It is all but impossible to conduct results-oriented psychotherapy with a bipolar patient who is not adequately medication managed. Manic symptoms breed poor insight and judgment, and the inability to accommodate and assimilate even the most basic tenets of psychotherapy in a meaningful way. Combine these factors with the DIG FAST symptoms that define the manic spectrum and there’s virtually nothing to be gained.
Bipolarity comes with significant challenges for the clinician employing psychotherapy. First, the psychotherapist has to treat two very different mood states – mania and depression. Second, mania is often a desired condition that a patient wants to continue experiencing rather than not. And the desire to remain manic often results in missed appointments and unaccountability. Also, the low energy and excessive sleeping symptoms of bipolar depression can exacerbate social isolation and poor attitude. Compounding all this is that the patient can “switch” at any time biologically or the switch may be induced by substance abuse of some sort.
The three components of a psychotherapy model that potentially can make a positive difference for the affected patient are:
- Cognitive-behavioral therapy which concentrates on helping the patient understand the ramifications of distorted thinking and irrational activity; emphasizes the likely lifetime prevalence of bipolar disorder and the importance of accepting this along with long-term medication compliance; and learning new ways to cope with the disorder.
- Family-centered therapy which focuses on the family’s ability to increasingly cope more effectively with the identified patient family member and recognize the warning signs of symptom worsening in their loved one; and developing communication and problem-solving skills within the family structure.
- Rhythm therapy which teaches the patient how to better stabilize and organize daily routines and adhere to eating, exercise and sleep/wake schedules.
