[Pinkfluffyunicorn]

Hi. I'm diagnosed with cyclothymia or bipolar 2 (psych wasn't sure which) and also generalised anxiety disorder and BPD. I was only diagnosed BP and BPD this year, although I'm in my 30's. I started psychodynamic therapy at the end of June and I get it for a year. I've done CBT and had counselling before, but nothing like this psychodynamic therapy.

I'm really struggling at the moment.
My moods are all over the place. I'm having therapy is horrendous and I think that's what's causing all these swings. I know I need to continue with therapy and my therapist says it won't continue at this intensity, but it's making life really hard.

I don't feel like my meds are doing anything. I declined a medication review because I think it's therapy causing all this (my care coordinator agreed) so I'm thinking no medication could combat what's going on at the moment and I'm worried that if I go for a change, I won't be able to tell if a different med would be effective if no meds can override this therapy fallout. Now I'm wondering if I should request a review, or what I should do, because it's got to the stage that I'm really, really struggling with the changes. I don't know where I am from one day to the next, my thoughts are all over the place, my emotions bounce between nothing or just plain depressed, or being overloaded with I don't know what (therapist said that's flooding) all mixed in with doses of stomach churning anxiety, plus dissociation when I'm in busy or stressful environments, and it's just way too much.

My therapist says that a lot has been bought up very quickly and has suggested I aim for less huge things to talk about for a while, but as it's free association it's hard, because the smaller things seem to lead to the bigger things. It's getting harder to go each week. I have sessions when I spend half the time dissociating. This is s new thing for me. Therapist says I've always lived 'on the surface' but I have never had anything I would have considered dissociation until I started seeing her.

I'm not sure if I should attempt to adjust my meds or how to handle the therapy fallout which is getting worse by the week.

Any thoughts appreciated.

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.

[Argonautomobile]

I'm sorry you're struggling, Pink. It doesn't sound like this therapy is very helpful. I don't think it makes much sense to do any kind of treatment that makes you feel less stable. I also don't think doing free association is a fantastic idea if bipolar cycling / stability is an issue.

Has your T specified what "less huge things" you can aim for and helped you stay on track? He/she should be. When I first saw my T in the midst of a hyomanic crisis and babbled on and on about Heidegger, he didn't allow me to free-associate my way into a deeper crisis - he shut that **** down and had me focus on small, specific (and, yes, surface-level) things that would immediately improve my stability and well-being. Existential questions could wait.

I agree with Lola that "let's work on how to live with bipolar disorder" makes much more sense.

Is it possible to see a different therapist?

[Pinkfluffyunicorn]

Thankyou for your replies.

My therapist and my care coordinator both tell me that things will get better and therapy will become less intense (although nobody can tell me when) and that I'll only move forward if I continue with therapy. I'm getting it through the NHS, so I didn't get to choose which type of therapy or my therapist. It was a case of 'Here's your therapist, you get a year of psychodynamic.' I had to really jump through hoops to get any psychotherapy at all. I don't think it's possible to change therapists and I don't know if I'd want to anyway. I keep being told it gets worse before it gets better.

When I was assessed for therapy, I didn't have a bipolar or a BPD diagnosis, although those were in the pipeline, so I suspect they had been told by my CPN that those diagnoses were probably on the way. I was diagnosed with depression and GAD then. They were aware of some emotional neglect, terrible self esteem, some issues with food and teenage issues with self harm, but since starting therapy a lot of trauma stuff has come up, some physical abuse and possible sexual abuse. All this trauma stuff came up by session 7. Because its all free association (my understanding is that is how psychodynamic works) I just splurged so much out so quickly, thinking the sooner I get it all out, the sooner I'll get 'better'
Even that was hard and I haven't really gone into much detail. Some sessions I freeze a lot and it'll take me 10 minutes to say anything, numerous times. Once I seemed to lose 20 minutes although I'm not sure if that actually happened or I just lost track of time. There was one session when I left the dissociation was pretty intense and the corridor seemed to stretch out in front of me. A lot of the time I can't remember what we discussed in session, I know the general topics but I find it very hard to remember specifics. I've told her that too and she said it's because I'm not really there and I've zoned out. She doesn't do anything to zone me back in - as far as I'm aware.

My therapist doesn't offer any practical support, nothing like grounding techniques or anything CBT like (I have done CBT previously) but I do have a care coordinator who I'm currently seeing weekly who does go through different coping mechanisms with me. Therapist did ask if I'm still seeing her this week and I said I was. I think she thought that was a good thing, she said that it's very different seeing the care coordinator and seeing her.

I have been very unstable since starting therapy and my eating problems have intensified, I have had strong urges to self harm (although I haven't) and definite suicidal urges. I've even had contact with the crisis team for the first time ever. My care coordinator keeps trying to get me to agree to allowing her to refer me back to the crisis team. My therapist knows all of this, because I've told her. I'm assuming she has access to my notes as well. She either hasn't said anything or I can't remember because I've zoned out.

I don't have any other options for therapy as there is no way I can afford to go private. I don't want to give up now and be left in the state I'm currently in, and I am hopeful it will improve because that's what everyone is telling me. I'm just finding it so hard to manage right now. I've had 2 weeks off work since starting which has pushed me further down in my sickness policy at work, this mad dissociation which is new as far as I'm aware and a couple of what I assume to be panic attacks and weeks of depression. I said to my therapist this week that I can't continue with this and it's seriously causing me problems in my ability to function in the real world. She said that she could see that and that it would improve and that it's a slow process. I said that I can't handle being around people right now so she suggested I tell my husband I need some alone time, which I have.

I dread going to see her every week. I've told her I feel like I've opened more and more boxes each week and that now I have all these boxes open and I'm screwed. That's when she suggested talking about lighter things for a while, maybe something that's happened in my week that has caused me some emotion.

I have wondered if this is the right kind of therapy for me or if she's the right therapist for me, but I don't have any other options and she tells me it will get better. I don't know. I just feel like it's making everything so much worse, but I'm told that is what happens and it'll get better.