What’s Love Got to Do with It? (Couple Therapy and Bipolar Disorder)

What's love got to do with it?

By "it" I mean you and your partner’s struggle with Bipolar Disorder - a struggle that can result from a clinician breaking the news of the diagnosis, the storm and aftermath of a bad manic episode, or the dread of a never ending depression. Can working on your relationship as a couple help to deal with any of these challenges? As a psychologist who is excited about the power of couple work I’d like to say yes, there is definitely a good place for couple therapy in your effort to tame Bipolar illness. 

The opportunity of introducing couple's therapy into the treatment of Bipolar Disorder is often overlooked because of the broadly acknowledged notion that Bipolar illness is at its core a biological illness. We've all heard the many variations of this notion. Bipolar disorder is cyclical, it has a genetic component, it has little to do with the patient’s personality, it is effectively treated by medication. The truth is, there is a lot about Bipolar Disorder that we do not know, and this hefty biology tends to push the considerations of what may be going on beyond the psychiatric symptoms to the margins. For the purposes of this blog, I would like to put the biological component aside for a bit and focus on something different. 

From a relational perspective, Bipolar Disorder is a trauma to the couple’s relationship that requires healing. 

The stories that the couples typically tell often reflect the relief of being able to identify and label the irrational behaviors as well as the hope that their subjective emotional experiences of the disorder will be controlled as long as the patient’s symptoms are well managed. Here is what a clinician would often hear: 

“He was not acting like himself… she was angry at everyone all the time… he went crazy with the credit card behind my back… she was blaming me for everything… we were constantly fighting… I was thinking about divorcing him… we almost broke up…”  

And then the story continues:

 “She got diagnosed and it all made sense… I know what symptoms to watch out for… as long as he gets enough sleep and takes the medication we should be fine… as long as I can get in touch with the psychiatrist when I need to I feel safe.”  

Figuring out the diagnosis and getting the right treatment for the person with the Bipolar illness is an absolutely necessary piece for success, but is it always sufficient to get the couple to a place where they feel secure with each other and confident in their future together? Sometimes it is. Maybe the stress produced by Bipolar disorder made you even stronger on the other side, or maybe it made you see each other in a new light and have deeper respect for each other. If you are involved with the Family Center, maybe you learned about the symptoms in depth, developed an alliance with the clinician, learned some new communication skills and feel supported and hopeful. 

But what if you still feel disrupted, if not traumatized by what the Bipolar illness brought into you relationship? What if you are resentful for what your loved one’s mania put you through or for your new “sick role?” What if you feel so powerless against your moods and doubtful of your capacity to have a clear judgment that you withdraw from the relationship instead of participating in it? And, finally, what if like many couples you had had preexisting problems and the Bipolar issue only added another layer to them? 

You can let time do all the healing but you can also turn to couple therapy and use it for what it is designed to do; bring the two partners closer together and help them develop an intimate relationship that can serve as a buffer against many troubles in life, including the ones caused by the illness. We all know, and I don’t think there is a need to look for research references here, that a good relationship, in which both partners feel understood and cared for make it easier to weather almost anything; problems at work, uncertainty of the future, cultural transitions, serious losses. Moreover, there maybe a bonus to the couple’s success; some experts believe that  changing a person’s way with his or her significant other can on it’s own change his or her behaviors and emotional responses outside this relationship...in other words, produce a higher level of overall mental health.

If you have any questions about couple's therapy and bipolar disorder, please leave them in the comments section below - I'd love to hear them! 

-Dr. Kazariants