Wednesday, March 22, 2017

Why Do I Want To Know Your Diagnosis And Why That's Not A Bad Thing - Part 2

Why Do I Want To Know Your Diagnosis; And Why That's Not A Bad Thing -
Recovery Empowerment Tips For 5 Mental Health Diagnoses - A Two-Part Series

Part Two: Empowering People With Bipolar, Trauma & Schizophrenia

In Part one I went into detail on the rational for treating and empowering the 5 Medi-cal accepted mental health diagnoses and then described in detail how I would treat a depressed person. In this Part 2, I will go into each of the other four. 


Most Bipolar people, by definition have depression, but that's not really their problem. They are dealing with excess energy, not lack of energy. They are dealing mainly with irritability and anger, and often times, anxiety too. Of course if they were in a depressive cycle I would revert to my depression tips.

They already are goal oriented so it's just some tweaking of the goals.

However during manic phases, they are already into action, always in motion, already engaged with life. They already are pretty much in control of and managing their lives, have activities and connections with others. Even if their lives are out of control in some way, at least they are moving. They enjoy goal-oriented activity. 

They may have problems with relationships or their relationship problems bring them the most anxiety.  They benefit greatly with some education on communicating and other coping skills when they are irritable and how to manage their manic phases by learning from their past ones. 

Just the fact that I understand that they're angry, without judging them, and normalizing their anger, is a relief for them.

They do need to vent, but not for venting sake. They actually work out their own problems by being given the space to vent. Just listen and nod your head and empathize with whatever they are venting about. 

When they feel the relief from being heard in this way, they become open to some recovery ideas. I talk about social support in recovery, because they like being social when they are manic and they need more (positive) social outlets where they can be themselves. 

You can also tell venting has helped when they get to something funny and start laughing or telling you something in a very funny way. 

Laugh with them in a way that says, "Yeah, we humans can be so funny sometimes". 

Laugh as a way to agree there's no shame in their mistakes. It helps normalize their feelings and mistakes. You've just done them a huge favor by combining socializing, laughter and recovery. 

Don't try and give them advice even if you know a perfect solution that they'll love, they tend to reject what comes from you because they need to work it out on their own. When they do, you can be there to agree with the healthy parts of what they came up with. Then you can add in a suggestion or give them some insider information. They are open to listen to things that make them feel more empowered. But they can't listen to you until they feel you've listened to them.

They Need To Feel The Idea Came From Them. It's Their Choice, You're Just Pointing Out Some Good Choices.

The point of this article was to explain why I treat different diagnoses differently. If we compare how I empowered a depressed person to how I'm empowering a bipolar person, the benefits to each will become more clear.

Depressed people are like the opposite of bipolars. They need the homework and the permission to do activities or be social or even to love themselves. They need permission to see their value and worth . They need to be redirected to make wellness a priority so they can generate their own relief from depression and peak their interest again.

So already you might be asking how or why I treat these two diagnoses differently rather than "treating both of them the same, and or as individuals". Well, here's why. If I let a depressed person vent, it would be enabling their ruminating, which in turn makes their depression worse.  So that's why it's important to know who is a depressed type and who is a true bi-polar.

Bi-polar's tend to be more extroverted and enjoy their energy and social connections, things a deep, introverted, depressed person would avoid or reject.  And a Bipolar might reject the soft, slow, solitary activities of self-nurturing that a depressed person finds comfort in. Depressed people shouldn't isolate for long periods of time, but they do need quiet, alone "me time". Bipolar people should dominate all conversations, but they do need loud, social, "fun time".

I hope you can see the difference and how I gave both the Depressed and the Bi-polar person empowering and nurturing support.. Knowing your diagnosis helps me know what won't work and what does work, what content to focus on and what to ignore, etc. 


These folks need the most love, respect, dignity and care that you can give. Just accepting them as they are and treating them like they are equal to you does a lot of good for these folks because they are the most rejected and stigmatized of all.

When you get to know them as people and see them, see their personality come out and act interested in them and their interests, they notice. It helps them accept themselves and stay in touch with treatment and helps them not to isolate.

They need love and respect "as if they were normal", which can mean simply being interested in their interests and not worrying about fixing them or anything like that. They do not need you sitting around feeling empathy for them like you would someone with trauma or depression who really need it and are deprived of it. 

What schizophrenics are deprived of is someone interested in conversation about their weird world of topics.

Attending To That Isolation By Just Being There With Them And Not Abruptly Abandoning Them Or Treating Them Differently Than Anyone Else.

They're treated differently out there in the real world and even in their family. Treating them like you would your neighbor or coworker is a gift of healing for them. You're giving them the gift of the natural human healing of connection which they are deprived of most. They suffer, almost like the trauma victim, from being disconnected from society. 

I introduce them to WRAP, I have the book with Mary Ellen Copeland's picture on it and let them know she has Schizophrenia and she got a PhD and became an author and a psychologist. So right there they get the message that they can still do anything anyone else can do and they can get well and feel better and take better care of themselves. They can learn to manage their symptoms and condition and live a good life.

I ask them questions about themselves and their life and what they are struggling with and I pause a lot, giving them a lot of safe space to answer. 

For those who outright ask, I'll give them tips on managing symptoms. It might be helping them see what stressors trigger their symptoms and what recovery actions help and helping them plan for how they will practice coping skills at home.

In general, stressors tend to increase bizarre symptoms so the focus is also on stress management and symptom management alongside increasing coping skills and wellness activities. It really depends on what they are struggling with at the time. I may find just one that works for them and just stick to that one thing for awhile 

This is different than the mood disorders where the focus of recovery is more about affect regulation along with nurturing self-wellness.


The sooner I know you have Borderline Personality Disorder the better. I stop the usual and switch gears, I tone down my empathy and increase awareness on my boundaries. 

I can't let you drain or manipulate me with your emotions because then I'm not helping you. Then I'm not in control, you are, and that makes you feel out of control which increases symptoms.

I can't feel sorry for you, try to rescue you, allow you to scare me, allow you to use me or pressure me or push my emotional buttons. I'm here to give you real safety. 

The safety of showing you were the edges are so you don't fall off the deep end.

To not allow you to move me helps you feel secure because you are still accepted by me. I still like you, I still care and I show all that in the way I talk, listen or look at you, but I am not taken in by your show and emotional manipulation.

I know you are not doing that for a bad reason, you can't help it and you're almost like an addict trying to get a fix so I help you sit down and have a cup of coffee instead and let you get the inner gratification of connecting with someone and that is hard for you.

 I'm still there whether you hate me or love me and that gives you consistency. I let you rattle on without getting caught up in your content. I help you self care and nurture but in general don't need to help you with much of anything except help contain you and teach you ways to contain yourself. 

Or I keep consistent limits so that in itself feels containing to you and you feel safe in my office. Feeling safe for borderline personality disorder is very healing.

I will praise your efforts and express confidence in your abilities, noting your strengths, skills, and accomplishments help your self esteem.

Social support is encouraged and general wellness concepts are encouraged but you're really going to do whatever you want to, so there's not sense in trying to say much of anything because you'll tend to disagree and reject a lot of what I say anyway (and that makes me feel drained, frustrated and unappreciated), so it's best to go with recovery concepts that are well established like exercise and eating good.

I hate to say it, but yes, things an authority would tell you is good for you. Borderlines need people in authority not to have it over them but to have it over themselves so they feel less out of control in themselves. Teaching them how to self sooth gives them authority over themselves.

People with Borderline Personality Disorder are famous for baiting you into giving advise  and then rejecting it and making you frustrated so they can split on you. So instead of telling them what to do ask them a lot of questions like, what would you really like to do? what do you think you need? what kind of support do you need? etc. 

Putting their treatment in their hands like this helps them with self control and empowerment and helps them not to split.

If they are hating on themselves good luck trying to convince them not to. It's better to ask them what it's like to go through what they are going through and acknowledge that sounds terrible. I give a little sympathy but no direct advice that can be rejected which would keep the cycle of asking and then rejecting help going around and around.  there is no goal and no agenda, your just keeping the edges for them.


First see the section on schizophrenia, then go to the mood section depending on what they are presenting with; depression or manic/irritability and follow the suggestions there.

basically someone with a schizo-affective diagnosis means a Bi-polar or depressed person with psychotic symptoms.

I always default to treating them like I would a schizophrenic first, with dignity and compassion and understanding because its been a huge struggle for them to feel normal, and be accepted in society and not feel stigmatized.

Some help with moods if they are depressed, give them some of the depression work, but if they are manic type or bipolar then its more about their actions and trying  to give them ideas about wellness stuff to do.

so treat them from the schizophrenic viewpoint and then decide which to add to that, the depression or the bipolar.


a lot like with depression but need to really slow down and see where they are in the trauma cycle and go from there. You have to be with them where they are and not go beyond. 

Help them with emotional regulation skills and self care and normalize the Symptoms by showing them you understand their torture inside of isolating but lonely and unable to connect and engage with life or others and letting them know that time plays a factor.

Validation is the number one healing gift you can give someone with Trauma, especially Complex Trauma.

They need healing info and time and patience, validation, it takes them more time to engage and connect with their self because the nature of trauma is that you are severed from what you thought was 'you' or 'normal' or 'life'. You've been ripped away from it or its been ripped away from you and they are truly tortured and stuck.

Teaching them emotional flashback management is the most empowering and compassionate thing you can do. educating them on all the symptoms of PTSD, including how they questions life and god and everything now and how it's like being the walking dead. (Jeff Walker's book "Complex PTSD" is a goldmine of what helps flashbacks and provides a paradigm shift that can pop them out of the self-hatred they've been stuck in.)

This gives them hope because they thought no one would understand what they're going through. for these folks I will share my own PTSD in a way that is educating them about Sx mgt and self care and how things got better over time.

These 5 Categories Are Brushed With Distinct But Broad Strokes.

Their edges are malleable and dynamic, growing wiser as you learn more through experience. Not every detail will work, but in general these are topics of best empowering to look at for each Dx.

They are not all-inclusive.

They are dynamic tips, in that you can use them all or just parts and weave them into your own unique ways of showing up for people who have a diagnosis.

Remember everyone is different and although they might fit into one of these 5 labels, they also come in combinations of them. It's OK to mix and match strategies of support and empowerment and see which one your client responds to best.

These Tips Also Empower Me And Bring Me Much More Fulfillment In My Job Rather Than Getting Compassion Fatigue And Being Burnt Out From Everyone' S Stuff.

It's my office they're in and I'm in control of it. It is not to be used by anyone as if it’s a cheap commodity. It’s a classroom and I protect its value and its energy by teaching.

Each mental health worker must do the same for themselves, in their own way, decide how you're going to show up, how much energy to give and manage your own Wellness and Recovery , and that includes empowerment.

Embrace your expert position so that you can help the public in the best way possible; not the way they want or you think it should be, which tends to lead to feeling worn out, unappreciated and drained.

Don't be afraid to practice your skills with your clients, you'll get better at it and you're clients will love you for it.  Don't try to dig into traumatic memories. In fact, stay away from "memories" as much as possible unless they bring it up, then listen, validate how terrible that was and lead them into self-compassion and remind them they are in the here and now and they are safe now.

Lastly, praise them for being survivors. Acknowledge that they've been through a lot. Give them hope that they can recover from this. They can re-invent themselves and go on to live a normal life, albeit with some coping and symptom management skills along the way. 

So with all that in mind, I hope you got a few pieces of wisdom out of this article. I know I would have loved to have read it twenty years ago! 

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 Thank you!
JP Bailey, M.A.

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