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Section 7
Techniques in Cognitive-Behavioral Therapy for Bipolar Disorder

Question 7 | Test | Table of Contents

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In the last section, we discussed self absorption.  I find that when helping the loved ones of a bipolar client deal with what to them appears to be self absorption, two techniques can be combined to bring about productive results.  First the client’s loved one can benefit from understanding feelings of loss.  Second, he or she can benefit from dealing with change. 

In this section, we will discuss help for the bipolar client’s loved ones.  Two Cognitive Behavior Therapy techniques which can benefit the bipolar client’s loved ones are stress management and personal support systems. 

As you listen to this section, consider your client.  How can his or her loved ones benefit the outcome of treatment and help support treatment goals?

3 CBT Techniques to Benefit Bipolar Client's Loved Ones

♦ Technique #1 - Stress Management
First, let’s discuss stress management.  Paula, from section 6, was trying to help her husband Gary through a depressive state.  I stated to Paula, "Stress management is essential when someone you love is ill.  It should involve some of the guidelines that we generally associate with self nurture but also focus on the specific stress of living with someone with bipolar.  Techniques include learning new skills regarding time management, learning to care for the caretaker, physical relaxation strategies, maintaining your own life, developing and practicing assertiveness skills and maintaining healthy nutritional and physical well being." 

Think of your Paula.  Could implementing these CBT techniques benefit your client?

♦ Technique #2 - Creating and Maintaining a Personal Support System
Next, let’s discuss creating and maintaining a personal support system.  Of what benefit could it be to your depressed or hypomanic bipolar client if his or her loved one had a personal support system? 

I stated to Paula, "Although you may be inclined to isolate yourself, maintaining ties with friends and relatives serves a variety of purposes, especially when you are experiencing a sense of loss.  Maintaining contacts with people you genuinely trust offers you emotional support and an objective perspective when your own objectivity is damaged by the emotional strain.  Support is also essential for your self esteem, which can decrease in reaction to this challenge.  People available to run errands and help out with chores can also be real lifesavers, especially during periods of exacerbation of symptoms." 

Think of your Paula.  Would it be productive to encourage her not to underestimate the importance of such a support system which leaves her mentally and physically able?

♦ Technique #3 - Looking Glass
With my bipolar clients I find the "Looking Glass" technique somewhat beneficial. 

First, in a couples session with Gary and Paula, I asked Paula to look into a mirror for several minutes, focusing on her feelings of loss and then to look at Gary. I asked her to look at Gary for the same length of time she looked at herself in the mirror. I asked Paula to try to imagine how Gary feels about himself and compare it to how she thinks he feels about her.  Paula wrote these comparisons down to evaluate with me later.  Paula identified her disregard for Gary’s feelings and her emphasis on her desire for continuous reaffirmation regarding the security of the relationship. 

Second, we discussed the ways in which Gary’s feelings about himself and her projected feelings toward Gary were similar and different. You may find this technique can also help a client understand how unreasonable certain behavior can be. Paula later stated, "I didn’t know I act so obsessed.  I need to start trusting myself and Gary. I also need to stop being so needy, but I never really knew I was!" 

Think of your Gary.  Does your bipolar client’s loved one acknowledge feelings of loss?  If he or she is starting to acknowledge methods of control, would your client be receptive to the use of a mirror in the session?

Peer-Reviewed Journal Article References:
Boyers, G. B., & Simpson Rowe, L. (2018). Social support and relationship satisfaction in bipolar disorder. Journal of Family Psychology, 32(4), 538–543.

Dejonckheere, E., Mestdagh, M., Houben, M., Erbas, Y., Pe, M., Koval, P., Brose, A., Bastian, B., & Kuppens, P. (2018). The bipolarity of affect and depressive symptoms. Journal of Personality and Social Psychology, 114(2), 323–341.

Dhokia, M., Elander, J., Clements, K., & Gilbert, P. (2020). A randomizedcontrolled pilot trial of an online compassionate mind training intervention to help people with chronic pain avoid analgesic misuse. Psychology of Addictive Behaviors. Advance online publication.

Holtforth, M. G., & Castonguay, L. G. (2005). Relationship and techniques in cognitive-behavioral therapy--A motivational approach. Psychotherapy: Theory, Research, Practice, Training, 42(4), 443–455.

Malouf, J. (1996). Review of Cognitive-behavioral therapy for bipolar disorder and Cognitive therapy for delusions, voices, and paranoia [Review of the books Cognitive-Behavioral therapy for bipolar disorder, & Cognitive therapy for delusions, voices, and paranoia, by M. R. Basco, A. J. Russo, P. Chadwick, M. Birchwood & P. Trower]. Psychotherapy: Theory, Research, Practice, Training, 33(4), 636–637.

Manassis, K., Lee, T. C., Bennett, K., Zhao, X. Y., Mendlowitz, S., Duda, S., Saini, M., Wilansky, P., Baer, S., Barrett, P., Bodden, D., Cobham, V. E., Dadds, M. R., Flannery-Schroeder, E., Ginsburg, G., Heyne, D., Hudson, J. L., Kendall, P. C., Liber, J., . . . Wood, J. J. (2014). Types of parental involvement in CBT with anxious youth: A preliminary meta-analysis. Journal of Consulting and Clinical Psychology, 82(6), 1163–1172.

Simons, A. D., Padesky, C. A., Montemarano, J., Lewis, C. C., Murakami, J., Lamb, K., DeVinney, S., Reid, M., Smith, D. A., & Beck, A. T. (2010). Training and dissemination of cognitive behavior therapy for depression in adults: A preliminary examination of therapist competence and client outcomes. Journal of Consulting and Clinical Psychology, 78(5), 751–756. 

QUESTION 7
What are two CBT techniques which can benefit the bipolar client’s loved ones? To select and enter your answer go to Test.

This CD set has covered such topics as:   the compassionate perspective, behavioral activation therapy, acceptance and commitment therapy, self absorption, and help for the bipolar client’s loved ones.

I hope you have found the information to be both practical and beneficial. We appreciate that you've chosen the Healthcare Training Institute as a means for receiving your continuing education credit.

Other Home Study Courses we offer include: Treating Teen Self Mutilation; Treating Post Holiday Let-Down and Depression; Living with Secrets: Treating Childhood Sexual Trauma; Interventions for Anxiety Disorders with Children and Adults; and Balancing the Power Dynamic in the Therapeutic Relationship. 

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