As illustrated by John and Carol, psychopharmacology can be used in an off-label way to treat maladapative but subclinical expressions of temperament. This use of medication is different from the more traditional use to address Axis I diagnostic symptoms. It is important to emphasize that medication was a small, but important, adjunct to Carol and John's therapy. Psychotropic medication, such as the selective serotonin reuptake inhibitors and buproprion, may have both acute and long-term side effects that need to be weighed carefully in the informed consent process. For example, psychomotor agitation, weight gain and elevated prolactin levels may be troublesome for some patients taking SSRIs; high blood pressure and memory loss can occur with buproprion. Long-term use should be carefully re-evaluated in the course of treatment. Nevertheless, personality and couples work represent arenas where integration of various modalities, including psychopharmacology, is crucial. The challenge is to consider a truly biopsychosocial approach that includes problem-solving, enhancing attachment and personality flexibility, and embracing difficult life transitions.