Bipolar Disorder A Family-Focused Treatment Approach

by Miklowitz, David J.

• ISBN13: 9781606236451
• ISBN10: 1606236458
• Edition: 2nd
• Format: Paperback
• Copyright: 2010-02-08
• Publisher: The Guilford Press

Summary

This indispensable guide describes how to implement FFT with adult and adolescent patients and their family members.

Author Biography

David J. Miklowitz, PhD, is Professor of Psychiatry at the University of California, Los Angeles Semel Institute, David Geffen School of Medicine, and Senior Clinical Research Fellow in the Department of Psychiatry at Oxford University. He was Professor in the Department of Psychology at the University of Colorado at Boulder from 1989 to 2009. His current research focuses on family psychoeducational treatments for childhood-onset bipolar disorder. Dr. Miklowitz has received a number of awards for his research, including, most recently, 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, and the Monica Fooks lectureship from Oxford University. Dr. Miklowitz has published more than 200 research articles and book chapters and five books on bipolar disorder and schizophrenia. The first edition of Bipolar Disorder: A Family-Focused Treatment Approach won the Outstanding Research Publication Award from the American Association for Marriage and Family Therapy.

Table of Contents

Bipolar Disorder and Families: Clinical and Research Background
Bipolar Disorder: Why Family Treatment?	p. 3
How Is Bipolar Disorder a Family Problem?	p. 5
Why FFT?	p. 6
The Six Objectives of FFT	p. 7
The Core Assumptions and Structure of FFT	p. 12
Is FFT Helpful?	p. 13
The Organization of This Book	p. 18
For Whom Is This Book Intended?	p. 19
A Word about Terminology	p. 20
The Nature of Bipolar Disorder and Its Impact on the Family	p. 21
Chapter Overview	p. 22
What Is Bipolar Disorder?	p. 23
The Impact of the Disorder on Family Members	p. 26
The Topography of Manic and Depressive Episodes	p. 27
The Role of the Family in Differential Diagnosis	p. 31
The Variable Life Courses of Bipolar Disorder	p. 32
Developmental Precursors to Bipolar Disorder	p. 35
The Interface between Drug Treatment and FFT	p. 41
Concluding Comments	p. 47
Family and Social Factors in the Course of Bipolar Disorder	p. 48
Chapter Overview	p. 49
The Vulnerability-Stress Model	p. 49
Family Environmental Factors in Bipolar Disorder	p. 50
Life Events Stress	p. 60
The Vulnerability-Stress Model Revisited	p. 63
Concluding Comments	p. 64
Conducting Family-Focused Treatment
Planning the First Encounter	p. 69
Chapter Overview	p. 70
For Whom Is FFT Appropriate?	p. 70
The Mechanics of FFT	p. 73
Getting Started: The Initial Contacts	p. 76
Concluding Comments	p. 83
The Functional Assessment	p. 84
Chapter Overview	p. 84
Assessing the History of the Patient's Disorder	p. 85
Assessing Family Interactions	p. 92
Concluding Comments	p. 97
Family Psychoeducation: The Initial Sessions	p. 98
Overview of the Psychoeducation Module	p. 99
A Word about Terminology	p. 100
The Therapeutic Stance	p. 100
"Setting the Stage" for the Psychoeducation Module	p. 101
Introducing the Treatment Program	p. 102
Presenting the Didactic Material: Reviewing the Index Episode	p. 109
Events Leading Up to the Episode: The life Events Survey	p. 117
Discussing the Hospitalization Experience	p. 122
The Expected Course of Bipolar Disorder	p. 125
Concluding Comments	p. 127
Family Psychoeducation: Etiology, Treatment, and Self-Management	p. 128
Chapter Overview	p. 128
The Etiology of Bipolar Disorder	p. 129
Treatment of the Disorder within the Vulnerability-Stress Model	p. 143
How the Family Can Help	p. 150
The Self-Management of Bipolar Disorder	p. 155
The Relapse Drill	p. 157
Addressing Unanswered Questions	p. 161
Concluding Comments	p. 162
Family Psychoeducation: Dealing with Resistances	p. 163
Chapter Overview	p. 164
Manifestations of Denial and Resistance	p. 165
Anticipating and Preempting Denial and Resistance	p. 167
The Meaning of Bipolar Disorder within the Family Context	p. 170
Differing Perceptions of the Disorder as a Source of Family Conflict	p. 175
The Stigma of Bipolar Disorder within the larger Society	p. 188
Medication Nonadherence: Its Management within the Family Context	p. 190
Concluding Comments	p. 201
Communication Enhancement Training; Rationale and Mechanics	p. 203
Chapter Overview	p. 203
Objectives of CET	p. 204
Why Introduce Communication Exercise at This Point in Treatment?	p. 205
CET: Getting Storied	p. 206
Teaching the Four Basic Communication Skill	p. 211
Concluding Comments	p. 233
Communication Enhancement Training: Clinical Issues	p. 234
Chapter Overview	p. 235
The Clinical Handling of Communication Enhancement Exercises	p. 235
Problems in the Generalization of Skills	p. 238
Using CET to Modify Family Dynamics	p. 243
Concluding Comments	p. 254
Dealing with Family Problems	p. 255
Chapter Overview	p. 256
Problem Solving: Why at This Point in Treatment?	p. 256
What Kinds of Problems Do the Families of Bipolar Patients Have?	p. 258
Conducting Problem Solving	p. 259
Dealing with Resistance	p. 267
The Problems of the Families of Bipolar patients-Are There Good Solutions?	p. 273
Concluding Comments	p. 279
Managing Crises in Family-Focused Treatment	p. 280
Chapter Overview	p. 281
General Principles for Managing Crises within FFT	p. 282
The Clinical Handling of Crisis Management Sessions	p. 284
Manic Relapses and Hospitalization	p. 285
Depressive Relapses	p. 291
The Suicidal Crisis	p. 292
Alcohol and Substance Abuse	p. 299
Other Psychiatric Crises	p. 306
Concluding Comments	p. 307
Termination
Chapter Overview	p. 309
Terminating FIT: Two Examples	p. 309
Tim Structure of Termination Sessions	p. 313
Reviewing the Course of Treatment	p. 313
Anticipating Future Problems	p. 315
Evaluating Future Treatment Needs	p. 316
Arranging for Follow-Up Visits	p. 321
Concluding Comments	p. 322
References	p. 323
Index	p. 335
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