I’m Sorry: Apology Can Make All the Difference

I’m Sorry: Apology Can Make All the Difference

I’m Sorry: Apology Can Make All the Difference

Sometimes I find that people are unable to apologize. These are often the people that will say, “you can’t just say I’m sorry and everything be okay.” Perhaps to them apologies are empty and meaningless; but for so many, apologies mean everything in the world. I, for one, am a person who can forgive just about anything that a person sincerely acknowledges.

At the core of our psychobeing resides the ego.

Refusing to acknowledge mistakes is a sign of an extremely weak ego. Some people would often rather get a divorce, quit a job, abandon family members, lose out on privileges, or walk away from something amazing just to save a little face.

What I most often see is that people who refuse to apologize are afraid that admitting an error will make them appear as inferior. What I believe is that the opposite is, in fact, true.

It takes a lot of courage to say to oneself or to others, I am wrong. I have made a mistake. I apologize. I’m sorry, I didn’t want things to happen this way. The fear of being inferior seems to be motivated by an effort to maintain a connection. If I don’t admit my weaknesses, perhaps I still have a chance to maintain my favor in the eyes of the other person. But what happens most of the time, I believe, is that we lose favor when we are unable to admit our wrongs.

So here is a simple life hack that will make your life so much more pleasant: just say “I’m sorry.”

These two little words are maybe just as powerful and just as simple as saying the words “thank you.” We try to teach our youngsters to be polite and say please and thank you. Those words don’t really mean anything, and they don’t really have any measurable value . But saying thank you is a matter of improving the connection with the giver. Someone shared something with me or does me a favor of some kind, saying thank you is just an acknowledgement of grace. It just means I appreciate you, this is meaningful. And maybe half of the population is built to thrive on “thank you’s.”

Is it so different to teach our children to also say “I’m sorry”when they have done something wrong? I have a 2 year old and a 1 year old and things are pretty exciting at my house! The other day my two year old accidentally bumped the one-year-old in the head with something and the baby started to cry. Already sensing that he was in trouble, the two-year-old decides to run away. I gently persuade him back into the room, and try to teach him that he needs to acknowledge that he hurt his brother, give him a little hug, and say sorry.

It was so interesting his reaction, immediately, he clammed up. He couldn’t bring himself to say he was sorry. This isn’t a matter of his speech development, he is able to pretty much say any single word that we share with him. He doesn’t mind hugging, in fact he’ll hug just about anyone at the drop of a hat. But sensing that he maybe in a diminished state somehow because of an error, he closed up, put up walls of some kind, and just could not bring himself to say that. But this article isn’t written for toddlers.

One of my assessment questions as I begin working with couples is: who is the least likely to apologize when they have made a mistake or otherwise been hurtful. Almost invariably, there is someone in the relationship who virtually never, ever, apologizes. And maybe my sample is skewed, because the people I’m asking this question of are seeking professional help for their relationship. It seems that that is one very quick indicator of the defensiveness and resistance in the relationship.

Conversely, there is often a person in a relationship who apologizes all too often. They walk around on eggshells, hoping not to upset the other partner and end up taking all the responsibility, even when they have none. This is equally unhealthy. I think this is part of the accidental reinforcement of the unapologizers inability to say they are sorry. They feel that apologies are meaningless and are using the example of their partner always trying to escape tension with an apology as just a super annoying habit.

Another group that I spend a lot of time with are those who are addicted to substances or processes like pornography or gambling what is the most effective means of recovery from these types of addictions is engaging in and participating in the 12-step recovery groups, like Alcoholics Anonymous, or Narcotics Anonymous.

A good portion of these programs have to do with taking account for one’s own mistakes. There are specific steps to acknowledge the exact nature of one’s wrongs, make amends, and promptly admitting when they are wrong as a way of life to sustain recovery.

That fact alone, tells me that at the heart of some of the most troubling issues known to man, like addiction, relational problems and others, is the inability to own one’s mistakes. And perhaps the remedy is just as simple, although not easy to do.

A popular assignment of therapists and self-development coaches around the world is for people to keep a gratitude journal, or a gratitude list.

I wonder what good it would do all of humanity, and even our own little relationship circles, for us to go around and likewise make lists of our own mistakes, and share them with people. Self-disclosure is at the heart of recovery from problematic addictions, for example. That’s why people stand up in meetings and say, “I’m Joe and I’m an alcoholic.” Why the hell is that the first step? Because it’s powerful, and it works.

Whatever the fear, whatever the dark imaginings that follow the notion of the resistant and hard-headed person apologizing, those things almost never really happen. I don’t even know what people picture would go wrong if they were to ever utter the words, “I’m sorry.” Do they think they will look bad? Melt like the Witch of Oz? What? It’s as if we’re on the playground and we’re saying “step on the crack and you break your mother’s back.” It’s not going to break your mother’s back to say you’re sorry and take responsibility for your actions.

What it will do instead, is bring you closer to the people you’re afraid of losing. What it will do instead is make you actually stronger. What it represents is strength in yourself. What it shows people is that you are secure. What it develops in you is deeper self love so that you can feel less threatened by your inferiority or mistakes in the future.

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What It Means to Hold Space for Someone

What It Means to Hold Space for Someone

What It Means to Hold Space for Someone

So the phrase “holding space” has been gaining popularity in podcasts and blog articles out there in self-help land and I just wanted to share some thoughts about what it means and a few tips on how this can help your relationships.

Holding space is the phrase we might use to describe unconditional support for someone. Holding space means giving the person exactly what they need from us without being overwhelming, judgmental, or forceful about it. It is a gentle type of support focused on emotions and practical aspects of a problem. Holding space is very important for anyone but can be especially significant in difficult situations like an illness or a loss. However, it can also be applied in therapy, education, or relationships. The concept of holding space means that you are creating a safe and comfortable environment where the person can feel and express their negative emotions. Here are a few tips for how you might hold space for someone.

Avoid judgment and criticism
Holding space means that you are giving the person your unconditional support rather than the conditional support associated with judgment and criticism. You will not expect the person to act differently or follow your guidance. You will not shame them for the choices they make or their past mistakes. You will instead reserve judgments, whether these are verbal or non-verbal. This is a key aspect of holding space: helping the individual feel safe.

Avoid overwhelming them
Sometimes, information can be overwhelming. For example, when we first receive a diagnosis, we might not be ready to hear everything, all the problems and solutions associated with our condition. Instead, we might require just the basics, just a little guidance until we are ready to assimilate the rest of the information. Do not focus on educating. You need to identify the basics and offer them in terms of information, handouts, advice, but avoid overwhelming the individual with data. The same is true for emotions. Avoid excessive emotions to make sure the person can focus on their own rather than on the emotions of the people supposed to give support.

Respect the differences
When we hold space, we need to be aware that the person will have their own culture, their own ideas, beliefs, and opinions. We cannot force our own even if we feel we know better. We have to respect the person and their autonomy, which is associated with the idea that they will make different choices, even choices we might not approve of. For example, when people grieve, they do this differently. Some choose to cry while others cannot. An absence of tears should be respected as much as an expression of sadness.

Allow complex emotions
The emotions people deal with are not easy and, often, they are not pretty. Many cultures might punish emotional displays of anger, especially for women, or sadness, especially for men. It is important to let the person feel what they are feeling and express those emotions. When you hold space, you might need to provide containment for these emotions but containment is not the same thing as denial or judgment. Let the person express their feelings within the safe space you create, even if it is messy.

What does this look like in real life? A client of mine recently explained how he and his wife have had major problems with their sexual relationship because his recently-admitted use of pornography hurt the wife so much, she felt she could not trust him. It turns out, she had all kinds of previous trauma, including sexual assaults, which surfaced after it was discovered that he was acting out with pornography. The client chose to hold space for his wife, and even though he had done all kinds of recovery tasks, attended meetings for his severe addiction, and maintained an entire year of sobriety, he allowed his wife to work through her own issues however she needed to. Although in some ways he felt he deserved to be trusted again with intimacy, he allowed her whatever time it took for her to feel okay again.

Holding space for others means we let them be wherever they are. We don’t impose unrealistic expectations or selfish demands on them.

The hardest part for us who are doing the holding of such “space” is that we are often doing so when it is least comfortable. We may be getting yelled at, rejected, criticized, belittled, pushed away and even emotionally abused. The point is not to support others while continually allowing ourselves to be victimized by them, but not to do any accidental victimizing of them, ESPECIALLY when they are down and out.

I have seen some of this lately, even in relationships of my own sphere. And what I have become intimately aware of (once again) is that it’s really the only way to be. Anger won’t do it. Lecturing won’t do it. Ridicule and complaints won’t do it. The only thing we can do to change behavior is love, and holding space is one of the most difficult and yet truest forms of that.

You’re reading this because you’re looking for some help with your situation. I can do that, I promise. Make an appointment with me and let’s get started.

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Put Down Your Chisel. Let Be. Appreciate.

Put Down Your Chisel. Let Be. Appreciate.

Put Down Your Chisel. Let Be. Appreciate.

Tonight a client asked me to share this with her, so I decided to post publicly so you can read it as well.

This is a thought adapted from  book called Please Understand Me by David Keirsey which deals with difference: differences in temperament and personality characteristics.  So often, what brings couples into counseling is the inability to understand each other’s point of view.  Those perspectives are shaped by temperament or basic personality functions, among other things.  The passage below is absolutely brilliant, and no matter who you are, I’m sure that you can benefit from this profoundly enlightening rebuke of our occasional tendency to see our way as THE way.  I hope this is meaningful to you.  🙂


If I do not want what you want, please try not to tell me that my want is wrong. 

Or if I believe other than you, at least pause before you correct my view. 

Or if my emotion is less than yours, or more, given the same circumstances, try not to ask me to feel more strongly or weakly. 

Or yet if I act, or fail to act, in the manner of your design for action, let me be. 

I do not, for the moment at least, ask you to understand me.  That will come only when you’re willing to give up changing me into a copy of you. 

If you’ll allow me any of my wants, or emotions, or beliefs, or actions, then you open yourself, so that someday these ways of mine might not seem so wrong, and might finally appear to you as right – for me. 

To put up with me is the first step to understanding me.  Not that you embrace my ways as right for you, but that you’re no longer irritated or disappointed with me for my seeming waywardness. 

And in understanding me you might come to prize my differences from you, and far from seeking to change me, preserve and even nurture those differences. 

Abandon the project, that endless and fruitless attempt to change me into a carbon copy of yourself.  You do not have a license to sculpt me using yourself as a pattern to copy.  Put down your chisel.  Let be.  Appreciate. “

(Adapted from Keirsey & Bates, “Please Understand Me”)



Keirsey, D., & Bates, M. M. (1978). Please understand me: Character & temperament types. Del Mar, CA: Prometheus Nemesis.

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The Dust and the Log

The Dust and the Log

The Dust and the Log

An ancient scroll tells the story of a teacher who sat on a hill, sharing wisdom for a crowd of people who followed him to the mount. The writer of this brief was only the recorder, not the speaker. The speaker himself has never written, and has only been written of. The passage tells people to stop looking at the “mote” or speck of dust in the eyes of others (like the dust that floats in the air) without first considering that in our own eyes may be a beam of wood. It was not the text of antiquity itself that most profoundly captured my interest in the oft-told parable; instead, the commentary by Talmage.


“Men are prone to judge their fellows and praise or censure without due consideration of fact or circumstance. On prejudiced or unsupportive judgement the [man of wisdom] set his disapproval. He admonished [that] according to one’s own standard of judging others, shall he himself be judged. The man who is always ready to correct [another’s] faults, to remove the [dust] from his neighbor’s eye so that the neighbor may see things as the interested and interfering friend would have him see, was denounced as a hypocrite.


“What was the speck in his neighbor’s vision to the obscuring beam in his own eye? Have the centuries [since] made us less eager to cure the defective vision of those who cannot or will not assume our point of view, and see things as we see them?


I don’t think they have.

In psychological terms, we speak of ‘projection’: the defensive assignment to others the unacceptable flaws we cannot deal with in ourselves. I am overweight and criticize someone’s food choices. I am secretly addicted to a substance or behavior, and incorrectly assume others are doing the same vile things. I believe someone to be unjust, when it is I who is discriminatory and prejudicial. It is a concept literally learned in Psychology 101 and is not understanding meant only for behavioral scientists. Think of a PowerPoint projector. That’s what we are doing so often when we judge people, from a distance we cast our own colors onto whatever or whomever lies in our path. What are you projecting, and on to whom? What are you not acknowledging in yourself that you point out in fury about others?

In my work with people, almost everyone, there is a measure of blaming in nearly every story. I can admit I do this, too. But as a third-party observer-slash-participant in a counseling environment, there is no shortage of opportunity to see this lack of self awareness in people seeking help for their relational problems.

My suggestion echoes the master instructor of old: stop trying to regulate others; first, get yourself aligned with what is good and true and correct. Take the telephone pole out of your own eye before brooding with the speck of dust you see in another’s. Second, seek forgiveness for your own unkind judgement and do everything possible to make amends.

Though I write here my thoughts regarding a spiritual text, what is so telling of the importance of this truth is that it is reflected everywhere in today’s  culture. From Ice Cube to Metallica…we hear that we should “check yo self” and “judge not, lest ye be judged yourselves.”

“Forgiveness is too precious a pearl to be cast at the feet of the unforgiving.”

–James E. Talmage



Talmage, J. E. (1963). Jesus the Christ: A study of the Messiah and His mission according to Holy Scriptures both ancient and modern. Salt Lake City: Deseret Book Co.

Metallica. (1991). Holier Than Thou [CD]. Elektra Records.

Ice Cube. (2001). Check Yo Self. Priority Records.


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Live Like You’re Divorced

Live Like You’re Divorced

Live Like You’re Divorced

Its not what you think.

I’ve been working with couples and families for 18 years and something I hear over and over is excuses about why things can’t be done better. I’d like to focus on excuses in marriage and show that if you want to make your marriage work, living as if you’re divorced can go a long way to helping you not just stay married, but thrive in your relationship.

There are four common problem areas the couples I’ve worked with seem to have: sex, money, time, and control.


With sex, there is often one partner who feels entitled to getting sex whenever they feel the urge. I recently heard a wife tell me that her husband reported changing the light bulbs and then asked in all seriousness, “So, can we spend some time together tonight?” which she knew was his way of asking to have sex as a reward for his hard work. Another client insisted that his wife’s duty was to help him release his tension since his body was producing sperm by the millions every day and the pressure was painful. Give me a BREAK! These men may not be married much longer unless they internalize what I’m suggesting: live like you’re divorced.

Here’s what I mean.

When you’re divorced, you don’t have the right to ask for sex from this person. The ex-spouse is under no obligation to provide “pressure relief” for your aching balls. And the same is true right now, while you’re married. You have to learn some respect and selflessness. Stop bugging her about sex or soon you will be at a point (divorced) where you won’t have sex with her ever again.


Often the complaint is about one or the other spending too much money, not saving, or somehow things not being “fair.” When you’re divorced, you don’t really have any business discussing your ex’s finances. Men are often paying child support, usually hundreds of dollars, and there is nothing they can do about it. Women, most often the recipient of child support aren’t able to make ends meet very well even though they receive the begrudged support payments each month. You lean to live on less. With less to control. Less complaints. Less nit-picking. Less demands. Less selfishness. How about beginning to live that way now?


Excuses about not spending enough time together are always so lame.

  • “We don’t have a babysitter we trust.” When you’re divorced, you are both going to be working. You will have responsibility for your child without the benefit of sharing that together. Often the time split is 50/50 in child custody agreements so 3-to-4 days a week, you will be responsible for your kids but will also have other assignments: school, work, yard work and housekeeping, car repairs, etc. And guess what? You’re gonna need a babysitter and will find one. You will utilize your existing support network more, like family and friends. You will learn to trust more and stop being paranoid that people are going to chop your toddler into pieces. You will make new connections. You will spend more money on a more trusted source of child care. The bottom line: you will have needs for child care and will find a way to make that happen. Why not now?
  • “Our schedules don’t match.” You live in a shift-work city. One works days, the other works nights. The obstacle here is often sleep and not having any matching time slots. When I’ve helped people through divorce here’s what I see them doing: dating within 3 months. How do they swing it, schedule-wise? They take days off work, call in sick, sacrifice some sleep, change jobs and do ALL KINDS of things that make for better dating availability. When you’re divorced, you are GOING to adapt to a new reality with regard to time management. Why not now?
  • “Going on dates always cost money.” Have you ever looked into how much a divorce costs? Some estimates range between $15,000 and $30,000. Let’s use $20,000 as an example. Most people put that on a credit card and it would take about 10 years to pay that off. Not including interest, that is 120 payments of $167. Spend $167 on a night out one hundred and twenty times in the next 10 years and you probably WON’T be divorced. Even better, 240 dates that cost $83.50 or 480 dates that cost $41.67. That’s a guarantee. I’ll bet $20,000 on it. 😉


By now you already know where I’m going with this. When you’re divorced, you cant: check their phone, tell them what to wear, choose their friends, keep them from their mother’s house, manipulate them into not playing golf, or anything else, really.

It really gets difficult to deal with when your spouse brings other people around your kids like a new partner, someone with a different look, a different race, a different religion, different values, etc. You may think it’s too soon, this person isn’t “good” for them, etc. Guess what? When you’re divorced, your rigid and judgmental opinion doesn’t matter and before you can have a peaceful existence, you will have to learn to keep it to yourself. Why not now?

The ex starts allowing your younger children to swear. Maybe they don’t follow up on homework as well as you’d like or start allowing them to wear immodest clothing. Maybe your ex spouse even picks up smoking or drinking. They do these things in the presence of your kids. Maybe they don’t take them to church or sports practices or start feeding them strange foods. You have zero control over this.

What if the secret to staying married is to live more like you were divorced instead? I don’t mean strippers and booze and vacations alone and an even more egocentric life. I mean “giving up the project,” as David Keirsey says, “that endless and fruitless attempt to change others into carbon copies of oneself.” When you’re divorced you lose power and control over the once-loved person. You lose the ability to be intimate with them at all. You lose the right to assert influence of what happens with the children while they are with the other parent. Out of necessity, you lose some of the excuses you’ve been using. Why. Not. Now


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Beyond Bipolar Basics

Beyond Bipolar Basics

What Is Bipolar Disorder?

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. Symptoms of bipolar disorder are severe. They are different from the normal ups and downs that everyone goes through from time to time. Bipolar disorder symptoms can result in damaged relationships, poor job or school performance, and even suicide. But bipolar disorder can be treated, and people with this illness can lead full and productive lives.


Scientists are studying the possible causes of bipolar disorder. Most scientists agree that there is no single cause. Rather, many factors likely act together to produce the illness or increase risk.


Bipolar disorder tends to run in families. Some research has suggested that people with certain genes are more likely to develop bipolar disorder than others. Children with a parent or sibling who has bipolar disorder are much more likely to develop the illness, compared with children who do not have a family history of bipolar disorder. However, most children with a family history of bipolar disorder will not develop the illness.

Technological advances are improving genetic research on bipolar disorder. One example is the launch of the Bipolar Disorder Phenome Database, funded in part by NIMH. Using the database, scientists will be able to link visible signs of the disorder with the genes that may influence them.

Scientists are also studying illnesses with similar symptoms such as depression and schizophrenia to identify genetic differences that may increase a person’s risk for developing bipolar disorder. Finding these genetic “hotspots” may also help explain how environmental factors can increase a person’s risk.

But genes are not the only risk factor for bipolar disorder. Studies of identical twins have shown that the twin of a person with bipolar illness does not always develop the disorder, despite the fact that identical twins share all of the same genes. Research suggests that factors besides genes are also at work. It is likely that many different genes and environmental factors are involved. However, scientists do not yet fully understand how these factors interact to cause bipolar disorder.

Brain structure and functioning

Brain-imaging tools, such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), allow researchers to take pictures of the living brain at work. These tools help scientists study the brain’s structure and activity.

Some imaging studies show how the brains of people with bipolar disorder may differ from the brains of healthy people or people with other mental disorders. For example, one study using MRI found that the pattern of brain development in children with bipolar disorder was similar to that in children with “multi-dimensional impairment,” a disorder that causes symptoms that overlap somewhat with bipolar disorder and schizophrenia. This suggests that the common pattern of brain development may be linked to general risk for unstable moods.

Another MRI study found that the brain’s prefrontal cortex in adults with bipolar disorder tends to be smaller and function less well compared to adults who don’t have bipolar disorder. The prefrontal cortex is a brain structure involved in “executive” functions such as solving problems and making decisions. This structure and its connections to other parts of the brain mature during adolescence, suggesting that abnormal development of this brain circuit may account for why the disorder tends to emerge during a person’s teen years. Pinpointing brain changes in youth may help us detect illness early or offer targets for early intervention.

The connections between brain regions are important for shaping and coordinating functions such as forming memories, learning, and emotions, but scientists know little about how different parts of the human brain connect. Learning more about these connections, along with information gained from genetic studies, helps scientists better understand bipolar disorder. Scientists are working towards being able to predict which types of treatment will work most effectively.

Signs & Symptoms

People with bipolar disorder experience unusually intense emotional states that occur in distinct periods called “mood episodes.” Each mood episode represents a drastic change from a person’s usual mood and behavior. An overly joyful or overexcited state is called a manic episode, and an extremely sad or hopeless state is called a depressive episode. Sometimes, a mood episode includes symptoms of both mania and depression. This is called a mixed state. People with bipolar disorder also may be explosive and irritable during a mood episode.

Extreme changes in energy, activity, sleep, and behavior go along with these changes in mood. Symptoms of bipolar disorder are described below.

Symptoms of mania or a manic episode include:

Mood Changes
  • A long period of feeling “high,” or an overly happy or outgoing mood
  • Extreme irritability
Behavioral Changes
  • Talking very fast, jumping from one idea to another, having racing thoughts
  • Being easily distracted
  • Increasing activities, such as taking on new projects
  • Being overly restless
  • Sleeping little or not being tired
  • Having an unrealistic belief in one’s abilities
  • Behaving impulsively and engaging in pleasurable, high-risk behaviors

Symptoms of depression or a depressive episode include:

Mood Changes
  • An overly long period of feeling sad or hopeless
  • Loss of interest in activities once enjoyed, including sex.
Behavioral Changes
  • Feeling tired or “slowed down”
  • Having problems concentrating, remembering, and making decisions
  • Being restless or irritable
  • Changing eating, sleeping, or other habits
  • Thinking of death or suicide, or attempting suicide.

Bipolar disorder can be present even when mood swings are less extreme. For example, some people with bipolar disorder experience hypomania, a less severe form of mania. During a hypomanic episode, you may feel very good, be highly productive, and function well. You may not feel that anything is wrong, but family and friends may recognize the mood swings as possible bipolar disorder. Without proper treatment, people with hypomania may develop severe mania or depression.

Bipolar disorder may also be present in a mixed state, in which you might experience both mania and depression at the same time. During a mixed state, you might feel very agitated, have trouble sleeping, experience major changes in appetite, and have suicidal thoughts. People in a mixed state may feel very sad or hopeless while at the same time feel extremely energized.

Sometimes, a person with severe episodes of mania or depression has psychotic symptoms too, such as hallucinations or delusions. The psychotic symptoms tend to reflect the person’s extreme mood. For example, if you are having psychotic symptoms during a manic episode, you may believe you are a famous person, have a lot of money, or have special powers. If you are having psychotic symptoms during a depressive episode, you may believe you are ruined and penniless, or you have committed a crime. As a result, people with bipolar disorder who have psychotic symptoms are sometimes misdiagnosed with schizophrenia.

People with bipolar disorder may also abuse alcohol or substances, have relationship problems, or perform poorly in school or at work. It may be difficult to recognize these problems as signs of a major mental illness.

Bipolar disorder usually lasts a lifetime. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of symptoms, but some people may have lingering symptoms.

Who Is At Risk?

Bipolar disorder often develops in a person’s late teens or early adult years. At least half of all cases start before age 25. Some people have their first symptoms during childhood, while others may develop symptoms late in life.


Doctors diagnose bipolar disorder using guidelines from the Diagnostic and Statistical Manual of Mental Disorders (DSM). To be diagnosed with bipolar disorder, the symptoms must be a major change from your normal mood or behavior. There are four basic types of bipolar disorder:

  1. Bipolar I Disorder—defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks.
  2. Bipolar II Disorder—defined by a pattern of depressive episodes and hypomanic episodes, but no full-blown manic or mixed episodes.
  3. Bipolar Disorder Not Otherwise Specified (BP-NOS)—diagnosed when symptoms of the illness exist but do not meet diagnostic criteria for either bipolar I or II. However, the symptoms are clearly out of the person’s normal range of behavior.
  4. Cyclothymic Disorder, or Cyclothymia—a mild form of bipolar disorder. People with cyclothymia have episodes of hypomania as well as mild depression for at least 2 years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.

A severe form of the disorder is called Rapid-cycling Bipolar Disorder. Rapid cycling occurs when a person has four or more episodes of major depression, mania, hypomania, or mixed states, all within a year. Rapid cycling seems to be more common in people who have their first bipolar episode at a younger age. One study found that people with rapid cycling had their first episode about 4 years earlier—during the mid to late teen years—than people without rapid cycling bipolar disorder. Rapid cycling affects more women than men. Rapid cycling can come and go.

When getting a diagnosis, a doctor or health care provider should conduct a physical examination, an interview, and lab tests. Currently, bipolar disorder cannot be identified through a blood test or a brain scan, but these tests can help rule out other factors that may contribute to mood problems, such as a stroke, brain tumor, or thyroid condition. If the problems are not caused by other illnesses, your health care provider may conduct a mental health evaluation or provide a referral to a trained mental health professional, such as a psychiatrist, who is experienced in diagnosing and treating bipolar disorder.

The doctor or mental health professional should discuss with you any family history of bipolar disorder or other mental illnesses and get a complete history of symptoms. The doctor or mental health professional should also talk to your close relatives or spouse about your symptoms and family medical history.

People with bipolar disorder are more likely to seek help when they are depressed than when experiencing mania or hypomania. Therefore, a careful medical history is needed to assure that bipolar disorder is not mistakenly diagnosed as major depression. Unlike people with bipolar disorder, people who have depression only (also called unipolar depression) do not experience mania.

Bipolar disorder can worsen if left undiagnosed and untreated. Episodes may become more frequent or more severe over time without treatment. Also, delays in getting the correct diagnosis and treatment can contribute to personal, social, and work-related problems. Proper diagnosis and treatment help people with bipolar disorder lead healthy and productive lives. In most cases, treatment can help reduce the frequency and severity of episodes.

Substance abuse is very common among people with bipolar disorder, but the reasons for this link are unclear. Some people with bipolar disorder may try to treat their symptoms with alcohol or drugs. However, substance abuse may trigger or prolong bipolar symptoms, and the behavioral control problems associated with mania can result in a person drinking too much.

Anxiety disorders, such as post-traumatic stress disorder (PTSD) and social phobia, also co-occur often among people with bipolar disorder. Bipolar disorder also co-occurs with attention deficit hyperactivity disorder (ADHD), which has some symptoms that overlap with bipolar disorder, such as restlessness and being easily distracted.

People with bipolar disorder are also at higher risk for thyroid disease, migraine headaches, heart disease, diabetes, obesity, and other physical illnesses. These illnesses may cause symptoms of mania or depression. They may also result from treatment for bipolar disorder.


Bipolar disorder cannot be cured, but it can be treated effectively over the long-term. Proper treatment helps many people with bipolar disorder—even those with the most severe forms of the illness—gain better control of their mood swings and related symptoms. But because it is a lifelong illness, long-term, continuous treatment is needed to control symptoms. However, even with proper treatment, mood changes can occur. In the NIMH-funded Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study—the largest treatment study ever conducted for bipolar disorder—almost half of those who recovered still had lingering symptoms. Having another mental disorder in addition to bipolar disorder increased one’s chances for a relapse. See STEP-BD for more information.

Treatment is more effective if you work closely with a doctor and talk openly about your concerns and choices. An effective maintenance treatment plan usually includes a combination of medication and psychotherapy.


When done in combination with medication, psychotherapy can be an effective treatment for bipolar disorder. It can provide support, education, and guidance to people with bipolar disorder and their families. Some psychotherapy treatments used to treat bipolar disorder include:

Cognitive behavioral therapy (CBT), which helps people with bipolar disorder learn to change harmful or negative thought patterns and behaviors.
Family-focused therapy, which involves family members. It helps enhance family coping strategies, such as recognizing new episodes early and helping their loved one. This therapy also improves communication among family members, as well as problem-solving.

Psychoeducation, which teaches people with bipolar disorder about the illness and its treatment. Psychoeducation can help you recognize signs of an impending mood swing so you can seek treatment early, before a full-blown episode occurs. Usually done in a group, psychoeducation may also be helpful for family members and caregivers.

In a STEP-BD study on psychotherapies, researchers compared people in two groups. The first group was treated with collaborative care (three sessions of psychoeducation over 6 weeks). The second group was treated with medication and intensive psychotherapy (30 sessions over 9 months of CBT, interpersonal and social rhythm therapy, or family-focused therapy). Researchers found that the second group had fewer relapses, lower hospitalization rates, and were better able to stick with their treatment plans. They were also more likely to get well faster and stay well longer. Overall, more than half of the study participants recovered over the course of 1 year.

A licensed psychologist, social worker, or counselor typically provides psychotherapy. He or she should work with your psychiatrist to track your progress. The number, frequency, and type of sessions should be based on your individual treatment needs. As with medication, following the doctor’s instructions for any psychotherapy will provide the greatest benefit.

Living With

If you know someone who has bipolar disorder, it affects you too. The first and most important thing you can do is help him or her get the right diagnosis and treatment. You may need to make the appointment and go with him or her to see the doctor. Encourage your loved one to stay in treatment.

To help a friend or relative, you can:

  • Offer emotional support, understanding, patience, and encouragement
  • Learn about bipolar disorder so you can understand what your friend or relative is experiencing
  • Talk to your friend or relative and listen carefully
  • Listen to feelings your friend or relative expresses and be understanding about situations that may trigger bipolar symptoms
  • Invite your friend or relative out for positive distractions, such as walks, outings, and other activities
  • Remind your friend or relative that, with time and treatment, he or she can get better.

Never ignore comments from your friend or relative about harming himself or herself. Always report such comments to his or her therapist or doctor.

How can caregivers find support?

Like other serious illnesses, bipolar disorder can be difficult for spouses, family members, friends, and other caregivers. Relatives and friends often have to cope with the person’s serious behavioral problems, such as wild spending sprees during mania, extreme withdrawal during depression, or poor work or school performance. These behaviors can have lasting consequences.

Caregivers usually take care of the medical needs of their loved ones. But caregivers have to deal with how this affects their own health as well. Caregivers’ stress may lead to missed work or lost free time, strained relationships with people who may not understand the situation, and physical and mental exhaustion.

It can be very hard to cope with a loved one’s bipolar symptoms. One study shows that if a caregiver is under a lot of stress, his or her loved one has more trouble following the treatment plan, which increases the chance for a major bipolar episode. If you are a caregiver of someone with bipolar disorder, it is important that you also make time to take care of yourself.

How can I help myself if I have bipolar disorder?

It may be very hard to take that first step to help yourself. It may take time, but you can get better with treatment. To help yourself:

  • Talk to your doctor about treatment options and progress.
  • Keep a regular routine, such as going to sleep at the same time every night and eating meals at the same time every day.
  • Try hard to get enough sleep.
  • Stay on your medication.
  • Learn about warning signs signaling a shift into depression or mania.
  • Expect your symptoms to improve gradually, not immediately.

Where can I go for help?

If you are unsure where to go for help, ask your family doctor. Others who can help are listed below.

  • Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors
  • Health maintenance organizations
  • Community mental health centers
  • Hospital psychiatry departments and outpatient clinics
  • Mental health programs at universities or medical schoolsv
  • State hospital outpatient clinics
  • Family services, social agencies, or clergy
  • Peer support groups
  • Private clinics and facilities
  • Employee assistance programs
  • Local medical and/or psychiatric societies.

You can also check the phone book under “mental health,” “health,” “social services,” “hotlines,” or “physicians” for phone numbers and addresses. An emergency room doctor can also provide temporary help and can tell you where and how to get further help.

What if I or someone I know is in crisis?

If you are thinking about harming yourself, or know someone who is, tell someone who can help immediately.

  • Call your doctor.
  • Call 911 or go to a hospital emergency room to get immediate help or ask a friend or family member to help you do these things.
  • Call the toll-free, 24-hour National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889) to talk to a trained counselor.

Make sure you or the suicidal person is not left alone.

This information adapted from: https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml