Manic Client

My client in a divorce case has disclosed to me that she’s been diagnosed as bipolar. Although she dismisses that view, my guess is that it’s accurate. She talks a mile a minute and I can’t keep up with the rate of ideas that she expresses; she leaves me voice-mails at 3 AM and apparently only sleeps a couple of hours a night; and her conception of the riches and success that will flow from this divorce are, to put it mildly, wildly optimistic. I have suggested that she see a psychiatrist for medications, which she adamantly refuses. Can you give me further insight or ideas?

It does sound as if your client may be experiencing a manic episode. Had you met her at another point in time, she might have looked much more depressed, and you may well find depression in her history that comes to light in the divorce proceeding. (It could also be other things – best to leave it to a mental health professional to make the diagnosis – but let’s assume for now that she does have bipolar disorder.)

Your sense that medication is the indicated treatment for bipolar disorder is correct. Psychotherapy has been shown to offer additional benefit, especially in adjunctive ways, such as helping people accept their illness, picking up early signs of relapse, and involving significant others in monitoring a person’s mood state, but the essential condition is considered biological, and the core treatment consists of mood stabilizers such as Lithium, Lamictal, and Depakote.

Unfortunately, people in a manic state very often deny that it presents a problem, and have little interest in treatment, since they may feel quite powerful and be very productive and (overly) confident. You may need to accept that your client will not follow your advice. Your best shot at a more constructive response might be the leverage of the divorce itself, i.e., pointing out to the client that, whether she thinks she has a problem or not, initiating and complying with treatment is likely to benefit her in the outcome of the case (which can be especially true if there are children involved). Your tone would best be non-judgmental but you might be saying, in essence, “Let’s face facts.”

An LCL clinician would be willing to meet with you to discuss your approach more specifically, as well as the types of resources that might benefit your client and how to access them.

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