Cannon Thomas, Ph.D., received his doctoral training in clinical psychology at the University of Virginia. He completed his internship at Palo Alto VA Medical Center and a postdoctoral fellowship at Stanford University Medical Center in the Department of Psychiatry. In addition to clinical practice, Dr. Thomas is actively involved in psychotherapy research and in the development of online support tools for use during psychotherapy. His work focuses on helping therapists and clients track progress during the course of treatment. He is an Assistant Clinical Professor at University of California, San Francisco, where he supervises psychiatry residents in providing evidence-based psychotherapy. He has taught courses on the theory of personality and the practice of psychotherapy at the University of Virginia, California Pacific Medical Center, and at the University of California, San Francisco.
Questions
When do you mention moods in the work place?
The first thing you have to be clear about is what the purpose of disclosing is. Many class members (Dr. Thomas teaches a class as part of the UCSD Bipolar Disorders program’s lecture series for bipolar patients) said, they wouldn’t disclose to a boss or other person at work. They said, “it is none of their business.”
But it may be necessary to disclose. For example, I worked with someone in the music industry, and because of the crazy sleep schedule in her job, and how that affected her moods, she really had to talk to her boss about an accommodation. She would have had to leave that profession if she had not disclosed. And in that case it worked out well.
Still, if you are thinking about disclosing in order to receive psychological support, you may want to think seriously about whether disclosing in a work setting is a good choice. Since the purpose of a workplace environment is getting work done, how much psychological support is it reasonable to expect there?
Just as in other situations, in a work setting you want to be clear about why you are thinking about disclosing. Your boss will probably want to know how to help (if he or she is supportive), but it is your job to think about what kind of help he or she could offer, and whether asking for that help is reasonable.
If you need a clear accommodation (for example a particular change in schedule) then there is a clear purpose and reason to disclose.
When asking for an accommodation, you will want to focus the conversation on the reasons for the request. Keep the conversation simple and direct. Talk about it in a way that is confident and competent. You want to convey the message, “this is a workable issue, with a small change you can count on me doing a good job for you.” People react to how information is conveyed, if you feel anxious and uncertain your boss will likely feel that way as well.
What are some things not to do?
The thing not to do is to express yourself in a way that is the opposite of simple and direct. Don’t give too much information. You don’t need to give a history of your diagnosis.
Try to not think about your boss as someone who plays somewhat of a parental in your life, and try not to share information with a goal of getting psychological support and concern.
Keep the emotional desire to be understood as a separate issue from establishing a good collaborative work environment.
If it seems not to have gone well this is the place to use your active listening skills. Ask an open ended question, “I see that you seemed a bit troubled, I wondered if you had any concerns.” If they had a misunderstanding of the disorder or any other specific concern you can respond with something like,
“I understand that you might have this concern… But I think that we can work things out…” Active listening is a way of disarming someone. Normalize their reaction but put it into an appropriate context.
You may need to clarify that you are very interested in being energetic in your job and dealing effectively with work challenges so that your boss can see that it isn’t that you are telling him or her that they will have a “problem worker” to deal with.
What about in an early romantic relationship, when do you bring up the topic?
The specifics of an individual relationship matter a lot. Certainly it doesn’t need to be discussed in the first couple of dates. It is when both of you seem to be committing to a longer term future that you will want to bring this up.
Just as you don’t want to bring it up right away, you won’t want to have avoided the topic for months. You will feel the stress of knowing that there are important issues that you can’t talk about with this person who is becoming increasingly important to you. And if it has been a year and you never mentioned anything to your partner, he or she is going to wonder why was this important thing was never discussed.
It is important that you convey to your partner your sense of competence in dealing with the problem. If your partner sees that you are really uncertain about taking care of the problem, ambivalent about treatment, then that will raise concerns.
The more you can normalize the issue the better the conversation will be. “This is the condition, this is my experience of it, this is how it has affected my life, and this is how I am managing it.”
Active listening is an important part of talking with your partner. It isn’t going to be just one conversation. Checking in with them about whether they have any concerns and answering their additional concerns in a calm and non-judgmental way that will help them is an important part of making this conversation a way of improving your relationship.
Besides my psychiatric disability, I also have serious epilepsy. I haven’t been able to get a doctor to sign off on permitting me to drive. How do I explain to people new in my life that I’ll likely need their help in taking me places? It sounds weird and I hate to inconvenience them…
The more that you can keep in focus that you are excited about getting to know them and they are excited to get to know you, the better. What is really important is the pleasure in getting together. If something is coming up around needing a special accommodation, the best way to address it is in the context of a specific need (when you are planning and activity that involves doing some driving, that is the time to bring it up). Again, do it in a way that is simple and direct.
You haven’t then made a big deal about the problem and lost focus on the fact that the beginning part of a relationship is about going out into the world and having fun together.
A lot of times people don’t mind being helpful as long as they real feel that they can help. As long as you are clear about what they need to do to be helpful then they can feel in control. You want to avoid making it a big scary thing.
What other issues come up that relate to communication for someone with a mood disorder?
One issue is the effect of depression. Social support is such an important part of protecting yourself from depression. Many times you have to push yourself not to isolate. You should think about who might be able to provide you with meaningful support.
Another big issue is dealing with conflict when people are either over involved (maybe treating the person as overly fragile) or when they are angry with the person with bipolar.
These are situations where we use active listening, and disarming, in order to address the issue but also to communicate assertively. “This is what the issue is and this is what I am feeling.” Using an “I” statement. As opposed to, “you are being so unfair.” “I am feeling overwhelmed,” is a communication about yourself and your feelings and a better way of beginning a conversation.
How to approach a conversation with someone who is uncertain about how to deal with you because you may need different amounts of support at different times?
Use your active listening. “I can understand how you feel given how out of control things were.” Then use an I statement – “On the other hand I feel a bit uncomfortable with how closely you are monitoring me now.” “i hope that we can talk more clearly so that you can see that I am doing the things that I need in order to stay in control, and then maybe we can relax together.”
Have you had experience with crisis plans?
It is of course helpful to have everyone agree on what should happen when there is a crisis, and to have that conversation when there is no longer a crisis. Everyone tends to want to avoid thinking about the crisis, but it is very helpful to take some time to debrief.
You should involve your treatment team and your family in the planning. There is research data showing that involving family and your treatment team both results in better outcomes.
My hope is that developing a formal crisis plan can be a model for how you can come up with mini-crisis plans. When things are getting a bit out of control how you can get things back on track.
Having a chance to debrief on those mini-crises will build confidence in the future for collaboration.
Final comments
There aren’t a lot of books that are specifically targeted to bipolar and depression. There are a few books that might be helpful but the group hasn’t really found ones that are consistently helpful.
I do think that the more comfortable you are with what you are communicating about, the easier the conversations are going to go. The information about your moods is new to other people, it will be a surprise to them. You need to model for them that you are comfortable with what you are talking about.
A cardinal rule of communication is that it is only good communication if you are sure that the other person has really heard what you wanted to stay. It is easy when you are anxious to keep on talking, but you need to check in to be sure they are understanding you.