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SeaHTuon February 23rd, 2006 05:48 PM

What can I do to Help?
Hello I'm Susan.

My husband has Bipolar, and we have worked hard over the last several years to work on his illness to make as normal to live as possible. We have lived together for 4 years and married since April 2005. Getting married has helped us a great deal. He is now covered under my insurance, and since he has been covered his mental healthcare has increased dramatically. He recently got a new doctor about 3 months ago, and she has decided to do several session of EMDR and I would like to know what I can do during the time he working through this. I know kind of what to expect, but I want to know how I should react and what I can do to help him. I am willing to go quite far out of my way to help him. Right now I'm reading with him a book called, "Loving someone with Bi-polar" Which has been an interesting read for us both. Always something new with this illness isn't there?

Sandra Paulsen February 24th, 2006 12:12 AM

Re: What can I do to Help?
Its hard to predict and we don't do specific case consultations here, but I'll make some general comments.

1) If the diagnosis of bipolar disorder is correct, then it's not at all easy to say what will come of the EMDR, because EMDR is not a treatment of choice for bipolar disorder. Rather, EMDR is the treatment of choice for trauma related conditions. EMDR may help the person adjust to the fact of having bipolar disorder, which is a traumatic experience to have, for many. I wouldn't expect it to affect a truly biological condition.

2) If the diagnosis of bipolar disorder is wrong, many things may be predicted. Why do I bother to say this, when I have no reason to believe the diagnosis is wrong? Because in my experience, a) bipolar disorder is the diagnosis du jour, since insurance will pay for it by law in some states, b) biological psychiatry will treat it with pharmacology, and c) some therapists overdiagnose the condition, so it is sometimes diagnosed where it shouldn't be. Having said that, I am NOT saying there is no bipolar disorder in your husband's case, and indeed, perhaps the diagnosis is correct here, I'm sure I don't know.

I do know that many many people with complex trauma histories get diagnosed with bipolar disorder when they should in addition or instead be diagnosed with a trauma related condition, such as PTSD, DDNOS or DID. This is not an all inclusive list. This diagnosis happens because people with trauma histories have labile moods, first one state, then another, and that resembles bipolar disorder, which is presumed to be a genetic condition for some. But trauma isn't typically genetic, except for the trauma of inheriting a genetic disease.

The reason this discussion is important is the following. When a person with an undiagnosed trauma-related condition is a) misdiagnosed with bipolar disorder and b) treated with EMDR, the EMDR can either produce a good result or remove needed defenses prematurely. Specifically, When EMDR is used on a dissociative client wrongly diagnosed with bipolar disorder, the EMDR will sometimes take down needed dissociative defenses when the preparatory work has not been done to keep the person contained, stabilized and safe.

Now please hear this clearly, I have NO idea if the diagnosis for your husband is correct or incorrect, and I am offering no comments on this case, about which I know, really, nothing.

What I will do here is clearly repeat my mantra that I have been echoing since 1992, far and wide, to each and every EMDR practitioner whom I can buttonhole. To those therapists, I say this. Keep your clients safe by:

1) At the time of your initial intake with a client, as part of the history and assesssment and diagnostic process, identify with the DES or other instrument, just how dissociative the person seems to be.

2) Never do EMDR on a person that one has not assessed with at least the DES or some other reliable and valid method how dissociative that person is.

3) If a client is dissociative, only do EMDR on that client if and when one is trained in the treatment of dissociative disorders.

4) Ensure that the person has plenty of alternative coping skills in case the dissociative defenses come down and

5) make sure the dissociative person has containment skills in the likely event that the EMDR is incomplete.

Although I know nothing about this case, I know this. If you print this off and if the therapist is trained and experienced in EMDR, and an ethical person, as I am confident most therapists are, they will consider these points carefully, and proceed with EMDR if and when appropriate.

I laid this out in detail not because I'm sure it applies to your husband, indeed, I haven't a clue. I laid it out because I haven't said it here in a long time, it needs to be said often, and your question opened the door to this pontification.

Respectfully submitted,

Sandra Paulsen PhD

SeaHTuon February 24th, 2006 04:09 PM

Re: What can I do to Help?
Not to seem, disinterested in all that you said. All that you have said is very important information to know, but I do believe that my husband was rightly disagnosed. He is Bi-Polar it is in his genes, but he also has had a great deal of trama in his life, that is only flairing his BiPolar further. I totally get what you are saying though. But unfortunatly this did not answer my question.

Sandra Paulsen February 24th, 2006 07:11 PM

Re: What can I do to Help?
Actually, I believe I answered it in the first sentence. If a person is correctly diagnosed with bipolar disorder, there is not much that can be predicted about response to EMDR that is much different from any other general predictions. I wouldn't expect EMDR to impact bipolar disorder much.

General information about responses to EMDR may be found in the book by Shapiro and Forrest EMDR: The Breakthrough Therapy to Anxiety, Stress and Trauma.

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