Attachment Security in Couples with a Bipolar Diagnosed Partner

Transcription

1 Attachment Security in Couples with a Bipolar Diagnosed Partner PRESENTED BY DR. REGINA BORDIERI, LMFT

2 WELCOME Thank You for Being Here!

3 Acronyms: Bipolar Couple Relationships (BCRs) BD as Influencing the Relationship Not Labeling the Couple Bipolar Diagnosed Partner (DP) Non-Diagnosed Partner (NDP) Bipolar Disorder (BD) Attachment Security (ARE)

4 Objectives: 1) BD & Systemic BCR Treatment (ID as Advocate) Call to Action for MFTs to Serve BCRs 2) Attachment in BCR Treatment (ID as Clinician) ARE: Accessibility, Responsiveness & Engagement 3) Conceptualizing BD & ARE BCRs (Advocate/Clinician) BD as Marginalized Aspect of Identity 4) Research & Treatment (ID as Researcher/Clinician) Dyadic Analysis & Clinical Applications

5 Bipolar Disorder & Couple Relationships Systemic Treatment

6 BD Treatment Significance 4.4% US Lifetime Prevalence Chronic, Life-Long Recurrence Fx Impairments & Suicide Risk (15x, up to 25% All) Dual Dx: Many Up to 3 Co-Occurring D/O (88% Anxiety, 70% Impulse Control, 50% Substance, 40% SAD)

7 BD Diagnosis & Mood Episodes Distinct Periods of Acute & Polarized Symptoms Observable Changes in Behaviors & Functioning (Hypo)Manic Elevated Mood, Energy & Activity Depressive Decreased Mood, Energy & Activity Euthymia = Periods Between Mood Episodes

8 Manic or Hypomanic? BD I or II? If Manic = BD-I Hypomanic Debilitating Functional Impairment If Hospitalization If Psychosis Significant Functional Impairment NO Hospitalization NO Psychosis

9 BD Mood Episode Metaphor Laura Bain Living with Bipolar Type II TEDx Terry Talks

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11 Bipolar Symptom Experience Acute Symptoms During Mood Episodes Not Representative of Functioning 67% Less Severe Symptoms Between 3x Greater Duration of Sx in Euthymia Range of Inter-Episode Functioning

12 Treating Widest Range of BD Symptoms Combined Medication & Therapy Medication: Best for Acute Sx (Mania) Therapy: Best Psychosocial & Functional Recovery MFTs: Systemic Specialists for Relational Context

13 Bipolar Disorder Relationship Functioning NDP Criticism/Hostility (EE)

14 Potential of Couple s Therapy Reduce Relationship Distress Enhance Attachment (Emotional) Bond Support BD Management Improve Partners Quality of Life

15 Attachment Lens Systemic BCR Treatment

16 Attachment Theory Primary, Universal Drive for Connection Seek Closeness with Select Significant Others Security Protects Against Stress (Internal & External) Attachment Behaviors are Adaptive Strategies Responses to Interpersonal Experiences (Attachment History)

17 Layered Emotional Experience (EFT) Secondary Emotions: Mask Attachment Distress Anger Frustration Primary Emotions: Reflect Attachment Distress Fear: Rejection/Abandonment Despair: Emotional Disconnection/Isolation

18 Reactive Anger (Secondary Emotion) Escalate Conflict as Negative Attachment Cues NDP EE (Critical/Hostility) DP Critical & Hostile Response BD Symptoms Irritability in Both Mania & Depression DP Defensiveness Feeling Unfairly Blamed, Real or Imagined Due to BD

19 Frustration (Secondary Emotion) Chronic Sx, Stressors & Ongoing Illness Management Escalate Attachment Anxiety Increase Negative Attachment Cues Reinforce Linear View of BD as Problem Secure Bond Supports Collaborative IM IM & Hope of Sx Management Reduces Anxiety

20 DP Fears (Primary Emotion) Rejection & Abandonment Feeling Unlovable or Inadequate (Shame/Stigma) BD Prevents NDPs from Fully Accepting Them That BD Makes it Impossible to Keep a Partner Fear of Driving NDP Away: Hiding Sx Support

21 BD Stigma, Shame, Isolation, Attachment Social Stigma Shame Social Isolation (Manic Hx) Rejection Abandonment Anxiety, Despair Internalized Stigma Emotional Isolation Attachment Emotions NDP Most Distressing

22 BD as Marginalized Aspect of Identity MFT Strength Systemic Understanding of Oppression on Multifaceted Identity Formation Does NOT Define but Must Be Integrated (Chronic) More Salient for Some & Varies Over Time Invisible Until Not, Unintentional Disclosures

23 Stigma & Labels The Power of Words

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25 Destigmatizing BCR Discourse (DP & NDP) Replace Patient & Caretaker in Literature Portrays DPs as Sick & Dependent on NDPs DP & NDP Distinguishes Based on Dx Undermines Equal Status/Responsibility Distress & Change Our Ethical Responsibility to be Mindful of Language with Clients & Other MH Professionals (Parallel Process)

26 Diagnosed Partner Resiliency (BD ID) BD Integrated But Distinct from ID & Partner Roles Anything Else You Would Like to Share: We are both very conscious of each other's behaviors. I notice if she tries to be a caretaker (not her job) and she notices if I begin to act like a mental patient (not my job). We want to make sure the other can be themselves in the relationship and not just a support role.

27 Non-Diagnosed Partner Resiliency How BD Currently Influences BCR: Her ups and downs are part of our relationship dynamic. I need to be in tune with them and aware so I can be as helpful as possible. Anything Else You Would Like to Share: My partner is more open and able to discuss feelings than me, so I feel like It's important for me to become more comfortable with it, because I have seen the positive effect on our relationship and the way we deal with our mental health.

28 Bipolar & BCR Research Clinical Applications

29 MFTs as Consumers of Research Enhance Quality of Systemic Tx Grounded in Systemic Theory Systemic Methodology (Dyadic) Provide Evidence that Systemic Tx Works Ethical Obligations & to Get Paid

30 Limited Research on BCR Population BD & Families (Couples) or Couples & Depression Limited Research BD & Attachment, Not Specific to BCRs Attachment, But not in context of BCR BD Sx on DAS, No Relationship Predictors. Tx with NDPs Sx Outcomes Only

31 Measuring Attachment Security Styles: Typologies (Secure vs. Insecure) Dimensions: Characteristics (Anxiety, Avoidance) Internal Models Self & Other (Social Comparison) Behaviors: Current State, Current Relationship

32 Dimensions: Anxiety & Avoidance Anxiety Varied by BD Subtype (Not Avoidance) Sx Polarity & Social Comparison (Internal Models) Depressive Decrease Self Compared to Other Manic Sx Increase Self Compared to Other No Direct Link BD Sx & Social Comparison

33 Attachment Behaviors & A.R.E. Behaviors as Attachment Cues Current State of Attachment Security A.R.E. You There for Me? Do I Matter? Accessibility: Availability Responsiveness: Ability to Soothe & Comfort Engagement: Emotional Presence

34 Negative Cycles of Conflict (BCR Tx) Rigid Patterns of Self-Reinforcing Behaviors Fueled by Attachment Fears & Longings Behaviors Perceptions DP NDP Secondary (Reactive) Emotions Primary (Attachment) Emotions

35 Distorted Perception & Attachment Cues DP NDP Bx Misinterpreted as Negative Cues NDP DP Bx Recognized as Sx Not Negative Cues DP Bx Misinterpreted as Negative Cues

36 My BCR Research

37 Procedure Cohabiting 1+ Years (M = 5.77) Adults: Age 19+ (M = 36) No Current SI or Hospitalization Past Month Separate Online & Anonymous Participation ID Codes to Match Partners for Analysis

38 BARE: Partner Perceptions of A.R.E. Accessibility: 1. My partner is rarely available to me. 2. It is hard for me to get my partners attention. Responsiveness: 3. My partner listens when I share my deepest feelings. 4. I am confident my partner reaches out to me. Engagement: 5. It is hard for my partner to confide in me. 6. My partner struggles to feel close & engaged in our relationship.

39 Measures Perceptions ARE Behaviors (BARE) Symptoms of Depression (HDI) DP Symptoms of Mania (ASMR) Dyadic Adjustment (DAS)

40 Dyadic Analysis Statistics Catching Up to MFT Field Assumes Reciprocal Dyad Relationships Matches Dyads for Analysis Relational Patterns Across Dyads, Population Trends Within Dyads: Actor & Partner Effects

41 Actor Partner Interdependence Model Diagnosed Partner Actor Effect Diagnosed Partner Non- Diagnosed Partner Partner Effects Actor Effect Systemic Effects Non- Diagnosed Partner Attachment Security & Depression Dyadic Adjustment

42 Diverse BCR Sample of 57 Dyads 61% Caucasian or White 79% Heterosexual or Straight 64% Bipolar I Subtype 39% Racial Minorities 21% LBGTQ 36% Other BD Subtypes 17% Black/AA, 14% Hispanic, 5% Asian, 1%, Native American, 1% Mixed 2% Lesbian, 12% Bisexual, 4% Gay, 4% Queer 18% BD-II, 5% BSD, 12% Unknown

43 Results APIM Model 60% DP 65% NDP Variance in Dyadic Adjustment

44 Summary of Primary Findings Systemic Partner Effects: BCRs Tx Population DP NDP ARE 2 **Partner Effect** DP ARE 3 NDP NDP ARE 1 DP HDI 5 **Partner Effect** DP HDI 4

45 Summary of Primary Findings BD Sx NOT Only Factor Relevant to DAS ARE Perceptions (Other s NOT Own) Add ARE to Prior Studies Dyadic Adjustment DP Depression (NOT NDP or Mania) Confirms Prior Trend

46 BCR Treatment Assessment & Clinical Considerations

47 Assess Role of BD Sx & Dx Presenting Problem Current Sx Severity (Risk) Interaction Btwn BD & BCR (Attachment) Hx Current Interactional Patterns Behaviors Perceptions Attachment Emotions (Masked by Secondary)

48 Prioritize Tx Focus Based on BD Role Acute Sx or Connection to Presenting Problem Increased Need for Initial Emphasis on IM Likely Limit Ability to Focus on Relational Needs Assess Potential Safety Risks (SI & High Risk Bx) Determine if Additional Tx Providers Indicated

49 Model Guides ARE Intervention (EFT) Create Corrective Emotional Experience Access & Reprocess Emotional Experience New Emotional Experiences Vehicle for Change New Emotion Turn to New Attachment Signals Secondary Change in Perception & Behavior

50 Safety Planning & Risk Safety Planning in Informed Consent Process Up to 56% Attempt Suicide (15x Risk) How Will Risk Be Assessed Therapist & Partner Action Plans Identify Outside Emergency Support Systems Natural & Professional Support

51 Psychoeducation Key for BD IM Understand Sx & Management Strategies Sx Reduced Even if Only NDPs Receive Common Language for Collaborative IM Agency Over BD Reduces Anxiety (Attachment)

52 NDP as Recovery Stakeholders How BD Currently Influences BCR: When she's angry, she has no love or mercy behind her actions or words Anything Else You Would Like to Share: Things get hard sometimes, we've come to acknowledge this and knowing about it has helped with bouncing back from a bad day. So far she's stuck by my side after some hard times between us. But she's stayed and showed her worth. So in return I've calmed down a lot and we seem to be improving. I love her and I'll do anything for her.

53 BD Illness Management (NDP Role) 1) Maintain Adequate Sleep 2) Monitor Triggers & Early Sx 3) Manage Stress & Activity 4) Social & Professional Support Natural Observers Problem Solving Partners A.R.E. Support if Security

54 Questions? Regina Bordieri, PsyD, LFMT BipolarCouples.com