By: Courtney Davey, MA, MFT
When you care for someone who lives with Bipolar Disorder, there can be a variety of questions around how to handle discussions that involve their symptoms or their behaviors. Wanting to be sensitive and not overstep is common, and sometimes it may be necessary to bring something up, regardless of that feeling. Here are a few suggestions on how to approach them.
Have the conversation before it happens-Do your best to have a discussion before a situation like that arises. Ask how they want you to communicate around their symptoms, as each person will have a different way that they can best hear that feedback. This may not always be possible, but trying to have the conversation when there is not a pressing issue reduces some of the tension and may reduce defensiveness around these behaviors.
Set boundary-When behavior is causing problems for that person, yourself, others or a situation, this is when a new conversation may need to happen. As a loved one, you care for this person. Similarly, you have other people in your life that you care about as well. How do you handle similar situations with those people? When discussing the troubling behaviors, be sure that you are give a similar level of attention and do not overemphasize the diagnosis as the reason for your discussion. If you would have a conversation with any other friend or family member, the same will apply to this loved one, and you may need to remind them of this.
Bringing it up-This is likely the hardest part of the conversation. Figuring out how to phrase it without causing an argument or hurt in the person can be tricky, but it can be done with the least damage possible. Focus on that person, rather than solely your response to it. If you come into the conversation angry or upset, this may affect the words, tone and volume that you explain your concerns. Check yourself to make sure that you are coming from a place of concern. Feel free to explain that when you do X, I worry or I become frustrated. This is important to ensure that the person understands that they are not affecting solely themselves when engaging in behaviors during mania or depression. Make sure that you are calm and able to talk through the conversation with them, rather than escalating yourself. A good starting example would be “Hey, I’ve noticed lately that you’ve started going out all night without sleeping the past few nights, you’re talking much faster and you seem to be spending an awful lot when you told me last week how broke you are. We also got into those bunch of arguments over little things the past couple days. I’m worried because I want what’s best for you, and it seems like maybe these are some of the symptoms you experience.”
How can I support-Focus on acknowledging the problems and then turning the conversation to solutions. Some of this will be their own coping skills and med management, but you can ask how you can support them while they are trying to change the behaviors to healthier ones. Bring alternatives to the situation, with options of how it could be handled differently in the future. Understand that bringing up the problems is not usually enough for anyone, regardless of diagnoses or not. As a loved one, part of that means being part of helping them grow and change. They may not have direct answers for how exactly you can help, so making sure they know that you are willing to help if it means the behaviors will change as a result is important.
Hold firm to boundaries-Some of us struggle with hearing constructive feedback. When it is connected to mental health challenges, it can be even harder as it can feel out of their control. All of this is true, and they do not excuse poor behaviors that are an issue for themselves and others. Particularly when behaviors affect you, it is going to be important to hold firm expectations. For example, “I’ve noticed lately that you are agitated whenever we talk about X,Y and Z, and you begin screaming at me at the top of your lungs and throwing things. I understand that it may feel out of your control when that happens, but I am not okay with you screaming at me. Either we talk about it or I am going to have to stop the conversation and walk away. We can try again later, but I won’t allow this to become unhealthy”. Stick to what you say, as this is both beneficial for you and them.
Remember this is hard for them-Sometimes behaviors that occur with Bipolar swings can be very difficult to handle from an outside perspective. Boundaries and expectations are vital to keeping positive relationships with the person living with Bipolar, and so is empathy. Frustration and worry can be very normal responses to anyone exhibiting poor behaviors. Remembering that this is part of a much longer fight for them and that literal differences in their biochemistry and anatomical structures contribute to the behaviors can ease some of those feelings. These can be overcome, but it is important not to forget the extra hurdles they experience. This will benefit both of you and your relationship in the long run.