21Family Focused Therapy and Interpersonal and Social Rhythm Therapy

Family Focused Therapy and Interpersonal and Social Rhythm Therapy
Family Focused Therapy (FFT) is a hybrid of two forms of psychotherapy. It is both a variety of psychoeducation (a type of therapy whose main goal is to teach patients and their families about the nature of their illness), and also a variety of family therapy. Family therapies are distinguished from other forms of therapy by their attention to family dynamics and relationships as contributing factors that help or hurt illness. Family therapies are sometimes referred to as ecological therapies because they recognize that individuals and their disorders cannot truly be considered to be independent entities separate from the family systems that contain them.
FFT starts with a deep appreciation of the ways that patients' family system and the complicated web of relationships found therein may support patients' conditions, or alternatively, exacerbate them. FFT therapists work to identify difficulties and conflicts within the family that may contribute to patient and family stress, and then help the involved family members to find ways to resolve those difficulties and conflicts. The term "expressed emotion" refers to critical, hostile, or over-involved attitudes and behaviors that family members may have toward or act out with other family members who have psychiatric disorders. Family focused therapists work to help family members to become aware of and bring under control any expressed emotion they may be acting out.
For example, the parents of a bipolar young adult daughter may be quite upset by their child's illness, and as a result, motivated to act in an over-controlling manner that the child rebels against. The daughter's rebellion adds significant stress to her already complicated condition. Recognizing this dynamic, the family focused therapist might advise the parents to find less controlling ways to express their caring and concern, and help them to manage their own stress in a manner more independent from their daughter than they were able to manage previously.
Family focused therapists also educate all family members about the nature of bipolar disorder, how it can be effectively treated, and ways that family members can best support their affected member. For example, the therapist might teach family members about the nature of manic and depressive mood swings, about the differences between Type I and II bipolar disorders, and about the need for medication to be the primary means of therapy. In addition to providing lecture or handout style educational information, therapists may also provide assistance and training to support the family's development of communication, and problem solving skills.
Bipolar disorder is a very serious condition associated with impulsive and self-destructive behavior. Suicidal behavior is frequent, as is sexual and financial acting out. Not surprisingly, families are frequently deeply affected by their bipolar member, and themselves experience a range of deeply felt emotions, not the least of which is a sense of helplessness to fix the situation. Such helplessness can easily turn into anger, frustration and aggravation expressed towards the bipolar family member. Caring for bipolar family members can easily become exhausting and infuriating. Family members can get burned out from trying to help, particularly if the patient is a reluctant patient. They may stop supporting their ill family member. Family focused therapists look for these sort of feelings and interactions (or lack of interactions), work to re-channel any aggression that may be present, promote re-engagement of family members who have checked out, and in general, promote a balanced blend of acceptance of the bipolar patient's limitations, as well as the need for the patient to take age-appropriate responsibility for his or her own well-being. Addressing family emotion in FFT can be a powerful tool for fostering stability within the family unit.
Interpersonal and Social Rhythm Therapy (IPSRT) is based on the observations that bipolar disorders are essentially body rhythm disturbances, and that altered body rhythms (e.g., circadian rhythms, seasonal rhythms, and social/occupational rhythms) can lead to mood disturbances. Body rhythm disturbances such as insomnia and other sleep disturbances, can be corrected or managed by helping patients to set up and stick to healthy sleep routines. As sleeping routines are stabilized, many body rhythms problems tend to go away.
Patients in IPSRT are taught to track their mood states and their daily activities and body rhythms. Patients record when they eat, sleep, shop, etc. on a social rhythm metric chart. They also complete an interpersonal inventory, noting social interactions, such as conflicts and stresses that have an effect on their daily body rhythms and thus on their emotional stability. For instance, an argument with one's spouse is recorded, particularly if that argument resulted in insomnia and agitation. The social rhythm metric chart is analyzed and discussed during psychotherapy sessions, where it becomes an important tool for raising awareness of the inter-relationship between body rhythms and mood. Therapists help patients to establish and maintain steady and stable routines such as taking medicine consistently and going to sleep at regular times. They also help patients to recognize the sorts of activities and interactions that cause their body rhythms to become disturbed so that these activities and interactions can be avoided. For some patients, this self-monitoring and problem-solving variety of therapy is effective in helping prevent recurring mood episodes.