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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5156
Experience:  Dr. Mark is a PhD in psychology in private practice
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How we we, as parents, support our 30 OKMH116100

Resolved Question:

How we we, as parents, support our 30 year old son with bi-polar. He recently lost his job and went through a divorce and trying to be the custodial parent of his 7 year old boy. what resources should we be looking for.

Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Mark replied 1 year ago.

Dr. Mark :

Hi! I'll be glad to help you with this issue.

Dr. Mark :

Am I correct that you mean he has legal custody of his son?

Customer:

Shared custody and custodial parent. Mom is living in a group home and in a narcotics recovery program

Dr. Mark :

Okay. He has no income, correct?

Customer:

Military disability of $600/month. Ex-wife has agreed to let him live in house and she pays the bills till next July - recently threatening to resind that agreement.

Dr. Mark :

Oh, he's a vet?

Customer:

yes. may not be a honorable discharge -- broke down.

Dr. Mark :

I see. This sounds like it's a really difficult situation for you.

Dr. Mark :

He's fortunate to have you there worrying about him and trying to help and being there.

Dr. Mark :

Are you looking for economic resources, like food stamps, etc. or for mental health resources?

Customer:

We did help him through applying with the VA and he is on the waiting list for a rep. We helped him with the food stamp ap but plays telephone tag and he doesn't follow through. Looking for everything -- right now we are the only "positive" support he has. No friends and Mom and mother-in-law (who helps out a lot) are critical of how he does things and very critacal of what he doesn't do.

Dr. Mark :

Wow, yes, this is so tough.

Dr. Mark :

Is he taking his meds?

Customer:

We can't live his life but want to do more than walk beside him.

Customer:

He is pretty good about the one med he has - to control mood swings - unless he has a bad stretch - he doesn't know. He thinks it's a three week cycle then his body just wants to hybernate.

Dr. Mark :

I see. Really this is probably the place to start. I mean other than getting the financial help for him like you've been doing.

Dr. Mark :

Does he have to go to the VA for treatment? Or does he have Tri-State or another of the veterans' insurance policies?

Dr. Mark :

Or perhaps he has Medicare because he has disability?

Customer:

There is only one bi-polar support group in the area and so far he has had an excuse not to make it. No insurance -- hoping that the VA would come through.

Dr. Mark :

The VA is not very comprehensive in mental health treatment.

Dr. Mark :

He needs to have both a psychiatrist and a therapist working with him.

Dr. Mark :

Is this possible?

Customer:

Possibly he could apply for the Oregon health plan. Right how he has no therapist - just the psychiatrist presciping the med and hasn't seen him in quite some time.

Dr. Mark :

I'm going to ask you the difficult question. It's difficult because you're doing so much

Dr. Mark :

and you love him

Dr. Mark :

Is he using drugs or alcohol?

Customer:

How should we go about finding a bi-ploar therapist. the Drugs and Alcohal question - don't know for sure -- he enjoys beer but quit to lose weight -- suspect marijuna use but pretty nieve about such things.

Dr. Mark :

First of all, good.

Dr. Mark :

I think that you are on the right track with looking for a Bipolar Disorder (BD) therapist.

Dr. Mark :

You need to have a professional with you on this

Dr. Mark :

and a therapist who is experienced working with BD is the most effective way to do this.

Dr. Mark :

I can give you a link to excellent directories for you to look in his area. Shall I do that?

Customer:

yes please

Dr. Mark :

May I also give you what I've written for people with BD? You can read it and decide if it will help him to have him read it okay?

Dr. Mark :

Give me a few minutes to gather it.

Customer:

sounds good

Dr. Mark :

Okay. It's going to be long, so you can print it out. You will always have access to this chat even after it closes. The directories are explained and linked in the essay. Okay, you are really being wonderful parents and I wish you the very best. Here it is:

Dr. Mark :

Now, this is really a good way to begin discussing behavioral treatment for BD. Because the concept of monitoring your moods and being able to gauge your cycling from the lows up to the manic and hypomanic and catching the lows and highs before they become problematic is the goal of behavioral treatment for Bipolar Disorder. It's what I call management of BD. And management is the key to living a "normal" life with BD.


At the end of my answer I'm going to give you a technique to use when you lose focus, when you're getting irritable, anxious, or even tired. It is not a cure. It is a quick self help technique you can use throughout the day to help yourself. It is a protocol for anxiety disorders. But with BD, there are a lot of derivatives of anxiety present and it's an important tool for you to have in your behavioral toolbox. (More on that in a moment.)


On the one hand Bipolar Disorder (BD) depends on managing your moods and being stable. But you should know, the management strategy I'm going to talk about is one that I use in treatment not just when meds are inappropriate. Meds are not enough for many people with BD to keep stable. There has to be a manual management strategy in place.


Let's work on three ways you can begin to build a behavioral program for yourself: diet, exercise, and specific psychotherapy geared toward BD. The first two are to help you feel more involved and in control of yourself and what's going on inside. The psychotherapy can actually teach you skills and give you tools for managing your symptoms. This is serious for you as you need to reprogram your thinking about yourself. Diet and exercise are great ways to begin such a reprogramming. Exercise will give you short term results within a week if you are reasonably fit and can establish a moderate/intense exercise regime.


Diet: cut out coffee, sugar, white flour. That may be tough. But you will see results as some of the newer research shows. And lean meats only. No fast food restaurants, no fatty foods. See what I mean about getting involved in controlling what's happening? With diet changes you are treating your problem with respect: you are acknowledging you need to make changes to get your body feeling better.


Vitamins can be useful for moods. A good quality daily vitamin, for example. One of the most important supplements is Omega 3 fatty acids, either in fish oil or capsules or in flax seed oil. Buy good quality. The clinical dosage is 800 to 3,000 mg daily. Try to get to the higher end of the dosage if you can. Omega 3 is the main supplement. The research on it and depression is conclusive. The newer research on it with BD is very promising and is growing. All these things you should get at the biggest and most frequented health food store and ask them for the best brands they trust in terms of quality.


Exercise: 5 days a week moderate to moderate/intensive exercise depending on your fitness level, to include 3 days of strength training as you get more used to it. Pretty amazing isn't it? Your doctor will verify the research results showing the benefit. With BD you want to make sure you have a set exercise program. When you start to feel like you don't have energy or interest or on the other side when you start to feel like you need to do twice as much as normal, then you will be able to use those feelings as signs of mood swings and as signs to use your management tools to get your moods back in control.


Now for psychotherapy. This is a very sensitive area. Many psychotherapists say they work with BD and if they use standard CBT therapy, it will be of some help. But you need to be working with someone who is using a CBT therapy that is modified especially for BD. So, if your therapists are not doing this, it may be time to seek someone who is experienced in these therapies. In my practice, I use the resources with people with BD from Mary Ellen Copeland. I have found her work easy for people to use and easy to keep with him . The biggest problem is forgetting to keep to the plan when times are good and then something happens! Copeland also had BD and was hospitalized. She's a therapist and developed a BD treatment protocol called Wellness Recovery Action Plan (WRAP). First let me cite one of her books for you.


The Depression Workbook: A Guide for Living with Depression and Manic Depression by Mary Ellen Copeland. Amazon: http://www.amazon.com/Depression-Workbook-Guide-Living-Second/dp/157224268X/ref=sr_1_1?ie=UTF8&s=books&qid=1284317815&sr=8-1-catcorr


 


Now here's a YouTube search I've put together on the WRAP program. I want you to look at the videos and see what you think:


http://www.youtube.com/results?search_query=copeland+wrap&aq=f


 


The video with Mary Ellen is a bit strong but worthwhile. Here is the web address for Psychology Today's therapist directory. You can sort by zip codes and when you see someone who seems like they might be helpful look at the listing and see if they list BD or mood disorders as something they work with and perhaps if they accept a sliding fee if he has no income. I'm assuming if you can't fund his therapy fully.




http://therapists.psychologytoday.com/rms/


 


Good Therapy is a non profit directory. Same idea as the one above:


http://www.goodtherapy.org/advanced-search.html


 


I believe from my experience that it is SO important for you to not just take the meds and expect them to do everything. YOU have to take charge of managing your BD. And having a strategy like the WRAP program is a coherent way to do this. So that you can regulate your moods as they cycle.


You may want to start by going to moodtracker.com and using the resources there to monitor your moods. Thus, when you start therapy you will already have this information with you to start the management process. A management program gives you tools to get your moods back toward the normal range when they start to swing toward one pole or the other. Here's what I mean:


Most people are like cars with automatic transmission. They tool around the day going from a little sad and then they feel a little glad and if they get to too high a gear, the emotional transmission just automatically sends them back to a lower gear and if the low gets too low, the transmission clicks into a higher gear. Rarely are they thinking about it. They are usually within their normal range.


You with BD are like a car with a manual transmission. You start having a racing mood and unless you downshift manually, you're going to be out of control soon until you can't maintain that and you cycle down and then get too far down, etc. So you have to continually use the clutch and manually adjust the emotional gear.


That's what a program like the WRAP plan is about. It gives you the tools to notice what's going on and to make adjustments. So that is why I'm stressing it for you. I hope it allows you to safely reduce your meds with your doctor so that you are functioning more optimally.


I wish you the very best!


Now, I want to give you a tool to use. Here are instructions on a therapeutic protocol called Progressive Muscle Relaxation (PMR). It's really quite easy to do almost anywhere. My patients suffering from depression or anxiety, when I teach them PMR at first are amazed how simple it is and that it is a psychological protocol. It was first used in the 1920s! Since then, of course, it has been refined and many studies have been done showing its effectiveness. You will practice PMR at first when you don't wake up with an attack so that you will be familiar with it. I want you to practice the PMR at least 5-6 times before an attack or feeling acute anxiety. Why? Because when you're in the throes of anxiety, you will only remember to do something you are very familiar with it. So practicing 5-6 times is really a minimum.


I want to stress the importance of breathing as well. Part of the physiology of what is happening to you in anxiety is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety reaction, which strengthens the attack and you are in a vicious cycle! Not good. So breathing is the primary tool. I have found in my practice that learning breathing techniques can be helpful. But some of my patients are not interested in learning more than one thing at the beginning, so I have found that just reminding you to BREATHE deeply at the same time you are doing PMR is almost as good. If you are willing to take a yoga class and learn breathing techniques, that's the best. But, breathing deeply with your PMR will help.

So, we're ready for learning PMR. I want you to print my instructions below my signature and have a copy in each of the rooms of your home where you may be when you have an attack. And again, you need to practice this easy technique at least 5-6 times as soon as you can. It needs to become as natural to you as breathing. Ah, remember breathing?


My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX



INSTRUCTIONS:



  1. After finding a quiet place and several free minutes to practice progressive muscle relaxation, sit or lie down and make yourself comfortable.

  2. Begin by tensing all the muscles in your face. Make a tight grimace, close your eyes as tightly as possible, clench your teeth, even move your ears up if you can. Hold this for the count of eight as you inhale.

  3. Now exhale and relax completely. Let your face go completely lax, as though you were sleeping. Feel the tension seep from your facial muscles, and enjoy the feeling.

  4. Next, completely tense your neck and shoulders, again inhaling and counting to eight. Then exhale and relax.

  5. Continue down your body, repeating the procedure with the following muscle groups:


    • chest

    • abdomen

    • entire right arm

    • right forearm and hand (making a fist)

    • right hand

    • entire left arm

    • left forearm and hand (again, making a fist)

    • left hand

    • buttocks

    • entire right leg

    • lower right leg and foot

    • right foot

    • entire left leg

    • lower left leg and foot

    • left foot


  6. for the shortened version, which includes just four main muscle groups:


    • face

    • neck, shoulders and arms

    • abdomen and chest

    • buttocks, legs and feet



Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.


What You Need:



  • A comfortable place.

  • Some privacy.

  • A few minutes.


Again:


My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX


 

Customer:

thank you for your time and info!

Dr. Mark :

Hi. The system says that your rating has not gone through and the chat is still open. Can I ask you to try again to give the rating? Thanks, XXXXX XXXXX

Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5156
Experience: Dr. Mark is a PhD in psychology in private practice
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  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
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  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
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Dr. Mark
Dr. Mark
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Dr. Mark is a PhD in psychology in private practice