Is therapy needed too? More than medications?

Q: My 18 year old sister was diagnosed with bipolar disorder in early December 2000, after a 3 week stay in a psychiatric unit, against her will. There has been speculation that the disorder may have been triggered by her pregnancy; she recently gave birth to a healthy baby boy. My question is treatment related. She sees a psychiatrist once every 2 months, he prescribed her with medication which he says she must take non-stop for at least a year. I feel that she should be involved in some sort of therapy or counseling. During her manic episodes she has mentioned many stories about rape which may or may not be factual. She also witnessed our father's death when she was 2 years old, an experience which she has recently begun writing poetry about. Am I wrong to assume that treatment should involve more than just medication? I can't help but think that medication will only mask the real problem that is causing her mental instability. She has also admitted to hearing voices. Any advice will help!

Dear Ms. B' --
Sounds like what's usually called "post-partum" start of symptoms?  Very common, a high risk period for someone with genetic leaning toward bipolar disorder.  And hearing voices is quite common in bipolar disorder, so that definitely doesn't mean the diagnosis is wrong (doesn't mean it's right, either, of course). 

So, what's the evidence for "some sort of therapy or counseling" helping in bipolar disorder?  Until very recently, not much.  Now there's some research showing that specific types of therapy focused on believing and understanding the diagnosis, and helping friends/family and the patient herself cope with it -- that helps get better long-term outcomes.  I definitely support that. 

How about some therapy targeting the talk about rape?  Just because she was manic at the time doesn't mean something like that didn't happen, of course.  Hard to know what to make of that until she's "not manic", according to her and several folks who know her well (like you).  Then, if she can be asked to reflect on those comments she made while ill, you may see whether there's something that needs to be targeted specifically there. 

Finally, even folks without bipolar disorder can benefit from therapy, of course.  So just because she has bipolar disorder doesn't mean she's any less likely to benefit, again obviously; and of course she's got this recent severe illness and it's implications to worry about, so yes, many people would think she could use some additional help with that.  If she gets fully well, and says she doesn't think she needs it though, I'd urge you to wait and see if she seems to be wrong about that somehow before you push it.  And how about  now?  Except for the types of therapy I mentioned above, she may not be well enough to be able to benefit?

Bottom line: it's a pretty individual matter, including timing as well as what type, and sometimes, whether.  Your support and concern can be a great help, though.  Just be cautious about how.  The folks at NAMI are a great resource in that respect, and the website for significant others.

Published February, 2001