We get a lot of calls from parents who are looking for help with their bipolar children. We make great progress within the first few visits, but too often run into an underlying issue that needs to be addressed. While the bipolar issues are certainly part of the problem, the family dynamics are a bigger issue.
Since the child has usually been diagnosed before contacting us, the parents assume all conflicts will be resolved as soon as the child is no longer in disorder. All issues are seen as being caused by bipolar disorder and the rest of the family is completely innocent; it is as if the diagnosis suddenly made everyone else perfect.
This does not happen when the parents have been diagnosed with any psychological issues. The parents recognize their own issues that need to be addressed and how those issues play a role in the conflicts. Even if the diagnosis is completely different from bipolar disorder, there is a recognition that nobody is perfect and we all have room for improvement.
I am not saying everyone is mentally ill or that parents need to be evaluated by a psychiatrist, but the path to harmonious relationships can be severely slowed down by not addressing everyone’s dysfunctional behaviors. This is equally true in families with no mental disorders as it is for families dealing with bipolar disorder or any other mental issue.
Therapists know this, but are sometimes blinded by the bipolar diagnosis too. They recruit the family to share their observations about the child’s disordered behaviors, but forget to look at the role each member plays in triggering them. They fall into the same trap that sees bipolar disorder as the sole problem to address instead of both a contributing factor and result of the family dynamics.
From the very beginning of the Bipolar IN Order program, we recognized the importance of including family and friends in the process. Marriage and family therapists have played a central role in both designing and implementing the program. Their influence helped us design an assessment protocol that has helped change the equation and produce better outcomes. I share it here in hopes that it will be useful for everyone: bipolar people, family and friends, and therapists.
Doing a thorough Family and Friends Assessment can uncover some very painful issues. While it is important to bring hidden issues into the open, they can trigger reactions that none of the participants are prepared for. It is best done under the supervision of a therapist who is specially trained in marriage and family issues. The therapist can help decide when it is right to share the information and under what circumstances.
The first set of questions needs to be about the family dynamics and home environment. How well does everyone understand bipolar and depression? What is the home environment like? What do you think it is like for the bipolar member of the family? What can you do to improve the environment so it is better for everyone? Leave bipolar out and everyone should talk about such things from time to time.
The second set of questions need to probe for issues the parents may be facing. Does mom or dad have any mental or physical conditions that contribute to the situation? Are they getting treatment or support? Do they take meds, use drugs or alcohol? Does such usage help or hinder the family dynamics? These questions and many more like them help bring issues into the light of day that can have a huge impact on the situation.
The next set of questions address relationship skills. What skills do the family members practice to maintain the health of their relationships? Is there a process in place to repair relationships when there has been an argument or crisis? What are the ways in which you monitor too closely, call into question your friend/family member’s judgement, or treat him/her as incapable or disabled? These and many other questions can help everyone to recognize what skills are missing as well as which ones are already in place..
Of course the assessment needs to cover observations about the bipolar person, but even that part of the assessment needs some major changes compared to what is typically asked. In addition to noticing the weaknesses in the bipolar person, it is equally important to assess the person’s strengths. Assessing each family member’s strengths is as important as assessing their weaknesses.
The full assessment questionnaire we use is six pages long and takes about an hour to answer all of the questions. It is too long for a short article, but I will send it to anyone who thinks it might be useful. Our website at http://www.bipolaradvantage.comwill let you sign up for our mailing list and I will have the full assessment sent from there.
Please share your thoughts about this important topic. The more we talk about it, the better chance we have of changing the situation for everyone.