Following your consultation, the clinician will recommend the most appropriate treatment or therapeutic approach for your circumstances.  The type of therapy that is useful in part depends on the stage of the illness.  Most therapeutic approaches are going to be useful for bipolar depressive episodes, as it is optimal to be able to minimize or avoid the use of antidepressant medication because of the risk for manic switch.  Most individuals are not amenable to therapy in the midst of a manic phase.  Patients in this stage usually have quite limited insight, and treatment approaches typically need to be supportive and educationally focused.  For bipolar depression or bipolar II disorder, there are many different approaches to consider.  Many therapists utilize a combination of therapeutic approaches in their work.  Some approaches are:

Psychodynamic therapy assumes symptoms, such as in depression, are due to unresolved, unconscious conflicts from childhood.  It is based upon the classic psychoanalytic approach developed by Sigmund Freud.  The therapist uses the concepts of transference, countertransference, resistance, free association, and dreams in order to help the patient develp insight into patterns in relationships that can then effect change.  It is a nondirective therapy.  Although classic analytical therapy can last for years, with sessions four to five days per week, psychodynamic therapy may be shorter in duration, with sessions one to three times per week.  Controlled research studies examining the efficacy of this type of therapy are minimal, due to the nature of this type of therapy.  This treatment approach is often helpful for those with chronic coping difficulties or with personality disorders.  This therapy approach does not address bipolar illness specifically.

Interpersonal therapy is useful for depression, conceptualizing it in a patient with the three components of symptom formation, social functioning, and personality factors.  It focuses on the patient's social, or interpersonal, functioning, with expected improvement in symptoms.  The goal is to improve communication skills and self-esteem.  It is a brief and highly structured, manual-based psychotherapy.  Areas of social functioning that may be addressed are interpersonal disputes, role transitions, grief, and interpersonal deficits.  Therapy is focused and brief in duration, typically lasting twelve to sixteen sessions.  Research studies have shown it to be an effective treatment for depression.

Interpersonal social rhythm therapy (IPSRT) is a relatively new treatment specifically geared toward the management of bipolar disorder, and it is based on the idea that disruptions in daily routines and problems in interpersonal relationships can cause recurrence of the manic and depressive episodes of bipolar disorder.  During the treatment, therapists help patients understand how changes in daily routines and the quality of their social relationships and their social roles can affect their moods.  After identifying situations that can trigger mania or depression, therapists teach the individuals how to better manage stressful events and better maintain positive relationships.  In bipolar illness, focusing on improvement of interpersonal relationships can be very important, as these are often adversely impacted by the illness.  In addition, the therapy can be used to help regularize daily routines that can help in prevention of manic episodes.

Cognitive-behavioral therapy assumes that symptoms are due to a pattern of negative thinking.  It works to help patients identify and change inaccurate perceptions of themselves and situations.  It also is brief in duration and manual-based, typically lasting for ten to twenty sessions.  It typically involves the use of homework assignments between sessions.  Research studies have shown it to be an effective treatment for depression and some anxiety disorders.  In bipolar illness, it can be especially helpful for bipolar depression, when use of antidepresant therapy may be deemed risky.