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Section 13
Psychosocial Interventions regarding Youth Bipolar Disorder

Question 13 | Test | Table of Contents

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In the last section, we discussed three key aspects of stress on bipolar child clients, which were biological processes; social factors; and transitions. We also included three techniques to reduce these stresses. These three techniques were Acclimation, Point System and Transition Form.

As you know, interacting with other children is a large step in helping any child to relate in a healthy way to the world around them.  When a bipolar child client is unable to communicate rationally with his or her peers, he or she might not develop necessary social skills.

In this section, we will examine three difficulties bipolar children have in relating to other children.  These three difficulties include impulsiveness; defiant attitudes; and disempowerment.
                                                  
3 Difficulties of Relating to Other Children

♦ 1. Impulsiveness
The first difficulty bipolar children must face is their own impulsiveness.  As non-bipolar children mature, they become increasingly capable of manipulating objects and events around them, thereby becoming free of concrete dependency on them.  I have found that a bipolar child, however, never connects with the sense of being able to control his environment.  As a result, this feeling of loss of control is translated into reactions that are impulsive and aggressive. 

Such simple tasks as taking turns, waiting on others, or holding back to talk first pose an imminent loss of control on bipolar children.  This can also be seen when a parent says the word no and a child reacts with rage.  Faced with a feeling of powerlessness, the bipolar child responds in the way his or her body demands:  a tantrum. 

Kyle was a nine year old bipolar client who could not share with others.  When someone asked him for a toy, he became angry.  When I asked him if I might see one of his toys that he was playing with, Kyle stated, "No!  You’re too stupid.  Shut up and get your own Lego."  When I asked again, Kyle threw the Lego set across the room.

♦ 2. Defiant Attitudes
The second difficulty that bipolar children face in interacting with other people is their own defiant attitudes.  Like impulsiveness, defiance is a way to control their surroundings.  Bipolar children do this by constantly standing their ground, admitting no new stimuli, no changes and no transitions. Many times, this comes as a misinterpretation of a person’s intentions. 

Such simple requests as "You’ve got to get up now so you have enough time to get dressed" raises anxiety in bipolar children and they respond with stubborn opposition.  Over time, these defiant behaviors in adolescents can be viewed as disrespectful and these bipolar teens are often met with negative attitudes from teachers and other authority figures.  As a result, they isolate themselves even more, which enhances their low self-esteem.

Technique: Communication - Misinterpreting Other People’s Requests
What many interpreted as Kyle’s irrationality was what I recognized as a miscommunication.  To Kyle, I was trying to encroach on his play time and ruin his day.  In his polarized mind, I was either a friend, or I was an enemy.  To help Kyle understand my intentions, I used the "Communication" technique.  When I asked Kyle again for the toy, I made sure to make my intentions clear.  I stated to Kyle, "Kyle, I see that you are playing with a fun toy.  I would like to have fun with you, but do not want you to stop having fun.  May I play with you, while you also play too?" 

Kyle’s second reaction was the complete opposite of his first reaction.  He let me sit with him and pick up his toy.  I then stated to Kyle that this was what sharing really was:  playing with another person.  Think of your "Kyle".  Is he or she misinterpreting other people’s requests?  Is he or she overreacting to these requests?

♦ 3. Disempowerment - Tunnel Vision
The third difficulty many bipolar children face when interacting with other people is a feeling of disempowerment.  Many times, this occurs when a child is in a new environment or has to interact with authority figures such as teachers or therapists.  This could cause them to fly into a depressed or manic state.  Much of this feeling of disempowerment comes from a lack of self-confidence.  In adolescents, this can be magnified by their changing social atmospheres and their own hormonal growth.  Have you found, like I, that adolescents have a much lower self-confidence than adults or younger children? 

Because they do not know how to handle their low self-esteem, teenagers become reclusive, and this is true with bipolar and non-bipolar alike.  However, the danger, as you well know, is that bipolar teens left alone do not have the support system to keep them from a manic or depressive state. 

Thirteen year old Jacqueline lost her self-confidence when her medication caused her to gain around fifteen pounds.  This extra weight bombarded her self-esteem until Jacqueline became severely depressed.  What I realized, and what is true about many teenagers today, is that Jacqueline was emphasizing the negative about herself instead of her positive attributes.  This tunnel vision causes many bipolar disorder teens and children to fall into a depressive state which needs to be counteracted with empowerment.

Technique:  Positive Questionnaire
To help Jacqueline gain confidence in herself, I suggested she fill out the "Positive Questionnaire".  I asked Jacqueline to finish the following sentences, emphasizing her qualities.  Jacqueline filled in the following sentences: 
1. "My strengths are... my sense of humor and my willingness to look on the bright side for most things."
2. "The aspects of my personality I like best are... my drive to work hard and friendliness." 
3. "The physical features I like best about myself are... my eyes." 

7 Other Phrases Jacqueline Used
Other phrases that Jacqueline completed included the following:
1. I am proud of...
2. What I appreciate about me is...
3. My accomplishments are...
4. Ways in which I take care of myself are...
5. The personality traits that make me likable are...
6. What others have told me they admire about me are...
7. When I feel powerful I can...
After Jacqueline finished filling out these phrases, I asked her to put the questionnaire in a place that she could see everyday.  Jacqueline decided to tape her questionnaire right above her bottom bunk so when she awoke each morning, she saw her positive qualities before she even looked in the mirror. 

In this section, we discussed three difficulties bipolar children have in relating to other children.  These difficulties included impulsiveness; defiant attitudes; and disempowerment

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