Family Therapy for Bipolar Disorder

Biopsychosocial model. Interesting article in today’s New York Times about incorporating family therapy for bipolar disorder. Family therapy, as the article points out, doesn’t always assume that the “identified patient” is the cause of the problem. Usually there are other dynamics within the family that contribute to the problem, even with a disorder conventionally looked upon as being biological in nature. In family therapy, focus sometimes shifts from the “identified patient” to another member of the family.

The key advantage of family therapy in this setting, is enlisting family members to assist in noticing symptoms, particularly oncoming mania. Here’s a bit about family therapy from the article:

Family-focused therapy, as it is called, breaks the image of the psychiatrist sitting in his chair, alone in a room with the patient, as well as the traditional wisdom that patient confidentiality is sacrosanct. In family therapy, the family might be treated as part of the problem; in contrast, in family-focused therapy the point is not to treat relatives, but to enlist their help in managing the patient’s illness.

And here’s a bit about the effectiveness of this kind of treatment:

“We’ve tested it in a number of different trials against different types of therapy, and consistently find that if you combine medication and family-focused therapy, you get quicker recoveries from episodes and longer intervals of wellness,” said David J. Miklowitz, a professor of psychology and psychiatry at the University of Colorado, whose pioneering research on the topic inspired the Beth Israel clinic. “So the relapses are less common, and their functioning improves, including relationship and family functioning.”

And a bit about the effectiveness of therapy as an adjunctive treatment:

For many years, Dr. Miklowitz said, the extreme mood swings of bipolar disorder had been thought of “as sort of an exclusively genetic, biologically treated illness,” to be managed primarily with medication. But his most recent study, reported a year ago in the Archives of General Psychiatry, showed that long-term therapy of 30 50-minute sessions over nine months, with medication, cut median recovery time to 169 days, compared to 279 days for those receiving short-term therapy of three sessions over six weeks.

One of the reasons enlisting the family is the opportunity they have for spotting early signs of mania:

… [the] founder of Beth Israel’s clinic, Dr. Igor Galynker, said their experiences with patients showed that families are in the best position to catch early warning signs of a manic or depressive episode.

“It can be something as subtle as a change in lipstick shade,” Dr. Galynker said. “Only a person who knows them very, very well would know.”

This is a nice example of where medication, therapy, and family work together in treatment. Hence, bio-psycho-social.

Kalea Chapman, Psy.D.

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