Bipolar Disorder, Second Edition: A Family-Focused Treatment Approach » (2nd Edition)

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.

Family-focused psychoeducational treatment (FFT) is among a very small number of psychosocial treatments that have been found to be effective in multiple studies to improve the course of bipolar disorder. This indispensable guide describes how to implement FFT with adult and adolescent patients and their family members. Provided are practical procedures for helping families understand the nature of bipolar disorder, strengthen their communication skills, solve day-to-day problems, and reduce the risk and severity of relapse. The book incorporates state-of-the-art knowledge on the illness and its biological and psychosocial management. More than a dozen reproducible handouts are included.

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.

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