Systemic Family Approaches to Intervention in Child and Adolescent Mental Health Problems: A Narrative Review

Öz

This narrative review examined the systemic family approaches from a theoretical comparison perspective in the context of child and adolescent mental health. Systemic approaches, which argue that psychological symptoms often reflect family dysfunctions, emphasize the role of family dynamics, emotional processes, and relational patterns in the development and treatment of these symptoms. The structural model focuses on reorganizing family subsystems, boundaries, and hierarchies to address dysfunctions, whereas the Bowen model emphasizes differentiation of self, triangulation, and the nuclear family's emotional systems and processes, including emotional reflection. The strategic model aims to restructure dysfunctional family communication patterns and roles to strengthen parental authority and emotional bonds. Clinical examples and empirical studies suggest that these models contribute to reducing symptoms and improving family functioning in children and adolescents. The information from this study suggests that systemic family-based interventions are critical to both expanding diagnostic insights and achieving lasting therapeutic outcomes using systemic change strategies in child and adolescent mental health services.

Anahtar Kelimeler

• Systemic Family Approaches
• Structural
• Bowen
• Strategic
• Child and Adolescent Mental Health

Çocuk ve Ergen Ruh Sağlığı Sorunlarına Müdahalede Sistemik Aile Yaklaşımları: Bir Anlatısal Derleme

Öz

Bu anlatısal derleme, sistemik aile yaklaşımlarını çocuk ve ergen ruh sağlığı bağlamında teorik karşılaştırma perspektifiyle ele almıştır. Psikolojik semptomların genellikle aile işlevselliği bozukluklarını yansıttığını savunan sistemik yaklaşımlar, bu semptomların gelişimi ve tedavisinde aile dinamiklerinin, duygusal süreçlerin ve ilişkisel kalıpların rolünü vurgular. Yapısal model, işlev bozukluklarını ele almak için aile alt sistemlerini, sınırları ve hiyerarşileri yeniden düzenlemeye odaklanırken, Bowen modeli benliğin farklılaşmasını, üçgenleşmeyi ve çekirdek ailenin duygusal sistemlerini ve duygusal yansıtma gibi süreçleri vurgular. Stratejik model ise ebeveyn otoritesini ve duygusal bağları güçlendirmek için işlevsiz aile iletişim kalıplarını ve rollerini yeniden yapılandırmayı amaçlar. Klinik örnekler ve ampirik çalışmalar, bu modellerin çocuk ve ergenlerde semptomların azaltılmasına ve aile işlevselliğinin iyileştirilmesine katkıda bulunduğunu göstermektedir. Bu çalışmadan elde edilen bilgiler sistemik aile temelli müdahalelerin çocuk ve gençlik ruh sağlığı hizmetlerinde hem tanıya yönelik içgörülerin genişletilmesi hem de sistemik değişim stratejilerini kullanarak kalıcı terapötik sonuçlar elde edilmesi için kritik önemi olduğunu göstermektedir.

Anahtar Kelimeler

• Sistemik Aile Yaklaşımları
• Yapısal
• Bowen
• Stratejik
• Çocuk ve Ergen Ruh Sağlığı

Kaynakça

1. 1. Yaman H, Akdeniz M. Sistemik aile hekimliği. Türkiye Aile Hekimliği Dergisi. 2011;15(2):77-80.
2. 2. Saraiva S, Bachmann M, Andrade M, Liria A. Bridging the mental health treatment gap: Effects of a collaborative care intervention (matrix support) in the detection and treatment of mental disorders in a Brazilian city. Fam Med Community Health. 2020; 8(4):e000263.
3. 3. Robinson WD, Jones AC, Felix DS, McPhee DP. Systemic family therapy in medical settings. İçinde: Wampler KS, Miller RB, Seedall RB, eds. The handbook of systemic family therapy: The profession of systemic family therapy. Wiley Blackwell; 2020:659-681.
4. 4. Ventres WB, Stone LA, Joslin TA, Saultz JW, Aldulaimi S, Gordon PR, et al. Storylines of family medicine III: Core principles—Primary care, systems and family. Fam Med Community Health. 2024;12(Suppl 3):e002790.
5. 5. American Academy of Family Physicians (AAFP). Mental and behavioral health care services by family physicians. 2024. Available at: https://www.aafp.org/about/policies/all/mental-health-services.html Erişim Tarihi: 15.07.2025
6. 6. Taş AK, Edirne T. Evaluation of primary care physicians’ approaches to mental health and diseases. Turk J Fam Med Prim Care. 2024;18(4):441-446.
7. 7. Riedinger V, Pinquart M, Teubert D. Effects of systemic therapy on mental health of children and adolescents: A meta-analysis. J Clin Child Adolesc Psychol. 2017;46(6):880-894.
8. 8. Galimidi N, Shamai M. Interactions between mental illness recovery processes in the family. Fam Relat. 2022;71(1):408-425.

9. 9. Walsh F. Clinical views of family normality, health and dysfunction: From a deficit to a strengths perspective. In: Walsh F, editor. Normal Family Processes: Growing Diversity and Complexity. New York: Guilford Press; p. 28–56.
10. 10. Xue Y. Family system and depression: Theoretical perspectives and intervention. J Educ. Human Soc Sci.2023; 22(1): 523-530.
11. 11. Jiménez L, Hidalgo V, Baena S, León A, Lorence B. Effectiveness of structural–strategic family therapy in the treatment of adolescents with mental health problems and their families. Int J Environ Res Public Health. 2019;16(7):1255.
12. 12. Weaver A, Greeno CG, Marcus SC, Fusco RA, Zimmerman T, Anderson C. Effects of structural family therapy on child and maternal mental health symptomatology. Res Soc Work Pract. 2013;23(3):294-303.
13. 13. Minuchin S, Nichols MP, Lee WY. Assessing families and couples: From symptom to system. Boston: Pearson Allyn and Bacon; 2006; s. 307-309.
14. 14. Thayyil MM, Rani A. Structural family therapy with a client diagnosed with dissociative disorder. Indian J Psychol Med. 2020;43(6):549-554.
15. 15. Feck W. A family systems approach to addressing depression in children. Int J Whole Child. 2022;7(1):63-72.
16. 16. Lindblad-Goldberg M, Northey WF. Ecosystemic structural family therapy: Theoretical and clinical foundations. Contemp Fam Ther. 2013;35:147-160.
17. 17. Gehart DR. Structural family therapy. In: Mastering competencies in family therapy: A practical approach to theories and clinical case documentation. Boston: Cengage Learning; 2018; s.204-208.
18. 18. Bowen M. Family therapy in clinical practice. New York: Aronson; 1978; s. 203-220.
19. 19. Brown J. Engaging with parents in child and adolescent mental health services. Aust N Z J Fam Ther. 2020;41(2):145-160.
20. 20. Thompson HM, Wojciak AS, Cooley ME. Family-based approach to the child welfare system: an integration of Bowen family theory concepts. J Fam Soc Work. 2019;22(3):231-252.
21. 21. Haefner J. An application of Bowen family systems theory. Issues Ment Health Nurs. 2014;35(11):835-841.
22. 22. Brown J, Errington L. Bowen family systems theory and practice: Illustration and critique revisited. Aust N Z J Fam Ther. 2024;45(2):135-155.
23. 23. Miller EA, Elder CR. Balanced parenting: Proposing a differentiation‐based parenting approach informed by Bowen family systems theory. Fam Process. 2025;64(1):e13092.
24. 24. Lebow JL, Stroud CB. Family therapy. In: Norcross JC, VandenBos GR, Freedheim DK, Krishnamurthy R, editors. APA Handbook of Clinical Psychology: Applications and Methods. New York: American Psychological Association; 2016. p. 327–349.
25. 25. Horigian VE, Anderson AR, Szapocznik J. Taking brief strategic family therapy from bench to trench: Evidence generation across translational phases. Fam Process. 2016;55(3):529-542.
26. 26. Szapocznik J, Hervis OE. Introduction. In: Szapocznik J, Hervis OE, editors. Brief strategic family therapy. Washington DC: American Psychological Association; 2020. p. 3–13.
27. 27. Sterrett-Hong EM, Karam E, Kiaer L. Statewide implementation of parenting with love and limits among youth with co-existing internalizing and externalizing functional impairments reduces return to service rates and treatment costs. Adm Policy Ment Health. 2017;44:792-809.
28. 28. Zagefka H, Jones J, Caglar A, Girish R, Matos C. Family roles, family dysfunction, and depressive symptoms. Fam J. 2021;29(3):346-353.
29. 29. Behere AP, Basnet P, Campbell P. Effects of family structure on mental health of children: A preliminary study. Indian J Psychol Med. 2017;39(4):457-463.
30. 30. Sanders A, Szymanski K, Fiori K. The family roles of siblings of people diagnosed with a mental disorder: Heroes and lost children. Int J Psychol. 2014;49(4):257-262.
31. 31. Calatrava M, Martins MV, Schweer-Collins M, Duch-Ceballos C, Rodríguez-González M. Differentiation of self: A scoping review of Bowen Family Systems Theory’s core construct. Clin Psychol Rev. 2022;91:102101.
32. 32. Neophytou K, Rodríguez‐González M. Triangulated children's reality: Medical model's concealing effect versus family systems' revealing effect. Syst Res Behav Sci. 2021;38(1):80-92.
33. 33. Satyanarayana VA, Das A, Shah A. Psychotherapy for families with adolescent children: clinical practice guidelines. J Indian Assoc Child Adolesc Ment Health. 2024;20(2):127-135.
34. 34. Gale J, Muruthi BA. Triangles and triangulation in family systems theory. In: Encyclopedia of couple and family therapy. Cham: Springer International Publishing; 2019. p. 3069-3071.
35. 35. Józefczyk A, Świętochowski W. The nuclear family emotional system: The regulatory function of symptoms according to Bowen. Psychoterapia. 2023;204:27-39.
36. 36. Papero DV. The family emotional system. Aust N Z J Fam Ther. 2024;45(2):156-167.
37. 37. Peleg M, Peleg O. Personality and family risk factors for poor mental well-being. Int J Environ Res Public Health. 2023;20(1):839.
38. 38. Wright J, Milligan R, Varcoe M. Reducing risk: navigating emotional triangles in clinical work with youth suicidality and self‐harm. Aust N Z J Fam Ther. 2024;45(2):209-217.