In the Spotlight: Family Therapy

By Alisha Brosse, Sutherland Bipolar Center Director

Some Sutherland Bipolar Center clients participate in family therapy, either instead of or in addition to individual therapy. Why do we provide therapy not only to individuals with bipolar disorder but also to their families? First, family conflict or stress can trigger or worsen mood symptoms. Second, bipolar symptoms can significantly affect family members. And, third, family members can be an invaluable resource when trying to prevent future mood episodes.

The family therapy model that we use at the Sutherland Bipolar Center is called Family-Focused Treatment (FFT). It was developed by Dr. David Miklowitz, the founding director of the Center. He and his colleagues have studied FFT for the families of adults and adolescents with bipolar disorder, and for the families of children who are at risk for developing it. Their research suggests that FFT is especially beneficial for families with high levels of “expressed emotion” (EE). Compared to families low in EE, high-EE families communicate more criticism, hostility, or emotional involvement (e.g., intrusiveness, overprotectiveness, excessive self-sacrifice).

Family-Focused Treatment is comprised of three modules:  psychoeducation, communication enhancement training, and problem-solving training. Via psychoeducation, family members develop a common lingo and a better understanding of the signs and symptoms of bipolar disorder that they experience. This helps people make more accurate attributions. They learn that certain behaviors are part of depression, rather than “laziness,” and that someone who is manic may have little control over their impulses. On the flip side, family members who once attributed everything to bipolar disorder, reducing all of a person’s experiences to their illness, gain a more nuanced perspective, learning to separate the individual from the illness. In psychoeducation, families also learn about factors that increase or decrease risk of further mood cycling, and develop a relapse prevention plan.

In communication training, family members refine their communication skills to be more effective when stress is high and communication becomes more difficult. They work on giving positive feedback, active listening, making requests, and giving negative feedback.

In problem-solving training we provide a template for how to work cooperatively on problems that affect the family. Families learn to first agree on the specific problem they are trying to solve. They then brainstorm possible solutions, agree on which solution(s) to implement, and make a specific plan regarding who will do what, and when. Common examples of problems we work on include how family members can support or help without “nagging;” how to balance the individual’s desire for more autonomy with family members’ need for reassurance; and, negotiating roles that shifted during an illness episode (e.g., household or childcare duties).

As with all of our services, we customize the treatment to meet the needs of each family. We may change the order in which we deliver the three modules, or work with only one or two of them.

Over the past 15 years we have delivered FFT to 68 families. These families attended an average of 16 sessions. We also engage families in our other services:  people in individual therapy are encouraged to invite family members to one or more sessions; whenever possible we include family in our psychodiagnostic evaluations; we have many family members at our educational seminar series; and, we sometimes deliver services just to family members (without the person with bipolar disorder present), in what we dub “family consultation” services.

The families of people with bipolar disorder can be an incredible asset in the management of this illness. At the Sutherland Bipolar Center, we help people harness this potential. We also help the family members who have, themselves, suffered by virtue of witnessing the suffering of their loved ones.

To see if you qualify for family therapy at the Center, call us at 303/492-5680.