Psychotherapy in bipolar disorder.
Bipolar disorder is highly topical and the emphasis of treatment is generally on medication. The author presents, as a counterpoint to that approach, the experience of an intensive psychotherapy over four years with a 35 year old woman whose various diagnoses included rapid cycling bipolar disorder and had been treated over several years with a range of psychotropic medications, cognitive psychotherapy and several courses of ECT. Her illness was severe and relapsing, episodes were predominantly of major depression and there was a significant risk of suicide. She was referred to a specialist unit for mood disorders where she was eventually assessed as treatment resistant and after lengthy consultation with several experts she was finally recommended for leucotomy. At that stage a trial of intensive psychotherapy was undertaken by the author.
The therapy took four years with four sessions weekly in the earlier phase and progressively diminishing in frequency. The theoretical framework was one of developing an internal working model of a secure attachment relationship and the capacity to self sooth; and also exploring what was a highly complex family system and issues of childhood trauma that were relatively subtle. Leucotomy did not proceed and at 15 year follow up she remains well.
