The following excerpt is taken from Chapter
of Bipolar Disorders: A Guide to Helping Children and Adolescents
by Mitzi Walsh, copyright 2000 by O'Reilly & Associates, Inc. For
book orders/information, call (800) 998-9938. Permission is granted to
print and distribute this excerpt for noncommercial use as long as the
above source is included. The information in this article is meant to
educate and should not be used as an alternative for professional medical
Medication alone can help reduce the symptoms of bipolar
disorder, but it can't cure the illness entirely. Nor can it help a child
or teenager cope with the stress, alienation, and residual symptoms that
remain. That's where therapy--the process of exploring feelings,
motivations, strategies for change, and personal goals with a trained
Therapy is also not a cure, but when it's done well, it contributes
greatly to better personal functioning and happiness.
Lisa sees a wonderful therapist who uses mainly traditional psychoanalysis.
The symptoms the therapist concentrates on are whatever Lisa bring in for
that particular meeting. If she's had a particular problem in some area,
like when her boyfriend broke up with her, or just in dealing with her
bipolar symptoms at times, the therapist gives her hints, such as the
coping skills Lisa learned while in the hospital, to help her get through a
particular situation. --Donna, mother of 16-year-old Lisa (diagnosed
bipolar II disorder, post-traumatic stress disorder, and anxiety
From time immemorial, people have known about the healing power of a
listening ear, a shoulder to cry on, and wise advice. These resources have
always been prized, whether they came from family members, friends, or
The industrial revolution of the late nineteenth century changed the way
people relate to each other, and also made life more stressful and complex.
Many people began looking for professional advisors, and often the person
they turned to was a trusted physician. Some physicians did have a high
level of expertise at helping people handle everyday emotional problems,
and did so as a matter of course while they also treated physical troubles.
Some, like Austrian neurologist Sigmund Freud, became fascinated with the
serious life difficulties faced by people with major mental illness.
When Freud and his circle of European colleagues founded the modern
practice of psychoanalysis in the late 1800s, not much was known about
mental illness, and no effective treatments existed. Freud himself believed
that bipolar disorder, schizophrenia, and some other major mental illnesses
were biological in nature, largely because he found that long-term
psychoanalysis didn't seem to help these patients very much. To benefit
from psychoanalysis, it seemed to him, the patient had to have a great deal
of insight into the roots of unusual thoughts or behaviors, not just a
desire to change.
The Freudians identified many emotional disorders (most are like what
today's psychiatrists call personality disorders) that he believed were
based on unresolved sexual conflicts, ensuing life experiences, and other
factors. The psychoanalytic process relied on conversations between
patients and therapists about childhood memories and experiences, dreams,
and current experiences to uncover the causes of problems and find avenues
for healing. Because the thoughts and behaviors associated with major
mental illnesses actually come from chemical imbalances, efforts at
ferreting out their roots in childhood traumas were fruitless.
That's not to say that no one tried. Psychoanalysis was indeed touted as
a treatment for major mental illness until very recently, and still is
suggested by some doctors. Until very recently, some people with bipolar
disorders who could afford it submitted to years of intense psychoanalysis.
The process was sometimes enlightening on a personal level, but rarely
afforded any reduction in troublesome symptoms. In fact, for some patients,
analysis itself was so stressful that it exacerbated their symptoms! But
until the advent of psychiatric medication in the 1950s and '60s, and the
first glimmerings of other types of psychological therapy around the same
time, psychoanalysis was simply the only treatment available.
The goal of psychoanalysis is deep personal understanding that
eventually leads to positive behavior changes. The patient gains this
understanding by forging a strong, trusting relationship with his
psychiatrist, which allows him to bring buried feelings to the surface in
their discussions. It's a very intensive process involving weekly or even
more frequent visits with a trained psychotherapist. The therapist helps
the patient look at how his life experiences, starting as early as the
emotional trauma that some people believe is associated with the birth
process, have created roadblocks to optimal personal development.
Today, it's a rare patient with bipolar disorder who would look at
psychoanalysis as a first-line intervention ... or even at all. There are
other therapeutic approaches that are more useful. These include:
- Cognitive therapy
- Play therapy
- Family therapy
- Group therapy
- Peer support groups
- Milieu therapy
- Behavior modification
All of these approaches share one basic characteristic with
psychoanalysis: they rely on forging a strong relationship between the
patient (who may be called a client) and a therapeutic professional to lay
the groundwork for change. Unlike psychoanalysis, however, these methods
rarely delve into the metaphysical or unconscious aspects of thought
patterns or behavior. Instead, therapists in these disciplines address
specific symptoms with targeted intervention techniques. Clients may even
have homework assignments that involve applying the lessons learned in
therapy to real life. In most cases, intervention is seen as a short-term
process, although because of the chronic and fluctuating nature of their
illness, many people with manic depression will need ongoing therapeutic
Some therapists are specialists in a particular method. Jungian
therapists use psychoanalysis-like techniques based on the theories of
Freud's contemporary, Carl Jung. Gestalt therapists specialize in helping
people uncover and meet hidden needs (encounter groups and sensitivity
training are two Gestalt-related ideas that were popular in the '60s and
'70s), and fall into the general category of humanistic or experiential
therapy. Holistic psychologists or therapists suggest diet changes,
meditation, and other interventions. There are other specialized therapy
styles. Most of these methods, while interesting, have not shown any
particular usefulness for bipolar disorders.
Many therapists use an eclectic approach: they take the best ideas from
each school of thought, and employ whatever methods and concepts seem most
likely to work with each patient.
The goals of therapy are usually set by the client in concert with her
therapist and, in the case of children, with the child's parents or other
caretakers. Goals are as varied as individuals with bipolar disorders
Kara used to see a psychologist who worked with her on her self-esteem, and
on coping techniques.
--Cindy, mother of 19-year-old Kara (diagnosed bipolar disorder)
Vanessa sees a therapist, and the concentration is on anger management.
Work is done in both group and family therapy.
--Sue, mother of 16-year-old Vanessa (diagnosed bipolar disorder, OCD,
borderline personality disorder, passive-aggressive personality disorder)
Billy sees a psychologist for a combination of cognitive-behavioral therapy
and play therapy. The primary focus has been on coping with frustration.
--Marlene, mother of 8-year-old Billy (diagnosed cyclothymic
Your child's therapeutic goals might include:
- Discussing the nature of her illness and how it can be treated
- Identifying personal mood-swing triggers
- Identifying ways to prevent or shorten mood swings
- Identifying and stopping detrimental thought patterns
- Coping with problem symptoms and medication side effects
- Improving behavior at home, at school, or in the community
- Obtaining support for making positive lifestyle changes, such as
- Developing personal strengths, resiliency, and self-esteem to counter
the detrimental social and personal effects of manic depression
If you don't think a therapeutic relationship is working well for your
child, or if a therapist tells you something about your child that doesn't
seem right, don't be afraid to seek a second opinion.
I saw a counselor when I was about 10. I was smart enough to outsmart him,
but not smart enough to know that it was not in my best interest to do so.
He told my parents I just had a bad attitude. For years after that, school
personnel and family friends tried to get my parents to seek help for me,
but they always relied on what that first guy said, and declined further
evaluations. --Stephanie, age 32 (diagnosed with bipolar disorder at age 15
and now the mother of a bipolar child)
Who benefits from therapy?
Generally speaking, therapy cannot produce changes in people with
bipolar disorders unless their most troubling symptoms are intermittent or
starting to recede. A person who is actively psychotic, extremely manic, or
depressed to the point of needing hospitalization usually cannot benefit
from therapy, although they may seek out and greatly appreciate their
therapist's support while weathering these storms. Once medication is
starting to help or the state is receding on its own, there is a window of
opportunity for therapeutic work.
Over a period of time, a bipolar patient in therapy should expect to
develop better strategies for handling his mood swings and other symptoms.
As these strategies begin to work, he will become even more able to benefit
Even preschoolers can make gains in certain types of therapy. Play
therapy was developed especially for the youngest children, and can be very
effective. In fact, recent studies have shown that therapy may actually
have long-term effects not just on how we feel, but in how our brains work
physically, including which neurotransmitters are produced in what
quantity. When therapy is undertaken in early childhood, it may change for
the better how the brain develops.