Adolescence is an important time for formulating ideas, developing autonomy and developing a sense of self. It is also generally understood that adolescence can be one of the most unsettling periods during development. Add to this the symptoms of bipolar disorder and what results can be a period of huge emotional turmoil for both the sufferer and their family.
The onset of bipolar disorder is quite commonly associated with adolescence or early adulthood, with up to 66 per cent people experiencing their initial onset before the age of 19 (Leverich et al., 2002). Medication is the basis for treating acute episodes as well as controlling symptoms. However, a high proportion of bipolar patients will not adhere to this form of treatment for reasons relating variously to side-effects, loss of control and/or the belief that the episode will not repeat itself. Whether or not medication is taken regularly, there remains a gap in the treatment of psychological and social issues resulting from bipolar disorder. There is evidence to suggest that family-focused treatments provide an effective partner to treatment by medication.
A useful illustration of family-focused treatment (FFT) is presented by Morris, Miklowitz and Waxmonsky (2007). They explain that FFT has its roots in research on ‘expressed emotion'. Briefly, a measure of high expressed emotion, for example, would occur if a relative is seen to use several critical or hostile comments, or is overprotective or regularly points to their level of self-sacrifice. Family environments associated with high expressed emotion are also associated with poor outcomes for bipolar disorder and a number of other psychiatric disorders. The role of FFT is therefore to help decrease negative interactions by helping relatives to understand the causes and course of bipolar disorder and ways in which the family can establish a functional relationship following a mood episode.
The central objectives of FFT are summarised as assisting the patient and relatives in:
- Integrating the experiences associated with mood episodes in bipolar disorder
- Accepting the notion of vulnerability in future episodes
- Accepting a dependency on mood-stabilizing medication for symptom control
- Distinguishing between the patient's personality and his/her bipolar disorder
- Recognizing and learning to cope with stressful life events that trigger recurrences of bipolar disorder
- Re-establishing functional relationships after a mood episode
Source: Morris, C.D., Miklowitz, D, J and Waxmonksy, J.A. (2007) page 436.
These objectives are generally realised over a period of around 21 sessions, at first weekly, then bi-weekly, then monthly. Families work closely with the clinician who in turn helps the family to make sense of the various forces that influence a more positive outcome. The authors point out that a key aspect of the sessions is to help families identify times when relapses might be prevented. Families are taught how to devise a relapse plan in which specific steps and individual responsibilities can be listed, and ways to keep the environment low in stress.
In FFT for adolescents, families receive education about developmental issues in teenagers and how to distinguish bipolar symptoms from the ups and downs of normal teenage development. Treatment sessions for adolescents, "often include strategies to put parents back in charge of their teen's healthy development" (p.438). For example, showing respect in the home, home-times, wake-times and encouraging adherence to treatment.
This brief overview of family-focused therapy comes at a time when there is increasing evidence of its effectiveness with bipolar disorder. These are still early days and questions as to economic feasibility still need to be addressed. However, research continues to illuminate the potential of an approach that appears to have a lot to offer.
Leverich, G.S., Mcelroy, S.L., Suppes, T., Keck, P.E., Denicoff, K.D., Nolen, W.A., et al (2002). Early physical and sexual abuse associated with an adverse course of bipolar illness. Biological Psychiatry, 51, 288-297, in Morris, C.D., Miklowitz, D, J and Waxmonksy, J.A. (2007) Family-Focused Treatment for Bipolar Disorder in Adults and Youth. Journal of Clinical Psychology. 63 (5), 433-455.
Morris, C.D., Miklowitz, D, J and Waxmonksy, J.A. (2007) Family-Focused Treatment for Bipolar Disorder in Adults and Youth. Journal of Clinical Psychology. 63 (5), 433-455.
Published On: October 08, 2007
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