The Family Focused Approach to Bipolar Disorder

The Family Focused Approach to Bipolar Disorder

I cannot imagine leading a normal life without both
taking lithium and having had the benefits of
psychotherapy….
Ineffably, psychotherapy heals.
Kay Redfield Jamison, Ph. D.
— An Unquiet Mind

Many group discussions in response to a prior post, Bipolar Disorder and the Family, included requests for more detail concerning the treatment protocol. The Family-Focused Treatment approach for bipolar disorder is an intensive, time-limited, evidence-based psychoeducational intervention designed to educate, enhance and support the family system within which the patient is functioning. Family-Focused Therapy is directed at teaching patients and their families about bipolar disorder and disease management, improving communication skills, and developing problem-solving skills. Family Psychiatry provides the ideal bridge between the biomedical and psychosocial worlds.

The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) is a multi-centered effectiveness research program with the stated goal of determining best-practice treatment options for all phases of bipolar disorder; mania, depression, remission, and recurrence prevention. STEP-BD research confirmed the efficacy of Family Focused Therapy, when used as an adjunct to pharmacotherapy, 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 for both adults and adolescents with bipolar disorder.

The Family Focused Approach has six major objectives based on three core assumptions:

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

The six objectives are:

1. Experience integration
2. Disease acceptance
3. Medication compliance
4. Symptom recognition
5. Stress reduction
6. Relationship restoration

Goals and objectives are directed towards two target variables: family environmental factors and stressful life events. Treatment involves patients and at least one, though preferably multiple, family member (spouse, partner, parent, or sibling) and is divided into three phases or modules delivered in 21 sessions (12 weekly, 6 bi-weekly, 3 monthly) scheduled over nine months.

The first module, family psychoeducation extends over 7 sessions and focuses on proactive recognition of signs and symptoms of relapse and recurrence, and developing relapse prevention plans that involve multiple family members. Patients and relatives develop a shared understanding of environmental factors that increase patients’ vulnerability to recurrences and address barriers to medication adherence. Families are acquainted with the stress-diathesis model and the reciprocal bidirectional effects between patient (symptom) and family (system).

The second treatment phase, communication enhancement training, continues over the next 7 to 10 sessions and focuses on skills for active listening, delivering positive and negative feedback, and requesting changes in other’s behaviors. The final treatment section, problem-solving training, concludes with 4 or 5 sessions aimed at developing and instituting solutions to specific family problems.

Psychotherapy interventions are key components in effectively managing bipolar disorder. Family involvement constitutes a critical support system for individuals with a serious mental illness. Dysregulated interpersonal family relationships deprive patients with bipolar disorder of this most important and enduring resource. By learning to “think family” — always viewing the patient in that context — we are more likely to provide the best possible psychiatric treatment.

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