therapy, narrative approaches and self-organization theory.
Less credit is paid to more traditional family therapy approaches including structuralstrategic approaches which were considered to be old-fashioned, which means that a
generation of systemic therapists have been trained with comparatively little knowledge of
the more pragmatically oriented schools of systemic therapy. A second textbook on systemic treatment of various disorders by the authors (Schweitzer and von Schlippe 2006)
received much praise and some criticism, as some systemic therapists consider it to be
inadequate to take a nomothetic position as a systemic therapist.
Realizing that non-directive play therapy is more effective if the family is involved in
treatment, Schmidtchen (1999) from Hamburg developed an integration of Rogerian and
systemic family therapy.
As in the USA in the 1990s, feminist issues in family therapy were widely discussed and
two members of the IGST (Rucker-Embden-Jonasch and Ebbecke-Nohlen 1992) addressed
the related issues in writing and teaching.
In the German Democratic Republic, Scholz had started to work with families in the
Dresden Hospital of Child and Adolescent Psychiatry even before the unification of the two
German states. His interest intensified after the family therapy conference in Hungaria in
1988 where he met Minuchin, Stierlin, Weber and many others. Together with Eia Asen
from London, he pioneered multi-family groups for young anorexic patients, and this
format is now widely used, including countries such as Sweden and Norway.
For more than a decade, clinical psychologists had pushed for a better status in the
public health care system. Two publications were highly important for the destiny of
systemic therapy and its position in the health care system. In a report to the Federal
Ministry of Health Affairs, published by Klaus Grawe together with psychodynamic
researchers, behavior therapy, psychodynamic therapy and psychoanalysis were recommended as evidence-based treatments but systemic therapy was not (Meyer et al. 1991). In
a more concise meta-analysis, Grawe et al. (1994) concluded there were not enough studies
supporting systemic family therapy as an evidenced-based treatment, stating instead that
there were promising data and the status might be different if more studies were available.
Grawe et al. were also highly critical about the evidence base of psychodynamic therapy
and psychoanalysis, much more critical than in the 1991 government report in which
Grawe had co-authored.
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In an attempt to gain recognition as an evidence-based treatment, Schiepek (1999)

published a somewhat imprecise report on randomized trials on systemic therapy. This
report was submitted by the German Society for Systemic Therapy and Family Therapy
(i.e. DGSF: Deutsche Gesellschaft fur Systemische Therapie und Familientherapie) and the
Systemic Society (i.e. SG: Systemische Gesellschaft) to the Federal Scientific Advisory
Board (i.e. WBP: Wissenschaftlicher Beirat Psychotherapie). Any form of psychotherapy
which is not part of the recognized treatments need approval by the WBP, before the Board
of Health Care Providers (i.e. GBA: Gemeinsamer Bundesausschuss) can even consider if
they will start a second, independent rigorous assessment. To the dismay of many systemic
therapists, this move was rejected by the WBP because of an insufficient data base.
Subsequently, all forms of family therapy were banned (and still are) from reimbursement
from the health insurance system of state and city officials (Beihilfe) and in the training
regulations of psychiatrists, child and adolescent psychiatrists and doctors of psychosomatic medicine. Only behavior and psychodynamic therapies and psychoanalysis were
considered a valid form of psychotherapy. In contrast, systemic therapy was not included.
Schiepek, who had for some time been intrigued by the paradigm of synergetics, started to
use this paradigm for psychotherapy process research. He now teaches at the University of
Krems.
After the cognitive turnaround of systemic therapy and the fashionable neutral stance
required of therapists, many of the multigenerational aspects, emotional relatedness and
meaning had been lost. In this context, Weber (1993) published a book on family constellations, developed by Bert Hellinger, which immediately became very popular. Hellinger, a former Catholic missionary to South Africa, who had been ousted from
psychoanalytic training in Vienna because of his unorthodox views, received training in
group therapy and Ericksonian therapy. He combined some ideas from Boszormenyi-Nagy
with a particular form of family sculptures, and his own theoretical systems orders of
love. Family constellations address the inner representation of family systems, within a
large group context, in a format which can be regarded as a form of healing rituals.
Hellinger never worked with families and did not use systemic concepts. Nonetheless, it
was called systemic and quickly turned into a mass movement, with many group therapists,
humanistic therapists and people with a health care license started to conduct large group
workshops across the country. The book was translated into many languages (Hellinger
et al. 1998) and Gunthard Weber conducted workshops around the world. Like in the 1970s
when Satir was criticized that her large group workshops on family sculpting were damaging to the reputation of family therapy, many systemic therapists were discontent with
family constellation work. Eventually, the DGSF and SG published at joint statement in
which they made clear that family constellations (as practiced by Hellinger) violated many
professional standards. Today, the movement has subsided, and family constellations are
regarded as a specific technique which can be used within a systems framework. Weber
and Schweitzer are currently making an attempt to probe its effectiveness as a therapeutic
tool in a study on treatment effects of family constellations.
After 2000
For a couple of years in the late nineties, the IGST in Heidelberg was shaken by internal
conflicts between the younger and older members of the group, and many of the former
trainees were unpleasantly reminded of a painful divorce conflict between parents. After
a stalemate that lasted several years, which crippled the productivity and creativity of its
members, the group split. Retzer soon founded his own institute, and the younger members
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Fischer, Gester, and Clement remained in the IGST. With support from Stierlin, Simon,
Schmidt, Weber, the late Rucker-Embden-Jonasch, Schweitzer and Ebbecke-Nohlen
founded the Helm Stierlin Institute (HSI) in Heidelberg, and later invited Nicolai, KindlBeilfuss, Reinhard and the author to join the HSI, which continues to operate as a highly
visible, successful post-graduate training institute.
Another more recent trend is an increasing interest in children and adolescents in
systemic therapy. With the largely verbal and cognitive orientation of systemic therapy in
the 1980s and 1990s, children somehow vanished from popular textbooks, and their needs
were not adequately addressed in training. After a few critical articles on the neglected role
of children in systemic therapy, the author published a series of articles and initiated a
special curriculum of systemic therapy with children and adolescents. Therapists such as
Wilhelm Rotthaus, Manfred Vogt, and Therese Steiner have published numerous books on
systemic therapy with children. A textbook on this topic by the author has received five
editions within just 4 years (Retzlaff 2012).
In recent years, along with changes in social structures and parenting styles, similar to
many other countries, parental helplessness became an issue in Germany. von Schlippe
started to invite, teach and publish with Haim Omer, a Brazilian-born psychologist who
now teaches in Israel. His ideas about coaching of parents became rather popular among
German systemic therapists because of its non-authoritarian stance. Ironically, while the
work of Minuchin is largely ignored today, rather similar concepts have been re-introduced
by this approach (Omer and von Schlippe 2003).
Only gradually does the German society realize the challenge posed to the health care
system by migration and the high number of citizens who have migrated to Germany.
Currently, about 35 % percent of children and adolescents have parents who were not born
in the country. Consequently, the number of publications on culturally sensitive systemic
therapy is on the rise (von Wogau et al. 2004).
In 1985, Helm Stierlin visited and taught systemic therapy in China. The ChineseGerman Academy of Psychotherapy (Deutsche-Chinesische Akademie fur Psychotherapie)
promoted regular trainings in systemic (and other forms of psychotherapy) and in the past
decades, a considerable number of systemic trainers volunteered to work in the Baltic
States, Poland, Slowenia, and other countries in Eastern Europe.
Couple and marital therapists in Germany tend to be an integration of systemic,
humanistic, and some psychodynamic and behavioral elements. Only recently, emotionally-focused therapy is becoming more known in Germany, and Volker Thomas from the
University of Iowa has carried out the first training workshops at the Department of
Collaborative Research and Family Therapy in Heidelberg in 2010 and 2011.
In 2004, after joining AFTA and participating in the Miami conference on children in
family therapy, the author brought home the idea that there are indeed a sufficient number
of randomized controlled trials (RCT) on systemic therapy to convince the WBP to recognize it as an evidence-based treatment. Together with Stefan Beher, a talented young
masters degree student, and Jochen Schweitzer, he founded a working group which was
joined by Kirsten von Sydow, formerly from the University of Hamburg, who had compiled a similar number of RCT on the effectiveness of systemic therapy, in order to get
recognized as an evidence-based treatment approach. In the beginning, the DGSF and SG
were highly reluctant to pursue another attempt for scientific recognition. As a matter of
fact, at a 2004 conference in Potsdam, the SG had even discussed dropping any attempt to
gain scientific recognition as meaningless. Then, an official of the internal revenues office
requested payment of 17 % value added tax from systemic training institutes, on the basis
that they did not provide education in a form of scientifically recognized psychotherapy
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(which is tax exempt) and rapidly, the professional organizations supported the working
group. The group prepared a series of articles and scientific reports to the Board of
Scientific Examiners in Berlin (von Sydow et al. 2006, 2007a, b, 2010). Kirsten von Sydow
was invited to present the evidence-base as a deputy member of the board, without formal
right to vote. In the meantime, the author continued to find additional RCT with support
from Beher, Schweitzer and a number of doctoral students. The authors idea to search in
Chinese databases with the help of Zhao Xudong from Tongji University in Shanghai and
Joyce Ma from Hong Kong, and Chinese doctoral students working at our departments was
a breakthrough. Eventually, in December 2008, the president of the WBP declared systemic therapy to be an evidence-based treatment. Ironically, this was the same person who
had wanted to close Stierlins department in Heidelberg. In the past 4 years, the author has
continued to work and publish on the evidence-base of systemic therapy in order to meet
the requirements of the German health insurance systems (Retzlaff 2009a, b). von Sydow
now teaches at the Psychological University in Berlin (PHB).
The Situation Today

Family therapy approaches flourish in a few other university hospitals. In Freiburg,
Wirsching continued to work with anorexia nervosa and psychosomatics, was involved in
family systems medicine, and published an edited textbook on marital and family therapy.
For the Working Group on Scientific Medicine (i.e. AWMF: Arbeitsgemeinschaft Wissenschaftliche Medizin), he also published the guidelines for couples and family therapy
(Scheib and Wirsching 2004). In Gottingen, Gunther Reich, who had worked with Cierpka,
continues to treat and study families with eating disorders. Friedebert Kroger started to
work at Aachen University Hospital and now directs a hospital in Schwabisch Hall. Previously, he had worked with Werner Herzog in Heidelberg at the Psychosomatic Unit of
the Department of Internal Medicine on family therapy with anorexia nervosa and the
circumplex model. With Askan Hendrischke, and Susanne Altmeyer, Kroger started to
invite Susan McDaniel and published a number of books on family systems medicine
(Kroger et al. 2000).
In the United States, a number of well-researched, manualized treatments such as Brief
Strategic Family Therapy, Functional Family Therapy, Multidimensional Family Therapy
(MDFT), Multisystemic Therapy (MST) have been used extensively. In an international,
multi-centered study in Belgium, France, Netherlands and in Berlin/Germany, MDFT was
implemented (Tossmann et al. 2010) and a number of groups started to use MST, especially in Switzerland (Furstenau and Rhiner 2010). The majority of those employed by
youth protective services and drug counseling centers already have some training in systemic or other forms of therapy. At this point, these trademark therapies were not or are
only partially superior to treatment as usual. Government authorities seem to be reluctant
to pay for the expensive training and license. Also, as systemic therapy cannot legally be
practiced in outpatient settings, the advance of any of these approaches is limited by the
lack of recognition by the board of health insurers.
Renaissance of therapy supported by video-feedback, which can be found in parentinfant therapy, is another more recent trend. This usually has a strong systemic foundation,
as well as in approaches such as Marte meo which were originally developed for families
with autistic children. However, it is now commonly used in a variety of settings such as
child guidance centers (Bunder et al. 2009).
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In recent years, a number of systemic therapists have started to teach at Universities of

Applied Science where social workers and educational specialists are being trained. Simon
and von Schlippe held a chair on Family Business at the University Witten-Herdecke, and
Jochen Schweitzer has been working on the organizational theory of medical hospitals. In
addition to teaching hypnosystemic therapy, Gunther Schmidt has worked in organizational consultation. He has also founded a flourishing private hospital, near Heidelberg
systelios, which is based on his hypnosystemic approach.
Systemic Therapy in Austria and Switzerland

In Austria, starting in the 1970s, Ludwig Reiter worked and taught at the renown Institute
for Marriage and the Family in Vienna. In Switzerland, Gottlieb Guntern, who had spent a
sabbatical at the Philadelphia Child Guidance Clinic, started to train family therapists in
the late 1970s. In 1967, Duss-von-Werdt founded the Institute of Marriage and the Family
in Zurich, which was later headed by Jorg Willi. Willi was a psychiatrist from Burgholzli
Hospital near Zurich who had developed his ecologically based marital therapy (Stierlin
and Duss-von-Werdt 1985). Rosmarie Welter-Enderlin headed the highly influential
Meilen Center. She had lived in the USA and trained with Haley and Patterson and
maintained close contact to the American Academy of Family Therapy and to her friend
Evan Imber-Black. She also promoted a humanistic-systemic couple therapy with a strong
narrative foundation. Part of the success of her team in Meilen was a series of regularly
held conferences to address specific aspects of systemic therapy. With Ulrike Borst as the
new head, the center has now moved to Zurich and cooperates with the institute which
Willi had founded. Guy Bodenmann at the University of Zurich has been researching and
teaching behavioral couple therapy for the past few years. In Bern, Liechti and Zbinden
provide comprehensive systemic training for therapists.
Journals and Publishers

There are three German language journals on systemic therapyFamiliendynamik (Family
Dynamics), founded by Stierlin and Duss-von-Werdt, Zeitschrift fur systemische Therapie
(Journal of Systemic Therapy) founded by Hargens, and Kontext (context), the journal of
the DGSF. System Familie (family system), founded by Rosmarie Welter-Enderlin, was
discontinued, but Psychotherapie im Dialog (dialogues on psychotherapy) discusses in
every issue various topics from the perspective of different psychotherapy approaches,
including systemic therapy. In 2005, Tom Levold, from the Psychoanalytic-systemic
Training Institute in Cologne started systemmagazin, an online-journal of systemic therapy
which is used by many therapists.
Most large scientific publishing houses have series on systemic therapy. An influential
publisher is Carl Auer Verlag in Heidelberg, originally founded by members of the IGST,
which is now owned by Weber, Simon and Trenkle, which has a large number of titles on
systemic therapy. Most scientific publishing houses such as Hogrefe, Jungermann, KlettCotta, Kohlhammer, Springer, Thieme, Vandenhoek and Ruprecht have a series of books on
systemic therapy as well. Two textbooks on systemic therapy have been highly significant
and have shaped the way systemic therapy is practiced and taught (Retzlaff 2012; von
Schlippe and Schweitzer 2012). With so many fine books available in German, and a
reluctance of many publishing houses to translate books because of the costs involved, many
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systems therapists as well as post-graduate training programs rely more on German language books than on books in English, which were previously used in the 1970s and 1980s.
Conferences
In 1994, Bernhard Trenkle brought the Evolution of Psychotherapy Conference to Hamburg, and a large number of therapists had a first-hand chance to meet many of the
international pioneers of family therapy. Trenkle organized other important conferences on
family therapyfor instance, one held in Karlsruhe with pioneers of the field, (1988) one
in Heidelberg (2004) with Minuchin, in cooperation with the Department of Family
Therapy. A popular conference is Trenkles Kindertagung, a conference on hypnotherapy and systemic therapy with children held every 4 years in Heidelberg.
Both DGSF and SG conduct annual conferences, with 3001200 and 300600 participants, respectively. Every 4 years, Trenkle organizes a conference in Heidelberg on
hypnotherapeutic and systemic approaches for children and adolescents, with about 1,200
participants. The biannual systemic research conference organized at Heidelberg University Hospital by Schweitzer attracts about 180300 people. In 2004, Ludewig organized the
EFTA-conference in Berlin, which was visited by way over 5,000 participants.
Systemic and Family Therapy Within the Current Medical and Social Services
Systems
In 2005, approximately 10,000 therapists had received a systemic training certificate. In
different German states, between 16.5 and 37 % of licensed psychotherapists have also
been trained as systemic therapists, and 55.9 % of counselors at child guidance centers are
systemic family therapists (von Sydow et al. 2007a, b).
Counseling services to adults including couples counseling are provided by agencies run
by charity organizations of the churches or other welfare organizations child guidance
work and child protective services are provided in counseling centers run by the cities or by
charity organizations, which are regulated by the Federal Children and Youth Protective
Services Act. They are funded by the administration of cities and counties. The vast
majority of people working in child guidance centers and the youth protective agencies
have obtained systemic training.
Health care servicesincluding psychotherapyfor people with and without a job are
being paid for by public health insurances and regulated by federal law. State employees
and people with a higher incomes can opt for private health care organizations which are
regulated to a lesser extent by federal law. When clinical psychologists gained access to the
public health insurance system in 1999, after an initiative by the Federal Minister of Public
Health who happened to be a professor of psychology from Heidelberg, only psychodynamic therapy, psychoanalysis and behavior therapy were considered to be evidence-based
treatments, but systemic therapy was not included on that list. Today, therapists may treat
patients with behavior therapy or psychodynamic therapy and involve relatives, but they
must not call it systemic or family therapy. Systemic (family) therapy is not covered by
health insurances, but it can be provided in inpatient settings.
To legally practice any form of psychotherapy, a state license either as an MD, as
clinical psychologist/psychotherapist or as a child and adolescent psychotherapist is
required. To regulate the thriving market of alternative medicine, there is another, legally
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inferior license as a health practitioner, many of whom offer some form of systemic
counseling. Medical doctors can specialize as a psychiatrist, child and adolescent psychiatrist or as a doctor in psychotherapeutic medicine, with 240 h of theory and four cases
treated with family therapy. This training clearly is insufficient to learn how to treat
families. Psychologists, after a bachelors and masters degree, receive 600 h of courses in
theory and 2,800 h of clinical practice. In addition, they will have about 812 h theory in
family and couple therapy. This also applies to training as a child and adolescent psychotherapist, which is also open to various professions with a masters degree who work
with children (i.e. educational specialists, etc.).
Training in Systemic Therapy

Universities generally provide only very limited courses on systemic therapy, usually as
part of a master degree program in clinical psychology. After the Bologna reform of
university education, some of the Universities of Applied Sciences have started to offer
programs in systemic social work, systemic supervision and the like, but these do not
qualify participants for the practice of systemic therapy. While systemic therapy is highly
popular with many practitioners, it has not entered into the university programs to a large
extent. Most training programs in Germany have a strong lenience towards post-constructivist rather that pragmatic, empirically-based approaches of systems oriented therapy
which means that systemic training and practice differs to a considerable extent from
countries such as the USA.
Training in systemic therapy is provided by about 150 private post-graduate institutes.
After 3 years training in systemic therapy or in systemic counseling, participants receive a
specialized certificate. Training consists of the following requirements: 300 h of theoretical
teaching, 150 h of supervision, casework, and peer groups, 150 h of systemic self-experience, written presentation of cases and a colloquium or a written presentation.
Training for specialization as a psychiatrist, child and adolescent psychiatrist or medical
psychotherapist requires about 240 h of psychotherapy theory. Only recently, some state
boards of medical examiners accept training in systemic therapy as valid hours. Kroger,
together with Herzog, founded a 100 h training program in family therapy for medical
doctors, which is based in Heidelberg.
In three out of 16 states of the Federal Republic of Germany, psychologists and child
and adolescent psychologists with a state license can obtain a formal recognition as a
systemic therapist, which is currently not yet honored by health insurances.
Although behavior therapists such as Revenstorf, Hahlweg, and Schindler worked and
researched behavioral couple therapy, there is no formal training and no professional
organizational group of behavioral family therapists in Germany. Following Richter,
psychodynamic family therapists from Gieen, Gottingen, Munich, and Heidelberg offer
training in psychodynamic family therapy in five training centers.
Accreditation Standards for Training Programs in Family Therapy

In order to get recognition, programs must be a member of one of the two systemic
organization (DGSF or SG). Training must last a minimum of 3 years with at least two
certified trainers/supervisors. The training must be continually evaluated in the process.
Maintenance of standards of training is assessed at regular intervals by external evaluation.
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Specialized Qualification and Certification for Family/Systemic Therapy

Practitioners
A number of specialized qualifications are available, all of which require supervised case
and peer group work as well as a varying amount of theoretical training: systemic therapy
with children (150 h of theory), systemic coach (250 h of theory), systemic mediation
(160 h of theory), systemic supervisor (250 h of theory). To qualify as a certified teacher of
systemic therapy, systemic therapy with children, systemic supervision or systemic
coaching, 5 years of practice and teaching and 5 years of experience and teaching are
required. A number of institutes offer 23 year training programs in systemic therapy with
couples, with 200 h of supervision and case work; however, no formal certificate is
offered. The criteria seem somewhat outdated, and in contrast to Anglo-American training
institutes, live supervision as well as observation of senior teachers doing case work is not
nearly as established as in other countries.
Relationship of Family Versus Couple/Marital Therapy

A 2 year long integrative psychoanalytic family therapy training exists, which includes a
considerable amount of systemic and structural elements. Professional organizations of
behavior therapists insist that all forms of pragmatic, evidence-based family therapy are
not systemic therapy but a form of behavior therapy. However, behavioral training institutes hardly offer any training in any form of marital or family therapy. A large number of
psychotherapists with a state license in behavior therapyand a smaller number with a
license in psychodynamic therapyhave received additional training at one of the systemic training institutes and will integrate both in their practical work (which is not legal).
Some people believe that sooner or later, a form of general psychotherapy will be taught
and practiced, which would include all forms of evidence-based psychotherapy, including
systemic therapy, but this scenario seems to be rather far away.
Professional Organizations for Family/Systemic Therapists

The German Society of Systemic and Family Therapy (DGSF, www.dgsf.org) is the largest
organization, with about 4,500 individual memberspsychologists, social workers, medical doctors; about 100 training centers are institutional members. Traditionally, the DGSF
has an integrative-systemic orientation, which is reflected in the journal Kontext for
members of the DGSF. About 25 special interest groups (such as systemic work in
psychiatric institutions) reflect the diversity of the members. The Systemic Society (i.e.
SG: Systemische Gesellschaft, www.systemische-gesellschaft.de) has about 900 individual
and 41 training centers as institutional members. Traditionally, it has a strong post-Milan
constructivist orientation. Both DGSF and SG cooperate on many levels. The Federal
Association Psychoanalytical Family Therapy (i.e. BVVP: Bundesverband Psychoanalytische Familientherapie, www.bvppf.de) has about 240 individual members and five
training centers as institutional members.
AS;
There is an Austrian Society for Systemic Therapy and Research (i.e. O
www.oeas.at) and a Swiss Union for Systemic Therapy and Counseling (i.e. Systemis,
www.systemis.ch).
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Future Directions for Family Therapy Practice, Training, and Recognition

in Germany
Future developments will depend on the larger sociopolitical influences. Generally, change
in the health care and the university system is exceedingly slow. In the 5 years since
systemic therapy has been recognized as an evidence-based treatment, the board of health
care providers has contemplated if they will start with an independent evaluation process.
Evaluation of systemic therapy with adults will take 35 years; only afterwards, a formal
evaluation of systemic therapy with children and adolescents could commence, which
would take an additional 35 years.
Within the next 610 years, universities might start a new type of training in both
clinical psychology and psychotherapy on a model similar to training in medicine, which
would lead directly towards a state license. This would be followed by 23 years of special
psychotherapy training offered at private and state schools of professional psychotherapy.
Possibly, this training could be based on some sort of an integrative psychotherapy model.
Another scenario is that, in case of a rapid decline of the social and health care system in
the aftermath of the current financial crises, psychotherapy might be dropped to a large
extent from the list of treatments paid for by public health insurance, which would be
detrimental to the practice and training of all forms of psychotherapy.
Conclusion
Systemic therapy has a long and diverse history in Germany. In contrast to the high number
of systemic therapists and post-graduate training institutes, the position within the system
of public health care remains dissatisfying. With the increasing pressure towards effective
treatments, large public health insurances will favor approaches which are resource-oriented, and provide short-term outpatient therapy instead of expensive inpatient treatment.
Systemic practitioners and the systemic professional organizations should be in an
excellent position to meet this challenge by offering various forms of systemic services, in
order make a valuable contribution to the German health care system.
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