I hold a bipolar diagnosis and a PTSD diagnosis. I found it was vital that I had a therapist well-versed in bipolar disorder, very knowledgeable about the medications I was taking, and willing to communicate with and work in conjunction with my psychiatrist (and a psychiatrist willing to do the same).

We ran into similar issues during therapy when the PTSD symptoms actually became more troublesome than the bipolar symptoms because they seemed to activate bipolar episodes. My therapist, by the way, worked from both behavioral and more psychodynamic approaches.

We found there were times when the focus in therapy had to be my behavioral -- working on and applying management skills so that I learned to be more cognizant of what was initially activating my bipolar symptoms, what steps I could take to minimize the severity of episodes so that I did not end up in the hospital, etc. CBT/behavioral techniques are really important, I truly believe, for long-term management of bipolar disorder because early recognition, intervention, personal management and responsibility, etc. are vital. During those times, medication management of the severe depressive episodes that left me suicidal and oftentimes hospitalized was THE focus and had to be. We had to set the other work aside for safety and stability.

We discovered the deeper psychodynamic work could not happen while I was in the midst of an episode or the episode would become dangerous very quickly. It meant therapy was a slow process as we essentially had two different paths we were navigating: one path dealt with bipolar management and the other path was dealing with the origins of my PTSD symptoms which required more psychodynamic approaches.

It took about a decade of working between the two to finally reach a place where both were under better control and not feeding each other. Over time, I have finally really learned how to be proactive about my bipolar symptoms so that they no longer create huge crises for me. Also, finally working through my history of trauma has pretty much resolved my PTSD symptoms which were complicating my bipolar episodes.

Having a therapist and psychiatrist who had the wherewithal and willingness to take the time to help me walk both roads was what got me through, but it WAS a very long process and not an easy one. I was hospitalized repeatedly, particularly in the first 5 or 6 years of our work together, until I reached a place where I was much more self-aware and disciplined about actually using the skills I needed to use behaviorally to keep myself safe and fairly stable AND had worked through much of the trauma so that the PTSD symptoms lessened and stopped activating severe bipolar episodes.

Is your therapist willing and able to help you dissect and analyze your own bipolar symptoms? Is your therapist willing and capable of helping you develop skills to deal with your bipolar symptoms? If the therapist just says, "Let's talk about lighter things" rather than "Let's work on how to live with bipolar disorder" may be ignoring very important work. Bipolar disorder is not managed through avoidance. It needs to be dealt with head on.