People with bipolar need the freedom to share emotions, challenges, and life issues honestly without worrying about feeling judged that everything about them is because of their condition.
For years, many in the mental health field believed that treating bipolar disorder came only in the form of medications, and that therapy, family support, and education about the condition were far less important. The truth is, while mood-stabilizing drugs are still the centerpiece for treatment, education and therapy that include family support are essential for lifelong success.
How can we help a loved one who is starting treatment?
The main challenges in the early phase of treatment are fear, denial, and stigma. People with bipolar are often reluctant to give up the “great high,” increased energy, and inflated self-esteem they feel when in a manic mood zone. But they also may fear the stigma against having a mental health condition and receiving treatment for it. Facing fears, denial, and stigma alongside your loved one builds a spirit of confronting the bipolar condition, instead of confronting the person. For example, fear of losing control is common. So rather than saying, “You’re in denial about bipolar,” it’s better to say something like, “I know this diagnosis is difficult for you. What are you afraid of losing if you go to treatment?” Having an open dialogue, especially with the help of a professional, can support positive feelings that no one is alone in the treatment process.
Having bipolar is nobody’s fault; no one caused it or ever needs to feel ashamed of it. Bipolar disorder is a genetically based condition that affects the brain’s ability to control emotions. Working to accept the diagnosis—what I call “owning bipolar”—is critical in establishing proper care. Moving forward with treatment is best accomplished with a collaborative approach, and caregivers and family members can be helpful partners in the treatment plan.
What can we do to be supportive during stabilization?
As a therapist, I appreciate when loved ones want to participate. It’s always good to remind each other that the goal in participating in the education and treatment of bipolar is not to gain control over the treatment plan, but to create a team approach for long-term success.
The stabilization phase of bipolar therapy can be a rough time for all involved. In my practice, I know it’s not unusual for people to get frustrated through trials of bipolar medications, and at times feel like giving up. This is natural. Know that you can ask all your questions about meds and stay informed. This improves support and guidance for the person taking the medication, and also puts you in a better position to observe how the meds are working and thus become an important source of information for the treatment team. I have seen much better results in mood stabilization and an increased sense of empowerment when fighting bipolar is a group effort.
In post-stabilization therapy, all can benefit from what I call the “Grand Bargain”: this means everyone agrees to keep each other apprised of how they feel treatment is going—without thinking that everything about the person is about bipolar. When a person with bipolar is having an emotional reaction to stress, it’s easy to too quickly ask, “Are you off your meds?” People with bipolar need the freedom to share emotions, challenges, and life issues honestly without worrying about feeling judged that everything about them is because of their condition. Through the Grand Bargain, I encourage loved ones to instead say something like, “You seem to be having a lot of stress lately. Is there something going on that I can help you with?”
When family members support open dialogue about bipolar—along with everything else that makes the person who they truly are—fear and shame are replaced with a new sense of trust and hope for the future.
Printed as “Ask the Therapist: Family Support—We’re All in This Together,” Winter 2019
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