Family-focused therapy (FFT) was developed by David Miklowitz, Ph.D., and Michael Goldstein, Ph.D., for treating bipolar disorder. It was designed with the assumption that a patient's relationship with his or her family is vital to the success of managing the illness. FFT includes family members in therapy sessions to improve family relationships, which may support better treatment results.
Therapists trained in FFT work to identify difficulties and conflicts among family members that may be worsening the patient's illness. Therapy is meant to help members find more effective ways to resolve those difficulties. The therapist educates family members about their loved one's disorder, its symptoms and course, and how to help their relative manage it more effectively. When families learn about the disorder, they may be able to spot early signs of a relapse and create an action plan that involves all family members. During therapy, the therapist will help family members recognize when they express unhelpful criticism or hostility toward their relative with bipolar disorder. The therapist will teach family members how to communicate negative emotions in a better way. Several studies have found FFT to be effective in helping a patient become stabilized and preventing relapses.
FFT also focuses on the stress family members feel when they care for a relative with bipolar disorder. The therapy aims to prevent family members from "burning out" or disengaging from the effort. The therapist helps the family accept how bipolar disorder can limit their relative. At the same time, the therapist holds the patient responsible for his or her own well being and actions to a level that is appropriate for the person's age.
Generally, the family and patient attend sessions together. The needs of each patient and family are different, and those needs determine the exact course of treatment. However, the main components of a structured FFT usually include:
- Family education on bipolar disorder
- Building communication skills to better deal with stress, and
- Solving problems together as a family.
It is important to acknowledge and address the needs of family members. Research has shown that primary caregivers of people with bipolar disorder are at increased risk for illness themselves. For example, a 2007 study based on results from the NIMH-funded Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) trial found that primary caregivers of participants were at high risk for developing sleep problems and chronic conditions, such as high blood pressure. However, the caregivers were less likely to see a doctor for their own health issues. In addition, a 2005 study found that 33 percent of caregivers of bipolar patients had clinically significant levels of depression.