Family Focused Therapy (FFT) for Bipolar Disorder

Status: Strong Research Support for depression


Family Focused Therapy (FFT) is a modification of the family-focused therapy originally developed for the treatment of schizophrenia (Goldstein & Miklowitz, 1995). All immediate family members are included, and therapy consists of several stages, beginning with psychoeducation about the symptoms and etiology of bipolar disorder and the need for medication adherence. Families are taught to respond early to emergent symptoms, and provided with training about the best coping responses. Then, drawing on the evidence that overly negative family interactions (expressed emotion) can trigger relapse of bipolar disorder, families learn communication and problem-solving skills for reducing conflict and resolving family problems. Treatment typically consists of 21 sessions over 9 months and was conducted in patient homes during the initial studies.

It is important to note that forms of family therapy other than FFT have not been shown to produce changes in manic or depressive symptoms (Clarkin, Carpenter, Hull, Wilner, & Glick, 1998; Miller, Solomon, Ryan, & Keitner, 2004). The FFT approach is distinguished from these other approaches by more structured exercises concerning family communication, more education about bipolar disorder, and more specific strategies for responding to symptoms.

Key References (in reverse chronological order)

  • Miklowitz, D. J., Otto, M. W., Frank, E., Reilly-Harrington, N. A., Kogan, J. N., Sachs, G. S., et al. (2007). Intensive psychosocial intervention enhances functioning in patients with bipolar depression: Results from a 9-month randomized controlled trial. American Journal of Psychiatry, 164, 1340-1347.
  • Miller, I., Solomon, D. A., Ryan, C. E., & Keitner, G. I. (2004). Does adjunctive family therapy enhance recovery from bipolar I mood episodes? Journal of Affective Disorders, 82, 431-436.
  • Miklowitz, D.J., George, E.L., Richards, J.A., Simoneau, T.L., & Suddath, R. L. (2003). A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder. Archives of General Psychiatry, 60, 904-912.
  • Rea, M. M., Tompson, M., Miklowitz, D.J., Goldstein, M.J., Hwang, S., & Mintz, J. (2003). Family focused treatment vs. individual treatment for bipolar disorder: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 71, 482-492.
  • Simoneau, T.L., Miklowitz, D.J., Richards, J.A., Saleem, R., & George, E. L. (1999). Bipolar disorder and family communication: Effects of a psychoeducational treatment program. Journal of Abnormal Psychology, 108, 588-597.
  • Clarkin, J. F., Carpenter, D., Hull, J., Wilner, P., & Glick, I. (1998). Effects of psychoeducational intervention for married patients with bipolar disorder and their spouses.Psychiatric Services, 49, 531-533.
  • Goldstein, M. J., & Miklowitz, D. J. (1995). The effectiveness of psychoeducational family therapy in the treatment of schizophrenic disorders. Journal of Martial and Family Therapy, 21, 361-376.

Clinical Resources

  • Miklowitz, D. J., & Goldstein, M. J. (1997). Bipolar Disorder: A Family-Focused Treatment Approach. New York, NY: Guilford Publications.

Training Opportunities

For information about workshops and additional training, contact David J. Miklowitz, Department of Psychology, University of Colorado, Boulder, Muenzinger Bldg., Campus Box 345, Boulder, CO 80309-0345,