Section 1
Track #1 - Stress History Catalogue

CEU Question 1 | CEU Answer Booklet | Table of Contents | Introduction | Bipolar
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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 affects of treatment and the disorder on their daily life. 

On this track, 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


Share on Facebook 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." 

I 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?

Share on Facebook 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. 

Share on Facebook 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. 

The questions 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 future?

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.

Share on Facebook 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 episodes.  Have you, like I, found that many of your bipolar clients 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.

Share on Facebook Technique:  Stress History Catalogue

When client’s 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 of sleeplessness." 
I asked Jean to also think back into her history and recollect any other periods of stress that might have lead to a manic episode.  Jean wrote "when my mother died", "when I moved to a new city" and "immediately after my children were born". 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. 

Think of your client who has been diagnosed  with bipolar disorder with rapid cycling.  Could stress be a trigger for this client?

On this track, 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 episodes.

On the next track, we will examine three types of resistant clients.  These are clients who reject diagnosis; the underidentifying; and the over-generalizing client.

Online Continuing Education QUESTION 1
What are three topics you might consider when  educating your bipolar client? To select and enter your answer go to CEU Answer Booklet.

 
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