One-Session Family Workshops for Bipolar Disorder and Depression
Family psychoeducational models have proved successful in outpatient settings, especially for families that include someone with schizophrenia. However, many families confronted with serious mental illness of a family member that have sought services from private practitioners or from acute care settings have not benefited from these psychoeducational models. There is a critical need to modify longer-term psychoeducational models into a brief intervention to address the needs of these families seeking services in these settings. A brief, two-hour, single-session family psychoeducational workshop was developed as part of a community outreach effort to reduce stigma, to increase links to community supports, and to assist families and consumers in coping with depression and bipolar illness.
The rationale for a one-session, family psychoeducation workshop was based on three primary factors: limited professional staff time available to engage families under the current managed behavioral health care guidelines, a desire to engage the largest number of families of newly diagnosed patients, and perceived difficulty in getting many families to commit to ongoing group psychoeducational sessions. The strategy behind the brief workshop, implemented in 2002, is that by having an opportunity to learn about the illness, confront stigma associated with the illness, and receive hints about coping strategies, families would be more committed to participating in their loved one's ongoing treatment intervention. In addition, the clinicians who designed the intervention hoped to improve identification of other family members with mood disorders by presenting information on how the illnesses manifest throughout the life cycle, from childhood to elderly populations.
During the first hour of the two-hour workshop, a PowerPoint presentation provides information on symptom identification, causes, prognosis, coexisting conditions, depression across the life cycle, suicide, medications, psychosocial treatments, neuromodulation treatments, exercise, nutrition, sleep, impact on family members, anger, coping strategies, and self-care. In the second hour, the group is divided into breakout groups for more intensive discussion and problem solving. Each group is facilitated by a clinical social worker and focuses on issues identified by the participants, who briefly introduce themselves to one another and list the concerns that brought them to the workshop. Using a problem-solving framework, the participants' concerns are addressed.
The workshop was specifically designed to be a service and not a treatment intervention. A flyer announcing the group is distributed to clinicians in clinic settings, with additional flyers placed in waiting room areas. The flyer is also posted on a Web site that focuses on depression and bipolar disorder. Participants are not charged to attend the workshop.
The brief, single-session family psychoeducation workshops have been offered since 2002. The development team secured human subjects approval for participants to voluntarily complete brief questionnaires before and after the intervention in an effort to focus on knowledge about the illness, the role of medication, and coping strategies. From fall 2002 until spring 2009, a total of 353 participants completed the questionnaires (35% were parents of a person with depression or bipolar disorder, 20% were partners, and 33% were persons with these disorders). In the preworkshop questionnaire, most participants (68%) indicated that they were not satisfied with the level of involvement that families have in the treatment of depression or bipolar illness, and about half of the participants did not believe that bipolar illness or depression is treatable. The postworkshop questionnaires indicated that participants found the information provided to be helpful (98%), with 78% indicating increased knowledge about stress reduction and coping strategies and 74% indicating that they had learned new strategies to prevent recurrence of severe symptoms of depression or bipolar illness. There was a significant difference (p<.001) between preworkshop and postworkshop measures on the importance of medication in the treatment of depression and bipolar illness, with more participants recognizing the importance of medication.
The single-session workshop, which includes didactic and problem-solving components, appears to fill a critical gap in the service delivery system. Families and mental health care consumers actively search for information about depression and bipolar illness and ways to cope with these illnesses. The preliminary data suggest that a group setting with structured supports facilitates participants' openness to learn from others and to gain an understanding about living with the illness. The pilot work suggests that a one-session family psychoeducation intervention helps families and consumers to better understand the illness and the importance of medications. It fills a gap in the treatment-focused delivery system by reaching out to families and consumers and providing a service that supports their goals of recovery.
