An Interview with Stephanie Greer
Expanding on my answer in #3 above by normalizing and validating that people living with bipolar disorder have all the typical dreams, wants, needs, challenges, and goals as everyone else, and then some! I want folks to understand that just because someone has bipolar disorder, it doesn’t preclude them from wanting and experiencing healthy and happy long-term relationships and/or families, career goals, and the need for meaningful purpose in their life.
Bipolar Disorder, a condition that affects millions around the world, not only impacts the individual diagnosed but also their surrounding family. It’s becoming increasingly clear that the journey towards mental wellness is not solely an individual pursuit but a collective one. Incorporating family perspectives and integrating a family approach in treatment methodologies can be pivotal in achieving holistic healing and stability. As a part of this interview series, I had the pleasure of interviewing Colleen King.
Colleen is a photojournalist turned psychotherapist who has been a mental health advocate for over 20 years. After receiving life-saving support for her own mental health needs, she went back to graduate school to become a licensed therapist specializing in supporting adults living with depression, anxiety, and bipolar disorder through trauma-informed approaches. She has a private practice serving adults online throughout California and in person in her Sacramento, CA office. Colleen enjoys spending time outdoors in nature, creating art, and being silly.
Thank you so much for joining us in this interview series! Before we start, our readers would love to “get to know you” a bit better. Can you tell us a bit about your background and your childhood backstory?
My twin siblings and I were raised by a single mother after my father died by suicide when I was six years old. My mother became my role model in overcoming adversity by pushing through painful struggles to achieve her goals, as she was determined to move us out of poverty and create stability. My mother’s persistence led to scholarships, awards, and an advanced degree from a prestigious university while raising three young children. My childhood observations of my mother’s survival mechanisms fostered my own methods of adapting to trauma by pursuing excellence and striving to fit in with my peers. As an adult, I learned that perfectionist expectations and abandoning myself to meet others’ needs lead to unhealthy relationships, anxiety, depression, and low self-worth, and I set out to foster a healthy relationship with myself through years of my own therapy.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
I have many favorite quotes that I try to live by with the theme of living in the present moment, even when it includes emotional distress, because it’s all we have. I have a daily practice I call mindful moments of microcosms of joy, where I seek out experiences that evoke curiosity, laughter, awe, entertainment, connection, and humility through small wonders like watching a bee snuggle into a flower’s pollen, or noticing the shapes of the clouds and changing light as they drift in front of the moon, or watching the antics of my pets, or enjoying a short interaction with a stranger while on a walk. These are small transitory experiences that I savor using mindful and somatic therapy techniques to embody the sensations, regulate my nervous system, and integrate the “good stuff.”
Let’s now shift to the main part of our discussion. Can you tell us a bit about your background and your professional career treating patients with bipolar disorder diagnoses?
I have close family members who live with bipolar disorder and so I became very familiar with how varied the symptoms and course of illness can be in different people. I’ve participated in many conferences, workshops, hearings, and trainings as an advocate, speaker, and clinician learning about and supporting treatment for serious mental illnesses including bipolar disorder. As my career progressed, I sought out trainings to address the spectrum of bipolar disorder symptoms that provide a holistic approach to treating and managing the illness while also focusing on improving self-worth and quality of life. I utilize multiple different therapeutic approaches including Interpersonal and Social Rhythm Therapy, Family-Focused Therapy, and of course several variations of Cognitive Behavioral Therapy including Mindfulness-Based Cognitive Therapy, Acceptance and Commitment Therapy, and Dialectical Behavioral Therapy. I also incorporate trauma-informed approaches including Mindful Self-Compassion, Brainspotting, and Somatic Therapy. I worked with youth and families with serious mental illnesses including bipolar disorder for over ten years in foster family agencies, public mental health, and community-based organizations before opening my private practice in 2015 specializing in supporting people living with bipolar disorder or other mood disorders.
When you work with patients, I understand that you often integrate family or friends into the treatment process. What do you consider the 3 primary benefits of including family?
The inclusion of family and friends in therapy helps build on existing relationships to enrich the connections that are important to everyone whether you have bipolar disorder or not, and fosters collaboration and encouragement to help maintain and sustain stability when challenges arise.
- Psychoeducation: Providing psychoeducation to my client and their family and/or friends helps increase understanding about the varied ways bipolar disorder symptoms may show up and what to do about it. Increasing confidence in recognizing the cues that may indicate depression, mania, or anxiety symptoms, the importance of circadian rhythm regulation, stress management, and developing and implementing coping skills through a holistic wellness plan gets everyone on the same page about their role and how to support their loved one. For example, understanding that bipolar depression may evoke irritability, lethargy, or apathy may help support people not personalize their loved one’s behaviors and offer support instead.
- Communication and understanding: Teaching and practicing communication skills helps increase understanding of each person’s expectations, needs, and limits and enables a more compassionate approach to treatment for each person present in the room. I facilitate conversations between my client and their support network to develop a wellness plan that includes identifying the cues or warning signs to a developing mood episode, a self-care routine based on circadian rhythm regulation, coping skills for symptom mitigation, and social and emotional fulfillment. I assist my clients in developing specific language or phrases that their support network can use to express observations of potential cues to emerging symptoms, or as a reminder of their self-care routines, or as a prompt to implement a coping skill for symptom reduction. Agreeing on verbiage ahead of time helps to reduce feelings of blame and/or shame, eradicate the need to “walk on eggshells,” and avoid unnecessary defensiveness or passive-aggressive communication styles.
- Belonging and Support: Including the family/friends of the person living with bipolar disorder provides an opportunity for me to learn about the quality of relationships, stressors, and problem-solving approaches in my client’s environment, which helps to form the direction of treatment goals. Having an informed and involved support network is crucial for long term stability because we’re human beings who need a sense of belonging. Feeling supported, loved, and important to others helps to create secure connections and stabilize overall well-being. When tension or conflict in relationships is a frequent and/or intense stressor, it can add to emotional dysregulation and mood. Creating routines and a mostly stable environment helps to reduce stress and increase stability.
What are some of the challenges you run into when working with families? How do you balance responding to the needs of the family with the needs of the patient?
Several of the biggest challenges are the differing communication styles, varied expectations and goals, and creating and respecting boundaries. I work to facilitate communication so each person’s perspective is acknowledged and understood. Identifying boundaries and naming them in session helps to make them overt and support effective communication during the session as well as outside the session at home. Often people have different needs or expectations of what they want to focus on in the therapy session or where/how they want change to occur, so I work to validate each person’s wants/needs while also ensuring the focus of the session is supporting my client to reach their goals. I provide community resources and educational material to family and friends, and often suggest they access their own therapy or support groups so they can address their stress, process their emotions, and get their needs away from their loved one.
Family dynamics can greatly vary depending on the sociocultural backgrounds of the individuals involved. How do you tailor your family approach to respect and incorporate different sociocultural perspectives and values?”
I work to enter each therapeutic relationship with cultural humility using an anti-racist, decolonization framework. I assume each client and their support network are the experts of their own lived experience and respect their beliefs and traditions. I work together with the client and their support system to create a treatment plan built on the foundation of their sociocultural lived experiences and perspectives, and work to educate myself so that I can be attuned to their needs.
Likewise, inter-generational dynamics can sometimes play a significant role in the therapy process. Can you share any insights or experiences on how inter-generational understanding and communication facilitate the healing process?
Yes, often there are multigenerational families and support networks that have different lived experiences and varied traditions and beliefs, and thus different communication styles and goals. I explore those multigenerational dynamics to understand and acknowledge the historical context of each person’s lived experiences and how it forms their perspectives. I facilitate communication amongst the members to assist each person with increasing their understanding of the roles, traditions, and values, and work to support collaboration across the generations.
Many mental health professionals don’t have training in working with families. How did you learn the techniques you use and what would you recommend to professionals that want to learn more about this approach?
I began my career working with children and their caregivers and so I learned early on how important it is to gain understanding of the family roles, rules, traditions, and expectations, and to facilitate effective communication within the constellation. I initially learned the typical Systemic Family Therapy approach and have since attended many specialized workshops and professional trainings geared toward increasing understanding of family dynamics and found Internal Family Systems, Family Focused Therapy, and Narrative Therapy models to be helpful.
Caring for a family member with bipolar disorder can sometimes be challenging and might lead to caregiver burnout. How does your approach incorporate strategies for self-care and support for family members who are involved in the caregiving process?
Part of my holistic approach to working with folks living with bipolar disorder is focusing on development of self-care routines, and I strongly encourage support people to also incorporate self-care strategies into their daily lives. It’s crucial for anyone in a caregiving role to take care of themselves first, and so I often refer support people to get their own needs met through support or therapy groups or individual therapy. We discuss what caregiver burnout looks like so people can recognize it, with the goal to prevent burnout and develop a healthy self-care routine that’s sustainable.
Preventive education is often seen as a powerful tool in managing bipolar disorder symptoms. How do you integrate education and awareness for family members within your family approach to treating bipolar disorder?
As I described above, psychoeducation is instrumental in a family approach to treating folks living with bipolar disorder. It can be stressful for all involved in a family treatment plan so part of what’s helpful is gathering information to increase the overall knowledge base about how bipolar disorder symptoms show up for their loved one, and the steps to take to mitigate symptoms and over time increase stability. Preventive education increases awareness and understanding, which inevitably reduces ambiguity and insecurities.
Thank you. Here is the main question of our interview. What are 5 things you wish more people knew about people navigating life with bipolar disorder?
1 . There is no one size fits all approach to understanding and supporting someone living with bipolar disorder. While the clinical diagnosis requires specific criteria be present over a particular course of time, bipolar disorder symptoms and mood episodes can manifest in wide-ranging manners. Become informed, open lines of communication, and seek out support instead of relying on assumptions based on mass media representations or stereotypes of bipolar disorder.
2 . Effective long-term management of bipolar disorder is best accomplished through a holistic framework rather than just focusing on medication management or therapy alone. A holistic approach includes psychoeducation, regulation of circadian rhythm, consistent therapy, support networks, effective coping skills, self-care routines, medications and/or supplements, meaningful social connections, and a sense of purpose that provides some fulfillment. Breaking down this holistic wellness plan into small, step by step tasks facilitates a shift from overwhelm that many people feel when first diagnosed, to an action plan that feels more attainable. For example, one step toward a self-care goal to create a sleep routine may be go to bed 15 minutes earlier than the previous night.
3 . People with bipolar disorder deserve to experience life without every emotion, action, or decision being pathologized. Oftentimes, people living with bipolar disorder become accustomed to perceiving themselves through the lens of the illness and tend to judge their emotions and actions as “bipolar” rather than typical life experiences. I want people to know they get to include themselves into greater humanity with all the complexity and messiness that shows up for every person simply because we’re all human. Part of my therapy with clients is helping them differentiate typical emotional responses and relational interactions from a cue that may indicate a larger pattern of symptoms or a shift toward a mood episode.
4 . Expanding on my answer in #3 above by normalizing and validating that people living with bipolar disorder have all the typical dreams, wants, needs, challenges, and goals as everyone else, and then some! I want folks to understand that just because someone has bipolar disorder, it doesn’t preclude them from wanting and experiencing healthy and happy long-term relationships and/or families, career goals, and the need for meaningful purpose in their life.
5 . People who are navigating life with bipolar disorder tend to be very self-critical while also working extra hard to manage all the ways the illness shows up in their life. Most of my clients living with bipolar disorder are usually doing the best they can to address typical adult responsibilities along with the myriad of concerns that are specific to chronic illness management. Patience, understanding, and encouragement are fundamental methods of support. Mindful Self-Compassion is a wonderful framework that can be immensely beneficial to support positive self-worth, reduce stress, and foster capacity to provide oneself with understanding and empathy.
There is a lot of misunderstanding when it comes to mental illnesses, especially involving psychosis. What do you wish more people were aware of either in the professional field or the general public?
Yes, there’s a great deal of stigma and misunderstanding about mental illnesses within the general public, especially when psychosis is present. And unfortunately, some mental health professionals don’t have the training to appropriately assess and treat people living with psychotic symptoms, which can cause further alienation or even harm. Additional training for mental health professionals would help to demystify the needs of people with psychosis, increase understanding and empathy for their experiences, and most likely lead to better treatment outcomes. Early intervention programs have been proven to be successful toward creation of a holistic long term treatment plan and can prevent deterioration or exacerbation of the course of illness.
Another important thing to understand about people experiencing psychosis is that it is usually deeply distressing and disorienting for the people who are experiencing it. Once people are in remission from experiencing delusions or hallucinations, they often have difficulty rectifying what they believed and experienced and integrating it into their identity.
I very much wish there was a great deal more invested in an extensive continuum of long-term treatment and care options. I’d like people to understand that best practice is to provide a range of choices for different levels of supportive care that spans the continuum of needs from inpatient hospitalization, intensive outpatient treatment, supportive housing, group supports for family and friends, and independent living with wraparound treatment.
We are very blessed that some very prominent names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US with whom you would love to have a private breakfast or lunch, and why? He or she might just see this if we tag them. 🙂
There are too many possibilities for me to choose just one person because I’d love to hang out with comedians like John Oliver and talk deeply about meaningful issues and then just laugh, or mind-blowing intellects like Neil deGrasse Tyson who have so much passion and awe for the universe, or an inspirational athlete like Simone Biles, who has been open about mental health and self-care, plus she’s the GOAT.
How can our readers further follow your work online?
Yes they can check out resources and articles on my website https://www.insightcounselingsacramento.com/
Instagram: https://www.instagram.com/bipolar_therapist/
Facebook: https://www.facebook.com/ColleenKingLMFT/
Thank you for your time and thoughtful answers. I know many people will gain so much from hearing this.
About The Interviewer: Stephanie Greer, PhD is the Co-founder and CEO of Akin Mental Health — a company dedicated to guiding families on their journey supporting a loved one with mental health challenges like bipolar disorder, schizophrenia and severe depression. Stephanie is passionate about this topic from her own personal experience growing up with a mother who struggled with bipolar 1 disorder and found a path forward to overcome the obstacles and live well. Stephanie’s professional experience includes a doctorate in neuroscience as well as design research roles at Hopelab and Apple. Stephanie brings this personal passion together with her world-class science and technology background to support families across the US in their personal journeys supporting loved ones with mental illness. To learn more about Akin Mental Health and join our community, visit us at akinmh.com.
Colleen King On The Benefits of Using a Family Approach for Treating Bipolar Disorder was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.