Family consultation for psychiatrically complicated health problems.

We describe a social cybernetic view of health behavior problems and a team-based family consultation (FAMCON) format for strategic intervention based on that view. This approach takes relationships rather than individuals as the primary unit of analysis and attaches more importance to problem maintenance than to etiology. Treatment aims to interrupt two types of interpersonal problem maintenance-ironic processes and symptom-system fit (conceptualized, respectively, as positive and negative feedback cycles)-and to mobilize communal coping as a relational resource for change. A case example features a depressed husband and bipolar wife complaining of severe communication difficulties related to the husband's kidney cancer and diabetes. Over 6 consultation sessions, strategic interventions focused on interrupting ironic interpersonal patterns resolved the presenting complaint. Although cost-effectiveness is an open question, FAMCON may offer a useful alternative to psychoeducational and cognitive-behavioral treatments in the framework of stepped care.