To be clear, not everyone simply swings back and forth between them. There are sometimes periods of relative normality or someone can live with depression for most of the time and have rare full blown manic phases. You can also have mixed phases in which there are symptoms of both mania and depression, which can be really tough.

So, bipolar depression is not necessarily a different issue; however, it’s important to pay attention to due to the fact that it exists within the context of bipolar. There can be roll over symptoms, or effects on someone’s life when they are coming off of a manic episode. There is also a much greater risk for substance abuse in individuals with bipolar and a great number of them have other issues like ADHD.

The reason drug companies talk about bipolar depression as if it’s a unique syndrome is because you don’t treat bipoloar depression with SSRIs – that can actually send them into a manic phase. Typically you would use mood stabilizers or antipsychotic medication, which is a whole different can of worms, but it basically serves to lessen the swings and bring things down to a more manageable state.

When approaching things therapeutically, you would certainly want to know whether someone suffers from major depression by itself or if they also have manic episodes as well because that would inform the techniques that you use. For instance, you want to work on establishing healthy consistency and rules for their behavior rather than continually pushing them to do more and more like you might do in depression, because in a manic phase they might overwork themselves or take your ideas way too far. You also have to acknowledge that in bipolar, depression is often influenced by the manic phase. They may be having reactionary sadness for poor decisions that they have made or things that they did to their body while manic.

It’s the same constellation of symptoms, but it’s just a different context.

Let’s answer an easy question first. The rules are different depending on where you life, but here in CA a psychologist is required to keep your records for 7 years after termination of therapy (or 7 years after you turn 18 if you are a minor).

You always have a right to your healthcare information. However, its important to know that there are generally two different kinds of notes that a psychologist will have – progress notes and process notes. Progress notes are the ones that go in your file or your online records system. Often times they are pretty minimal – the date, the length of session, broad topics discussed and techniques used, and other relevant diagnoses. Basically the minimum needed. Some people are more thorough, but that’s up to them. Everyone has a different style.

Now process notes are usually what would be kept in the psych’s little notebook or pad of paper. These are notes that nobody else ever has access to. It’s their own personal notes for their memory or their brain storming. They might write down quotes, ideas, questions for future sessions and things like that. These are generally not identifiable – most people will use aliases for their clients. Nothing you need to worry about being dug up or given out.

What would mainly be interesting to you would be any evaluations including the initial evaluation – that would have more detailed information that another healthcare provider could use. To request this, you would simply ask for a copy of your file, including any evaluations conducted. He might offer a summary if he thinks that would make more sense for you, but you have the right to your entire file if you really want it by law (again this is locally informed – check the laws for your area).

Now let’s get to your main question – how to break up with your therapist. There is not right or wrong way to do it. You could call or email and say I’d like to end our sessions together, please mail or fax a copy of my records, including any relevant assessments or evaluations. You could also do it in person. Most therapists or psychologists will offer you a final session to wrap things up. That’s up to you if you would like to go. They cannot hold your records hostage, though.

Now that that’s out of the way, let me talk a little bit about your experience. I’m sorry to say, friend.

You got a shitty old therapist.

It sounds like he comes from an old school psychoanalytic background stemming from Freud. That whole left and right hand writing things is a give away. This stems from ideas about bilateral stimulation and trying to integrate the parts of your brain – what most research ends up showing about things like this is it’s the other parts of the exercise that make a difference – not the techniques. For instance I already talked about EMDR which involves rapidly moving your eyes right to left while discussing your trauma – well it’s the repeated exposure to your trauma that makes a difference, not the eye movement.

We are all allowed to have our own style of therapy, within reason, but this is just so clearly not a good match. Match is really important and it’s 100% valid to want someone that you don’t have to explain every single thing about your modern life to.

The fact that he jumped to the question about your cycle rather than actually trying to understand the situation is frustrating and pisses me off. He’s not the one for you, so I support your decision to move on.

Please don’t let this spoil you, though. There are a lot of great therapists out there and sometimes it just takes some searching. I encourage you to use the tools that I mention in this post. You can browse through people that accept your insurance (if you have it) and look for someone that might be a better match. Your expectations matter. Don’t give up!

The advice that people give about dealing with this is inconsistent because it’s an uphill battle, but sometimes little tricks work. For instance, you could create a photo timeline for them; rather than just a picture of your grandmother, make a timeline of pictures with names and dates underneath starting from when they first started dating, through their marriage, and on until the present. This can sometimes help prompt them to remember; however, if they are advanced enough even this might not help.

It’s also important to realize that just because they may mix you up or not recognize you does not mean that they don’t care about you or that they are unhappy that you are there. Arguing with someone or trying to convince them of the truth often just causes agitation. What I would suggest is try to empathize and redirect.

Rather than pushing the issue, just say “Well okay, I’m sorry about that, but we are here now – could we maybe sit with you for a while. Would you like some water, maybe grandma could go get your some water while I wait with you?”

Try to identify with what they are feeling and focus your attention on that rather than the absolute truth of the situation.

No question about it, it’s tough and really hard to watch. This is why Alzheimer’s is such a difficult disease. This is something that often happens, and at a certain point there is no solution to it. I would encourage you to find the best ways of redirecting his attention. For instance, maybe there is some music from the time period around when they got married that you could play?

Your grandmother could say “You know what song I used to love? Listen… and then turn it on as a distraction.”

Again I’m sorry that this is happening, but trust me when I say that he is in a much better situation, even with this difficulty, because people that love him are involved with  his care. I see so many circumstances where that is not the case.

Just keep trying your best. There is no perfect answer.