Peer Support Groups
Peer support groups are a little like group therapy–but without the therapist. These range from ad hoc support groups formed by parents to professionally mediated support groups that may be available through a mental health clinic or public agency. Usually peer support groups do not charge participants, although a collection for snacks or meeting-room expenses might be taken up. Clinic-run groups, of course, may carry a fee.
Alcoholics Anonymous, Narcotics Anonymous, and other programs that use the 12-step model or a similar self-help approach are a particularly advanced kind of peer support group. These well-known programs bring together people with a common problem, and use methods for effecting personal change and supporting all members of the group that can be very effective. If substance abuse or dependency, eating disorders, or compulsive behavior disorders are additional problems for your bipolar child, you may want to look into the resources available along these lines.
The support experienced and friendships made in a peer support group can be very helpful for almost any family. Peer support groups for patients themselves can also be great–but without adult supervision, they can also be dangerous for bipolar teens. Before your child joins a support group, find out more about the program and the other participants. Some support groups provide a wonderful healing environment where young people with bipolar disorders can share their experiences with others who have been there. In a few strictly patient-run support groups for youth, however, solid information can go missing and misinformation can be spread. That can turn support group meetings into parent-bashing sessions, or lead participants to stop taking their medications due to peer pressure.
Local support and advocacy organizations, such as the National Alliance for the Mentally Ill (NAMI) and the National Depressive and Manic-Depressive Association (NDMDA), are often involved in setting up, sponsoring, and helping parents find peer support groups for bipolar children.
If your child is in a day treatment center, residential center, or hospital, milieu therapy is probably one of the program’s underlying concepts. “Milieu” is a French word for site and setting. Milieu therapy endeavors to make the site and setting of everyday activities in a school, hospital, or living center therapeutic. This requires paying close attention to physical characteristics, such as making sure that the classrooms and dorms are not dingy and depressing, and ensuring that toys, games, and activities are available that build positive experiences and help to eliminate negative behaviors.
Of course, careful structuring of interpersonal relations in the milieu is of prime importance. Every interaction between a patient and a staff member has therapeutic potential, whether that staffer is the cafeteria cook or an actual therapist.
This is obviously a thoughtful, intelligent premise for constructing a program to support and enhance the lives of young people with mental illness. If a program promises to follow the precepts of milieu therapy, that’s usually a good sign. Parents may also be able to take some ideas from milieu therapy and use them at home; see “The therapeutic home,” later in this chapter.
The most common place for children to see a counselor is at school. School counselors usually have a dual role: they advise students on academic issues and guide them through the college admissions process, and they also help them with personal problems. In the latter role, their focus is on maintaining wellness rather than on treating psychiatric disorders.
Accordingly, most school counselors are not equipped to provide regular therapeutic help to a child with a bipolar disorder–but they can be a key part of your child’s therapeutic team. The counselor’s office may be your child’s designated safe place at school, a place where he can go if the stress is building up too high and he feels a crisis coming on. The counselor (or a school nurse) may be able to control as-needed medication for symptom exacerbations at school. She can be the person the student or his teacher comes to in case of immediate problems. She may also be able to act as a sort of resource broker, helping the student and family get hooked into more intensive help through the school district or through community-based programs.
Outside of schools, other professionals may provide counseling services in private practice or in a clinic. As discussed earlier in this chapter, the title of counselor may or may not have a legal meaning in your state or province.
Behavior modification, also called behavior therapy, focuses on identifying problem behaviors, finding out what causes them, and eliminating them. That’s far less simple than it sounds on paper.
You are most likely to encounter “behavior mod” experts, also called behaviorists, in more restrictive settings, such as day treatment centers, hospitals, and youth corrections facilities. The quality of their training and expertise varies widely. Their role in your child’s treatment might include analyzing behavior and its antecedents and helping to develop a behavior plan to address problem areas (in a school setting, this is called a Functional Behavior Analysis plan). Some behavior therapists work one on one with bipolar youths, using techniques that are very similar to the related practice of cognitive-behavioral therapy.
One area where behavior therapy has proved particularly effective is the reduction of compulsive behavior, including self-injurious behavior. Another is the reduction of anxiety and panic. The exposure-reduction approach to phobias is an example that many people are familiar with. A child who has a severe school phobia, for example, would begin treatment by meeting with the therapist to discuss her fear. Then the therapist and patient would devise and carry out a plan to gradually and safely expose the child to the fearful situation or place, increasing the exposure over time.
Unfortunately, some behavior therapists are purists who feel that all human activity is based on conditioned responses to environmental stimuli. It’s important to find a professional in this discipline who understands, accepts, and works with the role of neurochemistry in the origin and treatment of bipolar symptoms. In the case of school phobia, for instance, medication can play a role in both causing the problem and in solving it.