Therapy as the Ethical Resolution of Doubt: Bringing Pragmatism and Reflexive Sociology to Systemic Practice

Fam Process. 2026 Jun;65(2):e70154. doi: 10.1111/famp.70154.

ABSTRACT

What do therapists do? The question seems obvious, yet systemic therapy has struggled to answer it with the philosophical rigor that both professional identity and ethical practice require. This paper proposes a reflexive scientific practice grounded in two theoretical traditions rarely brought into dialogue with systemic therapy: the pragmatist philosophy of C.S. Peirce and the reflexive sociology of Pierre Bourdieu. Drawing on Peirce, therapy is defined not as the treatment of dysfunction but as the professional resolution of doubt-the state arising when a client’s habits of mind fail to navigate new social contexts. Drawing on Bourdieu, large-scale social forces are seen to produce the specific form of doubt Bourdieu calls hysteresis, and how unexamined therapeutic interventions risk enacting symbolic violence by imposing the therapist’s habitus under the guise of clinical expertise. Together, Peirce and Bourdieu provide what systemic therapy has long needed: a framework that simultaneously grounds clinical authority in empirical, self-correcting practice and constrains that authority through systematic interrogation of the therapist’s social position. Integrative Systemic Therapy (IST) is presented as the operationalization of this synthesis, demonstrating how its problem-centered, cost-effectiveness, and failure-driven guidelines function not merely as pragmatic efficiency measures but as ethical safeguards against symbolic violence. This framework responds to recent calls for theoretical rigor in systemic practice while addressing a dimension those calls do not fully reach: the risk that theoretical authority enacts iatrogenic harm when deployed without reflexive discipline.

PMID:42134822 | DOI:10.1111/famp.70154