August 2, 2014

Bipolar Disorder-Developing a Strong Relationship With Your Therapist

Living with Bipolar Disorder (BD) is a challenge. For a lucky minority, symptoms are fairly easily managed but for most people it’s on an ongoing process that can be tedious and frustrating. Because BD is not age related and can affect even people who are quite young and otherwise healthy, those who are recently diagnosed are often unused to thinking of themselves as having a health condition that requires chronic management. This is not different from other medical conditions that strike the young such as Type I Diabetes. Younger people-and I’m including those in their 30’s and 40’s-often feel, “I’m too young to have to worry about my health”. They see their peers taking risks, living more carelessly and oblivious to health issues and they feel resentful and jealous. It’s easy to “rebel” and think, I’m not going to worry about how much I sleep or how much I drink or how I handle stress but the consequences are far more damaging to those with chronic illnesses. The body, I’m afraid tends to win out. Mind over matter is a nice idea but rarely practical.


After diagnosis-and that can take years as the most common form of BD is Bipolar II which masquerades as depression the majority of the time-it’s essential to find and develop a good relationship with a psychologist you trust. Shop around. Find someone that seems knowledgeable about Bipolar Disorder and who’s style is comfortable for YOU. It doesn’t matter if everyone you know thinks this is the best therapist in town. If you don’t feel comfortable, the relationship will not work. Be picky. This should be a long term relationship.

It is essential that you go to your therapist even when you are feeling fine. I usually recommend that people schedule every four to six weeks once their symptoms are under control. Of course during difficult periods you will need to get in once a week or even more often.


Bipolar Disorder is a chronic illness. It can be managed, often very successfully, but like all chronic illnesses it will naturally fluctuate. People with heart disease, diabetes, MS, arthritis, even cancer all take regular medicines, have regular check-ups and evaluations and require changes and adjustments in their treatment. We are all living better, longer and healthier lives with chronic illness due to advances in care. Bipolar Disorder is no different. The condition changes! Even if you are doing everything perfectly; taking your medicine, going to therapy, eating and sleeping well, exercising regularly-your condition CAN get worse. It’s not fun, it’s not fair but that’s just how it works so far. And as soon as BD is worse your self-awareness and insight will diminish making it harder for you to see that you aren’t doing as well and need to change something in your regimen. Loved ones can help by alerting you to the fact that you seem more negative or more hyper, but a therapist with whom you have a developed a long-term, strong relationship, who knows your symptom pattern well, is in a great position to catch deteriorating symptoms early and help you take action to prevent serious, negative outcomes. That’s why I always recommend regular check-ups even when you are feeling fine. It’s a great insurance policy to prevent relapse.


No one wants to have BD. No one enjoys taking medicine and constantly worrying if a bad mood is simply a normal day to day fluctuation. It’s easy for us as well as those around us to deny the severity of a problem by thinking, “well of course I’m upset” or “it’s normal to be excited and revved up about getting  this done”. We don’t want to be getting sick. The ongoing surveillance and questioning necessary to manage psychological symptoms is burdensome for all.  It is human nature to hope that everything is fine and that we don’t need to worry. People with heart disease and diabetes or cancer that’s in remission always want to hope that the mild changes they feel are not evidence of more serious problems. But we have to be sure. An ounce of prevention is truly worth many pounds of cure-especially in BD which can have such devastating consequences in our lives.


The longer and better you know your psychologist, the easier it becomes for that therapist to recognize your patterns and early warning signs. All chronic illnesses require occasional adjustments in treatment and medications. Bipolar Disorder is no different. You and your therapist working together can identify the early warning signs of depression, anxiety or agitation that indicate your condition is shifting and that changes in medicines or dosages are necessary. The earlier this can be identified, the better the chance for avoiding a serious relapse.


You didn’t choose it, you didn’t cause it and you can’t make it go away but you can manage it and with a good treatment team you can keep it under control so it interferes with your life as little as possible. In my next article, I will talk about how to work with your psychiatrist in managing Bipolar Disorder.


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