Schizophrenia and schizoaffective disorders are considered to be the most severe psychiatric illnesses. While classical psychiatry focuses on the affected individuals and primarily on biological findings, systemic therapy assumes that complex interactions within the biological, psychological, and social systems contribute to the development and maintenance of these disorders. From a systemic perspective, the symptoms are fundamentally changeable, and there is hope for a life without psychosis. Gerhard Dieter Ruf describes schizophrenia and schizoaffective disorders based on typical patterns and circular processes, deriving systemic therapy principles and methods for various contexts. Suitable interventions are proposed for individual and family therapy to disrupt these patterns.