If you or someone you love lives with bipolar disorder, you may already know that medication is a key part of treatment. But you may also wonder whether therapy for bipolar disorder can help, and what it would even focus on. The answer is that therapy can make a real difference. It can help you spot early warning signs, keep your routines steady, improve relationships and feel more in control of your life.
This guide explains what bipolar disorder is, how therapy fits with medical care and what to expect when you start.
What is bipolar disorder?
Bipolar disorder is a mental health condition that causes big shifts in mood, energy and activity. These shifts go well beyond normal ups and downs. They can last for days or weeks and affect sleep, work, relationships and judgment.
There are a few main types:
Bipolar I involves at least one episode of mania. Mania is a period of very high or irritable mood, with lots of energy, little need for sleep, racing thoughts and sometimes risky choices. Many people with bipolar I also have periods of depression.
Bipolar II involves episodes of depression and hypomania. Hypomania is a milder form of mania. It may feel productive or even good, but others often notice the change.
Cyclothymia involves ongoing mood swings that are milder than full episodes but still affect daily life.
Between episodes, many people feel well for long stretches. Bipolar disorder is not a character flaw, and it is not the same as being "moody." It is a real health condition that can be managed.
A doctor, psychiatrist or psychologist can diagnose bipolar disorder. It is sometimes first mistaken for depression, because people often seek help when they feel low rather than when they feel high. If you have had periods of depression and also times when you needed much less sleep and felt unusually driven or restless, it is worth mentioning both to your care team.
Why medication usually comes first
For most people with bipolar disorder, medication is the foundation of treatment. Mood stabilizers and other medications can prevent episodes and make them less severe. Canadian treatment guidelines, developed by the Canadian Network for Mood and Anxiety Treatments (CANMAT), describe medication as the core of care and psychological treatment as an important addition.
In other words, therapy works best as a partner to medication, not a replacement. If you are not yet connected with a doctor or psychiatrist, that is an important first step. Our OHIP-covered psychiatry pathway can offer medication guidance for mood disorders, and it is open to clients in Waterloo Region, Ottawa and online.
How therapy helps with bipolar disorder
So what does therapy add? Quite a lot. Here are some of the main goals.
Understanding your condition
Learning about bipolar disorder is called psychoeducation. It sounds dry, but it can be powerful. When you understand what is happening in your brain and body, you can make informed choices, feel less shame and take an active role in your care.
Spotting early warning signs
Most people have their own early signs before an episode. For one person, it may be sleeping less and starting lots of new projects. For another, it may be pulling away from friends or losing interest in food. A therapist can help you map out your personal signs and make a plan for what to do when they appear.
Keeping daily rhythms steady
Sleep and routine have a big effect on mood in bipolar disorder. A late night, jet lag or shift work can sometimes trigger an episode. One approach, called interpersonal and social rhythm therapy (IPSRT), focuses on keeping regular times for sleep, meals, work and social contact. It also looks at how relationships and life changes affect mood.
Changing unhelpful thoughts
Cognitive behavioural therapy (CBT) helps you notice and challenge thoughts that feed depression, like "I will never get better." It can also help you slow down before acting on the big ideas and urgency that come with hypomania.
Taking your medication consistently
Many people with bipolar disorder stop medication at some point, often because of side effects, feeling well or missing the energy of hypomania. Therapy offers a safe place to talk about these feelings honestly, so you can bring your concerns to your prescriber instead of stopping on your own.
Coping with the aftermath
Episodes can leave a trail: strained relationships, money problems, missed work or regret. Therapy can help you work through guilt and shame, repair trust and rebuild confidence.
The role of family and partners
Bipolar disorder affects the whole family. Loved ones may feel scared, frustrated, exhausted or unsure how to help. Research on family-focused therapy shows that when families learn about the condition and practise better communication together, it can support recovery.
Family or couples sessions can help everyone:
understand the condition and its warning signs
agree on a plan for when an episode starts
talk without blame
set healthy boundaries
take care of their own well-being
Learn more about our family therapy services. If you are a family member, you can also come to therapy on your own to get support for yourself.
Building a wellness plan
Many people find it helpful to write down a simple wellness plan with their therapist and doctor. It might include:
Your personal early warning signs for both highs and lows.
The daily routines that keep you steady, like regular sleep and wake times.
People you trust who can let you know if they notice changes.
What you want others to do if you become unwell.
Contact details for your doctor, psychiatrist and crisis supports.
Keeping this plan somewhere easy to find, and sharing it with someone you trust, can help you act early.
What to expect when you start therapy
Your first session is a chance to share your story and your goals. Your therapist will ask about your mood history, your current treatment and what support you have. You don't need to have everything figured out.
With your permission, your therapist can work alongside your doctor or psychiatrist so everyone is on the same page. Sessions are usually weekly or every other week at first, then may space out as you feel steadier. During a hard stretch, you might meet more often.
It helps to look for a therapist who has experience with mood disorders. Several of our therapists work with bipolar disorder, and our care team can help you find a good fit.
Therapy for bipolar disorder at Transformation Counselling
We offer therapy in person in Waterloo, Kitchener, Cambridge and Ottawa, and online across Ontario. You don't need a referral, and evening and weekend appointments are available.
Sessions with our therapists are $130 to $200, and there is a one-time $50 setup fee. Psychologists on our team can provide diagnostic assessments. Assessment fees depend on the service, and your free consultation covers them. Many workplace benefit plans cover therapy.
You may also find support on our depression counselling page, since depression is often the hardest part of bipolar disorder for many people.
If you are in crisis, thinking about suicide or worried about someone's safety, call or text 9-8-8 at any time. In Waterloo Region you can also call Here 24/7 at 1-844-437-3247. In Ottawa, call the Ottawa Mental Health Crisis Line at 613-722-6914. In an emergency, call 911 or go to your nearest emergency department.
Frequently asked questions
Can therapy replace medication for bipolar disorder?
For most people, no. Medication is usually the foundation of treatment. Therapy works alongside it to help you stay well, spot warning signs and handle stress. Always talk to your prescriber before making changes to your medication.
What type of therapy is best for bipolar disorder?
Psychoeducation, CBT, family-focused therapy and interpersonal and social rhythm therapy all have research support. The best fit depends on your needs, and a good therapist may draw on more than one.
Can I come to therapy if I haven't been diagnosed?
Yes. If you are worried about mood swings, a therapist can talk through your experiences with you. If a diagnosis is needed, we can explain your options, including assessment with a psychologist or seeing a doctor or psychiatrist.
Should I come to therapy when I'm feeling well?
Yes. Times of stability are often the best time to build skills, make a wellness plan and work on relationships.
Can my partner join my sessions?
Yes, with your consent. Many people find it helpful to bring a partner or family member to some sessions.
Take the next step
Living with bipolar disorder is easier with a team behind you. Book a free 15-minute consultation and our care team will help you find a therapist with experience in mood disorders. You can also book an appointment directly.