Family-Focused Psychotherapy for Patients with Bipolar Disorder

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FFT 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, and family reintegration requires development of new coping strategies. The six objectives, experience integration, disease acceptance, medication compliance, symptom recognition, stress reduction, and relationship restoration are operationalized into two target variables, family environmental factors and stressful life events. Treatment involves patients and at least one family member (spouse, partner, parent, or sibling) and is divided into three phases or modules, delivered in 21 sessions (12 weekly, 6 biweekly, 3 monthly) scheduled over nine months. The first module, family psychoeducation extends over 7 sessions and focuses on recognizing early warning signs of recurrence, proactive recognition of prodromal symptoms of relapse, and developing relapse prevention plans that involve multiple family members. Patients and relatives develop a shared understanding of environmental factors that increased the 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. NIMH recently approved funding for a new study to develop Focused Family Therapy for children ages 9-17 at high risk for developing bipolar disorder. High-risk children have some symptoms of bipolar disorder, but do not show all the symptoms required for a formal diagnosis, and have an immediate family member with bipolar disorder. The long-term goal is to reduce or delay the development of bipolar disorder in at-risk youth. Children will receive pharmacotherapy if needed to help manage symptoms, though they do not have to take medication to participate in the study. Outpatient psychiatric treatment needs to follow principles of chronic disease management, which includes medication, self-management and psychosocial strategies. Pharmacotherapy and psychotherapy treatments should be integrated into a new standard of care. Families are a neglected resource for psychiatrists and their patients. Family involvement constitutes a critical support system for individuals with a serious mental illness. Dysfunctional 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. Despite this, training in family therapy is still the exception rather than the rule in psychiatry residency programs.

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