While external factors (drivers) determine the net heat energy and water delivered to a stream, the internal structure of a stream determines how heat and water will be distributed within and exchanged among a stream's components (channel, alluvial aquifer, and riparian zone/floodplain). Therefore, the interaction between external drivers of stream temperature and the internal structure of integrated stream systems ultimately determines channel water temperature. This paper presents a synoptic, ecologically based discussion of the external drivers of stream temperature, the internal structures and processes that insulate and buffer stream temperatures, and the mechanisms of human influence on stream temperature. It provides a holistic perspective on the diversity of natural dynamics and human activities that influence stream temperature, including discussions of the role of the hyporheic zone. Key management implications include: (1) Protecting or reestablishing in-stream flow is critical for restoring desirable thermal regimes in streams. (2) Modified riparian vegetation, groundwater dynamics, and channel morphology are all important pathways of human influence on channel-water temperature and each pathway should be addressed in management plans. (3) Stream temperature research and monitoring programs will be jeopardized by an inaccurate or incomplete conceptual understanding of complex temporal and spatial stream temperature response patterns to anthropogenic influences. (4) Analyses of land-use history and the historical vs contemporary structure of the stream channel, riparian zone, and alluvial aquifer are important prerequisites for applying mechanistic temperature models to develop management prescriptions to meet in-channel temperature goals.