Although unusual, psychodynamic psychiatrists engage in the practice of treating multiple members, and constellations of members, of families with psychodynamic psychotherapy as well as other treatment modalities. Such clinicians are considered the “Family Psychiatrist.” Psychological characteristics of such families who cannot be referred to other clinicians are articulated. The literature on psychotherapy in small rural communities is reviewed as having relevance to define the ethical issues that arise in such treatments. These issues include: maintaining therapeutic neutrality; creating functional, flexible, and appropriate boundaries; maintaining confidentiality; promoting patient autonomy and growth; as well as managing conflicts of interest. Relevant countertransference issues are examined.