The psychotherapy of mania

The manic or hypomanic patient paradoxically lives on the edge of loss and lowered self-esteem. This is due to present realities of the impact of the illness upon life and the prospect of cycling into depression and earlier developmental problems to which bipolar patients may be especially prone. Furthermore, manic behavior itself engages others in arguments and countertransference problems that may actually worsen the course of the illness. A psychotherapeutic approach taking these factors into account can have a favorable impact on the acute episode and the long-term course of the illness, provided the patient and psychiatrist are able to form a trusting relationship that survives any recurrences. Justification for these views derives from small series of patients and anecdotal impressions of experienced clinicians. Empirical research is needed on the efficacy of psychotherapy, independent of medication effects.