PSYCHOBIOLOGICAL FAMILY THERAPY MODEL

Over the years, my intent has been to create a coherent and strategic model of health and therapy that provides for me a consistent methodology in which to reconcile psychiatric practice and systems/family therapy. Psychobiological Family Therapy is my name for the theory and practice that I have developed. It allows me to conduct traditional psychiatric services while utilizing ecosystemic assessments and interventions simultaneously. Each clinical method informs the other. The model encourages me to add new developments arising in both practices, and to continually critique my own thinking.

This effort is based on the fundamental premise of consilience, which suggests that alternative perspectives of unique disciplines may be reconciled into one unified and coherent whole, and that when this occurs it lends richness and insights hitherto unrealized. This principle manifests the phenomenon of emergence, central to the process of evolutionary change.

AXIOMS OF PSYCHOBIOLOGICAL FAMILY THERAPY

  1. Well-being is built upon connections to others which add to understanding of ourselves.
  2. The primary purpose of the evolved human brain is to connect with other people while growing to know ourselves.
  3. Emotion and reason are complementary, working together they enhance awareness and creativity.
  4. Cognitive processes are profoundly influenced by interpersonal relationships.
  5. The family triggers uniquely strong emotions throughout the life-cycle.
  6. Growth is essential to human health, health is growth.
  7. Growth in personal responsibility and mutuality defines clinical goals.
  8. Curiosity and respect are the roots of clinical merit.
  9. Participants are empowered through strength-based perspectives; recognizing the need for help reflects integrity and courage.
  10. Psychiatric diagnosis cannot be separated from context without sacrificing some degree of validity and reliability.
  11. Diagnosis seeks to de-pathologize suffering while it acknowledges vulnerability and susceptibility.
  12. Ethical issues are medical, interpersonal, and ecological.
  13. Conjoint therapy, meeting with others, creates unique opportunities for growth and healing.




Raised in Hawai’i, my earliest memories are playing at the beach, testing myself against the will of the sea. I grew up in a racial minority in a society of diverse cultures and histories, and flowed with the rhythms of respect and difference that shaped daily life. The natural world and different-ness have shaped my interests ever since.

My curiosity has guided me throughout my life. This passion led me to master subjects by locating my inherent interest in them and to find interconnections among them. The coherence and depth that arose, leading to new interests, questions, and ideas, has been my ultimate reward.

Throughout my schooling, I have always worked for my self-understanding more than for grades. My interests in both science and the humanities from the very beginning have helped me to seek reconciliation between these often-times incompatible paradigms.

I now see that this is because I wanted a balanced life of critical analysis and creative synthesis. I find balance through my love of food and its shared enjoyment, along with many sports. I continue to avidly snowboard, bicycle, surf, ski, sail, and hike. I try to bring my full energy to both work and play.

I came to psychiatry and family therapy simultaneously, at a time of general social ferment and extensive critiques of conventional social norms. Synthesizing and reconciling the two fields has been my life’s work.

I have spent thirty-five years honing my skills and insights, always looking for new ideas and perspectives to nurture my growing competencies.

Above all, I have learned from my own family about who I am and who I wish to be.

AUTOBIOGRAPHY OF A HEALER

Unaware of it at the time, I am now sure that I gravitated to psychiatry and family therapy in medical school because I was raised in Hawai’i. Long suppressed stories of the collective pain of the many ethnic groups mingled there are now common knowledge. In my early years this was not the case. Hawai’i was in my small world indeed the paradise of the Pacific, yet I could feel that there was something that did not add up and was concealed. These many years later I recognize this feeling as my intuitive grasp of the fact that people, for a variety of reasons and in a variety of ways, continue to suffer as a result of an edited history of their own stories. Sometimes these edits are imposed upon them, sometimes they are self-inflicted. They always leave a residue of anxious uncertainty and denial, the foes of growth and meaning that are essential to health.

I chose to become a physician because it blended my interests in science and art, the healing “art of medicine”. While in medical school, I was introduced to the magic of understanding the human condition from the viewpoint of interactional systems, ecology, and feedback. The origins, development, and maintenance of pain of individuals and groups became linked with the overt evidence of their interactions and their shared history. Once I learned these lessons, no person could be felt to be an island anymore. The notion of pathology as a useful construct lost explanatory power as a web of meanings arose around people’s problems and their origins. Over time my clinical stance evolved into a new look at things altogether: description rather than explanation gained increasing status and legitimacy.

I went on to residency programs in psychiatry that bolstered my commitment to the ecological view, and was blessed with wonderful mentors and a vibrant diversity of thought that required me to find my own identity as a healer. The medical ethics and commitment to collaboration demonstrated regularly to me by my father, a surgeon, and his colleagues in a multispecialty clinic were touchstones for me at times of uncertainty and doubt. Working with the most “mentally ill” I could not and did not wish to avoid mastering the practices of traditional psychiatry, but I always did so from a family-centered position.

A few years later I realized why the family was so deeply embedded in my consciousness and value system when I discovered the ancient practice of ho’oponopono, family therapy Hawai’ian style, stretching back a thousand years. It was a moment as if a veil had been lifted from my eyes when I was delighted to learn that the Hawai’ians had recognized that hysterical conditions and psychosomatic diseases are manifestations of pain in the family, and not just located within the patient. Their knowledge and their healing arts constituted affirmation that people problems are shared, and that there is a spiritual dimension to both suffering and recovery.

I have continued this journey of discovery for thirty five years, eager for creative syntheses of additional information, always with the desire to reconcile theories that were estranged from one another. Often they were contentious, but I would not and could not “pick a side” when both had something to offer. I felt I needed to resolve these polarities in order to be at peace within myself, to follow the great ethical principles of medicine to do no harm and never waiver from the effort to provide optimal care and health for my patients.

I bring this commitment to each day. I am allowed to enhance my own growth by witnessing the courage and yearning of the people I see. I am pleased with a model I have developed which has resolved much of the fretting of my earlier years, and invites me to continue to grow as a seeker and healer.





I have been blessed with a remarkable education. At Punahou School in Hawai”i, I was encouraged to enjoy my inquisitive mind. At Weslyan University, I learned how to ask questions without certain answers, and to enjoy the creative “wrestling” this generated. At medical school in San Francisco, I was plunged into the social and philosophical turmoil of that time, when the role of physician was changing profoundly.

Carl Whitaker has been the most influential mentor in my development as a family psychiatrist. He modeled unrestrained creativity mixed with rigorous critique of self and a deep ethical commitment to the healing arts. For twenty years, we were colleagues, friends, co-therapists, and collaborators.

Over the years, I have incorporated those advances in psychiatric diagnosis that have helped us to understand rather than merely to label people. I have kept current with advances in psychopharmacology while maintaining the attitude that medications should be used to facilitate growth rather than to fix problems. I am concerned that current practices and models of care in mental health care lead to chronicity and a troubling change in how people see their suffering, as well as how others see them.

I have benefited from working in public and private practice settings, inpatient and outpatient services, and direct medical care in a variety of locations and cultures, including Hawai’i, many communities throughout the US, and New Zealand.

Workshops, training, and education have spurred my growth as a therapist. For thirty years my intent to clarify my thinking has benefited from offering workshops, trainings, papers and supervision to psychiatrists, psychotherapists, and primary care physicians in the US, Canada, New Zealand, Australia, and Europe. At this point in my career I plan to spend more time in these efforts, sharing the lessons that thousands of families and many wonderful collaborators have given to me.

CERTIFICATIONS AND MEMBERSHIPS

  • Board Certified General Psychiatry
  • Board Eligible Child and Adolescent Psychiatry
  • Approved Supervisor, American Association of Marital and Family Therapy
  • American Family Therapy Academy
  • Founder and Chair of the AFTA Group “Families, Family Therapy, and Psychiatry”
  • International Family Therapy Association
  • Association of Family Psychiatrists, American Psychiatric Association
  • Physicians for Social Responsibility
  • Union of Concerned Scientists
  • Natural Resources Defense Council
  • Australian and New Zealand Royal College of Psychiatrists

AWARDS

  • Innovation Award for “Home based care for eating disorders,” Auckland, New Zealand, offered by the Royal Australian and the New Zealand College of Psychiatrists
  • Champion, Super Master Division, Mount Baker Legendary Banked Slalom (Snowboarding)
  • Service to the State of Idaho, as Wraparound Consultant in Psychiatry for the Department of Family and Children Services
  • Service to Family Medicine of Spokane, a Family Medicine training program




  • Psychobiological Family Therapy: Ecological Psychiatry in Practice
  • “Third Order” Change: Mindfulness, the Brain, and Family Therapy A New Frontier in Family Therapy: the Confluence of Spirituality, Social Neurobiology and “New Science” Families and the Future: The Intimate Ecology of the Global Climate Crisis
  • Effects of Health Care Organization and Structure on Clinical Practice
  • Ecological Assessment of the “Difficult Patient”
  • Ecological Assessment of the Therapeutic Relationship
  • Values, Medicines, and Family Therapy
  • The Problem of Responsibility in Family Therapy
  • Thinking about Thinking in Psychiatry
  • Involuntary Treatment of Children and Adolescents: Risks, Practices, and Opportunity
  • Developmental Cybernetics: The Family with a Child Diagnosed with Attention Deficit Hyperactivity Disorder
  • The Centrality of Ethics in the Practice of Family Therapy
  • Existential Family Psychopharmacology
  • Gender Politics and the Capacity for Concern in Marital and Family Therapy
  • The School-Family “Marriage”: A Model for Consultation to Schools and Parents


The Curriculum vitae is available for download in Portable Document Format ( .pdf ):

-- click to download --


Services on offer at your location in the U.S. and around the world:
  1. Combined psychiatric and family therapy services for children, adolescents, and/or adults as a visitor or locum tenens providing essential direct services, preferably in a team with a philosophy that would harmonize with my own.
  2. raining and education in my model of PBFT and the areas indicated in the section “Training Modules”. Invited institutions and programs include:
    • Family therapy training institutes and programs
    • Adult psychiatry programs
    • Child psychiatry programs
    • Family medicine programs
    • Medical schools
    • Public services such as community health and mental health centers
    • Integrated collaborative services providing both mental and general health care
  3. Supervision of family therapy.
  4. Supervision of family centered psychiatry.
  5. Supervision of primary care physicians in family-centered behavioral medicine.
  6. Consultation to existing services and programs regarding service organization and coherence, instituting a family centered philosophy and methodology, and implementing innovative approaches to uses of and rationales for psychiatric medications.

PRINCIPLES AND INTERESTS

I am interested in working with clinical services, clinicians, and educational/training programs. As a member of a direct service team or as a consultant and trainer, I offer particular expertise in the following:

  1. Integration of interpersonal neurobiology (IPNB) with individual and family psychotherapy. A startling development of the past fifteen years, IPNB and its companion, mindfulness therapy, resolves many disputes about health and the human condition while affirming many of the basic premises of family therapy. It has not become well studied from a family systems perspective. I have been working on conceptual syntheses and innovative family therapy strategies that harness the potential of this exciting frontier.
  2. Combining family therapy and medication uses: I have been able to reconcile polarized clinical theories and practices, use a comprehensive clinical model that can be used consistently in each clinical encounter, and continue to develop strategies and considerations for how and when to use medications in order to enhance individual and family growth.
  3. Psychotherapeutic potentials of medication use: There are many unique opportunities that arise in understanding and intervening with individuals, families, and systems when medication is prescribed. I consider transactional, developmental, and interactional consequences among family therapy members, between clinicians and the family, and between clinicians. Intentional demystification of diagnosis and of medical intervention, meant to empower patients and providers, underlies this effort.
  4. Symbolic/experiential family therapy integrated with psychiatry. Psychiatric practices carry great symbolic meaning for all involved. These include diagnosis, prescription and discontinuation of medication, hospitalization, and involuntary commitment. Commonly seen to be in conflict with a systemic approach, these practices create symbolic moments that are opportunities to generate deeper understanding of the individual and family. Interventions are designed to deal with the whole system and induce synthesis and growth.
  5. Family centered community-based services: development and fine-tuning. I believe hospitalizing individuals is best avoided if at all possible and I have worked throughout my career to that end. Working with a person’s natural social network and adding vigorous community support commonly allows for successful case management without hospitalization. Understanding the dynamic interplay between the individual, the family and social network, and treatment services is essential to achieve optimal outcome. Central to this effort is the commitment to avoid problems with the larger system and minimize chronicity.
  6. Ecological ethics: “deep” compassion and the global future. Family therapists are accustomed to consider the social context of problems and solutions as they assess and intervene in family and social systems. The next step in ecologically informed practice is to include the natural world in the clinical frame. The wisdom of compassion shows us that we are happier and healthier when we care for others, or “the Other”. It has now been established that we benefit from time in the natural world. Combining the two, it is evident that personal wellbeing and family stability is impacted by our engagement with our greatest public health challenge and most profound moral predicament: our shared future.




The following services are offered at the Bellingham, Washington (USA) office:
  1. Combined psychiatric and family therapy services for children, adolescents, and adults in my private practice.
  2. Integrated care with other therapists, preferably those who share my commitment to providing family centered services.
  3. Collaborative care with “alternative” medicine practitioners.
  4. Consultation to schools interested in better understanding the systemic issues arising with children they identify as of concern.
  5. Consultation to teacher groups on the application of social neurobiology and mindful practices to managing their own stress and dealing with students.
  6. Consultation and discussion groups to primary and specialty medical care providers engaged with their own personal responses to the challenges of providing care to patients and working with one another.
  7. Supervision in my office and/or by phone to individual, paired, and group formats of family and child therapists and physicians.
For further information or to schedule or change an apointment, please call the Bellingham office:
Office: 360-752-5527
Fax: 360-752-5543
119 n Commercial Street #1360 Bellingham WA 98225



I understand that this email form is not meant to be used to make or re-schedule appointments at the Bellingham Office.