Psychotherapy approaches for bipolar disorder can vary considerably. The work can be thought of as representing one of the seven areas outlined below. It is also frequently the case that more than one area of focus is attended to concurrently.
A. Stabilization and psychiatric referral
When someone commences treatment and he/she is actively symptomatic, the first priority following assessment is to assist with lessening the acuity of current bipolar symptoms. This typically entails looking at lifestyle patterns and their impact upon day-to-day functioning. Recommended modifications will be discussed while also looking at elements such as stress management, impact of current relationships, exercise, diet and substance use. Essentially, I take a very holistic approach towards stabilization.
In addition to therapy, psychiatric medication is often an essential aspect of achieving stability with bipolar disorder. I work collaboratively with numerous psychiatrists in the Charlottesville area and if a new patient does not already have an effective psychiatric relationship, a referral will be made. If a new patient is already receiving psychiatric treatment, I will obtain a signed release so that I can work collaboratively with a patient’s treating psychiatrist.
B. Acceptance of the disorder
This is one of the most important aspects of working with the disorder and the related therapy can span a broad range from as briefly as one to two months… up to a full year or more.
Each person reacts to his or her diagnosis uniquely. For many this reflects where they’re at developmentally. Accepting bipolar disorder is usually more difficult in late adolescence and/or early adulthood, particularly as many of the recommended lifestyle modifications are in conflict with lifestyle norms of the 17 to 25 year old. However, if an individual has already been diagnosed and treated for bipolar disorder and has progressed beyond the initial adjustments, the issues of acceptance may be less problematic.
That said, I do find that for most who live with bipolar disorder, struggles with acceptance are recurrent. Reaction against the disorder manifests in different ways at different times in one’s life. Truly accepting the disorder at a deep level usually takes years of personal growth and maturation, though it’s fair to say that the process typically becomes easier the longer one lives with the disorder.
C. Psychotherapy for maladaptive patterns
Sometimes people have personality characteristics that tend to be maladaptive. Rather than facilitating ones progression through life, maladaptive patterns create their own set of issues or difficulties. For the bipolar individual this can be like trying to extinguish a fire while repeatedly adding new kindling. Maladaptive personality patterns are not a symptom of bipolar disorder, but they can definitely exacerbate the illness.
Personality patterns don’t change easily. They have evolved over many years time, and for most of individuals, they occur outside of conscious awareness and volition. We don’t try to be ourselves. We just “are”.
In the course of working with bipolar disorder I try to discern whether there may be personality issues that are contributing to an individual’s difficulties. Where this is the case, we will discuss the potential for change and specific psychotherapy approaches that can be utilized. When the patient has sufficient motivation and resources then the work on “personality” may become a central part of treatment.
D. Supportive psychotherapy
Sometimes life with bipolar disorder can be a bumpy ride. Even when doing all the right things, individuals can still find themselves struggling with mood instability. Supportive therapy for the bipolar individual provides a time to feel heard and understood without having to worry about burdening friends or family. Supportive psychotherapy helps the patient to maintain perspective while also providing supportive guidance in facing the challenges that come with bipolar disorder.
And if a patient is in the midst of one of those times when insight, behavioral adjustments and support don’t facilitate sufficient change, then therapy can also provide opportunities to explore feelings of frustration and helplessness. Essentially, therapy is a time and place where any and all feelings are permissible. It’s part of what distinguishes the experience from typical day-to-day interactions.
E. Brief treatment for relapses
Intermittent relapse is a given for many with bipolar disorder. The question isn’t so much – will relapse occur, but more – how often will it occur and what degree of symptom acuity will the individual be faced with. The good news is that for many with bipolar disorder, maturation and life experience generally helps to lessen the highs and lows of bipolar disorder.
When one has achieved a relatively good degree of stability, then ongoing psychotherapy is usually unnecessary. However, when mood does destabilize it can be helpful for a patient to come in for several sessions in order to receive brief assistance in getting back to mid-range mood. Think of this like intermittent visits to a family practice physician. Once symptoms have returned to a manageable level, then continued sessions become less necessary and can be spaced out at broader intervals.