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
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 Ronald B. Cohen MD of discusses the growing senior generation and how they can continue aging in a healthy way.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.

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 Ronald B. Cohen, MD
Bowen Family Systems Coach
1 Barstow Road, Suite P-10
Great Neck, NY 11021
(516) 466-7530
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  1. Mindy Haber on May 25, 2013 at 8:45 am said:

    Dear Ron,

    I am in total agreement with the value of the family in helping the individual cope more effectively. What about those families who are so dysfunctional they are unable to help or try to undermine the process?

    • Ronald B Cohen, MD on May 28, 2013 at 8:05 am said:

      Hi Mindy,

      Great question. When families are stuck with a script that no longer works and has outgrown its usefulness the task is to balance needs for autonomy and healthy interdependence. Working with family members to address their own unmet emotional needs helps foster positive adaptation within the context of significant adversity so families can acknowledge suffering, restore dignity, recover and grow. As another commentator wrote, “This approach allows the whole family to be heard, grieve, learn, celebrate and heal.”

      Each of us has the ability to improve and better ourselves to be more loving, thoughtful, and considerate. Our task as therapists is to help people resolve conflicted interactions, strengthen relationships, improve communication, reduce chronic stress and anxiety, and create a nurturing atmosphere in which to promote active problem solving, healing and emotional well-being.

      Working through the dynamics of the whole family provides a practical and constructive approach for individuals to explore and understand the rules of their family of origin, their role in it, the influence of these experiences, and how they impact their current relationships. This approach creates a nurturing atmosphere, which is both healing and protective. The broad systemic impact reduces stress and vulnerability, fosters healing and growth, and empowers families to overcome persistent adversity. The goal is to solve problems in current relationships so as not to leave a damaging legacy for future generations.

      I define Psychiatric Family Therapy as working with patients and their families to successfully adapt to the physical, psychological, emotional, and spiritual challenges of severe and chronic psychiatric illness. The beauty and value of Systemic Family Theory and Therapy is that in contradistinction to traditional psychotherapy it is uniquely applicable and productive regardless of the situation.



  2. Carol Cronin on May 27, 2013 at 11:35 pm said:

    Thank you for posting this article. This psychoeducational approach can be life-saving to families. Often times family members are overwhelmed by a loved one’s behavior and life becomes very unmanageable. I believe adults as well as children need to be given a more active role, so everyone gets the tools they need to deal from an empowered position rather than an emotionally depleted one. The family working together will definitely benefit the person with bipolar disorder.

    • Ronald B Cohen, MD on May 28, 2013 at 8:21 am said:

      Hi Carol,

      Thank you for your supportive comment. It is true that with severe persistent psychiatric dysregulation the extent of the disruption to the family can easily meet or exceed the individual’s symptomatic suffering and impaired functioning. Every family member, including parents, spouses, siblings, children, and cohabiting partners is affected. The loss of trust and severe attachment injury forever changes the relationships. 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”. Bringing family members together to help transform their interactions and learn to solve the problems in their relationships has a power to achieve the full range of emotional health that is almost magical.



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