chapter  4
Psychobiological Family Therapy: Toward an Ecological Psychiatry
ByLarry Freeman, MD
Pages 26

The world of mental health practices is fraught with debate, conflict, and confusion. Nowhere is this more evident than in the contrasting practice patterns and theoretical underpinnings of family therapists and psychopharmacologists. The unfortunate result has been a “failure to communicate” or, worse, a communication that one or the other approach is “wrong.” These beliefs in the incorrectness of others’ work, and the rightness of one’s own and like-minded clinicians’, stem from conflicts of values, world views, politics, economics, and personal biases (Fancher, 1995). This state of affairs is likely to continue as long as these fundamental practices are seen to be in conflict, or even merely different yet compatible. Unless they are reconciled, this tension will continue. An alternative, a theory and clinical practice that takes a both/and approach, offers the promise that this can change. The many resources and approaches to helping troubled persons could then be integrated, complementary, and synergistic (Havens, 1973). Recent issues of the Journal of Marriage and Family Therapy and Family Systems and Health are excellent examples of this state of affairs. The JAMFT discussion centers on the issues of medication in assisting teenagers battling depression. The lead article (Sparks, 2002a,b) clearly takes a strong position of advocacy for alternatives to medication from a postmodern, narrative, feminist perspective. The author clearly and

successfully challenges many medical practices, as well as the theory and evidence that support them. In addition to advocating for the right of her 16-year-old client Amy to choose her treatment, she protests-with some validity-the marginalization of psychotherapists. Her incisive critique of the “science” of drug trials and stress upon the importance of patient empowerment in the therapeutic alliance are critically important. While vigorously distinguishing herself from medical providers, she claims that she empowers her clients, respects their choices, and does not privilege one approach over another. Unfortunately, to strengthen her argument, she creates a stereotype, “white-coated male physicians” who construct “a passive tentative single patient” and “subdue and pathologize women’s complaints” by prescribing medication. The end result is that one is left feeling one must take a side in the debate over ways to assist the troubled.