What is Family Focused Therapy And How is it Used in Treatment for Bipolar Disorder?
Family-focused therapy (FFT) was developed by David Miklowitz, Ph.D., to help treat individuals with bipolar disorder. FFT was designed based on the assumption that a patient’s relationship with their family is vital to the success of managing both their bipolar, and overall well being. Family-focused therapy uses a combination of two approaches to therapy, including psycho-education and family-oriented psychotherapy. FFT treats the whole family unit (i.e. both parts of the couple, the entire family, etc.), as having a family member with bipolar can hugely impact the entire family (as a unit and as individual members).
Treating the whole family means all members of the family are included in the therapy sessions and work together towards establishing healthier familial relationships, more effective communication, and enhanced connectedness so family members can better serve as an emotional support system for one another.
For many, finding out that you or a loved one is struggling with bipolar disorder, can feel frightening due to the stigma often associated with the disorder. However, bipolar disorder is well-understood by the therapist community and can be readily treated by a combination of medications and psychotherapy. While bipolar disorder can be treated in an individual setting, more psychologists are starting to recommend family-focused therapy. Family-focused therapy often involves bringing in members of the family to help them better understand the disorder and to make sure that they understand their role in the healing process. This form of therapy provides numerous benefits to the family, and it has helped to provide long-lasting positive results.
According to the Journal of Clinical Psychology. 2007 May; Family-Focused Treatment for Bipolar Disorder in Adults and Youth, “Levels of familial expressed emotion during an acute episode are consistently associated with rates of recurrence among bipolar patients.” Utilizing techniques consistent with Family System Therapy, FFT is a time-limited treatment consisting of psychoeducation, family communication, and problem-solving skills.
How Family Focused Therapy Helps Treat Bipolar Disorder
Diminishing the Fears and Stereotypes of Bipolar Disorder
Bipolar disorder carries much stigma with it. While bipolar disorder is a serious mental illness, it can look quite different from person to person, and not all with bipolar experience the same symptoms or have the same behaviors. Yet, because of the stigma surrounding bipolar, many still have significant biases and false beliefs about it. Thus, an integral part of family-focused therapy is psychoeducation. More often than not, by providing the family (including the individual diagnosed) education about bipolar (including symptoms, causes, common behaviors, etc.), the fears, biases, and false beliefs begin to fall away. Family-focused therapy can help family members talk about bipolar disorder within the specific context of their family member who has been diagnosed.
Addressing the Needs of All Family Members and Collaborative Care
Bipolar disorder can result in destructive behaviors that tear at the heart of the family. Thus, all family members (not just the individual with bipolar disorder) are likely in need of support. In family-focused therapy, all family members are encouraged to discuss their struggles and needs and process them in a supportive environment. Through this process, the patient (the individual with bipolar disorder) can begin to understand the impact they have had on the family, not for the purpose of blaming or shaming, but as a way to increase their motivation towards change. FFT sessions serve as a way to rebuild what might have previously felt “broken” in the family, and provide healing and growth for all members.
As the work progresses in the FFT process, families can begin to see a working alliance being developed. Family members are able to begin to understand (and make sense of) the roles that things such as stress, functional impairments, biological predispositions, and personal responsibility have on the functioning of the family as a whole unit. Then, through a collaborative care approach, family members are trained in self-management strategies (how to better cope with their own emotions and with the difficult symptoms displayed by the patient) and also gives each family member a voice in the treatment planning process (identifying potential goals for the family unit).
As the family begins to learn more about bipolar disorder and the family functioning as a whole (during the psychoeducation phase), they are also introduced to relapse prevention planning. Family members are asked to identify contexts that have put the patient at an increased risk of relapse (falling back into old, unhealthy behaviors) in the past. These “warning signs” may vary from patient to patient, but some common signs include drug or alcohol use, lack of structure and schedule, and changes in eating/sleeping habits. Once the warning signs are identified, the clinician will help the family identify concrete steps to take to help the patient get back on track, or to seek any necessary additional support.
Communication Skills Training
Another integral part of family-focused therapy is the importance of communication. Healthy and effective communication skills are taught through behavioral modeling on the part of the therapist and role-playing with the family. The skills training emphasizes both verbal and non-verbal communication, as well as communication skills for effective problem-solving.
Having a family member with bipolar disorder can be a huge struggle and have significant impacts on the entire family unit. Yet, through engaging in family-focused therapy, family members can not only begin to heal individually, but also grow stronger as a unit.
COVID‐19 has had a pervasive effect on families by disrupting routines, changing relationships and roles, and altering usual child care, school and recreational activities. Families that were already experiencing financial, health and/or abuse issues felt the impacts of quarantine and job disruptions exceptionally challenging. The pandemic disproportionately impacted lower-income families, families from ethnic minority and vulnerable groups, and women. These unprecedented times did yield one positive: parents shared more dinners and read to their children more often, according to the U.S. Census Bureau’s 2020 Survey of Income and Program Participation (SIPP). In addition, several families have adapted to a new normal with parents working from home and are increasingly focused on a healthier work life balance. Reliance on technology to stay connected at work, at home, and in therapy are likely here to stay as well.
George, E., Taylor, D., Goldstein, B., & Miklowitz, D. (2011). Family-focused therapy for bipolar adolescents: Lessons from a difficult treatment case. Cognitive and Behavioral Practice, 18(3), 384-393.
Morris, C. D., Miklowitz, D. J., & Waxmonsky, J. A. (2007). Family-focused treatment for bipolar disorder in adults and youth. Journal of Clinical Psychology, 63(5), 433–445.
Simoneau, T., Miklowitz, D.J, & Saleem, R. (1998). Expressed emotion and interactional patterns in the families of bipolar patients. Journal of Abnormal Psychology. 107, 497–507.
Lebow JL. Family in the Age of COVID-19. Fam Process. 2020 Jun;59(2):309-312. doi: 10.1111/famp.12543. Epub 2020 May 15. PMID: 32412686; PMCID: PMC7273068.
Lebow JL. COVID-19, Families, and Family Therapy: Shining Light into the Darkness. Fam Process. 2020 Sep;59(3):825-831. doi: 10.1111/famp.12590. Epub 2020 Aug 28. PMID: 32856753; PMCID: PMC7461170.