On the last track we discussed acceptance and commitment therapy. First we examined the focus of acceptance and commitment therapy or ACT. We then discussed the two steps in implementing ACT. These are supporting identification of value and confronting distraction. A technique for confronting distraction presented on this track was the worry time technique.
On this track we will discuss self absorption. I find that when helping the loved ones of a bipolar client deal with what to them appears to be self absorption, two Cognitive Behavior Therapy techniques can be combined to bring about productive results. First the client’s loved one can benefit from understanding feelings of loss. Second, he or she can benefit from dealing with change.
As you listen to this track, consider your bipolar client like Gary and a loved one like Paula. How can coping with self absorption and feelings of loss ultimately benefit the client regarding his or her depressive states or hypomanic episodes?
Recall Gary from the last track. Gary, age 56, was married to Paula. I spoke with Paula during one session regarding Gary’s depressive states. Paula stated, "Gary just seemed to lose interest. He doesn’t enjoy anything any more. He spends all his time sitting around and worrying about being in debt. We owe a few hundred dollars on our credit card, but we pay it off every month! He’s so caught up in his own worries I feel like I’ve lost my husband."
Think of your Paula. Do bipolar depressive states or hypomanic episodes lead to a perceived self absorption that leaves loved ones with feelings of loss?
Two CBT Techniques to Help Clients Deal with Self Absorbtion
#1 Understanding Feelings of Loss
Clearly, the dynamics of the relationship shift as the afflicted person becomes less available or responsive. In Paula and Gary’s case, I believed that Gary’s increasing self absorption may producing such a shift in his personality that Paula no longer felt that he was there. One view of Gary’s lack of attention to Paula is that he was self absorbed by his own needs, selfish, and unable to be empathetic with another human being.
However, I explained to Paula that Gary was able to love her and restore their intimacy as long as he could learn to cope with his bipolar disorder. This information allowed Paula to consider a different expectation behind Gary’s behavior, which she could then use to evaluate whether it was a genuine lack of caring or his heightened distractibility that made him unavailable to her. Paula stated, "This sense of loss isn’t as intense when the depression is at a mild level, but as Gary’s symptoms get worse, so do mine."
I stated to Paula, "If we first understand ourselves, we are then in a better place to manage our loss. The second step involves learning how to deal with this change."
#2 Dealing with Change
Regarding dealing with change, a major goal in working with people with manic depression is to help them accept the reality of their illness. I stated to Paula, "You may benefit from learning how to manage your own part of the relationship constructively and to acknowledge and accept feelings you experience in reaction to Gary’s illness.
"For example, if you tune in to your self talk, you might hear, ‘If only I say the right thing, then maybe he’ll go for a medication assessment;’ or, ‘if he cared more for me, he would be motivated to spend more time with me instead of on his many projects;’ or, ‘I was too involved with my career and didn’t pay enough attention to him.’ While any one of these comments may reflect some reality during the stable phase of the relationship, they are far less relevant when accounting for the reality of intense mania or depression." Would you agree?
On this track we discussed self absorption. I find that when helping the loved ones of a bipolar client deal with what to them appears to be self absorption, two techniques can be combined to bring about productive results. First the client’s loved one can benefit from understanding feelings of loss. Second, he or she can benefit from dealing with change.
On the next track we will discuss help for the bipolar client’s loved ones. Two techniques which can benefit the bipolar client’s loved ones are stress management and personal support systems.
Peer-Reviewed Journal Article References:
Gaudiano, B. A. (2011). Evaluating acceptance and commitment therapy: An analysis of a recent critique. International Journal of Behavioral Consultation and Therapy, 7(1), 54–65.
Jacobs, A. M., & Antony, M. M. (2009). Review of A CBT-practitioner’s guide to ACT: How to bridge the gap between cognitive behavioral therapy and acceptance & commitment therapy [Review of the book A cbt-Practitioner’s guide to act: How to bridge the gap between cognitive behavioral therapy and acceptance & commitment therapy, by J. V. Ciarrochi & A. Bailey]. Canadian Psychology/Psychologie canadienne, 50(4), 295–297.
What are two CBT techniques which can be used regarding self absorption? To select and enter your answer go to .