University counseling centers are faced with the challenge of effectively treating bipolar students while also utilizing brief treatment frameworks and managing high patient volumes. Potential destabilization, particularly within the elevated mood phase, poses significant behavioral management issues for university clinicians and administrators, though for many years the common default position for university counseling centers has been to refer students with bipolar disorder to off-campus resources for longer-term treatment. The author argues against this and instead poses a four-point rationale for treating most bipolar students on campus. The recommended treatment approach includes the integration of brief individual psychotherapy, psychiatric medication, and a bipolar student support group. An important additional component entails lifestyle modifications which include healthy sleep hygiene, the application of stable life patterns, effective stress management, and abstinence from the use of psychoactive substances. Normative striving toward independence, identification with contemporary group norms, and fears of the long-term implications of bipolar disorder predictably give rise to defensive denial and resistance to the diagnosis. Such should be an essential focus of the early phase of treatment, with particular attention given to students’ narcissistic injury reflecting loss of the ideal self they are striving to become. Participation in an ongoing student support group will provide important support in relation to this loss, a place to feel accurately perceived and understood and an alternate source of group identification. The potential benefit from support group involvement will also be instrumental in sustaining healthy treatment compliance.

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