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In the last section, we discussed steps I take to prevent a client’s
establishing a family history, reviewing a checklist of risk factors, and
giving advice to the client’s family.
In this section, we will examine the role childhood and upbringing play in a
bipolar adult client’s life: characteristics of functions and dysfunctional families; types of dysfunctional families; and family communication.
♦ Characteristics of Functional and Dysfunctional Families
The first characteristic I take into account is the effect of a
dysfunctional family on an adult bipolar client’s life. Obviously,
childhood is not necessarily the defining factor as to whether or not a
client develops bipolar disorder. However, researchers at the National
Institute of Mental Health have identified some family behavioral patterns
that may contribute to mental illness which include: using denial to manage
anger and anxiety; having unrealistic expectations and standards; finding it
difficult to form intimate external relationships; and passing low
self-esteem from parent to child.
A functional family is one that supplies
both social and appropriate sexual training; provides an environment
conducive to every family member’s survival and growth; values each
individual equally; reinforces each member’s self-esteem and sense of
belonging; and reduces anxiety and promotes a spontaneous atmosphere of
laughter and fun.
Dysfunctional families might value every individual, but gives on special treatment; belittles or criticizes when
members express their thoughts or emotions. There are several types of
dysfunctional families and include the following: the perfect family;
the overprotective family; the distant family; the chaotic family; and the
♦ Types of Dysfunctional Families
In a "Perfect Family," members may look happy and content on the surface,
are really submerging their feelings whether out of fear of criticism or any
other reason. In this type of family, members focus on appearances. A
bipolar client that comes from this type of family may be more prone to deny their illness due to how it would look to outside people.
"Overprotective Family" is one in which members smother other family members
rather than support them naturally. Bipolar adults raised in this kind
environment may not prove resistant to diagnosis, but may resist talking
about emotions in therapy because they’ve been taught to regret expressing
In a "Distant Family," members show little affection for
other members which will result in a bipolar adult’s isolating him or
The "Chaotic Family" is one in which the parents are unavailable
rules are either inconsistent or nonexistent. Bipolar adults who are raised
in a chaotic environment tend to have relationship problems because of their
inability to abide by the rules and guidelines of a healthy relationship.
the "Abusive Family" is the poster child for dysfunctional families. In this
type of family, violence and anger are given free reign. Children may experience
physical, sexual, or verbal abuse which is manifested by only one parent while
other one lives in denial. Adults who are brought up in this type of family
tend to have numerous trust problems and may be generally cynical against
any kind of therapy treatment.
♦ Family Communication: Ladder of Inference
In addition to the characteristics of dysfunctional and functional families,
I also analyze a client’s family’s communication styles. Often,
miscommunication occurs in the Ladder of Inference presented by Dr. Chris
4 Rungs of Inference
In Dr. Argyris’ theory, there are four levels or rungs.
first rung represents an observable action or statement. An example might be
kissing a child good night or saying "I love you".
b. The second rung represents a culturally understood meaning. In Western cultures, a kiss
saying "I love you" means someone cares for you.
c. The third rung represents
a meaning we attribute to the action or statement. If, for instance, a
parent does not kiss a child or say, "I love you," the child may
that the parent does not care.
d. The fourth rung represents the theories
clients use to make third-rung conclusions. For this example, the child
might theorize that parents who care always kiss their children and say "I
love you." Although a parent might indeed love their child, that communication might be lost in the ladder of
Lorraine, age 46, used to concluded that her parents did not
her as a child because their communication was not as affectionate as
Lorraine believed loving families should be. Because of this, Lorraine
had unknowingly taken a fatalistic stance to her disorder, believing that she
herself deserved the disorder.
♦ Technique: Affirmations
To help my clients like Lorraine improve their self-esteem, I asked her to
try the "Affirmations" exercise. I asked Lorraine to write
positive statements as "I have the power for positive change", "I
do what I want to do", and "I am worthy of being happy and healthy". To help her with her affirmations, I asked Lorraine to review these
affirmations regularly. To do so, I gave her the following suggestions:
1. List them on a tablet or compile them in a notebook.
2. Place them on cards small enough to carry in your wallet, purse, or
3. Post them on signs and sticky notes on the bathroom mirror, the
refrigerator, a desk lamp, or some other surface you’ll see daily.
4. Call your answering machine and leave them as messages to yourself.
5. Use a computerized reminder program or a text-to-speech program.
6. Transfer them to audiotape.
7. Subscribe to an automated service
Using these techniques, Lorraine can inundate herself with positive
affirmations that will help her regain her self-confidence. Think of your
adult client who is the product of a dysfunctional family. Could he or
benefit from the affirmations exercise?
In this section, we discussed the role childhood and upbringing play in a
bipolar client’s life: characteristics of functions and dysfunctional
families; types of dysfunctional families; and family communication.
In the next section, we will examine the three types of treatments that
clients may take in addition to therapy: psychotropic medications;
non-medicinal treatments; and hospitalization.
Peer-Reviewed Journal Article References:
Fredman, S. J., Baucom, D. H., Boeding, S. E., & Miklowitz, D. J. (2015). Relatives’ emotional involvement moderates the effects of family therapy for bipolar disorder. Journal of Consulting and Clinical Psychology, 83(1), 81–91.
Horan, W. P., Wynn, J. K., Hajcak, G., Altshuler, L., & Green, M. F. (2016). Distinct patterns of dysfunctional appetitive and aversive motivation in bipolar disorder versus schizophrenia: An event-related potential study. Journal of Abnormal Psychology, 125(4), 576–587.
Miklowitz, D. J., Alatiq, Y., Geddes, J. R., Goodwin, G. M., & Williams, J. M. G. (2010). Thought suppression in patients with bipolar disorder. Journal of Abnormal Psychology, 119(2), 355–365.
Sullivan, A. E., & Miklowitz, D. J. (2010). Family functioning among adolescents with bipolar disorder. Journal of Family Psychology, 24(1), 60–67.
What are three aspects to keep in mind when analyzing the role childhood plays in an adult bipolar client’s life? To select and enter your answer, go to .