After a psychiatrist effectively tweaks brain function with the right brew of medications, your problems may be mostly solved. For many people with bipolar disorder, however, medications provide only partial relief; some symptoms persist and you need additional interventions to reach a more complete recovery.
Even if you experience full symptom relief, your system may react in ways that override the medication's mood-moderating effects if you live under constant stress, don't get enough sleep, or use ineffective strategies to resolve problems and deal with conflict in your life.
This is where a good therapist comes into play. Your therapist's primary roles are to help you develop strategies to relieve symptoms, make positive lifestyle changes that reduce stress, and establish healthy thinking and behavioral patterns so you can cope more effectively with life's ups and downs. For example, a therapist may teach you how to identify triggers and develop healthy responses instead of getting caught up in unhealthy thought patterns.
A therapist can play many additional roles on your mood-management team, acting as coach, career consultant, mood monitor, and wellness manager.
Your therapist and psychiatrist often function as co-leaders of your treatment team, and their roles may overlap to some degree. Psychiatrists tend to play some role in therapy, education, and support functions, whereas therapists, with their patients' permission, may contact psychiatrists to voice concerns when they think medication adjustments are necessary.
Coach, trainer, and referee
An effective therapist addresses not only the symptoms of your illness but all aspects of your life that may be suffering from bipolar symptoms or worsening the illness, including but certainly not limited to the following:
Your thought processes can often darken your perceptions and create a vortex that spins you into a deeper depression.
Your daily patterns, including a regular sleep schedule and consistent daily routines, can help to stabilize your mood.
Interpersonal conflict with partners, family members, and friends often affects the illness and other aspects of your life.
Family issues may include raising children or managing finances.
Career challenges can span from problems on the job and conflicts with coworkers to time off needed to manage your symptoms. A therapist may provide valuable assistance in suggesting reasonable workplace accommodations, for example.
Social situations that stress you out or that have suffered due to your illness may exacerbate mood episodes.
Look for a therapist who specializes in the form of therapy you need most.
Mood thermometer
You can and should monitor your moods, but when depression weighs on you like a lead blanket or mania thrusts your moods into the dizzying stratosphere, staying motivated and objective enough to create an accurate mood map may be nearly impossible. And friends and family members may be too busy with their own needs to be of much help.
Your therapist can function as a mood thermometer, providing you with objective observations concerning your moods and demeanor. He may be able to help you strategize ways to monitor your moods more regularly or effectively even when you aren't feeling well. Sometimes mood observations and advice are easier to accept from a third party than from a loved one.
Resident soundboard
Some forms of therapy don't offer any particular advice. The therapist sits and listens attentively as you, the client, describe a particular issue. Sure, he uses a little body language to indicate his interest, but he says very little overall. Often, airing out your issues allows you to calm down so the therapist can gently guide you toward your own solutions, which may have been there all along. Other therapy models are much more proactive and focused on problem solving, but active listening remains the starting point in developing solutions and strategies that will work for you.
If you can find a therapist who listens well and inspires you to solve your own problems, you've struck gold. But keep in mind that even if this is your therapist's primary way of working, it's likely to be less effective during more active periods of your illness. When a mood episode is brewing or active or even tapering off, a good therapist usually needs to play a role that's much more active than just listening.
Wellness manager
One of the most important factors in the success of long-term management of bipolar disorder is the continuity of care — carefully planned and executed treatment that's consistent over time. A therapist (or a caseworker, family member, or close friend) can improve your continuity of care by helping you keep detailed records of medications and therapies that have (and have not) worked for you in the past. Your wellness manager can also help smooth the transition if you change doctors or therapists so the new care provider doesn't engage in a process of trial and error that's already been done.
Referral service
Therapists are people who know people. If your therapist can't solve your problem, he probably has the contact information for someone who can. He'll dig through his desk and hand you a business card or flip through his smartphone and jot down the name and number of a specialist you need. "Buried in debt? Here's a financial consultant that other clients rave about!" "Need a job? Here's a career coach I know." "Need a break from the drudgery of daily life? Here's the travel agent I use." "Can't pay me? Check out this information on government-subsidized health insurance."
When having a therapist isn't an option
Not everyone has access to a therapist or the money to afford one. When a therapist isn't an option, you may need to rely more on self-help strategies and your personal support network and formal support groups. Books, and in some cases videos, can bring you up to speed on the basics of various do-it-yourself therapies, including cognitive behavioral therapy (CBT) and mindfulness training. Family members, friends, and fellow support group members can fill the role as soundboards and problem solvers, helping you track down solutions and resources to meet your needs.
Be skeptical of self-help titles in bookstores; many self-help books espouse ideas that haven't been researched at all. Seek out reputable resources for information. National organizations, including the Depression and Bipolar Support Alliance (DBSA), the National Alliance on Mental Illness (NAMI), and the National Institute of Mental Health (NIMH), offer reliable information and resources. These organizations and your psychiatrist or primary care physician can guide you toward reliable books and other resources for learning about well-researched treatments to try on your own.