Understanding the Bipolar Spectrum, Depression, and Bipolar Counseling

Could this be me?

There is more than one type of Bipolar disorder. All of the types involve depression.

Bipolar disorder affects more than 5.7 million Americans, or about 2.6% of the U.S. population age 18 or older every year. (National Institute of Mental Health) Estimates that include the full range of bipolar disorders are 3-4% of the population.

The median age of onset for bipolar disorder is 25 years (National Institute of Mental Health). Bipolar disorder, as the name suggests, indicates fluctuations in mood and energy.

Because of the variety of patterns of fluctuation, bipolar disorder can be challenging to diagnose. Bipolar disorder is what used to be called manic-depressive illness. As is true with depression, the word bipolar can be tossed around loosely, leading to fear and confusion.

I mentioned in the section on depression, that people with depression can feel alone and isolated, afraid and ashamed. These feelings can be intensified if you have sought help and don’t fit neatly into a diagnostic category. It requires courage to persist and find the right help.

Bipolar disorders are not a personal weakness or a personal failure. It is not your personality or your identity. It is an illness that pervades how you feel emotionally, how you behave and your sense of physical well being.

When people are offered education about bipolar disorders they often feel relieved and curious. Could this be me on the spectrum? My intention is to provide information and hope. A place to begin to find your way. Effective treatment and support are available. Bipolar counseling is an option you may want to pursue.

What is the range of Bipolar Disorders?

It used to be that we would hear about “manic-depressive illness.” Maybe it would be an article about Patty Duke or a book of personal experience of the illness like An Unquiet Mind by Kay Redfield Jamison. Manic states might be associated with high energy, poor judgement, grandiosity, spending sprees; the depressive pole with severe symptoms and hospitalization.

It gave the impression that those suffering the illness were relatively rare and relatively recognizable.

But as you can see, bipolar disorder affects millions of people and the process of getting an accurate diagnosis can span a number of years. Since 1987 the medical community has been exploring the idea that what we now call Bipolar 1 is one point on a continuum, Bipolar 2, with hypomania rather than manic episodes, another point and multiple points beyond described as soft bipolar disorder. If we followed along the line even further we would eventually reach the other end of the scale, unipolar depression.

Why should I care?

If you have been diagnosed with depression, and are not responding to treatment it is helpful to be aware that there is a possibility that you could be further “down the line” on the spectrum.

If your doctor uses the word “bipolar” it helps to know there is a range of the disorder, to not get too overwhelmed or frightened, and to ask for more information.

If there is a family history of mood disorders, it can be helpful to educate other family members.

If you have certain types of bipolar disorder, certain antidepressants may not be helpful or may make it worse.

What exactly are these types of bipolar disorder?

Okay, here we go with just the basics.

  • Bipolar 1

    as we mentioned, is what we have traditionally thought of as manic depressive illness. It is with Bipolar 1 that people will report distinct episodes of mania and depression, that may occur cyclically or seasonally. During the distinct periods of mania and depression the person is likely to have difficulty functioning at their job or socially. Hospitalization may be required.

  • Bipolar 2

    as you might guess is a milder form symptomatically. We talk about hypomania instead of mania and 90% of the time patients will seek treatment for depression. Bipolar 2 doesn’t interfere as directly with job and social functioning. People are less likely to be hospitalized for Bipolar 2.

  • Soft bipolar

    is even milder and less distinct in terms of symptoms, most often manifesting as depressive symptoms.

This sounds like the medical profession making up more diagnoses.

It is actually the medical profession looking at more clinical data and patient reports and getting clearer about treatment.

It is giving hope to folks who don’t respond to standard depression treatment and may in fact have a form of bipolar disorder.

It is making doctors more careful about prescribing antidepressants before considering the possibility of a bipolar diagnosis.

And we can only hope that those who have been waiting up to ten years for an accurate diagnosis, well we can hope that the time is getting much shorter and the treatment more effective.

The “soft bipolar” description is confusing to me. Are there any good resources to learn more?

One of the best books on the topic is by Jim Phelps,M.D. and it is called Bipolar,Not So Much?: Understanding Your Mood Swings and Depression. He has a very user friendly writing style that is easy to read and understand.

How do you work with people, Kathy

Most of the people I see that have a bipolar disorder are referred to me by doctors and psychiatrists. A portion of the time, someone will come to see me, the question of diagnosis will arise and I will recommend an evaluation by a psychiatrist. Psychiatrists are highly trained to make diagnostic distinctions. An accurate diagnosis sets the stage for us to work together with clarity.

When you come to see me for a consultation, my first consideration is respectful listening. The people I meet with are experts about what they experience. Making sense of the experience and knowing how to work with it is the issue at hand. A collaborative relationship is developed with each person, so that we can explore how to begin to unravel the bipolar symptoms and move toward stabilization.

My intention is for you to be heard completely enough so that you have a feeling of “Kathy gets me.”

Collaborative coaching regarding lifestyle is integrated into our work, usually starting with the most basic aspects: sleeping and eating. That’s often where we start to build a foundation.

One of the ways the depressive symptoms manifests is negative thought patterns. We look at these patterns together so that we can begin to separate the negative thinking of depression from who you are.

Feeling isolated is also a part of bipolar disorders. Cultivating meaning, contact and community is an important part of the treatment.

What if I have been to therapy before and it didn’t work?

There are many kinds of wonderful therapies out there. Many of them are based on insight, i.e., understanding oneself more deeply. That may or may not be helpful with bipolar disorders. I believe that to effectively work with the mood changes related to bipolar disorders it requires helping you to live your life more functionally and fully.

I conduct my practice this way: if we determine for any reason that our work together isn’t beneficial, I make a commitment to offer referrals based on you telling me what you need.

I am afraid that you will expect too much of me. I already feel like a failure.

I hear you. I am aware that this is one of the aspects that makes you feel so alone.

My approach is to work step by step with you. Beside you. Right where you are. On any given day. We will explore and experiment together to find what works for you. If something does not work, it is not a failure, it is an indicator for us to investigate further.

I am embarrassed that I need this kind of helpIt seems like I should be able to do this on my own.

Again, I hear you. Folks suffering from mood disorders are affected on so many levels. It is an illness that affects how you perceive and experience your world. Truly, your brain is not working optimally. You might feel irritable, overwhelmed, forgetful, unmotivated, exhausted. Most people call me when doing it on their own hasn’t produced the desired results.

Good knowledgeable bipolar counseling can be transformative. Connecting and being understood is usually a huge first step. Sometimes the first step is the hardest. The concern about embarrassment is most often replaced with a profound sense of relief of being seen and understood.

Can you tell me about the kinds of people you work with Kathy?

There isn’t necessarily a typical client. I work with adolescents in their teens to twenties and I work with elders. Many of the folks I work with have an additional medical issue like ADD, traumatic brain injury, chronic pain or illness.

I think what is typical is the effort to individualize treatment for each person. I see folks who do not wish to use medications. I see folks who feel like medication has changed their lives dramatically. Sometimes we focus on work performance. Sometimes I see couples to help them navigate and enhance relationship. What is the immediate need, where does the client have energy to focus?

If you check out the About page you will see that I have been on a long path toward doing this work well, creatively and in a very down to earth way.

What are the next steps toward bipolar counseling?

I hope this introduction to Bipolar disorders and the work that I do has been helpful. I encourage you to download my free report shown below. Contact me to schedule a chat on the phone or to make an appointment at 303-473-4447.

bipolar help booklet