The easiest way to approach and understand this class of disorders is to think severe mood swings. We all have variable moods to some extent, but bipolar disorders describe extreme highs that put us in danger (such that we're speedy and sleepless and engaging risky behaviors like overspending, sexual promiscuity, grandiosity that overestimates our abilities, etc.) alternated with extreme lows that take us out of the game (such that we’re having depressive episodes, frequently calling out of work, isolating from friends and family, etc.).
Without minimizing the often devastating personal and interpersonal outcomes of mindless behaviors during a mood extreme, it's important to consider the inherent, if unanchored, strength and richness of the bipolar client's changing emotional weather. While it is conventionally appropriate for a psychiatrist to diagnose and treat (hypo)manic-depressive cycles with mood-stabilizing medications, I submit that unusual sensitivity is at the core of the bipolar client's inner experience, and that courageous awareness can and must be cultivated during treatment by the non-prescribing therapist.
Genuine courage and sensitivity often come about by realizing how afraid and guarded we humans are. People who are emotionally regulated can ride their naturally fluctuating moods, which accompany their changing personal and interpersonal experiences, with bravery and openness. They don't cling destructively to good feelings and situations and they don't react destructively against bad feelings and situations. All along the way from good to bad and back again, mood-stable people meet change with sensitive awareness and courageous compassion -- toward themselves and others.
Sounds great, yet is hard for most of us, right? It's especially hard for the bipolar client.
Therapy with me explores the tragic logic of a bipolar client's shutting-down to and then exaggerated experience / expression of what are basically authentic and trustworthy feelings. Feelings, whether tinged or flooded with sadness or joy, are crucial to allow and understand early, plainly, and often; when they are refused, they go dormant and then they explode forth. For the bipolar client, the more vulnerable aspects of feelings and situations have become amplified and uncomfortable if not unbearable, and are therefore bypassed to powerful extremes. With insight and training in mindfulness/awareness practices, mood swings can slow down, subtle and strong feelings can be met, and genuine sensitivity to sad and joyful times alike can be channeled into courageous healthy expression.
Good therapy will encourage mood awareness and balance via insightful discussions with a trauma-informed provider, as well as contemplative / behavioral homework geared toward getting the client’s body and mind reasonably grounded during times of agitation and constructively active during times of despair. Emotional regulation begins with more subtle and sophisticated understanding of physical and emotional sensitivity than has been previously taught to, modeled for, and experienced by bipolar clients. It takes practice, patience, safety, courage, and at times a sense of humor to learn more about misunderstood aspects of strong moods and difficult situations. And it absolutely can be done.