A Stage-Phased Psychodynamic Intervention For School Refusal In Adolescent Bipolar Disorder

Adolescent bipolar disorder is a severe psychiatric condition frequently complicated by school refusal behavior, a debilitating functional impairment that often persists even after the pharmacological stabilization of mood symptoms. While medication effectively targets biological dysregulation, it frequently fails to resolve the deep-seated separation-individuation conflicts and pathological family dynamics, such as triangulation, that actively maintain social withdrawal. Given the scarcity of manualized psychotherapeutic protocols for this specific clinical challenge, this article demonstrates a structured, stage-phased psychodynamic psychotherapy protocol for the treatment of adolescent bipolar disorder comorbid with severe school refusal behavior. We present a comprehensive 60-session intervention applied to a 17-year-old female patient. The protocol integrates standard pharmacotherapy with a three-phase psychodynamic model: (1) Alliance and stabilization; (2) Working through, utilizing dream analysis and transference interpretation; and (3) Termination and separation. Progress was monitored via serial electroencephalogram (EEG) topography and standardized psychological scales. Application of this protocol was associated with the resolution of school refusal and successful university entry in this patient. Longitudinal assessment demonstrated a significant reduction in depression scores to within normal ranges, although anxiety scores remained above the clinical threshold at follow-up. Furthermore, while EEG topography demonstrated overall stability, mild -band dysregulation persisted. This protocol provides a step-by-step roadmap for clinicians, highlighting that resolving underlying family triangulation may be a valuable component in supporting successful school reintegration in pediatric bipolar disorder.