A MODEL FOR PSYCHIATRIC CONSULTATION IN SYSTEMIC THERAPY *

In the early decades of the discipline, many family therapists hoped that restructuring family relationships would prove curative for most psychiatric illnesses. By the end of the 1980s, however, most family therapists were acknowledging more complex perspectives, including the view that adequate explanations for psychiatric illness must often include impaired brain physiology as a contributor to psychiatric symptoms. Today, many family therapists who twenty years earlier derided psychopharmacology work collaboratively with psychiatrists who prescribe medications. However, changes in the language used to describe clinical problems often lag behind changes in clinical practice. This is particularly true in collaborations between systemic family therapists and psychopharmacologists. Systemic therapists and psychopharmacologists use quite dissimilar ways of construing a patient’s problem, and the different metaphors used to describe the problem can be fundamentally incongruous. This incongruity may be problematic for family members who are presented with language from multiple systems of meaning in the absence of any overarching description that includes all the perspectives. We are interested in the kinds of metaphors with which problems are described when family therapy and psychopharmacology are employed together. We have identified coupling metaphors that support both family therapy and pharmacological therapy as valid treatments and exclusionary metaphors that invalidate one approach or the other. We have designed a consultation model for psychiatrists consulting to family therapists wherein the psychiatrist utilizes a coupling metaphor to frame the problem whenever prescribing medications to a family member in family therapy.