Dear Psychologist:

I am in need of some serious advice; I appreciate any and all information shared and greatly appreciate whatever time you share with me.

My girlfriend has severe bipolar and mild anorexia along with purging (developed recently). She has very serious psychological issue's stemming from her childhood. She has a family history of bipolar, whom several members have taken there own life from (including her mother) this disorder. Her psychological issues revolve around constant and severe child abuse, drug abuse, sexual abuse, and verbal abuse. None of these issues have been dealt with. She is currently 19 years old.

Currently she is in a treatment facility located in Alberta (for now I shall leave it nameless). She is currently being treated with medication and is also in group cognitive therapy.

I know for a fact, that her psychological problems are so severe, that the group therapy sessions she is in simply cannot correct her issues. She desperately needs one on one therapy sessions, multiple times a week. Her group sessions are cognitive therapy sessions.

I am at a loss of where to turn, I currently live in British Columbia and she lives in Alberta, we plan on marriage in the very near future. It seems as though, since I am not immediate family, but a mere boyfriend that I have no say or input on how she is treated. When in fact, I know so much more valuable information than the doctors, nurses, and therapists know. I am the only person she can fully trust and communicate her feelings 100% with.

I have researched and studied the material she has been learning in her therapy sessions, it is based off The Feeling Good Handbook by David D. Burns, M.D. and is the basis of there cognitive therapy class. I have also researched and studied bipolar, depression and the various drugs and anything else related to her situation. I have consulted with several doctors, pharmacists and people in the mental health field.

I honestly believe that the view of the physiatrists and those involved in her therapy underestimate just how serious it is. It seems to me they are relying heavily on drugs, very heavily on drugs. She is given uppers or downers when she's manic or depressed, completely avoiding the issue at hand. Instead of dealing with the things that bother her, they merely seem to try and deal with the symptoms with drugs such as ativan.

She desperately needs intense one on one cognitive and behavioral therapy sessions several times a week (she even tells me this herself). Her thoughts are extremely distorted and she gets depressed and suicidal over the simplest things because her thought pattern is so negative and there has been nothing done to correct this. I cannot see how someone with a history, right from birth that has faced child abuse, sexual abuse, alcoholism, and drug abuse can deal with her problems in a group setting.

I thank you your time and value your every opinion on this matter. I am in need of some serious input, and shall be forever indented to the information you share.

Sincerely - Jonathan

Dear Jon, I apologize for the tardy reply ,but, I have been out of town. I have read your letter several times and appreciate the tone of desperation and frustration in your words.

I understand that you believe that individual therapy could more adequately address your girlfriends' current needs, particularly given her extensive history of various abuses. My experience in both facilitating and participating in group therapy is that it can be a powerful tool for growth because generally the other participants have similar issues which one can learn from. Having said this, individual therapy is also useful and I encourage your girlfriend when she leaves the treatment facility to find a therapist that she can relate to. The literature seems to support the value of cognitive-behavioral therapy in the treatment of bipolar condition and there does appear to be a high rate of success with this approach.

However, with your girlfriend, there is the compounding factor of a history of child abuse which can be worked through with a therapist who she can develop a sense of trust and someone who she is willing to share her experiences. I have found in the past few years that more therapists are working with a body-focused modality when it comes to the issue of abuse. It makes sense to me that if the body was traumatized as a child, that it then continues to hold the memory of these traumatic experiences. So the abused individual needs to be guided by a skilled therapist who can assist them to release these body memories so that the trauma can be adequately integrated (meaning the experiences become conscious) so that it no longer triggers the person. If the person is triggered by a situation in the present which reminds them (this all happens unconsciously) of their past abuse, they immediately return to that past situation and respond as if they are back there. There are several types of body-focused therapy, two come to mind. One being Integrated Body Psychotherapy and Hakomi Body Focused therapy (www.hakomi.ca). There are many practitioners in Alberta that offer these two modalities of therapy.

I agree with you Jon that we live in a society that tends to over-medicate. It is certainly, absolutely necessary for her to be on certain medications to treat her bipolar condition. However, you questioned her use of Ativan to manage her anxiety. She needs to get to know herself well, so that she can decide whether she wants to deal with a situation by going to her fear and feeling her anxiety or whether she wants to deal with the situation by taking an anti-anxiety. Some individuals with bipolar may decide to manage their anxious symptoms more naturally by removing all stimulants, such as coffee, coke, sugar, substances which increase symptoms related to anxiety. One must be willing to feel some anxiety if they chose to manage it without medication. These decisions however must be made in consultation with her physician or psychiatrist. She must, however, know enough about her own condition to be able to properly advocate for herself.

I know of people like yourself Jon that want to help or rescue their partner from their suffering and this is not possible, only the individual themselves can work this through. If you are planning on marrying this young woman, be prepared for some difficulties together as she will likely(not because she wants to) be in a victim place a good deal of the time. This is a place of collapse where she becomes depressed and blames her past and the people who abused her. She will end up becoming angry at you for wanting to help her and your support of her can contribute to her staying in this victim place. I would support you both to find a therapist who can work with her individually and work with you as a couple as you will both need some assistance. You need to look at yourself, Jon, and see that this it not all about her, many individuals hook up with someone who has a lot of emotional needs to avoid having to look at their own issues. So, I would suggest to you that you find a therapist to begin looking at your own individual needs, they may not look as obvious as your girlfriend's, but if you dig below the surface you will find them.

I hope that this feedback has been helpful as you find your way to emotional well-being.