Treatment:   


Treatment with medication is often required to stabilize moods.  It is important to get the diagnosis clear.  Often people with bipolar are diagnosed as having major depression only.  This could happen because manic symptoms are not apparent during the assessment and are not reported by the patient.  Often Bipolar begins with a major depressive episode and when the patient is first seen there has not yet been a manic episode. Antidepressant medication can sometimes make manic symptoms worse.  It's important to report experiences that could be evidence of a manic episode to your treating physician in order to get an accurate diagnosis. Bipolar patients are usually prescribed "mood stabilizers."  Often other meds will be added to address depression, anxiety or psychotic features if they are present. This is usually done by a psychiatrist (an MD specializing in mental health problems.) Sometimes a primary care physician will prescribe these medications.   

Psychotherapy, in addition to medication, is recommended for newly diagnosed individuals and on an ongoing basis even after symptoms are more controlled in order to help the client monitor moods and learn and continue to improve coping behaviors. 
     Often the first goals of therapy include learning more about what it means to be bipolar and deciding whether to accept that this diagnosis is accurate for you.  If you are bipolar and your symptoms sometimes interfere with your ability to keep a job, maintain friendships, stay in a healthy intimate relationship or make good choices for yourself, this is a situation that is not going to disappear.  Once you accept that it is real and decide to learn what you can do to live successfully with bipolar, you have passed what I consider the biggest roadblock to recovery.
     We will talk about how you feel about taking medication​ and address your concerns if you have them. Most people with bipolar do much better when they are on the right medication and stick with it.  It can be hard to accept that you will probably be taking meds on a long term basis.  Compliance with the medication regime that you and your physician have developed is a very important component of maintaining good functioning with Bipolar.  I work with clients to help them stay on their meds and help them address concerns with the prescribing medical professional. I often communicate directly with the Doctor.
     With my clients I work on recognizing internal cues​ that signal oncoming changes in mood.  We develop a personalized list of coping responses​.  These may include mindfulness practices; enlisting a support person; physical coping strategies such as relaxation breathing, stretching, walking, singing; cognitive strategies such as recognizing irrational thoughts and developing a repertoire of rational responses and positive "self-talk"; improving communication skills to deal with conflict and fallout from past episodes of erratic, angry or odd behavior; improving anger management​. 
     In particular, most bipolar individuals need to learn to develop realistic goals and ​manage time effectively. During periods of expansiveness, individuals may bite off more than they can chew and end up overloaded with commitments.  This often leads to a "crash" which precipitates a depressed episode.   It is sometimes challenging for individuals who love the exhilaration of the creative stages of a project to tolerate the routine and sometimes unexciting phase of follow thru with a plan. It is possible to learn to be more of a tortoise who succeeds through "slow and steady" effort. It is also possible to learn to successfully harness your enthusiasm during more energized periods without spinning too fast.  Learning to prioritize and stick to a plan and a schedule​ can be an important key to successful functioning with Bipolar.
     Bipolar often affects ​cognitive functioning and memory. Some of these problems can be ameliorated by learning to focus attention, write things down and develop other organizational skills.

     Often we will focus on specific issues of impulse control and addictive behaviors that may include, substance abuse, spending, gambling, eating problems, sexual activity, self-harming, and others.  
     Besides the special issues of bipolar disorder, my clients present the same range of additional issues that other clients present. We may also address anxiety, relationship problems, substance abuse and addiction, grief and loss, recovery from trauma or abuse, self-acceptance and identity issues, phase of life issues, and others. Please see the Home Page for a list of various therapy approaches in which I am trained and experienced.

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     I LOOK FORWARD TO MEETING YOU AND ANSWERING ANY QUESTIONS YOU MAY HAVE ABOUT THERAPY