Bipolar disorder: the time between episodes
Services focus on crisis. What is left is the ordinary work of a job, relationships and a diagnosis other people have opinions about. That is where therapy earns its place.
The diagnosis explained a great deal. It did not tell you how to live with it. Medication may have taken the top and bottom off, and you are still left with sleep, work, relationships and a quiet dread of the next episode. Between episodes is where most of life actually happens, and it gets the least attention.
I understand why. Services are built around crisis, and they have to be. But what is left over when the crisis has passed is a long, ordinary stretch of holding down a job, repairing what got damaged, and living with a label that other people have views about. That stretch is the ground therapy is good at.
What the between-time asks of you
There is the practical work nobody hands you a manual for. What to tell an employer, and when, and how much. How to talk to family about warning signs without being watched all the time. How to handle the friend who has read one article and now has a theory. How to rebuild finances, or trust, or a routine, after an episode took them apart.
There is the emotional work that runs alongside it. Low mood between episodes that is not itself an episode but is real and wearing. Anxiety about relapse that can shape every decision. And, very often, a loss to sit with: of a job, a relationship, a version of yourself, or of confidence in your own read on things.
All of it responds to structured, practical therapy, and none of it is what the crisis team is for.
What CBT does here
Therapy is an addition to psychiatric care for bipolar disorder, never a replacement. NICE recommends structured psychological work alongside medication and monitoring, and that is exactly where I fit. I do not prescribe, advise on medication, or provide crisis cover.
Within that, CBT has a clear job. We map your own pattern in detail: what your particular early warning signs look like, days or weeks out, and what tends to precede them. We build a staying-well plan that you actually believe in, with sleep and routine at its centre, because they do more work here than almost anything else.
And then we work on the between-time itself: the low mood, the relapse anxiety, the self-criticism about what happened during an episode, and the practical rebuilding.
The self-criticism after an episode
The self-criticism is often heavier than the episode was. Episodes leave real consequences: money spent, things said, work missed, relationships strained. Afterwards comes a shame that can sit for months, painful in itself and a risk factor for the next low.
Part of the work is separating what you did while unwell from who you are. It means refusing to let an illness write your character reference, without pretending nothing happened or that no repair is owed. We work on repairing what can be repaired, and on a more accurate account of what happened, one that includes the illness as a cause rather than filing everything under personal failure.
Routine as treatment
Sleep loss is one of the most reliable triggers for mood elevation. Irregular days destabilise mood before anyone notices a symptom. So routine gets more attention here than in almost any other work I do. A steady rhythm of sleep, meals, activity and rest is part of the treatment, and it is something you can do for yourself between appointments with anyone.
Where trauma is in the picture
For some people there is trauma underneath or alongside, and that includes trauma from hospital admissions, which is more common than services like to admit. Where that is the case, and once there is enough stability to work with, EMDR can be part of the work.
How it runs
We start by understanding your history, your current care and who else is involved. Work is usually 12 to 20 weekly sessions of 50 minutes, with the option of spacing out towards the end so the gap between sessions grows as things steady. With your agreement it is often useful for me to be in touch with your GP or psychiatrist; therapy that runs in isolation from the rest of your care is less safe and less useful.
If you have found that the crisis is well covered and the rest of life is not, there is more on how I work alongside bipolar disorder.