How do you help a bipolar I patient to explain how they are feeling to you?

If someone is currently, acutely severely manic, then it is unlikely to be an easy dialogue. You may be working motivate the person to engage in therapy. Creating an accepting space in the interview, tolerant and not rejecting of a currently agitated situation, can help access what is often the irritability and the distress underpinning the excitability through being a calm, containing presence.

There is also the issue of long-term management and prevention of recurrence and relapse in people who may be in remission. You may want to explore with them the precipitants, their trajectory, and their relapse signature. You may want to think about a previous episode with them, and the first things they noticed that might have indicated something was wrong. I think that requires a certain calmness and presence.

The particular field that I work in is mindfulness-based interventions. There is increasing evidence favouring the idea that mindfulness training can help therapists be more accurately empathetic. One may encounter patients who meditate. In Australia, for instance, something like 30% of women in their middle years have some kind of regular meditation or yoga practice. A therapist can ask a patient who practices mindfulness, ‘What happens if you try to meditate, is something different about how your thoughts are going?’ For some people, an early warning sign might be a change in the quality of their meditative experience.

We recently did a study which gave us some pilot data suggesting that mindfulness-based cognitive therapy is useful in reducing the recurrence of depression in mania. It’s still early days for the use of mindfulness in bipolar I disorder.