Difficulty in implementing a family intervention for bipolar disorder: Thepredictive role of patient and family attributes

Family affect was examined as a predictor of difficulty implementing a 9-mo nth, manual-based, psychoeducational family therapy for recently manic bipo lar patients. Prior to therapy, family members were administered measures t o assess both their expressed emotion and affective behavior during a famil y interaction task. Following family treatment, both therapists and indepen dent observers rated the overall difficulty of treating the family, and the rapists also rated each participant's problem behaviors during treatment, i n the areas of affect, communication, and resistance. Therapists regarded a ffective problems among relatives and resistance among patients as central in determining the overall difficulty of treating the family. Relatives' cr itical behavior toward patients during the pretreatment interaction task pr edicted both independent observers' ratings of overall treatment difficulty and therapists' perceptions of relatives' affective problems during treatm ent. Moreover, patients' residual symptoms predicted independent observers' ratings of overall difficulty and therapists' perceptions of patients' res istance to the family intervention. Results suggest that difficulties in co nducting a manual-based family intervention can be predicted from systemati c, pretreatment family and clinical assessment.