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

Ronald B Cohen, MD of www.familyfocusedsolutions.com by Family Focused Solutions discusses how family therapy can help the individual with bipolar disorder.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”.

Please feel free to ask any questions or to comment in the “Leave a Reply” box below. To request more information and/or schedule an initial consultation, click here . If you found this post helpful, please don’t keep it a secret. You are encouraged to click on the buttons in the second to the right hand column at the bottom of the page and share this article with your own networks.

Ronald B Cohen, MD, PC www.familyfocusedsolutions.com Ronald B. Cohen, MD
Bowen Family Systems Coach
1 Barstow Road, Suite P-10
Great Neck, NY 11021
(516) 466-7530
RBCohenMD@FamilyFocusedSolutions.com
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4 comments

  1. Karen A. Musicaro on March 20, 2013 at 2:37 pm said:

    I am very interested in this work. I am presently involved with a family with a 28-year-old daughter (diagnosed) bipolar and mother with symptoms. There is a second 23-year-old daughter too. All three of them are living together along with the youngest’s boyfriend. I am planning family sessions in order to help them separate, as this is their plan for October.

    • Ronald B Cohen, MD on April 9, 2013 at 4:23 pm said:

      Hi Karen,

      Family-Focused Therapy (FFT) is directed at teaching patients and their families about bipolar disorder and disease management, improving communication skills, and developing problem-solving skills. Helpful books by David J. Miklowitz’ Professor of Psychiatry in the Division of Child and Adolescent Psychiatry at the UCLA Semel Institute, and a Senior Clinical Research Fellow in the Department of Psychiatry at Oxford University, include Bipolar Disorder: A Family-Focused Treatment Approach, The Bipolar Disorder Survival Guide, What You and Your Family Need to Know, The Bipolar Teen: What You Can Do to Help Your Child and Your Family and Understanding Bipolar Disorder: A Developmental Psychopathology Perspective. Please watch for a future post on the specifics of the Family-Focused Approach for Families living with Bipolar Disorder. Please feel free to contact me directly if I can be of additional assistance.

      Regards,

      –Ron

  2. Patricia Reynolds-Meade on May 16, 2013 at 3:05 pm said:

    FFT is oriented toward seeing that the person with bipolar disorder counsels together with family members. It emphasizes education about the nature of the disorder combined with active work in providing better communication patterns and the development of problem-solving skills that promote an understanding and overall well-being for the family as a unit. NAMI has great support and education for family members also that is free. As a consumer, I do agree that the family plays a role in exacerbating or maintaining your symptoms. However, It must be emphasized that FFT focuses on the perceptions derived from the family of origin that influences how the client who lives with bipolar disorder thinks, feels, and ultimately behaves. Sounds rather messy to me.

    • Ronald B Cohen, MD on May 16, 2013 at 4:16 pm said:

      Hi Patricia,

      You are correct that The Family-Focused Approach to Bipolar Disorder is directed at teaching patients and their families about bipolar disorder and disease management, improving communication skills, and developing problem-solving skills. I would disagree that it emphasizes family of origin work. Rather goals and objectives are directed towards current family environmental factors and co-occurring stressful life events. Family psychoeducation 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. Communication enhancement training focuses on skills for active listening, delivering positive and negative feedback, and requesting changes in other’s behaviors. Problem-solving training is aimed at developing and instituting solutions to specific family problems.

      Helpful books by David J. Miklowitz’ Professor of Psychiatry in the Division of Child and Adolescent Psychiatry at the UCLA Semel Institute, and a Senior Clinical Research Fellow in the Department of Psychiatry at Oxford University, include Bipolar Disorder: A Family-Focused Treatment Approach, The Bipolar Disorder Survival Guide, What You and Your Family Need to Know, The Bipolar Teen: What You Can Do to Help Your Child and Your Family and Understanding Bipolar Disorder: A Developmental Psychopathology Perspective. I will be posting additional details of the clinical protocol of the Family Focused Approach next week.

      Regards,

      —Ron

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