9781572302839

Univ. of Colorado, Boulder. Presents a complete nine-month outpatient program designed to help patients and families manage the effects of bipolar disorder. Focuses on improving and reducing the risk of relapse. For therapists, advanced level students, researchers, and patients.

David J. Miklowitz, PhD, is Associate Professor of Psychology at the University of Colorado, Boulder, where he has taught in the graduate Clinical Psychology program since 1989. Focusing on family environmental factors and family interventions in the major mental disorders, with particular emphasis on bipolar affective disorder, Dr. Miklowitz's work has been funded by the National Institute of Mental Health and the MacArthur Foundation, and recognized by awards from the International Congress on Schizophrenia Research and the National Association for Research on Schizophrenia and Depression. He is the author of 60 journal articles and book chapters.

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.

PART I: BIPOLAR DISORDER AND FAMILIES: CLINICAL AND RESEARCH BACKGROUND

3

(56)

1. Bipolar Disorder: Why Family Treatment?

3

(15)

How Is Bipolar Disorder a Family Problem?

5

(1)

Why FFT?

6

(1)

The Six Objectives of FFT

6

(6)

The Core Assumptions and Structure of FFT

12

(1)

Is FFT Helpful?

13

(2)

The Organization of This Book

15

(1)

For Whom Is This Book Intended?

16

(1)

A Word about Terminology

17

(1)

2. The Nature of Bipolar Disorder and Its Impact on the Family

18

(23)

Chapter Overview

19

(1)

What Is Bipolar Disorder?

19

(3)

The Impact of the Disorder on Family Members

22

(1)

The Topography of Manic and Depressive Episodes

23

(4)

The Role of the Family in Differential Diagnosis

27

(1)

The Variable Life Courses of Bipolar Disorder

28

(3)

Developmental Precursors to Bipolar Disorder

31

(3)

The Interface between Drug Treatment and FFT

34

(6)

Concluding Comments

40

(1)

3. Family and Social Factors in the Course of Bipolar Disorder

41

(18)

Chapter Overview

42

(1)

The Vulnerability-Stress Model

42

(1)

Family Environmental Factors in Bipolar Disorder

43

(9)

Life Events Stress

52

(2)

The Vulnerability-Stress Model Revisited

54

(2)

Concluding Comments

56

(3)

PART II: CONDUCTING THE FAMILY-FOCUSED TREATMENT

59

(242)

4. Planning the First Encounter

59

(15)

Chapter Overview

60

(1)

Who Is Appropriate of FFT?

60

(3)

The Mechanics of FFT

63

(3)

Getting Started: The Initial Contacts

66

(7)

Concluding Comments

73

(1)

5. The Functional Assessment

74

(13)

Chapter Overview

74

(1)

Assessing the History of the Patient's Disorder

75

(7)

Assessing Family Interactions

82

(4)

Concluding Comments

86

(1)

6. Family Psychoeducation: The Initial Sessions

87

(29)

Overview of the Psychoeducation Section

87

(1)

The Therapeutic Stance

88

(2)

"Setting the Stage" for the Psychoeducation Module

90

(1)

Introducing the Treatment Program

91

(6)

Presenting the Didactic Material: Reviewing the Index Episode

97

(8)

Events Leading Up to the Episode: The Life Events Survey

105

(5)

Discussing the Hospitalization Experience

110

(3)

The Expected Course of Bipolar Disorder

113

(2)

Concluding Comments

115

(1)

7. Family Psychoeducation: Etiology, Treatment, and Self-Management

116

(34)

Chapter Overview

116

(1)

The Etiology of Bipolar Disorder

117

(13)

Treatment of the Disorder within the Vulnerability-Stress Model

130

(7)

How the Family Can Help

137

(5)

The Self-Management of Bipolar Disorder

142

(2)

The Relapse Drill

144

(4)

Addressing Unanswered Questions

148

(1)

Concluding Comments

149

(1)

8. Family Psychoeducation: Dealing with Resistances

150

(37)

Chapter Overview

151

(1)

Manifestations of Denial and Resistance

152

(1)

Anticipating and Preempting Denial and Resistance

153

(4)

The Meaning of Bipolar Disorder within the Family Context

157

(5)

Differing Perceptions of the Disorder as a Source of Family Conflict

162

(11)

The Stigma of Bipolar Disorder within the Larger Society

173

(1)

Medication Nonadherence: Its Management within the Family Context

174

(11)

Concluding Comments

185

(2)

9. Communication Enhancement Training: Rationale and Mechanics

187

(29)

Chapter Overview

187

(1)

Objectives of CET

188

(1)

Why Introduce Communication Exercises at This Point in Treatment?

189

(1)

CET: Getting Started

190

(4)

Teaching the Four Basic Communication Skills

194

(20)

Concluding Comments

214

(2)

10. Communication Enhancement Training: Clinical Issues

216

(21)

Chapter Overview

217

(1)

The Clinical Handling of Communication Enhancement Exercises

217

(3)

Problems in the Generalization of Skills

220

(5)

Using CET to Modify Family Dynamics

225

(10)

Concluding Comments

235

(2)

11. Dealing with Family Problems

237

(24)

Chapter Overview

238

(1)

Problem Solving: Why at This Point in Treatment?

238

(1)

What Kinds of Problems Do the Families of Bipolar Patients Have?

239

(1)

Conducting Problem Solving

240

(7)

Dealing with Resistance

247

(7)

The Problems of the Families of Bipolar Patients: Are There Good Solutions?

254

(6)

Concluding Comments

260

(1)

12. Managing Crises in Family-Focused Treatment

261

(26)

Chapter Overview

262

(1)

General Principles for Managing Crises within FFT

263

(2)

The Clinical Handling of Crisis Management Sessions

265

(1)

Manic Relapses and Hospitalization

266

(5)

Depressive Relapses

271

(1)

The Suicidal Crisis

272

(6)

Alcohol and Substance Abuse

278

(6)

Other Psychiatric Crises

284

(2)

Concluding Comments

286

(1)

13. Termination

287

(14)

Chapter Overview

287

(1)

Terminating FFT: Two Examples

287

(4)

The Structure of Termination Sessions

291

(1)

Reviewing the Course of Treatment

291

(2)

Anticipating Future Problems

293

(1)

Evaluating Future Treatment Needs

293

(6)

Arranging for Follow-Up Visits

299

(1)

Concluding Comments

299

(2)

References

301

(10)

Index

311

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Bipolar Disorder Family-Focused Treatment Approach, A

Bipolar Disorder Family-Focused Treatment Approach, A

1572302836

Summary

Author Biography

Table of Contents

Supplemental Materials