Bipolar Disorder by Francis Mark Mondimore

Author:Francis Mark Mondimore
Language: eng
Format: epub
Publisher: Johns Hopkins University Press
Published: 2014-03-11T04:00:00+00:00

“Traditional” Individual Psychotherapy

I hope I haven’t given you the impression that traditional psychotherapy isn’t useful for patients with bipolar disorder. Quite the contrary. Kay Redfield Jamison has written: “At this point in my existence, I cannot imagine leading a normal life without both taking lithium and having had the benefits of psychotherapy. Lithium prevents my seductive but disastrous highs, diminishes my depressions … and makes psychotherapy possible. But, ineffably, psychotherapy heals. It makes some sense of the confusion, reins in the terrifying thoughts and feelings, returns some control and hope and possibility of learning from it all.”12

So far in this chapter we’ve talked about “situational” supportive counseling focused on episodes of illness, either the first one or a relapse. The goal of this counseling is to help patients deal with the acute stresses of diagnosis, hospitalization, reintegration back into their job, or other specific issues related to an episode of illness. We’ve discussed the cognitive therapy of depression, a course of treatment that might be recommended for chronic or smoldering depressive symptoms that medication alone doesn’t seem to quite take care of. In the preceding section we discussed some new therapies that aim to teach patients and their families how to smooth out the bumpy spots in their relationships, improve communication and conflict-resolution skills, and regularize their social rhythms. These treatments are perhaps more preventive than the others and might be thought of as providing psychological immunization against future problems as well as ways of dealing with present ones.

What, then, of traditional psychotherapy? By traditional psychotherapy I mean individual meetings with a therapist, usually over an extended period of time (months or years), in which the person in treatment discusses his past and present experiences and feelings with the goal of self-understanding, self-acceptance, and personal growth. (Dynamic or insight-oriented psychotherapy is the same thing.) Disappointments and accomplishments, affections and enmities, fears, inspirations, passions, and worries—all are “grist for the mill” of therapy, as psychotherapists are fond of saying. The patient and the therapist will, of course, talk about symptoms like sadness and anxiety too, but traditional therapy sees symptoms as indicators of underlying psychological conflicts rather than as the focus of treatment in and of themselves. Traditional psychotherapy emphasizes exploration of the meaning of symptoms, the development of self-awareness and maturity.

So when would we recommend traditional psychotherapy to a person with bipolar disorder? For what types of problems would it be helpful? Basically, for the same types of problems that people without bipolar disorder go to therapists for: dealing with psychological traumas and setbacks—past and present—that, understandably, cause feelings of sadness, anger, or anxiety, or thought patterns, self-attitudes, and interpersonal styles that disrupt a person’s ability to be happy in relationships, effective at work, carefree in play, and confident in making decisions about the future. Sounds like a tall order, doesn’t it? Well, of course it is. That is why psychotherapists often study and train in their profession for as many years as physicians train in theirs. That is why people are sometimes in therapy for months or even for years at a time.

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