Bipolar Disorder and the Family

Bipolar Disorder and the Family

“No pill or computer game can ever help
anyone find meaning in their lives.”
–Amit Etkin
Stanford University School of Medicine

In response to my previous post on Psychiatric Family Therapy, which I define as “helping families, using a biopsychosocial reference frame, to successfully adapt to the physical, psychological, emotional, and spiritual challenges of complicated psychiatric illness and dual diagnosis”, LYNN FRIEDMAN LCSW,BCD in the LinkedIn Addiction Professional Referral Group discussion reminded us of the development of the construct of Expressed Emotion (EE) and the bidirectional reciprocal interactions between symptoms and system in families with Schizophrenia. High EE refers to high levels of criticism, hostility, and/or emotional overinvolvement.

David J. Miklowitz and colleagues have applied and expanded this knowledge base in one of the most helpful and productive psychosocial interventions for Bipolar Disorder. The Family Focused Approach addresses and resolves many of the disabilities that “cause clinically significant distress or impairment in social, occupational or other important areas of functioning.”

Bipolar disorder is a complex disabling illness consisting of recurrent mood episodes, cognitive impairments, physical and psychomotor abnormalities, sleep and appetite disturbances, and deficits in social, occupational and executive functioning. Every family member, including parents, spouses, siblings, children, and cohabiting partners is affected. When the family organizes itself around the ill person many other aspects of the family’s growth and development will be impaired.

The Family-Focused Approach (FFA) teaches families about bipolar disorder, improves communication skills, and develops problem-solving skills. FFA has six major objectives based on three core assumptions:

  • An episode of bipolar disorder is a non-normative family life cycle crises
  • Each episode produces disorganization in the family system
  • Family reintegration requires development of new coping strategies

The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) research confirmed the efficacy of the Family-Focused Approach to reduce time to recovery, delay relapse/recurrence, reduce relapse rates, improve patient functioning, reduce inter-episode symptoms, improve medication compliance, and increase total time in recovery.

In July of last year, I was privileged to be part of the creative process, and engage in a wonderfully enlightening audience talk back for a production of Next to Normal a profoundly sensitive and thoughtful drama that presents a painfully spot-on portrayal of one woman’s struggle with the “Unquiet Mind” of bipolar disorder. The Family-Focused Approach significantly improves symptomatic resolution, enhances relationship functioning and increases life satisfaction by helping all family members to integrate the trauma, make sense of the loss, regain wholeness and stability, and adapt to a new “next to normal”.

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Ronald B. Cohen, MD
Psychiatrist / Family Therapist
1 Barstow Road, Suite P-10
Great Neck, NY 11021
(516) 466-7530
[email protected]