The table also illustrates that one of the first decisions you'll need to make is whether you need access to a medication approach. Should you start with psychotherapy
, or medications? We’ll look at medications and therapy in later chapters. At this stage you just need a sense of which you’d like to emphasize at first, in order to look for treatment. You can start with psychotherapy and then add an additional provider to do the medication part; or vice versa. If you get lucky and find a good psychiatrist or psychiatric nurse practitioner, you may be able to get both in one place.
If you’re just starting out to try to get some help with your symptoms, you may first need to focus on figuring out just where on the Mood
Spectrum you have been swimming
. Therapists may be better diagnosticians than primary care doctors. They have more mental health training. However, they cannot prescribe medications. Since they are only able to do therapy, sometimes there is a risk that they can’t “see” hypomania
very well. Remember the old adage “When all you have is a hammer, everything looks like a nail”? In the mental health business, when all you do is therapy, everything might look a bit more like plain depression
, as that is what most therapists are best trained to address (unless you find a therapist who has experience with one of the bipolar-specific psychotherapies).
Psychiatrists are generally trained to use both psychotherapy and medication approaches, and have a lot more experience with the Bipolar end of the Mood Spectrum. Theoretically they should be the best diagnosticians. However, in my experience, psychiatrists also have some of the strongest diagnostic biases of any of the providers listed in the table above. So starting elsewhere is not necessarily a huge set-back, in terms of diagnostic accuracy. As you hopefully already understand, you are one of the most important factors in diagnostic accuracy, through careful consideration of your personal history, and careful explanation of your history to whomever you see.