Family-focused therapy (FFT) is a psychoeducational treatment for adults and adolescents with bipolar disorder. It is given in up to 21 sessions over 9 months, and consists of three modules: psychoeducation, communication enhancement training, and problem-solving skills training. Therapist fidelity to FFT is measured using the Therapy Competence and Adherence Scales, Revised (TCAS-R). In a recent 8-site study of youth and young adults at risk for psychosis, TCAS ratings were highly reliable across raters, and distinguished sessions of FFT from sessions of a briefer psychoeducational control treatment.
The TCAS-R is rated by an expert supervisor or independent evaluator on every case, using hour-long audiotapes or videotapes of randomly selected sessions drawn from all three FFT segments. The main portion of the scale consists of 15 items measuring effective delivery of psychoeducation (e.g., accurate explanations of didactic material) and communication or problem-solving skills training, nonspecific factors (e.g., ability to develop rapport with the patient and family, efficient use of time, and session command), and an overall rating of fidelity. These items are rated from 1 (poor) to 7 (excellent). Three additional scales (rated 1-3) measure the difficulty of the family under consideration. The second part of the scale consists of a content and skill checklist. These items (e.g., education about symptoms of the prodrome of psychosis or mania; expressing hopefulness or enthusiasm) are rated as present/absent and, if present, are rated further on a 1-3 scale of competence. There are four items measuring proscribed therapist behavior (e.g., unfocused exploration for the majority of a session).