This article provides an overview of systemic therapy (ST) for children and adolescents, which focuses on the interaction between psychiatric disorders and their familial and extrafamilial contexts. The theoretical foundations (e.g. family systems theories, multigeneration perspectives, attachment theory, biopsychosocial model and moderate constructivism) and clinical practice are described. The basic attitude is strengths-, solution- and problem-focused; therapists try to understand the perspective of all involved family members. Therapy goals are collaboratively developed and therapy is flexibly carried out in various settings (e.g. individual, family and couple therapy) using interventions, such as genograms, sculptures, working at the boundaries of familial subsystems and positive reframing. The indications, contraindications, the state of research and scientific recognition as well as the implementation of ST in Germany are discussed.