Group Therapy for Bipolar Disorder

Group therapy can be educational, problem-solving, or supportive, and it can serve a variety of other functions as well. When I was working on an inpatient adolescent unit years ago, I learned that adolescents often listen to their peers better than they listen to adults (even the therapist at times). The old phrase "misery loves company" is often true. There's an element of destigmatization in knowing that others have problems and that you're not alone. By working together in groups, young kids and adolescents get to discover that they are not the only ones in the world who are sometimes held hostage by their mood fluctuations. They also learn that these mood swings don't define who they are. This type of treatment is frequently used in inpatient programs, day programs, and outpatient settings. It can be extremely helpful for children and adolescents who have the verbal and cognitive skills to benefit from it, but its efficacy depends on the match between the group's leader and the individual patients, as well as the compatibility between the patients.

Multifamily Groups

Some clinicians have applied the principles of group therapy to what are called multifamily groups. Mary Fristad, PhD, and her colleagues at Ohio State University first published their results on the effectiveness of multifamily psychoeducation groups (MFPG) specifically for children with bipolar and depressive disorders and their caretakers in 1998.¹ The current model of this treatment approach consists of eight sessions in which family members (including the child) meet together to learn about mood disorders and better ways of communicating with each other. After the joint meeting at the beginning of the session, the families are divided into two groups, one for parents and one for children. The children receive information about their disorder that helps to demystify the condition, as well as symptom-management skills and social skills training. For example, a youngster who attributes her depressive irritability to "being bad" might be told instead that her short temper and sadness are to some degree innate—in the same way that a tendency to nearsightedness is part of some kids' biologic makeup. But just as you can wear glasses to correct nearsightedness, you can take medicine and have therapy to alleviate the symptoms of Bipolar Disorder. While the children are in their session, the adults are learning about their children's illness and developing symptom-management strategies, too. At the conclusion of each session, families are given projects to work on together at home.

So far, Fristad's research indicates that both parents and children who participate in the groups feel happier about their relationships, more knowledgeable about the mood disorders present in family members, and empowered to use the new coping skills they've learned.² As this book was going to press, a comprehensive study on the effectiveness of multifamily therapy was close to completion. Families may soon be able to avail themselves of this type of therapy outside a group setting. Fristad is now adapting her treatment approach for use with individual families.³

Social Skills Groups

These groups are useful for bipolar children and other kids who have difficulty getting along with peers, making and maintaining friendships, and knowing how to act in social settings such as restaurants, family functions, or the grocery store. Often, this type of therapy is recommended by a therapist or the child's teacher, or it is sought out by a parent.

In social skills groups, which are led by trained therapists, children practice such things as how to join in a conversation and take turns in games. They practice socially appropriate behaviors such as how to accept a present graciously or how to ask for help in a store.

One of the goals of social skills groups is to address the misperceptions bipolar kids often have about their world. When these kids are depressed, they often experience paranoia and feel that others don't like them or are saying mean things about them. When they act on these incorrect assumptions, it creates problems. Social skills groups can also help bipolar kids to better "read" facial expressions and emotions, a skill they often find difficult.

1. M. A. Fristad, S. M. Gavazzi, and K. W. Soldano, Multi-family psychoeducation groups for childhood mood disorders: A program description and preliminary efficacy data, Contemporary Family Therapy 20 (1998): 385.
2. M. A. Fristad, J. S. Goldberg-Arnold, and S. M. Gavazzi, Multi-family psychoeducation groups (MFPG) for families of children with bipolar disorder, Bipolar Disorders 4 (2002) 254.
3. M. A. Fristad, Psychoeducational treatment for school-aged children with bipolar disorder, Development and Psychopathology (2006).

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