The Two Most Important Relationships With Bipolar - Part Two

Today we are going to talk about the second most important relationship you can have with bipolar disorder. We will discuss finding a psychiatrist. Psychiatry is not an exact science. There are no tests or physical exams to determine that you have bipolar (not yet at least). Your diagnosis is going to come from the symptoms you describe, and not just from one session, but over a period of time where the psychiatrist can get to know you (avoid one that wants to diagnose you in one session). This places more responsibility on you in finding a psychiatrist you can connect with.

A BRIEF HISTORY
There used to be a biological/psychological split in how psychiatrists were trained. Biological training involved teaching a psychiatrist to be a doctor that provided diagnosis, medication, and psychotherapy (usually psychodynamic oriented). As time has progressed, the emphasis has changed and is now focused on diagnosis and medication treatment. Many times a psychiatrist will work hand in hand with a therapist. Mine does. Personally, the best therapists and psychiatrists I have ever had have worked together.

A CONSIDERATION

In 2007, a study was done between psychiatrists, nurses, and patients. Each was asked to rate the most important keys to a successful relationship between psychiatrist and patient. Almost 50% of psychiatrists felt that "ability of the patient to communicate" was the most important key. Around 40% of patients felt "being a good listener" was the most important key. This brings us to our first point.

YOUR RESPONSIBILITES
The more information you are armed with about your symptoms and management, the better. Educate yourself. Keep a mood log. Make a list of questions and/or concerns. Be ready to discuss how you have been since your last visit with your psychiatrist. Learn as much about bipolar as possible. There is no one definite place to research the symptoms of bipolar. I would suggest starting with NAMI and NIMH. This will give you a general idea. Remember that each person has their own journey with bipolar. For me, I quickly lose the ability to sleep whether I am in a hypomanic or depressive state. Many people report that when in a depressive state, they want to do nothing but sleep. So, because psychiatry is not an exact science, the psychiatrist needs meaningful communication from you. Help them help you.

There are a few other ways to help your psychiatrist help you:

• Stay medicine compliant - this means taking your meds every single day, at as close to the same time as you can manage.
• Be willing to make healthy lifestyle changes - diet, exercise, and sleep, etc.
• Be reasonable and expect reasonable outcomes - because psychiatry is complex a combination of evaluation and treatment, and the choosing and monitoring of medications, it may take months to find a med set that works for you. Patience may be something you will have to have.
• Be punctual and prepared - most likely after your initial office visit or diagnosis, your psychiatrist will manage your visit into 15 minute time blocks. They need to treat efficiently to be affective. Having a list of questions and/or concerns, along with your mood log, is a good way to help that happen.

A FEW ASSUMPTIONS
If everything is right, there are two things in your favor:

• Location
• Insurance/Finances

If you are missing either of these key advantages that allow you to have the freedom of choice, finding your psychiatrist match will be difficult. You may be left with choosing the best you can find even if it isn't the best match. If insurance/ finances are an issue, contact your local NAMI chapter or your local mental health center. They will help point you in the right direction. Unfortunately, most psychiatrists will not work on a sliding pay scale.


CHOOSING A PSYCHIATRIST

• Referrals - ask your family doctor. Ask your therapist. Call your insurance company and find out who is in your network. Use Psychology Today to find a psychiatrist close to you.
• Specialty/Focus - if you have bipolar disorder and a psychiatrist doesn't specialize in mood disorders, you will not accomplish anything. Make sure the psychiatrist treats your age group.
• Experience - I like the saying, "practice makes better". While this won't guarantee a better psychiatrist, someone who has experience in practicing has had the opportunity to have worked with all kinds of individuals.
• Availability - Is the psychiatrist available during off hours for emergencies and crisis's? Some psychiatrists belong to a group of psychiatrist that share on call duties. If they don't, your only option in a crisis will be 911 or a crisis hotline.
• Shop Around - Nothing says you have to stay with the first (or even subsequent) psychiatrist you choose. If you educate yourself about bipolar, you probably have a gut feeling on what you need to manage it when your mood is relatively balanced. You deserve to work with the best person possible for yourself. Be your own advocate for self care. A good psychiatrist will strike a balance between making sure you are on the right medications, but not too many or too few. I have been through quite a few psychiatrists. I was diagnosed with PTSD in December of 2014. After a few months, my psychiatrist looked at me and told me I was "going to have to get over it". He never offered medicinal help for the violent nightmares I was experiencing. I didn't even have any idea there was anything out there for PTSD nightmares until June of this year. I now see a different psychiatrist. You are most likely willing to shop around for the best buy on something you want. Don't be afraid to shop around for the right psychiatrist, also.

A GOOD FIT

Around 40% of you reported finding a good listener was the most important factor in a successful relationship with a psychiatrist. So, you are going to see that a few times below in the suggestions because it is important. A good listener will listen without interrupting. They will also ask questions relevant to what you say. Find a good listener. If your responsibility is to communicate, then the psychiatrist's responsibility is to listen. They should be able to repeat, or paraphrase what you say. In fact, ask the psychiatrist to tell you what they heard so you make sure you and he or she are on the same page. That may seem uncomfortable, but it is part of being your own self care advocate. Here are some suggestions on finding the right one for you:

• Bedside Manner - Are you comfortable speaking to your psychiatrist? Do they display empathy and compassion? They should have good listening & observation skills. They should spend time educating you. They will listen to your concerns, input, perspective, opinion, questions, and are willing to discuss any and all of those with you. You should feel like you are a partner to your psychiatrist and not simply expected to do what they say. It is important that you are heard if you disagree with their observations or treatment decisions. An excellent psychiatrist will even ask your opinion, collaborating with you and coming up with plans that work for both of you.  If you see a psychiatrist that seems rigid, intimidating or disrespectful towards you when speak up, it may be time to seek someone else out.
• Method - Most psychiatrists are going to meet with you for an hour on your initial visit and then schedule you for 15 minutes appointments after that. Stay away from psychiatrists that meet with you for less than an hour on your initial visit. It will take time to get to know you to treat you most effectively. They shouldn't be in a hurry. Neither should you. If you feel the psychiatrist doesn't have enough information about you after the initial visit, speak up! You have to be your own mental illness advocate. A psychiatrist should also see you once a month at first, gradually weaning you to every three months. The psychiatrist should be willing to see you in between times if you think you need to. Some psychiatrists will not hesitate to write a prescription, and some think less is more. Regardless of their method, they should be following you closely and listening to your questions, observations, and concerns.
• Knowledge -  Psychiatric diagnoses are complex. The symptoms you have often overlap between different disorders. Even if a psychiatrist thinks they know what disorder you have, they will consider a broad range of possibilities. This is where your knowledge can be an advantage and can (secretly) test how knowledgeable your psychiatrist is. I do it all the time, but I am careful in how I approach it because, of course, my knowledge is layman at best. This will also tell you how well you will partner with your psychiatrist. The same about knowledge can be said when it comes to your treatment. There isn't one set of medications that work to manage bipolar. Your psychiatrist should discuss a variety of treatment solutions with you.
• Ethics - unless you live in a very rural area, do not enter into a relationship with a psychiatrist that treats a family member. You shouldn't even use a psychiatrist that treats a friend. This potentially compromises the psychiatrist's ethical responsibility and could skew their treatment.

Finding a good psychiatrist is trickier than finding a good therapist. More than anything, they need to be wiling to listen and partner with you. You need to communicate and speak up for yourself. With those things together, you will be able to find a good fit.


To balanced and productive days my friends,

Laura

The Two Most Important Relationships With Bipolar - Part One

Everyone's life is full of relationships. Some are more important than others. If I was to ask you what relationship was most important to you, who would you reply with? Family? Friends? You may think they are, but I would like to approach this from a different perperspective. Today, we are going to talk about the first of two of the most important relationships you need to have in your life with bipolar. Both of the relationships mentioned above are, indeed, very important. However, the two relationships we will begin talking about today are not either of the above. The ones we discuss are going to help you succeed and draw closer to all other relationships in your life.

The two most important relationships are your therapist and your psychiatrist. Meaningful and successful relationships with each of these will touch your life in every aspect, including how you interact with your loved ones. Today we will discuss a therapist.

THERAPIES AVAILABLE
There are two types of therapies currently in practice by therapists. I'll include a brief overview of both, although if you would like to go much deeper into either, there is plenty of information available via your friendly Google search. They are:

• Cognitive Behavioral Therapy
• Psychodynamic/Psychoanalytical Therapy

Most therapists today will actually sometimes blend the two and practice either based on your needs. Find out which of the two therapies your therapist uses, and/or if they use them both.

Cognitive Behavioral Therapy:
Also known as CBT, cognitive behavioral therapy focuses on the role of thinking about how you feel and, in turn, what your reactions or behaviors are. It focuses on you in the present. There are several approaches to CBT. The general idea behind each is that your feelings cause you to think and behave in a certain way. Thoughts, feelings and behaviors all work together. Irrational thoughts and feelings result in irrational behavior and poor coping skills. By focusing on improving irrational feelings and thoughts, you can change how you react to situations (stress at a job, personal relationships, life challenges). You will learn rational, self soothing skills, based on thinking through situations factually instead of emotionally.

All of us have problems, so the therapist's goal is to help you feel and think rationally through those problems. With irrational thinking and feelings, not only do you have a problem, but you also have an unproductive and irrational reaction to that problem. Your CBT therapist will teach you how to respond to problems in a calm manner. The role of your therapist will not be to tell you what you should feel. Their role is to listen, teach, and encourage you how to feel. Your role is to express yourself and your feelings, learn, and then implement what you learn.

CBT is less time consuming than psychodynamic/psychoanalytical therapy and can produce results faster. It follows a highly instructive manner and normally has homework between sessions to reinforce what you learn. It's model is based on a scientifically supported assumption that your emotions, feelings, and actions are learned. The goal is to unlearn irrational and unwanted behaviors and to learn a more rational way of thinking and reacting.

Psychodynamic/Psychoanalytical Therapy:
Originally called psychoanalysis, it was created as a set of theories and techniques by Austrian physician Sigmund Freud and is rarely used as the primary focus for therapy. It has been revised and has developed in different directions, resulting in the predominantly used term of psychodynamic. There are 5 basic principles behind psychodynamic therapy:

1. a person's development is determined by often forgotten events in early childhood besides inherited traits
2. human attitude, mannerism, experience, and thought is largely influenced by irrational drives that are rooted in the unconscious
3. it is necessary to bypass psychological resistance in the form of defense mechanisms when bringing drives into awareness
4. conflicts between the conscious and the unconscious can materialize in the form of mental or emotional disturbances, for example: neurosis, neurotic traits, anxiety, depression, etc.
5. liberating the elements of the unconscious is achieved through bringing this material into the conscious mind (via e.g. skilled guidance, i.e. therapeutic intervention).

With psychodynamic therapy, you are encouraged to express your thoughts, fantasies, and dreams. The therapist infers what they think are unconscious conflicts and interprets them for you, giving you insight into how to resolve your problems. The therapist focuses on, and confronts, what they feel are your defenses, wishes and guilt. They will hypothesize how you may be your own worst enemy and rely on the concept that it is only after having a healing experience will you be cured and/or aided.

Psychodynamic therapy has been criticized as having no scientific basis. Because of it's approach, psychodynamic therapy can take years for results. It's focus is on the past and it's role in your development, rather than CBT, which focuses on your now self and how to learn new thinking.

A FEW ASSUMPTIONS
If everything is right, there are two things in your favor:

• Location
• Insurance/Finances

If you are missing either of these key advantages that allow you to have the freedom of choice, finding your therapist match will be difficult. You may be left with choosing the best you can find even if it isn't the best match. If location is an issue, ask a therapist if they are willing to Skype or conduct sessions over the phone. Mine does. If lack of insurance/finances is an issue, ask a therapist if they will make an exception and work on a sliding pay scale.

CHOOSING A THERAPIST

• Referrals - ask your family doctor. Ask your psychiatrist. Call your insurance company and find out who is in your network. Use Psychology Today to find a therapist close to you.
• Licensing - Unfortunately, anyone can call themselves a therapist. So, the letters behind your therapist's name are important. Look for "LPC" ( licensed professional counselor), "LPPC" (licensed professional clinical counselor), or "LISW" (licensed social worker). Different states use different wording and different acronyms. If not sure, ask! Ask them what their training is and where it is from. There are counselors out there certified to practice based on their own lived experience with mental illness. As a personal opinion, I would suggest using these as a compliment to a licensed therapist if you choose to do so. A certification is different than a license.
• Specialty - if you have bipolar disorder and a therapist doesn't specialize in mood disorders, you will not accomplish anything.
• Experience - I like the saying, "practice makes better". While this won't guarantee a better therapist, someone who has experience in practicing has had the opportunity to have worked with all kinds of individuals.
• Shop Around - Nothing says you have to stay with the first (or even subsequent) therapist you choose. This is your therapy! You deserve to work with the best person possible for yourself. You don't necessarily have to tell the therapist you are leaving them if that truly bothers you. Just do it. Be your own advocate for self care. I have been through many therapists. I had one who told me they couldn't help me when I brought up an issue. That was my last visit and I didn't tell them because I was uncomfortable stating it since I had seen them for a long time. I also know of someone who asked why their therapist always yawned, and was told they were always tired and sleepy from lack of sleep. You deserve better!!! You are most likely willing to shop around for the best buy on something you want. Don't think you have to like your therapist and be afraid to shop around for that, also.

A GOOD FIT

Can you say "relationship"? Good. Say it three times while tapping your heels together, and repeat after me. "There's no place like home, there's no place like home." Studies have proven the relationship between you and your therapist is the most important factor in successful therapy. Your therapist should feel like coming to a warm, accepting home where Mom and Dad still realistically expect the best from you. My therapist is gentle, yet doesn't let me get away with anything! If you can't talk about the ugliest parts of your life, you are with the wrong therapist. You have to feel comfortable enough to be painfully honest with your therapist. Here are some suggestions on finding the right one for you:

• Comfort and Connection - does your therapist make you feel comfortable? Can you make small talk? Can you talk about the things you find the most difficult to manage? I call this sharing the ugly. To have success in therapy you have to share the ugly and never lie to your therapist for any reason. Being real with your therapist is difficult because we all try to put on the face of being okay and you must let your therapist see that you need help. Having bipolar and the resulting mood swings is not easy. Find a therapist you feel comfortable sharing the ugly with. You deserve to be understood and guided to a better mentality. The way you connect with a therapist is important. Do they seem empathetic? Do they encourage you to share? Are they good listeners? Do you feel heard and understood when talking ugly? While you have an important part in this part of the relationship, a therapist has the job of making you feel comfortable to say what you need to say. You should have the kind of connection where your therapist is open to your feedback. Never be afraid to disagree or tell your therapist you don't understand. A good connection with your therapist will ensure that you speaking up will have them adjust to your needs and understanding. He or she should be open to feedback and to learning that something they said hurt or offended you. Good therapists are willing to look at themselves, to check their feelings, and to honestly and openly admit mistakes.
• A Plan - your therapist should present you with a plan for therapy so you have an idea of what they think you can accomplish together. After a few sessions, a therapist should even have an idea of how long therapy will be necessary. I want to note that for me personally, I have decided that my therapy is for life. All of this depends on how stable you remain in general. I need constant work!!!
• Approach - how do you feel your therapist approaches your therapy? You should feel their compassion. Ask them to describe themselves to you and how they approach therapy. Their answer will give you an idea of if you can connect with your therapist. Does your therapist seem to encourage dependence or independence? A therapist won't solve your problems. You will. They are simply there to guide you. And, therapy is hard work. Their approach shouldn't soothe you but encourage you to learn how to soothe yourself. If you find your therapist always providing you with what they think are the answers instead of encouraging you to come up with the answers yourself, you will become dependent on your therapist instead of yourself.
• Self Work - a therapist who has been in therapy has experience with both sides. If you ask a therapist if they have been in therapy, they should be willing to answer you. If they aren't, consider that a red flag. Most good therapists are wounded therapists.
• Ethics - unless you live in a very rural area, do not enter into therapy with a therapist that treats a family member. You shouldn't even use a therapist that treats a friend. This potentially compromises the therapist's ethical responsibility and could skew their treatment.

I can't express the importance of relationship. Do not be fooled. You don't need to feel like your therapist is your friend. You should feel like they are a trusted guide that accepts you. If this isn't the case, stop wasting your money and move on. You are spinning your wheels.

Next time we are going to discuss finding the right psychiatrist for you. You will find a good psychiatrist needs to have many of the same qualities as a therapist, but with a few differences in their approach.

To balanced and productive days my friends,

Laura