EVALUATING THERAPIST COMPETENCE AND ADHERENCE TO BEHAVIORAL FAMILY MANAGEMENT WITH BIPOLAR PATIENTS

The present study assessed fidelity to the behavioral family managemen t(BFM) model for treating bipolar disorder patients and their families . The BFM Therapist Competency/Adherence Scale (BFM-TCAS) was develope d to evaluate clinicians' competency and adherence to BFM, as outlined by Miklowitz' (1989) BFM Manual for use with bipolar patients. Therap ist competency and treatment adherence was also evaluated with regard to two family characteristics: overall level of family difficulty and family expressed emotion (EE) status. The BFM-TCAS was used to code 78 videotaped sessions of 26 families with a bipolar member, selected fr om a larger treatment study of bipolar disorder patients. The findings suggest that, overall, clinicians adhered closely to the BFM manual. Specific areas in which there was high competency and treatment adhere nce were (a) skill in conveying factual information about bipolar illn ess, (b) establishment of a therapeutic environment, and (c) ability t o take command of therapy sessions. The one area in which there was le ss compotency and relatively weak adherence to the manual was the use of between-session homework assignments to assist families in masterin g the BFM exercises. Results of this study also suggest that, for the most part, therapist competency and adherence ratings were not related to overall level of difficulty or to family EE status.