Bipolar Disorder: A Family-Focused Treatment Approach

The introduction of lithium in the early 1970s brought enormous relief to the suffering of bipolar patients and their families. Decades later, however, the illness continues to take a painful and pervasive toll: even patients receiving optimal medication are likely to endure multiple recurrences and to have trouble holding jobs and maintaining relationships. This cogent and practical manual by David J. Miklowitz and Michael J. Goldstein presents a complete 9-month outpatient program designed to help patients and families understand, accept, and manage the effects of bipolar disorder. The book builds upon both the late Dr. Goldstein's pioneering work with the families of schizophrenia patients and Dr. Miklowitz's extension of this work to bipolar disorder. Aimed to improve family functioning, facilitate patient willingness to follow a medication regimen, and reduce the risk and severity of relapse, this unique psychoeducational treatment approach maximizes limited time and resources and can be readily incorporated in a range of clinical settings. The book first reviews the research basis for family-focused psychoeducational treatment (FFT) and illuminates the interactive effects of family stress, life stress, and biological predisposition on recurrences of bipolar disorder. Chapters then present a clear and comprehensive framework for conducting FFT, from assessment, education, and communication and problem-solving training sessions, to crisis management and termination. Aided by numerous clinical case examples and session vignettes, clinicians learn to educate patients and family members about bipolar disorder and to address their core concerns in coming to terms with it. Specifically, the program helps families: Accept the existence of a major psychiatric disorder in a loved one. Accept the notion of vulnerability to future episodes. Work through emotional resistances to pharmacotherapy. Distinguish between the patient's personality and his or her disorder. Recognize and cope with stressors that may trigger the onset of episodes. Enhance family relationships with new communication and problem solving skills. Based on extensive research and clinical experience, this authoritative guide is an invaluable tool for therapists from any background - including psychologists, psychiatrists, marriage and family therapists, social workers, counselors, and nurses - and contains much information of relevance to patients and family members as well. FFT also has important implications for other serious psychiatric and medical conditions, making the book a useful resource for researchers. It serves as a supplementary text for advanced undergraduate and graduate-level courses.

Table of Contents:
Wynne, Foreword. Part I: Bipolar Disorder and Families: Clinical and Research Background. Bipolar Disorder: Why Family Treatment? The Nature of Bipolar Disorder and Its Impact on the Family. Family and Social Factors in the Course of Bipolar Disorder. Part II: Conducting the Family-Focused Treatment. Planning the First Encounter. The Functional Assessment. Family Psychoeducation: The Initial Sessions. Family Psychoeducation: Etiology, Treatment, and Self-Management. Family Psychoeducation: Dealing with Resistances. Communication Enhancement Training: Rationale and Mechanics. Communication Enhancement Training: Clinical Issues. Dealing with Family Problems. Managing Crises in Family-Focused Treatment. Termination.

About the Author :
David J. Miklowitz, PhD, is Professor of Psychiatry at the University of California, Los Angeles (UCLA), School of Medicine and Senior Clinical Researcher at the University of Oxford, United Kingdom. He directs the Child and Adolescent Mood Disorders Program and the Integrative Study Center in Mood Disorders at the UCLA Semel Institute for Neuroscience and Human Behavior. Dr. Miklowitz is a recipient of the Distinguished Investigator Award from the National Alliance for Research on Schizophrenia and Depression, the Mogens Schou Award for Research from the International Society for Bipolar Disorders, the Bipolar Mood Disorder Research Award from the Brain and Behavior Research Foundation, and the Gerald L. Klerman Senior Investigator Award from the Depressive and Bipolar Support Alliance. Michael J. Goldstein, PhD (1930-1997), was a pioneer in research on family factors relevant to the onset and course of major psychiatric disorders, particularly schizophrenia. After receiving his doctorate from the University of Washington in 1957, he served as Professor of Psychology at the University of California, Los Angeles, for 40 years. The author of nearly 200 journal articles, books, and book chapters, Dr. Goldstein's honors included the Alexander Gralnick Award from the American Psychological Association, the Gerald Klerman Research Award from the Association for Clinical Psychosocial Research, and the Distinguished Contribution to Family Therapy Award from the American Family Therapy Association.

Review :
"This book [presents] the first treatment approach for bipolar disorder that truly integrates the use of medication and family intervention...Miklowitz and Goldstein succeed brilliantly in not being bound to a Procrustean bed of limited therapeutic rules. Instead, their treatment guidelines continuously emphasize a psychotherapeutic attitude in which the experience, stories, and special life circumstances of the family members are given attention....This volume should quickly become required reading in every family and marital therapy training program. In addition, it should be read as well by all professionals, especially psychiatrists, who need to learn more about how the effectiveness of the medications they prescribe can be substantially enhanced with family-focused treatment." - From the Foreword by Lyman C. Wynne