Welcome to Bipolar in Focus, I'm Jane Pauley.
Therapy that involves the family has been shown to be particularly effective.
To discuss family focused therapy is Dr. David Miklowitz professor of psychology at the University of Colorado and welcome. Can you describe what the therapy is like?
Sure. It starts with educating the family about the disorder, about how to recognize early warning signs why medications are important, how one gets the disorder, what the family can do to help.
Then in later stages of the treatment we work on communication skills how to effectively resolve conflict, how to communicate messages effectively and how to solve problems.
That's the final stage of therapy.
Could it work for anyone?
We think that the majority of people who have families who are involved in their care can benefit from this treatment.
There are certainly are some people for whom it will not work and among the examples I can think of, first there are often logistical problems of bringing everybody together once a week.
Sometimes it's the family has not been impressed with the mental healthcare before and doesn't want to get re-involved. They'd rather have a support group, for example,
or there's such hostility going that the family just doesn't feel like they'll benefit or perhaps the person with the disorder would rather be seen individually.
Yeah, how do you balance the possibility of over involvement of family?
When people for example, parents are making decisions for the person they could be making for themselves.
Sometimes, if we hear for example a complaint on the part of a person with a disorder, I really want to make these decisions myself.
I really want to make decisions about my medications, my therapy. We respect that. And we'd say for example, we might divide the therapy into some individual sessions, some family sessions.
We might gradually wean the person out of the family therapy and into individual therapy or we might encourage them to attend a bipolar support group if that makes sense.
It often is the case that early on people can't accept the disorder and therefore can't take ownership of the disorder.
As they age and become more and more used to what the disorder requires then they need less from their families. They may feel pride in being able to take care of it themselves.
Blame and guilt can sometimes get in the way. How do you handle that?
Often it's the case that you have a parent who feels whether or not they come in for therapy. They feel implicitly blamed for the fact that they've got a son or daughter with a disorder.
It's because of my genes. I gave him this where I didn't parent him or her correctly. We see the family as an ally in the treatment process.
It's not their fault that this happen anymore that any biological disease would be someone's fault. What's important is for the family to be able to congregate around its recovery.
It's exciting that the study really show rather impressive efficacy when families are involved.
And what we find is that people who get family focused therapy with medication do better overtime than people who get just medication.
They have fewer recurrences, they end up in a hospital less frequently, they have less severe symptoms if their family has been through psycho-education and they have received medication.
Do you know why?
We suspect there are at least three reasons why people who get involved in the family treatment do better.
One is simply that when the family gets educated about the disorder and the person gets educated, they're more compliant with medications. They take medications more consistently.
Secondly, we know the family environment is very important to recovery. If somebody's had an episode and they're trying to recover in an environment where there's a lot of fighting, hostility,
it's much harder to get back to a baseline symptomatic state in that kind of environment.
The family can be very protective in terms of hastening speeding up recovery and what we try to do in treatment is to try to create a more protective environment
which will allow the person to recover more completely.
Another very important reason is that family members become good at recognizing the early warning signs of a recurrence.
So for example if the person is getting manic they -- the person may not recognize themselves that their mood is starting to escalate.
However, the family members say things like, "He's got that look in his eyes again."
Or "He's staying up late at night on the internet," and it's often the family that gets on the phone with the physician that says, "I think we need to change medications."
And an early warning sign can interrupt a recurrence and progress? Can stop it?
Yes that's the idea for what we want to do is catch the escalation early or catch the deterioration into the depression early enough to get to derail the full blown episode
and keep the person from having to go back in the hospital.
Thank you. Thank you very much and thank you for watching Bipolar in Focus.