Clients with Bi-Polar Disorder

[Searcher 5.0]

I know some people on this board have shared that they personally have Bipolar disorder, and I'm sure other members have clients with this diagnosis. I'm looking for advice on how best to work with these clients. I have one woman in particular who is definitely one of my most difficult clients (high maintenance) and it also seems that so much of her tension comes from her mental illness that the bodywork isn't always effective.

I realize I can become impatient with her. (Don't worry - I hide the impatience & treat her very respectfully & positively). I'm trying to develop more compassion for her, and maybe hear some fresh insight into how to work more effectively with her and clients with Bipolar in general.

I realize there's going to be a lot of variety among people with Bipolar disorder, but if there's any general advice you can give, I'd appreciate it!

 

[Apple Pi]

Hi,

Is she on medication and/or seeing someone about it?

Being bi-polar can cause people to act in ways that are unlike who they really are, so when they are feeling well, the shame of past actions can come into play. Many a business or personal relationship has been harmed during "bad days" of a bi-polar. Very difficult disease.

 

[rain]

She's on medication. It evens out her mood swings, so she's functional, but still a challenging personality.

 

[Shay P]

Do you think she might be using her disorder as an excuse to be inconsiderate and difficult?

 

[Dreamer :)]

Actually, I don't think she sees herself as difficult.

 

[paultopg]

Being diagnosed as borderline bi-polar, plus all the other stuff, gives me a name to call whatever it is happen to my mental state when I fail to take proper care of myself........... diet, sleep, etc. Since I am not on meds and am not likely to be put on meds because of the non-severity of my mental state, the best advice I can offer is this....

Realize that many "actively" bi-polar individuals throw off some really wild energies that make them "ouchy" just to be around. One of my clients has an adult daughter who can clear a room w/ her energies because they are so violently confused.... that's her mom's description by the way! Have met the gal once, and I concur w/ her mom's assessment!!! Had to do a full body massage for this gal and it was all I could do to stay in the room with her physically!!! I played really calming music [for my own welfare], used Soothing Touch Calming Cream for the client [and myself] and proceeded to do the best massage possible incorporating as many soothing techniques into the mix as I could --- presented complaining of feeling "ouchy" everywhere. The gal was thrilled with the massage, I came out of it fairly unscathed, and that was that.

Armoring myself in a ball of white light also seemed to help me feel like I was protected from receiving any of the energy she was giving off.

Hope this helps you!

 

[BWphotos]

Clients with Bi-Polar Disorder

I realize I can become impatient with her. (Don't worry - I hide the impatience & treat her very respectfully & positively). I'm trying to develop more compassion for her, and maybe hear some fresh insight into how to work more effectively with her and clients with Bipolar in general.

Hi Blisss, I just want to share that I have felt, many times, exactly what you have described.

One thing I wanted to point out to you, is that you are being too hard on yourself. You stated a contradiction, that you "become impatient", but "hide the impatience". It sounds to me that in reality, you FEEL impatient. Hey, that is normal, for heavensakes!! But you are acting in a very kind and compassionate manner, by doing your best to treat her, and hiding your impatience. I think you're doing everything right, and the feelings of impatience will still be there, but it's our actions that count. And, it has been my experience, that the irritation wans a bit with time.

Also, be sure to continue to maintain your boundaries. If you are making unusual accomodations for someone that threaten your boundaries, that can create feelings or irritation and resentment towards a client. For me, there have been times when I have been interested in working with a mentally ill client, but that necessitated having different boundaries than what I would have had with a regular client. That was a conscious decision that I made, but I did set boundaries around working with that person, developing specific boundaries on a case-by-case basis. Perhaps it is time to re-evaluate what your boundaries are with this particular client.

Noel

 

[intrigued]

Thank you all for your support & advice. It sounds like my feelings are normal for the situation. I can relate to AnastasiaB's description of her client's "ouchy" energy. I do "pump up" my positive energy whenever I see this client, to balance the negative energy she brings to the room. (She talks throughout the appointment, which is mostly a stream of venting & complaints about her life.) Although I give her my best work, I don't attach myself to outcome. Some days she'll say that was the best massage she ever received and express how much my work benefits her. Other days she'll tell me she doesn't think the massage helps her at all. On the days when she complains about my work, I remind her that massage therapy is optional. She's welcome to stop coming for a while, and see how she feels. I've also offered to refer her to other massage therapists, to see if their skills might give her greater benefit. She backpedals quickly then and says she'd like to stay on my schedule. (She's a regular client who I see every other week.)

Seekingequanimity, it's funny you should mention boundaries. I have strong boundaries in my massage practice with all of my clients, but this client challenges them weekly in new and creative ways. Thankfully, she respects any boundary I set, but she requires me to set them constantly (which can be tiring.)

Truthfully, I would have dropped her as a client long ago if it weren't for her husband. He has progressive illness, and requires massage as palliative care. He is one of my absolute best clients. He's reliable, considerate, easygoing, kind, funny, and respectful. He's an absolute joy to work with. However, if I stopped working with his wife, I know he would stop coming to see me as well. Since I don't want to lose him as a client, I've committed to working with her as well.

So, I've decided to see this as a positive challenge. Part of life is knowing how to relate to all kinds of people, including the ones we find difficult. I have learned a lot working with her: about maintaining boundaries; taking care of myself; letting go of outcomes; and cultivating patience and compassion. From an eastern perspective, I feel like this married couple represents the full Ying/Yang of client personalities. I remind myself that sometimes it does take darkness, in order to see the light.

Thanks again everyone for your support. And for those of you who work with similar clients, my support and positive energy go out to you as well! t049


Edit: If any of you read this post in the first few minutes after I posted, you'll see I have since edited it to remove some details. I realized I had originally given too much information about this couple, making it easy for someone to identify them if they lived in my town. For confidentiality purposes, I'm keeping it a little more vague.

 

[peacelove]

Bliss
as the father of a 17 year old daughter with severe bipolar, be prepared for the constant needyness/wants of this client. The mood swings can be quite quick,and for seemingly no reason. This is just their perception or take on what you have just said. I find that my daughter responded well to a slower more swedish style massage and it did help to even out her moods, to some degree

Tim

 

[congaihieuki]

Hi Toller. Yes, this client is very needy. In fact, she seems to take pride in being needy and is happiest with people when she feels they're anticipating & meeting her needs, before she even has to ask. Although her husband has a serious physical illness, he's definitely the caretaker in their marriage. It's been difficult for me to watch the imbalance in their relationship. I need to remind myself that it's not my place to judge, and they seem to prefer their roles, anyway. They're very happy with each other.

I didn't realize the neediness was part of the bipolar. I thought that was just her personality -- separate from her illness. It helps with my understanding, and my compassion. Thank you!

 

[feedphillipnow]

One of the other issues of being Bi Polar can be negative thinking. It's a hard disorder to live with.

 

[Pompal 09.]

Hi Leener. I definitely see the negative thinking. She seems to find me fascinating, because I strive to be so positive, especially when I'm with her. (To counteract her negativity). She likes to "pick my brain" since it works so differently from hers. On the other hand, she also has hinted that she thinks happiness is a sign of lower intelligence. She has said that she'd prefer to be dumb and happy, rather than intelligent with a mind that's out of control. I told her that I didn't think those were the only available choices. :

 

[azagames]

Sometimes the meds that are available to help those w/bipolar disorder do make them feel "dumb," so if she's ever used those I can see why she might think that.

 

[Pompal 09.]

Thanks, BJB-LMP. She did have the experience of feeling dumb and even drunk when she was first put on the meds. So, I'm sure she was referring to that feeling, in part. However, she also tends to project her experience onto other people, making her admire & disrespect happy people simultaneoulsy. She has told me that she thinks happy people must not be very smart, but at the same time, she wishes she was one of them. I guess that's a bipolar quality, too.

 

[Stephbiatchxxx]

Hi Leener. I definitely see the negative thinking. She seems to find me fascinating, because I strive to be so positive, especially when I'm with her. (To counteract her negativity). She likes to "pick my brain" since it works so differently from hers. On the other hand, she also has hinted that she thinks happiness is a sign of lower intelligence. She has said that she'd prefer to be dumb and happy, rather than intelligent with a mind that's out of control. I told her that I didn't think those were the only available choices. :

No wonder she goes to you! Good response!

The thing with this disorder is it's a many headed hydra and all of those heads need to be addressed. It's very important that people with Bi Polar are seeing someone for "talk therapy", in addition to meds , etc. (Cognitive therapist, psychotherapist). It's one of the important components because as you have heard from her, the thought processes can be damaging to a productive life.

In any case, defo shield and clear yourself, with her or any negative client.

 

[tott1]

Hi everyone. I just wanted to give an update on a new technique I use that helps me with this client: Humor. I find that if I can get her to laugh during her session, it dispels the negative energy in the room. When I laugh, it acts as an energetic shield for me, and when she laughs, it transforms her mood (at least temporarily). Win-Win. I can't always do it, but I try. Now for those of you that are picturing me telling jokes, I'm no stand-up comedian. The comedy's not that formal. Rather, this client's a talker, and I regularly work to steer the conversation in positive directions. Sometimes, I'm lucky enough to remember a topic-related anecdote to share that's funny as well as positive. When there's plenty of laughter in the massage room, those are the best sessions.

P.S. I've tried to suggest silence during the massage, but for this client, it's very difficult, because her thoughts often turn darker than conversation, since there's no one else giving a balanced perspective. This makes it hard for her to relax if she's quiet too long, so she likes to talk.

 

[kdanley]

That sounds like an incredibly positive approach, Blisss! Thank you for the update. I'll keep that in mind for my few *downer* clients.

 

[Praful]

Hi everyone. I just wanted to give an update on a new technique I use that helps me with this client: Humor. I find that if I can get her to laugh during her session, it dispels the negative energy in the room. When I laugh, it acts as an energetic shield for me, and when she laughs, it transforms her mood (at least temporarily). Win-Win. I can't always do it, but I try. Now for those of you that are picturing me telling jokes, I'm no stand-up comedian. The comedy's not that formal. Rather, this client's a talker, and I regularly work to steer the conversation in positive directions. Sometimes, I'm lucky enough to remember a topic-related anecdote to share that's funny as well as positive. When there's plenty of laughter in the massage room, those are the best sessions.

P.S. I've tried to suggest silence during the massage, but for this client, it's very difficult, because her thoughts often turn darker than conversation, since there's no one else giving a balanced perspective. This makes it hard for her to relax if she's quiet too long, so she likes to talk.

i don't know how i've missed this thread - i have a client with BPD and everything you've said here is right on with her too. the laughter helps to get that good breathing going and also helps to unlock so many areas of the body. glad to see this post!

 

[Abby A]

i don't know how i've missed this thread - i have a client with BPD and everything you've said here is right on with her too. the laughter helps to get that good breathing going and also helps to unlock so many areas of the body. glad to see this post!

I have some family members who are bi-polar, I'll try to be more aware of this when I massage them in the future.
I have found that "laughter therapy" as I like to call it, has been beneficial when I was working with clients suffering from panic attacks. I think it's a great distraction and pretty soon they're taking deeper breaths again.

And though we don't have to be ready to join the local "improv" team, a little levity at the appropriate time can be a good thing. There's more than one way to "lighten up!" :

 

[Shayy <3]

Bi-polar can easily be described as the individual does not understand what it means to be okay or fine. They lack the chemical responses in the brain that regulate their emotions which is thought to be through heredity or situational. They usually range from one extreme (manic high or manic low) to another. It's a horrible combination for the client since they often feel "betrayed" by their own mind and live with the daily tension of trying to balance these two extremes and be perceived as “normal”.

It is very important that their medical routine includes the proper medication mix and dosage as well as counseling by a trained professional to provide proper understanding of their moods, emotions, and mental development. Often their medication mix is very dependent upon what specifically works for them personally and may often need to be changed in dosage and type. Their moods may be “evened out” but the medication can still leave them in one extreme or the other as with your client’s difficult mood appearing to be within the area of a manic low.

Because of the very nature of the illness these individuals may not unable to relate to others when it comes to feelings that they themselves can not related to and thus they welcome any opportunity to explain their views with another person - often to bounce ideas and thoughts with and to help them form an opinion on the matter – outside the realm of their medical team but from a “normal” person perspective. Your client has expressed an ideal about happy people that she can not relate to herself.

A word of caution though, some of these individuals unconsciously seek a type of relationship that can quickly become "co-dependent". A co-dependent enabler is a person that allows "bad" behavior in respects to letting the person push their boundaries and over-step them repeatedly to a point where the enabler is contributing negatively to the bio-polar's behavioral pattern. As it has already been pointed out, it is very, very important to set boundaries and keep them (and thus the reason why they like and need to have their boundaries reaffirmed.)

Therapeutic massage is very helpful for the individual in connecting with their body – as they often feel that it betrays them. It helps with the symptoms, such as muscle tension, that is a side effect to the medication and the secondary issues, such as panic attack disorders, that often are part of their emotional make-up.

These individuals will require a lot of empathy, patience, and understanding while you, as their MT care-giver, will need to take the necessary emotional steps to protect your own personal boundaries. It will be important for you to de-attach yourself from the internal need for positive feedback normally received from a good therapeutic session. You will have to recognize that you are helping her without it.

As your therapeutic relationship continues, be aware that you are a representation of their medical health and they will view you as part of their medical team. This will naturally lead to placing you up on a pedestal - a dangerous place to be. You will have to carefully negotiate this behavior as you are the one in a position to read the behavior. For example, remember to carefully state your opinions as just that – opinions (as opposed to statements of fact).

You will also need to adjust your massage technique to meet her emotional needs. In this current emotional state near a manic low, a deeper massage tends to be beneficial; whereas a lighter massage will be more affective when she is closer to a manic high. (An under-stimulated body needs a more stimulated massage and an over stimulated body does not need more stimulation.) I personally will utilize Ayurvedic dosha profile to determine their current frame of mind and utilize the corresponding massage and ayurvedic oil.

There's my 2-cents worth...