As a counselor with specializations in a variety of mental health disorders I have been fortunate to be given many opportunities to provide therapeutic services and achieve desired outcomes for many clients. There are moments during clinical practice where challenging or complex cases can present, but this is where didactic and experiential training components can provide valuable ideas for an individualized approach to care. Given the variety of clients and client cases that a counselor can encounter, it is important to always be on the cusp of new therapeutic or treatment approaches, in the field. This is particularly important when it comes to the diagnosis and management of bipolar disorder.
Do I believe that I am fully informed about the best and available therapeutic interventions for bipolar disorder? This is a question that I pose to myself each time I am presented with a new client. The degree of training and clinical practice experience that I have gained over the years coupled with staying abreast of the latest updates help to answer this question. The ability of any counselor to effectively counsel a client that is diagnosed with bipolar I disorder takes a comprehensive understanding of the potential benefits of this process.
Signs and Symptoms
Bipolar I disorder, formerly called manic depression is considered to be a multifaceted mental health condition whose etiology is still not fully understood. According to epidemiological studies, bipolar I disorder has a lifetime prevalence of around 1%, with the average age of onset being in the early twenties. The knowledge of the potential risk factors allows clinicians to better identify which individuals are more likely to develop bipolar disorder and also how to effectively manage the symptoms. A counselor can encounter a client with bipolar disorder at any phase of their professional career, so there should be an ever increasing awareness through continuing education and development in this area of mental health.
When I am presented with a client who has been diagnosed with bipolar disorder and is struggling to manage the symptoms of their condition, I work to first identify if they meet the criteria for the disorder. For Bipolar I disorder a person should have at least one manic episode that may have come before or after a hypomanic or major depressive episode. In some cases, it is the manic episode that can lead to a break from reality. A manic and a hypomanic episode can include three or more of the following symptoms:
- Abnormally upbeat or jumpy
- Increased activity, energy or agitation
- Exaggerated sense of well-being and self-confidence (euphoria)
- Decreased need for sleep
- Unusual talkativeness
- Racing or speeding thoughts
- Easily distracted
- Poor decision-making
The major depressive episode of bipolar I disorder can include symptoms that are significant enough to cause impairment in activities of daily living whether it is observed at work, school, interpersonal relationships, or other aspects of life. Based on my observation and client encounters there may also be other features of bipolar I disorder such as distress, melancholy, or psychosis. I always encourage counselors to perform a thorough assessment and ask those important questions that will help to determine if atypical symptoms of bipolar I disorder may occur. According to the National Library of Medicine, the atypical features of bipolar I disorder can be considered one of the most valuable indexes to help with identifying bipolar disorder in depressed clients. Atypical features can prove to be helpful with ruling out conditions when there are a number of differential diagnoses to begin with, and to help narrow the diagnosis down to one.
Counseling of Bipolar I Disorder
From what I have read and experienced in practice, there are hallmarks for the management of bipolar I disorder which include medication, psychotherapy or counseling. The combined use of these approaches can help to lower the dose of the medication that might be required to help stabilize a client’s mood changes. When it comes to counseling new clients that have been diagnosed with bipolar I disorder it is best to carefully explain to them the benefits of the process.
The benefits of counseling can include helping to deal with the symptoms of the condition and identifying the extreme mood changes that require immediate assistance. In addition, being able to provide advice to clients on how to cope with suicidal thoughts or ideations can be vital to the counseling process. Lastly, it is important to stress that clients get support from other individuals who also have the condition as well as from their family members. For any clients who seek counseling services I make it a point to educate them on the types of counseling that can be used with individuals who are diagnosed with bipolar disorder which can include cognitive behavioral therapy, family focused therapy, or psychoeducation to name a few. The better informed a client is the more likely they will also be able to comply with the expectations of counseling.
To learn more about bipolar I disorder click on the fact sheet below. It is through proper education and information that a counselor is able to effectively treat a client and the client is able to get the most out of the counseling experience.
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Resources
ABCT Bipolar Disorder Fact Sheet: https://www.abct.org/fact-shee...
References
News Media Life Science "Bipolar Disorder Counseling"
Mayo Clinic, "Bipolar Disorder"
Peng, D., Huang, Y., & Jiang, K. (2016). Atypical Features and Bipolar Disorder. Shanghai archives of psychiatry, 28(3), 166–168. https://doi.org/10.11919/j.iss...
Rowland, T. A., & Marwaha, S. (2018). Epidemiology and risk factors for bipolar disorder. Therapeutic advances in psychopharmacology, 8(9), 251–269. https://doi.org/10.1177/204512...
