rather than prescribing coping strategies. If therapists rely on persuasion or prescribing coping strategies, clients may find sense of autonomy offended and hence reject therapists’ suggestions. In any case, clients’ circumstances are different. Techniques prescribed routinely without taking clients’ experience and circumstances into consideration are unlikely to work. It is not unusual for bipolar clients to like the early stages of mania. They find being more confident, energetic and sociable enjoyable. They may want to pursue certain risky behaviours to get the best out of their high levels of energy. The temptation is understandable, particularly when clients usually suffer from depressive residual symptoms. Therapists should respect the clients’ opinions but discuss the pros and cons of certain coping strategies in order to guide them to come to a conclusion about whether these strategies are dysfunctional. It often works better if clients can see the pros and cons and then decide on the most appropriate coping strategies for managing the early warning signs for manic episodes. Working with unrealistic positive ideas Many of the features of cognitive therapy for bipolar clients, particularly concerning episodes of low mood, are recognisable from CBT for clients with depression. The issue of working with the thoughts associated with elevated mood can present a different problem. Whereas when working with low mood and negative thoughts both therapist and client are working to try to remove unwanted symptoms, with elevated mood and positive thoughts many clients are at best ambivalent at first. The main approaches that are important here are retrospective evaluation of thoughts and outcomes, challenging unrealistic, overoptimistic thoughts, and using delaying tactics.
rather than prescribing coping strategies. If therapists rely on persuasion or prescribing coping strategies, clients may find sense of autonomy offended and hence reject therapists’ suggestions. In any case, clients’ circumstances are different. Techniques prescribed routinely without taking clients’ experience and circumstances into consideration are unlikely to work. It is not unusual for bipolar clients to like the early stages of mania. They find being more confident, energetic and sociable enjoyable. They may want to pursue certain risky behaviours to get the best out of their high levels of energy. The temptation is understandable, particularly when clients usually suffer from depressive residual symptoms. Therapists should respect the clients’ opinions but discuss the pros and cons of certain coping strategies in order to guide them to come to a conclusion about whether these strategies are dysfunctional. It often works better if clients can see the pros and cons and then decide on the most appropriate coping strategies for managing the early warning signs for manic episodes. Working with unrealistic positive ideas Many of the features of cognitive therapy for bipolar clients, particularly concerning episodes of low mood, are recognisable from CBT for clients with depression. The issue of working with the thoughts associated with elevated mood can present a different problem. Whereas when working with low mood and negative thoughts both therapist and client are working to try to remove unwanted symptoms, with elevated mood and positive thoughts many clients are at best ambivalent at first. The main approaches that are important here are retrospective evaluation of thoughts and outcomes, challenging unrealistic, overoptimistic thoughts, and using delaying tactics.
C10.Bipolar.docx