Counseling regarding Bipolar Disorder - Capella Homework Assignment Post

u06d2 Creative Interventions

ASSIGNMENT

For the first portion of this discussion, provide a brief overview of the two articles you read from the Capella Library on creative techniques in counseling. Share an example of how the interventions discussed might benefit a client who is severely and persistently mentally ill. Where could you seek training regarding the interventions discussed?

 POST:

My interest  currently (due to client circumstances and due to a relative’s experiences with dysregulation of mood) is in the treatment of bipolar disorder and mood disorders.  Looking for creative treatment protocols was not particularly effective.  I found significant literature about new applications of medications dedicated to other disorders now applied to treatment of bipolar disorder, such as the Zarate webinar on Ketamine infusions for treatment of mood disorders  (Zarate, 2013).  I found research about the biomechanical pathways which are perhaps responsible for the symptomology of bipolar disorder.  However, there was a paucity of information about creative counseling techniques. 

Treatments utilizing psychopharmacology compromised the majority of the research articles and literature/body of knowledge.  Treatments based on CBT were prevalent.  There are also self-help books available incorporating CBT (Basco, 2006; Bauer, Kilbourne, Greenwald, Ludman, & McBride, 2008) or Family-Focused Therapy (FFT) (Miklowitz, 2011).  None of these things are particularly creative.  In fact, CBT and FFT modalities are reputed to be evidence based practices and considered to be fairly clear-cut.

A person is experiencing “treatment resistant” mood disorder NOS with hypomania, mixed episodes, irritation, suicidal and homicidal ideation, severe depression, insomnia, anxiety, cognitive dysfunction in thinking and perceiving, inability to concentrate, etc.  The person cycles on a weekly basis.  I have tracked this person’s moods since March when Prozac prescribed for depression triggered severe mania and resulted in hospitalization for a week.  The person’s mood-cycle is fairly consistent oven the time since March.  The person has tried, and failed, multiple medications used to treat bipolar disorder including Depakote, Remeron, Seroquel, and about 8 antidepressants trialed before the manic episode… of which Prozac was the worst one.  Currently the person is somewhat stable with Zyprexa – which was very effective for 4 days and now has decreasing effectiveness.  This person’s experience shows me that psychopharmacology is not the “magic bullet” to resolve mood disorders. 

I have several clients who have seen multiple counselors, psychiatrists, medical doctors, and other health practitioners.  Medication is often worse due to side-effects than the disorder, is non-effective, or has limited effect.  One client has seen counselors for over 20 years.  This client’s medical history and mental health history is very extensive.  The client is intelligent, creative, and dedicated to trying to find resolution for bipolar symptoms.  I provided the client with copies of the three books I mentioned as available self-help books.  The client read all three books and we discussed what the client has tried and not tried.  The client’s experience shows me that CBT and FFT are not able to help everyone.

I have been reading extensively.  For my client who was feeling quite hopeless, we have worked together to develop a way to return some control to the client.  This plan was based on the reading I have been doing and the observation of my relative's life.  Therefore, it is NOT evidence based, but instead the start of a theory.

The idea starts with an understanding of eustress and distress.  If humans are considered to be systems (dynamic systems theory, Freud’s theory, other theories) at equilibrium, then things that cause change in that equilibrium are stressors.  Each stressor has specific cost of energy required to return the system back to an equilibrium.  Maintaining equilibrium is the function of any system.  Therefore, stressors can be conceptualized by assigning them a ratio. 

We talk about eustress as taking less energy to return to equilibrium than distress.  We also talk about the system’s resistance to change (which we conceptualize as resources or balancers).  The description I use is this:

If I go walking in the woods and see a little black snake with a red ring around its neck, I get all excited.  I like snakes, that is a very obviously non-poisonous snake, and so, I can hold and play with the snake.  If my friend is walking with me and sees the snake, she is running the other way – screaming.  She is phobic about snakes.  (About 30% of the people I tell this are shaking their head at this point because they are not so fond of snakes either.  We laugh for a minute and move on).

Now – the snake is the same.  It is just a snake, nothing has changed except the perception of the snake.  Furthermore, we talk about how much less energy it takes me to return to my normal than for my friend to return to her normal.  So we talk about how for each person discovery of the ratio of eustress to distress is important.  For some people eustress is worth one point, while distress is worth 3 points.  For others, eustress is worth 2 points and distress is worth 7.  It is something each person needs to find out for him or herself. 

So, the next couple weeks are spent tracking activities versus moods.  Sleep is also very important and so are life activities like eating, cooking, interacting with others, etc.  All these things are tracked - through smart-phone apps, journal entries, graphically, or otherwise.  After the events are tracked, we spend a session analyzing the data.  This usually gives us a ratio.  Often the tracking also gives us a “flip-point”.  The flip-point is where mood switch happens. 

As a side note, from my observations, it seems the flip-point is where the most self-loathing and distress is felt.  For my client, this is the point in which the client experiences suicidal urges.  I do not understand why.

Then, the client learns how to use that ratio to moderate moods.  For example, understanding that at a flip-point of 12, moods are likely to switch; and that eustress is worth a 4 and distress is worth a 6, then the client can decide that going out to a movie, having a church function, and dinner with family is enough to be up to the flip-point.  Therefore, picking two things to do instead of three can delay or avoid mood-transitions.  Some clients are starting to find that there is a correlation between energy-expenditure dealing with stressors and length of time in mood-switch.

The other side of this tracking is to build resilience or balancers.  This things help make the system of the client less responsive to stressors.  To explain this, we talk about money in the bank and cars.  If I have an extra $1000.00 in the bank and my car has a problem, it is inconvenient.  If I have $1.00 in my bank account and the car has a problem, it is a crisis.  The money is a resource…  It is something that buffers me from feeling as much distress from the exact same stressor of the car having problems.  Humans can build resilience.  This is done by some things as simple as breathing exercises, meditation, and other wellness practices.  It can be done by things as complex as changing where you work, live, and who you have in your life.  However, ALL THESE THINGS are directly under the control of the client.

By using tracking and this conceptualization, the clients I am working with have been able to gain some control of their moods.  While mood switches are not completely alleviated, the distress felt by the client is decreased, mood switches are decreased, and suicidal urges are less likely to be acted upon.  One reason for this is that if length of moods can be predicted (even in a very small way), it becomes more tolerable.  Understanding and control seem to make it easier to accept the disorder.  Further, when energy is not spent fighting against the disorder, the stressor of having a chronic condition/illness can be reduced, which benefits system response and is a source of resilience.

So, while this is not a journal credited source of creative counseling practice, it is the beginning of my hope that somewhere there is information which will provide holistic treatment of a disorder that is pervasive across all domains of a person’s life, which does not have particularly favorable prognosis in treatment-resistant forms, and which can be very debilitating.

Laura Collins

References

Basco, M. R. (2006). The bipolar workbook: Tools for controlling your mood swings. New York, NY: Guilford Press.

Bauer, M. S., Kilbourne, A. M., Greenwald, D. E., Ludman, E. J., & McBride, L. (2008). Overcoming bipolar disorder: A comprehensive workbook for managing your symptoms & achieving your life goals. Oakland, CA: New Harbinger Publications, Inc.

Miklowitz, D. J. (2011). The bipolar disorder survival guide: What you and your family need to know [2nd Ed.]. New York, NY: Guilford Press.

Zarate, C. (2013, August 13). Meet the scientist webinar: Ketamine and next generation therapies. Retrieved from Brain & Behavior Research Foundation: bbrfoundation.org/august-webinar