An argument is made for Bhaskar's critical realism as a more coherent, accountable and enabling philosophy of practice for systemic psychotherapy than the kinds of strong constructionism and pragmatism that are currently powerful in our field. Constructionism is positioned, not as an opponent to realism in the usual way, but – in a moderate version – as a necessary partner to give realism its critical edge. The dimensions of critical realism are sketched and its potential for the coherent support of practice is illustrated with an analysis of a moment of therapeutic change. Practitioner points Critical realism supports the understanding of multiply interacting causal tendencies, from genetics to discourse, providing a new platform for eclecticism and integration and a renewed, though cautious, relationship with science. The growing split between structuralism and poststructuralism is closed by critical realism, giving the potential for systemic family therapy to become a unified field. The covert use of realism by clinicians is made accountable by critical realism.