Goal

The basic goal of Session 3 is to have patients learn about the biological nature of their disorder and, above all, to learn to distinguish between the “causal” concept of the disorder, which we always emphasize as biological- and the “triggering” concept, which can be either biological or environmental. This distinction plays a basic role in the way many patients handle the feelings of guilt they have about their disorder, given that they believe they are suffering from bipolar disorder because of some factor they are responsible for and that acted as a trigger; for example, the consumption of toxic substances, stress, or interrupted sleep.

Although Session 3 is considered as part of Unit 1 (Awareness of the Disorder), it also covers aspects relative to Unit 3 (Avoiding Substance Abuse, see p. 147). Working on the topic of attributions is particularly relevant in patients whose feelings can fluctuate between feeling guilty and feeling no responsibility at all. Making a special emphasis on the biological nature of the disorder can have an unwanted effect. It can lead patients to blame all of their behavior on their disorder and adopt an attitude ranging from victimism, learned helplessness, or “passiveness, ”depending on each patient's personality.

Procedure

• Although we are going to begin the session, like we always do, with an informal discussion and review questions that may have come up regarding the material and contents of Session 2, we should be cautious not to let the discussion carry on too long or fall into the trap of answering endless general questions about the disorder that patients might ask.

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