The Bipolar Therapist: Speaking Out About Speaking Up

I have used a variety of therapeutic orientations in my psychotherapy practice behavioral, cognitive, brief, client-centered, psychodynamic, humanistic, and family systems. The list goes on, spanning more years than I care to admit. In helping clients to deal with difficult issues, I have added self-disclosure to this list. This serves to underscore that someone else has experienced what they are going through and encourages empathy between the client and therapist. The client feels understood without feeling “one down.

To some in the field of psychotherapy, the idea of equality and therapist self-disclosure is antithetical to good treatment. I know, because in the past I numbered myself among those who believed this to be true.

The latest evolution in my thinking, therefore, came as a complete surprise to me. As a wounded healer with a history of manic depression going back 30 years, as I became more comfortable with my recovery, I was able to bring this area of expertise to the treatment of others who also have mental illness. I recognize, and clients confirm, the helpfulness of working with a therapist who has been through what they have been through. It is one thing to understand how psychotic thinking impacts one’s ability to make rational decisions; it is quite another to know how the thought impacts one’s logical thinking.

Recently, I was asked by a client to speak to a court evaluator regarding the client’s visitation rights with his children. The client needed a place to sort out mixed feelings about his ex-wife and his role as a father. At one point the evaluator asked if we were doing any “deep work.” I had difficulty expressing that the client needed a place to sort out mixed feelings, not to delve into the deep recesses of his unconscious mind. I felt intimidated by the expression, “deep work.” Because we as therapists cannot seem to move past the status quo and the “tried and true,” I felt uncomfortable with my belief that wider self-disclosure and equality between therapist and client benefits treatment. Today, as described in the following case, my discomfort at self-disclosure has disappeared:

John, age 32, has had anxiety most of his life. He was acutely shy and would be diagnosed today with social phobia. In his early 20’s John began to experience panic attacks and became phobic to most social gatherings. He had few friends and was becoming increasingly isolated. We began therapy by cultivating a conversational dialogue. Though mundane, reporting daily details helped John to talk about himself in a manner that was non-threatening. As he became more comfortable, he gradually began to share feelings of how he felt about himself and his difficulty living in this world, shut off from others. I shared with him my own confrontations with myself at a younger age, my self-consciousness at social encounters, and the discomfort of trying to engage in and maintain conversations. I expressed to John several ways I had confronted my anxiety, suggesting he might find ways of his own to do the same, as we delved deeper into his emotional life and the beginnings of his difficulty with anxiety. My honest input of similarities between us dovetailed with his growing need to understand what happens in others so afflicted. He came to understand there are those who experience life in the same way as he and still find ways to cope. Our relationship began to signify his resolve to venture into the world on his own.

Today, John has been able to conquer his demons. Being able to share with him not only my past history, but my emotional experiences as well, has enabled him to let go of his fears. He realizes his fears are only as big as he has allowed them to be.

Self-disclosure and equality, along with a sense of connection and oneness, merge to create change. If allowed to emerge, clients bloom in an atmosphere of mutual give and take.

I get something from these relationships as well. I am transported to a mindset that is uplifting and satisfying. I feel fulfilled. This is not only important to my personal well-being, but it enhances my work as well. I have learned that as therapists, we listen. The question is, how do we respond?

Why Psychotherapy for Bipolar Disorder?

We’re often told the best treatment for bipolar disorder is a combination of medication and psychotherapy. For some, medication is acceptable, the logic being if bipolar disorder is an imbalance in the brain’s biochemistry, then taking medication to correct the imbalance would be sensible. While many diagnosed with the illness resist taking medication, it nonetheless is logical that if there is a discrepancy in neurotransmitters, some pharmaceutical agent would be helpful to restore the mood balance.

But what about psychotherapy? What contribution to mental wellness does talk therapy make to the overall treatment along with meds?

There is an argument going on about this beneath the surface. We, as a society, have a bias toward the technical and scientific outlook. Such a slant in perspective has us accepting a therapy that is in a physical form—a pill. This is not to say there isn’t a controversy over medication treatment in society today, a view natural substances or mind-over-matter thinking will bring relief. The mindset that pills are bad stems from a view we embrace attacking any ingestion of a foreign substance. At the heart of this is the suspicion we are being led down the garden path by labeling more and more behavior as pathological, losing sight of the varieties of human actions, which in the past we either put up with or kept behind closed doors.

Regardless of our personal opinions as to the efficacy of having an increase in conditions labeled aberrant, there are still illnesses we are coming to understand in biological, brain-centered maladies. Therefore, it is no great wonder acceptance of medication as treatment for bipolar disorder is seen as making sense. But what do we gain from talk therapy? What is so important about it that it is put before us as an equal to meds and stands as part of a two-pronged approach, a best scenario for success in a return to normalcy?

Many believe talk is hardly a treatment. The primary and predominant view often held by the public is that bipolar disorder has brought about dysfunctional, harmful behaviors, which have led to aberrant acting out. What does talking do to alleviate this? The answer is simple. Psychotherapy can help bring insight. It is an opportunity to think through and take responsibility for what we have done, finally coming to terms with ourselves as the flawed beings we are. Often this foray into healthy introspection makes it possible to identify those we have hurt, damage done to our social lives, and careers harmed in the course of an episode. How can all of this take place simply by engaging in a conversation, albeit a therapeutic conversation?

Opening up to ourselves about our greatest fears is the narrowest of beginnings to mend the tentative, long-sought and struggled for acceptance of psychotherapy by those from all stratas of our culture. There is still much work to be done to gain far-reaching acceptance for psychological treatment.

Today, there is not just one psychotherapy, there are many. They can be relied upon to reduce symptoms and correct harmful mood effects. Psychotherapy helps to clear the cobwebs in our thoughts. In the beginning, it may consist of keeping on track with medication before we are ready to confront our illness and face living life with a mental illness diagnosis.

A pill can return you to biochemical balance, but only therapy can help sort out the repercussions of a manic episode or depressive slide. How to deal with, how to sift through, how to make amends; these are all the province of psychotherapy.

How often is one who is diagnosed bipolar brought back to sanity by medication only to be overwhelmed by actions taken in a mood swing of major proportion? Perplexed how to explain to others the lies, financial malfeasance, infidelities, substance abuse, job loss or debt, there is more here than a person can likely handle alone. To understand, to think through, to gain acceptance and guidance is the work to be done with a mental health professional. In short, talk can heal.

BIPOLAR AND PSYCHOTHERAPY: The Other Part of Recovery

Taking a pill is not the only solution to bipolar disorder. Though the need for biochemical treatment to offset the imbalance of human chemistry is key, it does not alone insure a complete resolution of symptoms. Acceptance of a mental disability and attention to the social consequences of bipolar dysfunction is critical to living a life impacted by manic and depressive impulses.

Along with the ravages of personal dysfunction, which is a hallmark of bipolar disorder, there are the aftershocks of behavior that are often tumultuous for personal relationships. Hypersexuality, which can be a consequence of a manic excess, affects your relationship with your partner and/or your image of yourself. Guilt and embarrassment follow in the aftermath. So, too, financial misbehavior affects your functioning, sometimes for years to come. Grandiosity, when finally brought to ground, disrupts the connection we have with others close to us. In short, there is a need for mending fences with those near to us, as well as ourselves. Simply rebalancing the biochemistry is not going to address what we do now to reclaim our lives. That is where counseling and psychotherapy come into the picture.

Sitting down with a therapist and sorting out our feelings about having a mental illness can go a long way toward reducing the stigma we often experience within ourselves and from others. Clearing away the debris of a life lived without restraint, unleashed and unapologetic, can only be addressed by a thoughtful coming to terms with our excesses in a therapeutic environment.

Support from a friend or family member is helpful to recovery. Often, however, the deeper feelings of self-loathing and regret for episodic excess can only be addressed with someone trained in the art of listening objectively and offering perspective untainted by personal biases. This is true of both depressive and manic occurrences.

A therapist at his best is an ally and advocate, someone who can be there for you. Whether education, support, or analysis is called for, a therapist can pave the way for your acceptance and understanding. He can also be a bridge between dysfunction and redeeming your life.

Sometimes we need a guiding hand. Psychotherapy is that step-up. Along with medication it is our strongest antidote to the confusion and chaos that often results from an illness gone awry. Reach out for a fuller recovery for yourself and your loved ones. You needn’t be alone as you traverse the road to recovery. Sometimes you need an honest broker to hold up a mirror to yourself; sometimes you need a caring listener to set your fears at rest; and sometimes you need the support of an ally to walk with you for awhile, someone who can help you find the answers to your inner turmoil and confusion. As a friend of mine once said, “Don’t be afraid to call the doctor if there’s nobody else at home.”