Do I Need a Bipolar Disorder Specialized Therapist?
You are here because you want to know more about who or what to search for when looking for the right therapist to support you or your family member with bipolar disorder. Or you may be another therapist curious to know what might set aside someone specialized in treating bipolar and someone that specializes in depression. I am here to share some of my experiences exploring these nuances as a therapist myself who treats bipolar disorder. Together, we’ll go over factors to keep in mind when finding a new therapist, why you may want to consider selecting a therapist with expertise in bipolar, and answer the big question, “do I need a bipolar specialized therapist to get my needs met?”
Inpatient World and Outpatient Therapy
When I worked inpatient behavioral health as a social worker, I saw many patients get hospitalized who were navigating manic and depressive episodes. Part of my role outside of setting up discharge plans for patients often included coordinating care with their outpatient therapists. I think back to how many calls I had with various therapists over the years who had limited awareness that their client was heading towards an episode. While this certainly didn’t apply to every single therapist I spoke to, it was concerningly more often than it should have been.
I would provide recommendations for step-down programs, like partial hospitalization (PHP) or intensive outpatient (IOP), and some of the therapists were less knowledgeable about program logistics or reputable recommendations in the area. At times, they seemed unsure whether or not they wanted to continue working with their clients post-hospitalization. I could sense the discomfort when therapists were ambivalent if they wanted the responsibility for clients that may be more at risk of hospitalization, which is valid. If a therapist wasn’t comfortable, or the needs were beyond their scope, it was certainly appropriate to refer out. However, I believe a majority of the discomfort ultimately boiled down to having limited skills in helping someone recover and stabilize from an episode.
There was an inherent gap in outpatient therapists who were skilled in treating bipolar disorder. It became abundantly clear when I went into private practice that there was a great need for more therapists comfortable and experienced that also wanted to work with clients with bipolar.
Top Questions to Ask When Screening for a New Therapist that Treats Bipolar Disorder
Most therapists offer a free brief phone consultation for you to determine if they are a good fit to support your needs before moving forward with an intake. During this call, you’ll have an opportunity to ask some questions. While you may not get to all of these in such a short period of time, the following are my top 4 questions I recommend asking a potential therapist during a screening call, the reason for asking, and what you can expect for a good potential response.
Question: What is your experience and training with people with bipolar?
Why you should ask this: It’s helpful to know what their experience looks like and that you aren’t just seeing someone who is brand new in the field or has no training or experience working with people with bipolar. While seeing an associate therapist may work just fine, I typically recommend working with therapists who are fully licensed, meaning they have completed all their hours of direct service, received supervision, and passed a licensing exam. I’m usually cautious seeing therapists that have every diagnosis listed on their website or profile, as the likelihood someone is skilled similarly in every single one is low, so be mindful about what they say about bipolar on their websites.
A good example answer:
✓ The therapist is fully licensed (e.g. LICSW, LMHC, LMFT, PsyD, LPC) as opposed to an associate (e.g. LSWAIC, LMHCA, AMFT, LPCA).
✓ Has a background in higher level of care (HLOC) settings, such as inpatient or partial hospitalization and/or has spent time working in community mental health.
✓ Highlights bipolar on their website as one of their primary populations vs someone that treats many conditions or just lists bipolar but has no other information or detail.
✓ Trained in IPSRT (interpersonal and social rhythm therapy), a specific treatment and approach for bipolar disorder, or something similar.
2. Question: What outcomes or goals do your clients with bipolar accomplish?
Why should you ask this: You may have similar goals you want to work on based on examples of what you hear. Knowing common outcomes will give you a better idea if those are in line with what you are wanting and needing, helping narrow down your selection process. If you hear goals that don’t align with what you’re looking for or the therapist can’t come up with relevant goals, this may not be a good fit.
A good example answer:
✓ Helping you catch and prevent episodes before worsening
✓ Ongoing management of depressive and manic/hypomanic symptoms
✓ Building tools to reduce stressors
✓ Recognizing when symptoms need to prompt medication adjustment
✓ Increasing healthy structure/routine and motivation for following through
✓ Improving and repair relationships
✓ Reducing the risk of hospitalization
✓ Supporting with safety planning for episodes
3. Question: What does safety planning in regard to preventing episodes look like?
Why you should ask this: Just because you may have no suicidal ideation doesn’t mean safety planning isn’t necessary. A therapist using safety planning to help you become aware of your triggers and warning signs is invaluable for catching yellow flags that may not be full-blown episodes. For example, if you experience some increased productivity and happier mood, this does not automatically mean you are dealing with hypomania, but it is important your therapist can openly observe what they notice and help you pay more attention to potential signs that can contribute to episodes.
A good example answer:
✓ Collaborating on a safety plan that captures your triggers and warning signs for both depressive and manic/hypomanic symptoms
✓ Going through your history of episodes to understand patterns of behavior and triggers
✓ Coordinating with your medication provider and/or support system to help get everyone on the same page
✓ Sharing their approach for how they help clients catch episodes
✓ Affirmation they will be honest and direct about what they observe
✓ Comfort and confidence in them being able to discuss potential safety concerns with you
4. Question: What is your knowledge of higher level of care (HLOC) and offering recommendations when appropriate?
Why you should ask this: Bipolar disorder has a vast range of symptoms and intensity. While it would be ideal to not ever need a HLOC, this is not a guarantee. You may not ever need it, may need it in the future, or perhaps you are needing it now. The reality is people with bipolar are at higher risk of needing hospitalization, residential, PHP, or IOP. Therefore, it’s imperative you find a therapist who has knowledge and experience with referrals and understands how to assess if you need a HLOC. If you are struggling with an increase in symptoms and may benefit from a HLOC, the last thing you need is a therapist that won’t make the recommendation either because they want to keep getting your business, or they don’t know when to assess for HLOC determination. I highly recommend finding someone who will always make the judgment call and help ensure you are in the right level of care.
A good example answer:
✓ Assurance they will always do their best to assess if you’re needing HLOC
✓ Ability to discuss and collaborate on HLOC recommendations and not just send you to the hospital every time, unless of course that is what you are needing
✓ Confidence when talking about HLOC and how they would handle it
Differences between a therapist with a depression specialty and bipolar specialty
You might have noticed you’ve been to a therapist in the past who was very skilled at addressing your depressive symptoms. While therapists that specialize in depression have a lot to offer in helping manage these symptoms, one of the key differences is they likely do not have the skillset to help catch potential manic or hypomanic episodes. A therapist specializing in bipolar disorder will be more thorough and pay attention to all your triggers and warning signs, know what to look for prior to an episode starting, and can give you specific tools you need to help maintain stability in the short and long term.
Disadvantages of not having a bipolar specialist
Having a therapist that specializes in depression as someone with bipolar may not be a complete dealbreaker. However, it’s important to note potential downsides of this, so you can be well-informed and ensure you are getting the best care possible. Please note, these are just some common examples of disadvantages, but not exclusive to everyone that does not specialize in bipolar:
Risk of more frequent episodes
Increase of stressors to manage
Only treating part of the problem
Therapy feeling less productive
Not checking in as frequently about medication-related concerns and side effects, or catching symptom concerns that may prompt medication changes
Lack of consistency in routines
Unpredictable and unstable moods
More challenging to access HLOC if you need it
So, do you need a therapist who specializes in bipolar?
The answer will depend on your own needs and preferences. If you have a therapist you connect with and feel very supported by, who is comfortable helping you navigate potential episodes, but doesn’t specialize in bipolar, that may work well for you. However, if you are questioning whether or not your current therapist can help with ongoing stability, it may be a good time to look for someone new. If you are already on the quest for a new therapist, I hope this information was helpful with knowing potential drawbacks and key points to consider so you can find the best fit for you.
Ready to connect?
If you’re looking for specialized therapy if you or someone you know has bipolar disorder, please visit my therapy for bipolar page and fill out a contact form to schedule a free 15-minute consult call to see if we’d be a good fit.
If you are a family member with a loved one with bipolar disorder, I offer individual and family therapy for mental health caregivers supporting those with chronic mental illness.
If you are a mental health professional and are looking for case consultation on a client with bipolar or navigating higher level of care, I offer professional consulting for this. Please explore my service and reach out if you have a case you’d like to discuss!
If you’re looking for other options, PsychologyToday.com is a great resource to search for therapists that work with bipolar disorder as well.
