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Emotion in Bipolar Disorder
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One of the most helpful tactics I have found when treating adults with bipolar
disorder is providing them with information. Because bipolar adults are
already curious and assertive people, they feel that they have a right to know why they were diagnosed with this disorder, what they can do about it, and how this disorder and the subsequent treatment will affect their
lives. I often see less resistance to treatment and an overall improvement
in the client-therapist relationship when they receive an explanation.
If the client is married or in a serious relationship, I ask them to share
this information about bipolar disorder with their spouse or significant other. Too
many times I have had bipolar clients come to me confused because their last
doctor prescribed them medications and neglected to educate them on the effects
of treatment and the disorder on their daily life.
In this section, we
will present the various topics I emphasize to educate my bipolar adult and prepare
them for the therapy process this will include the symptoms of the disorder;
its effect on the client’s relationships; and the effect of stress
on the intensity and timing of manic and depressive episodes.
3 Topics for Educating the Bipolar Adult
♦ 1. Educating Your Client about Symptoms
The first topic I explain to the client is the system of diagnosis
and the symptoms of the disease. Obviously, it’s important to distinguish
the difference between bipolar I, bipolar II, and bipolar disorder with
rapid cycling. Marianne had been referred to me after a week and a half
long manic episode which required her to be hospitalized for exhaustion. Marianne,
who resented the doctors’ diagnosis of her extra energy
as a "disorder", stated, "Why do people think I’m deranged? I
needed to get things done, that doesn’t mean my brain’s
messed up. I
could have stopped, I didn’t need to go to the hospital."
explained to Marianne that the DSM diagnoses of bipolar I as a
disorder in which symptoms of mania (such as grandiosity, decreased need
for sleep, and pressured speech) lasted for more than a week. In some
cases, if hospitalization is required, there is no time limit for the disorder. Because
this was the case with Marianne and because her symptoms lasted for more than
a week, I told her that this was the reason she had been referred to me. I gave
Marianne a copy of the symptoms from the DSM and a list of reading material
she could look to for more information.
The next session,
Marianne stated, "Doctor, I read some of the books you told me about. One
of them had a self-quiz and I took it. I was dead on for this thing and
I never knew it." As you can see, through education, Marianne started
to accept her condition and her treatment started to go more smoothly. Think
of your assertive bipolar client who is in denial. Could he or she benefit
from symptom education?
♦ 2. Bipolar Disorder and Relationships
The next topic I educate my clients on
is the effect the disorder has on relationships. If the client is married
or in a serious relationship, I ask them if they would allow their spouse
or partner to sit in on this part of a session. Many times, the bipolar
client is not aware of their significant other's feelings. Often, the
other person in the relationship feels resentful at having to change their communication
styles to fit a manic or depressive mood.
Sharing Exercise - 6 Questions
If both people are willing, I
ask them to complete the "Sharing" exercise. In this exercise, I give both people a
set of questions and ask them to answer them separately and then to discuss
their answers together in the privacy of their own home.
include the following:
1. How has bipolar disorder affected my relationship as a whole?
2. How has it affected me as a person?
3. What is the hardest thing that I face daily regarding this illness?
4. What do I want to see change right now?
5. What do I need in my own life to find happiness?
6. If things stay as they are, where do I see my relationship in the
One couple, Mark and Eileen, completed this exercise. Mark,
who had been diagnosed with bipolar II disorder, stated, "Eileen told
me it hurt her every time I went through any kind of stage. I hate hurting
her. She’s such a good natured person. That will definitely
be my motivation to try harder during treatment." Because Eileen
decided to be honest with Mark about her feelings, Mark found new motivation to cope with his disorder.
♦ 3. Bipolar Disorder and Stress
In addition to symptoms and its effect on relationships,
the third topic I educate my clients about is the affect of stress on their
you found that many of your bipolar client's episodes are
triggered by a stressful period in the client's life?
Jean had recently
undergone a divorce. During the subsequent custody battle, Jean became obsessed
with copying legal documents that related to her case. She also would
call friends across the country to speak to their own lawyers for advice. Jean
soon revealed that she gradually slept less and less each night. Luckily,
her custody hearing turned in her favor. With the removal of this
stressor, Jean’s moods stabilized.
Technique: Stress History
When clients like Jean have a history of stress triggers, I
ask them to fill out a "Stress History Catalogue". I asked Jean
to make three columns labeled "Date or Age", "Type" and "Description."
1. Under "Date
or Age", I asked Jean to put the date of the episode or the age she was
when it occurred. Jean wrote, "last year".
2. Under "type",
I asked her to write the type of episode it was, either manic,
hypomanic or depressive, under which Jean wrote, "manic".
3. Under "description",
Jean wrote, "hyperactive obsessive behavior with long periods
asked Jean to also think back into her history and recollect any other periods
of stress that might have led to a manic episode. Jean wrote "when
my mother died", "when I moved to a new city" and "immediately
after my children
For each of these, Jean noticed a pattern of manic behavior
running concurrent with these time periods of stress. By reviewing her
stress history, Jean could better predict her own episodes of manic behavior.
of your client who has been diagnosed with bipolar disorder with rapid
cycling. Could stress be a
trigger for this client?
In this section, we discussed various topics I emphasize to educate my
adult bipolar clients and prepare them for the therapy process. We discuss
the symptoms of the disorder; its effect on the client’s relationships;
and the effect of stress on the intensity and timing of manic and depressive
In the next section, we will examine three types of resistant
are clients who reject diagnosis; the under identifying; and the over-generalizing
Peer-Reviewed Journal Article References:
Hunsley, J., Elliott, K., & Therrien, Z. (2014). The efficacy and effectiveness of psychological treatments for mood, anxiety, and related disorders. Canadian Psychology/Psychologie canadienne, 55(3), 161–176.
Kang, Y., & Gruber, J. (2013). Harnessing happiness? Uncontrollable positive emotion in bipolar disorder, major depression, and healthy adults. Emotion, 13(2), 290–301.
Sperry, S. H., & Kwapil, T. R. (2020). Bipolar spectrum psychopathology is associated with altered emotion dynamics across multiple timescales. Emotion. Advance online publication.
What are three topics you might consider when educating your bipolar client? To select and enter your answer, go to .