I have been in and out of therapy for almost a decade now. Ever since my bipolar diagnosis in 2012, I have more or less stuck to the recovery regimen of religiously seeing a therapist weekly, a psychiatrist every one to three months, and taking medication daily. As I worked out the kinks in my stability, for the first few years these three activities were the cornerstones of my wellness. Nine years and three hospitalizations later, this routine isn’t at the forefront of my recovery. Yes, I have come to terms with the fact that I will probably need to me on medication for the rest of my life; finding a psychiatrist I truly love and respect has made that pill a little easier to swallow. However, I am in a stage in my healing journey where I am questioning the role of therapy in my life.
Since my last big crisis in 2019, my self-knowledge and awareness about my condition has grown exponentially. I found a community through attending peer support groups and making friends with people who know what it’s like to inhabit a mind like mine. I’ve learned new coping skills through CBT to monitor my thoughts. I’ve constructed a Wellness Recovery Action Plan (WRAP) to identify triggers and implement tools for course correction when I dip into depression or escalate into hypomania. In the event that I may become unwell to the extent that I no longer have the capacity make decisions or advocate for myself, I created a Psychiatric Advance Directives (PAD) in the hopes that my loved ones and my care team provide me with the dignifying care I would want.
Once I found stability with my moods, I become acquainted with the traits and triggers of Generalized Anxiety Disorder (GAD). Even when I was in a euthymic state with no depressive or manic symptoms, I still experienced paralyzing anxiety (especially during the first few months of the COVID-19 pandemic). After some exploration with anxiety medication and CBT, now I also have the pharmacological and cognitive behavioral tools to manage my anxiety so that it does not get to a level that it triggers a mood episode.
I also have material stability in the form of secure housing and steadying income, huge factors that were not always present in my recovery. Now I am grateful that I have a support system of friends and family who are educated about my mental health issues and know how to help. I am blessed to have a life partner that is very aware of the subtitles of my various cycles — he’s seen me at my lowest and my highest. He gently and lovingly reflects my fluctuations back to me which helps me eventually bring myself back to center. Since it is common for people with bipolar to be unaware of when their moods veer off (especially into mania) this kind of gentle feedback is invaluable. My daughter also gives the best cuddles and is so eager for me to get out of bed in the morning and seize the day with her. She is a big motivating factor for me to stay well.
So where does this leave me with therapy? With all of this growth I feel like I’ll be out of the woods for a while. It’s been three years since my last big psychiatric crisis and I am working towards reaching to five and ten years without any huge mental disturbances. Right now, I feel like I’m just going through the motions with therapy because I assume this is what is expected of someone with my psychiatric history. But I’m no longer in a place of hypervigilence when it comes my moods. My mood tracker app has become obsolete. I am finally in a place where I no longer feel like I have to go to therapy to work on trauma or moods, but on the common stuff of everyday life like balancing work life and family time, parenting, and maintaining healthy relationships.
This phase of my life requires celebration of how far I have come and fine-tuning and optimizing how I operate in each area of my life. Though this is not a direct focus on issues pertaining to bipolar disorder, self-improvement in these areas will only enhance my mental well being. For instance, my husband and I were in couple’s counseling for a few months. Although my mental health was not the center of the work, the sessions greatly improved our ability to work collaboratively, which in turn had positive effects on my mental health.
Instead of individual therapy as I have known it, what I am looking for almost requires a life coach, career coach, or specialized therapy for working professionals or “high functioning” people with bipolar disorder. I know this kind of thing exists, but I don’t know if it’s accessible and affordable for me. I’ll keep looking, but maybe it’s also time for a break from therapy all together and see what other avenues I find. The only fear with that is the feeling of going out to sea without a liferaft. It’s better to be prepared with the resources for a crisis in advance instead of scrambling when a storm hits. When I was ready to resume therapy after my last crisis, which happened to be during COVID-19 and my postpartum, it was hard to find anyone. It seemed like everyone was going to therapy so therapists were fully booked. I fear not being able to find a good therapist again when I need one.
Someone in group described going to therapy as an insurance policy where they invest their time and money in cultivating a therapeutic relationship for the day that they become unwell. When you’re in a low state, it’s much better working with someone who knows you than to have to start over with someone new. In my experience, the beginning stages of working with a new therapist requires weeks of intake and background history before you can really get anywhere productive. I hope I can eventually find someone who is worth this kind of investment, but at the moment the insurance policy doesn’t feel like it’s worth my time and resources.
If you have a mental illness, have you felt like you’d outgrown therapy before? What did you do instead? I would love more thoughts on this.
Image Description: A person against a green chalkboard looking up at the squiggly arrows drawn around his head pointing in outward directions.