Creating a Treatment Plan for Bipolar Disorder: What to Include + Example

Bipolar disorder is a serious mental health concern that is characterized by unusual shifts in mood, energy and activity levels, and concentration.  There are three types of bipolar disorder; bipolar I, bipolar II, and cyclothymic disorder. The key difference between these disorders is the presence of manic, hypomanic, and depressive episodes and their varying severities.

While researchers have not yet narrowed down the exact cause of bipolar, they have identified factors that are believed to influence the development of bipolar disorder, including differences in brain structure, and having a first-degree family member who has bipolar disorder. Similar to other mental health disorders, bipolar is an individualized and complex mental health condition, that develops and affects each person differently.

The National Institute of Mental Health explains that approximately 2.8% of the adult population in the United States were living with bipolar disorder within the last year, with rates about equal for men and women.  4.4% of the population will experience bipolar disorder at some point during their life. Research has shown that the highest prevalence of bipolar disorder falls in individuals between the ages of 18 and 29, and declines with age. Of those who experience bipolar disorder, over 80% experience serious impairment from their symptoms, and 17% experience moderate impairment. These are important details to be mindful of when developing a treatment plan because individuals who are experiencing manic or depressive episodes may require hospitalization for crisis stabilization services.

Individuals who are experiencing severe symptoms from bipolar disorder can have several areas of their lives affected, including their relationships, career or schooling, physical health, finances, self-esteem, and legal concerns. The treatment options for bipolar disorder often include a combination of psychotherapy, education, and medications.

Common therapies that are used to treat bipolar disorder include cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), and interpersonal and social rhythm therapy (IPSRT). Education is also an important component of treatment because it helps individuals learn about bipolar disorder, which can be an empowering experience that allows clients to learn to manage their symptoms more effectively.

Medications that are used in the treatment of bipolar disorder include mood stabilizers, antipsychotics, antidepressants, and in some cases, benzodiazepines on a short-term basis. Medications are used to stabilize a person’s mood, alleviate specific symptoms associated with mania and depression, and reduce the recurrence of episodes, all of which work together cohesively to improve a client’s overall quality of life.

Setting Goals and Objectives With Clients in Your Treatment Plan for Bipolar Disorder

The first step in developing your bipolar disorder treatment plan will be to determine which level of care would be appropriate for your client. In some situations, this has already been decided, and you are meeting with a client who has had some form of an assessment already. As an example, it is common for someone experiencing a manic episode to be hospitalized. This would include symptoms of psychosis, severe impulsivity, engaging in risky behaviors, extreme agitation and aggression, severe insomnia, loss of insight, and self-harm or suicidal behaviors. In these cases, crisis support services are needed before any other treatment.

If you encounter a client whose diagnosis is not as obvious, there are several tools that you could use in your assessment to gather needed information. This includes:

  • A clinical interview
  • Mood disorder questionnaires, including Mood Disorder Questionnaire (MDQ), Bipolar Spectrum Diagnostic Scale (BSDS)
  • Structured Clinical Interview for DSM-5 (SCID-5) or Schedule for Affective Disorders and Schizophrenia (SADS)
  • Psychological and Neuropsychological Testing

Your evaluation will likely explore your client’s history of mental health concerns, including bipolar-related symptoms and concerns. Bipolar disorder can be treated in an inpatient or outpatient treatment program, which would be determined by the severity of a client’s symptoms, their level of functioning, and their access to appropriate resources. Individuals living with bipolar disorder may experience recurrent episodes of mania or depression, which means that they may already be working with a prescribing physician or other healthcare provider, which would require care coordination and communication for comprehensive care. Once you have completed your assessment, and determined that your treatment program would be an appropriate fit for your client, you can begin developing your treatment plan goals for a bipolar disorder treatment plan.

What to Include in a Treatment Plan for Bipolar Disorder + Sample

When you are ready to begin crafting your bipolar treatment plan, it is important that you use a comprehensive and detailed treatment plan form. This is important because it can provide you with more opportunities to include client-specific information so that your treatment plan can easily be referenced for guidance. TherapyByPro is a great resource for clinicians looking for handouts, worksheets, treatment plans, and other forms that can be used in sessions. For the sake of this exercise, we will be following the TherapyByPro customizable treatment plan to walk through a step-by-step example of developing an effective treatment plan.

Example for John:

John Smith, a 28-year-old software engineer, arrived for his intake appointment at an inpatient clinic with escalating mood swings during his appointment. He expresses concerns about the increasing frequency and intensity of these mood fluctuations over the past year, and described periods of heightened energy, impulsivity, and irritability, followed by profound sadness, hopelessness, and fatigue. Other symptoms that he discussed were having a rapid flow of thoughts that made it challenging for him to focus and concentrate. He recognizes that these mood swings are affecting his work performance, relationships, and overall quality of life. John reports no known family history of mood disorders and denies any history of substance abuse or significant medical conditions. He recalls occasional mood fluctuations beginning in adolescence but notes nothing as severe or with the same frequency as he has had in the past year. During manic episodes, John describes feeling euphoric and invincible, engaging in impulsive behaviors such as excessive spending, risky investments, and gambling. He becomes easily agitated and exhibits signs of irritability. Despite sleeping only a few hours per night during manic phases, John reports feeling invigorated and energetic. Conversely, during depressive episodes, he feels overwhelmed by feelings of sadness, worthlessness, and despair. John experiences persistent fatigue, struggles with concentration and decision-making, and admits to occasional thoughts of death and suicide. He endorsed having changes in his appetite as well. His motivation for coming in for help was his wife voicing concern about his mood shifts, and being worried that he would experience another period of being “up” and engaging in risky behaviors.

Agencies Involved and Plans for Care Coordination

While John is in an inpatient program, he will be working with the prescribing physician on staff. This information would be explained to John during his intake. This treatment plan template identified providers working in a different agency, which John does not currently do. Upon discharge, you may need to help him find a local physician who can continue providing him with medication management services.

Example for John:

Other Agency: None at this time

Plan to Coordinate: None

Clinical Diagnoses

John’s symptoms indicate that he is living with bipolar I disorder. His specific symptoms that align with the DSM-5 criteria include:

Manic Episodes:

  • Elevated Mood: John describes feeling euphoric and invincible during manic episodes, with an exaggerated sense of confidence and optimism.
  • Increased Activity: He engages in impulsive behaviors, such as excessive spending, risky investments, and gambling.
  • Irritability: John becomes easily agitated and snaps at others over minor issues.
  • Decreased Need for Sleep: He reports sleeping only a few hours per night during manic phases, without feeling fatigued.
  • Racing Thoughts: He experiences a rapid stream of thoughts, making it difficult to concentrate or focus on tasks.
  • Impulsivity: John engages in reckless behaviors, such as driving recklessly and engaging in promiscuous sexual encounters.

Depressive Episodes:

  • Depressed Mood: John feels overwhelmed by feelings of sadness, worthlessness, and despair during depressive episodes.
  • Fatigue: John experiences persistent fatigue, even after sleeping for extended periods.
  • Cognitive Impairment: He struggles with concentration, memory, and decision-making.
  • Appetite Changes: John experiences fluctuations in appetite, ranging from overeating to having no appetite.
  • Suicidal Ideation: He admits to having fleeting thoughts of death and sometimes considers suicide as a means of escaping his emotional pain.

Example for John:

Clinical Diagnosis: Bipolar disorder, current episode manic   F31.0

Supporting Assessments: Young Mania Rating Scale (YMRS), Score of 30

Hamilton Depression Rating Scale (HAM-D), Score of 24

Current Medications and Responses

Since you are working in an inpatient program, you will likely be working closely with the prescribing doctor within your program. This can help you understand John’s current medication regimen, and what changes would occur for long-term support regarding the management of his bipolar symptoms.

Example for John:

Medications:

  • Lithium Carbonate X mg, X times per day
  • Olanzapine X mg, X times per day
  • Depakote X mg, X times per day
  • Clonazepam X mg, X times per day

Presenting Problem and Related Symptoms

The presenting problem of your treatment plan should be detailed enough to provide a reader with a glimpse into John’s concerns, diagnosis, and current needs. This can be a valuable resource for members of a clinical team within an inpatient treatment program so that multidisciplinary team members are all on the same page.

Example for John:

John Smith, a 28-year-old software engineer, was diagnosed with Bipolar I Disorder based on his presentation during the intake appointment. He exhibits escalating mood swings, characterized by manic episodes of heightened energy, impulsivity, and irritability, often leading to reckless behaviors such as excessive spending and gambling. During these manic phases, John experiences inflated self-esteem and a decreased need for sleep, engaging in multiple projects simultaneously with rapid speech and racing thoughts. Conversely, he also endures depressive episodes marked by profound sadness, hopelessness, and fatigue, losing interest in previously enjoyable activities and struggling with concentration and decision-making. These mood fluctuations significantly impair his occupational functioning, as John finds it challenging to maintain focus and productivity during manic phases, while depressive episodes leave him feeling overwhelmed and unmotivated.

John’s relationships also suffer as a result of his bipolar symptoms, with his mood swings causing strain and misunderstanding among family members, friends, and colleagues. Despite his efforts to manage his symptoms, John experiences substantial distress and impairment in various aspects of his life, including work performance, social interactions, and overall well-being. Consequently, a comprehensive treatment plan, including pharmacotherapy to stabilize his mood and psychotherapy to address underlying emotional issues, is warranted to help John manage his mood instability and improve his overall quality of life.

Goals and Objectives

Your goals and objectives will be unique to John and his symptoms. Objectives can be viewed as short-term, or smaller goals, that work together to achieve a larger, or long-term goal. When developing John’s goals, it is important to be mindful and realistic about his abilities and the time frame being given for his goals. You’ll want to include details in this section so that it can be used as a reference down the road.

Examples for John:

Goal 1: Stabilize Mood Swings

  • Objective 1: Reduce the frequency and severity of manic episodes by implementing early intervention strategies, such as mood tracking and relaxation techniques, to recognize and manage symptoms at the onset.
  • Objective 2: Enhance emotion regulation skills during manic episodes by incorporating mindfulness techniques and distress tolerance skills from Dialectical Behavior Therapy (DBT) to manage intense emotions effectively.
  • Objective 3: Challenge cognitive distortions associated with grandiosity and impulsivity during manic episodes through cognitive restructuring exercises aimed at promoting more balanced and realistic thinking patterns.

Goal 2: Improve Coping Skills for Depressive Episodes

  • Objective 1: Increase engagement in pleasurable activities and social support networks during depressive episodes using behavioral activation techniques, including activity scheduling and graded task assignments.
  • Objective 2: Address negative self-beliefs and feelings of worthlessness during depressive episodes through cognitive restructuring exercises aimed at replacing negative self-talk with more compassionate and realistic self-statements.
  • Objective 3: Develop problem-solving skills to address practical challenges and reduce stressors contributing to depressive symptoms using problem-solving therapy, involving a structured approach to problem-solving and stress reduction.

Goal 3: Enhance Interpersonal Functioning

  • Objective 1: Improve communication and conflict resolution skills in interpersonal relationships through communication skills training, focusing on assertiveness techniques, active listening, and empathic responding.
  • Objective 2: Address maladaptive relationship patterns and expectations contributing to relationship difficulties by exploring interpersonal issues and attachment patterns in interpersonal psychotherapy (IPT).
  • Objective 3: Develop a social support network and reduce social isolation through social skills training, including role-playing and behavior rehearsal, to improve social skills and build confidence in initiating and maintaining social connections.

Specific Interventions to Be Used

The therapeutic interventions that you use should be incorporated into your objectives to help you work towards your client’s goals. You’ll want to use evidence-based approaches to ensure that your client is receiving the best care. This treatment plan template allows you to indicate who is responsible for the specific intervention, which can be used as a reference for yourself, and for homework assignments for your client.

Example for John:

  • Intervention/Action: Complete a mood tracking sheet to begin learning signs of mood fluctuations
  • Responsible Person: John
  • Intervention/Action: Use psychoeducation to introduce the use of mindfulness techniques and distress tolerance skills to cope with emotional and psychological distress
  • Responsible Person: Counselor A
  • Intervention/Action: Use behavioral activation techniques, such as activity scheduling, to improve coping skills for depressive symptoms
  • Responsible Person: John
  • Intervention/Action: Communication skills training including assertiveness techniques, active listening, and empathetic responding to improve interpersonal relationships
  • Responsible Person: Counselor A
  • Intervention/Action: Social skills training, such as behavioral rehearsal and role-playing, to help improve interpersonal functioning
  • Responsible Person: Counselor A and John

Family Involvement

Family involvement for John could be beneficial in a few ways. One of which would be that educational sessions may help his wife gain a more in-depth insight into bipolar disorder, the signs, and symptoms associated with manic and depressive episodes, and learn how to support him with his mental health. Family therapy can be helpful as well by providing a safe place for them to come together and work through some of the challenges that they have experienced within their relationship. It is, of course, up to the client with what he is comfortable including his wife in for his treatment.

Example for John:

Psychoeducational and joint therapy sessions with his wife to promote social support

Additional Services and Interventions

In John’s case, an example of an additional service would be continued medication management services with his prescribing physician. Medications used to treat bipolar disorder are used on a long-term basis, to reduce the severity of and decrease the frequency of recurrent mood episodes. Support groups may also be a good recommendation for him because they can provide a sense of validation and support regarding his mental health concerns and related experiences. 

Example for John:

Additional Services:

  • Continued medication management services
  • Support Group for those living with bipolar disorder

Estimation for Completion

In this scenario, John is being treated in an inpatient psychiatric setting for a manic episode. The focus of his treatment is clinical stabilization so that he can reach a place where his symptoms are stable, and he can participate in outpatient treatment options. Inpatient programs for mania are dependent on the severity of his symptoms, and his response to medications, which can last anywhere from one to two weeks.

Example for John:

Two weeks of inpatient psychiatric care including medication management, psychoeducation, and supportive counseling services to help him achieve stabilization. Adjust as needed to ensure safety and low risk at the time of discharge.

Aftercare Plans

The aftercare plans for John are important because he will need to have continued support to maintain optimal wellness at home. This should include medication management and psychotherapy on an outpatient treatment basis. To promote engagement, the location of the treatment provider should be thoughtful, ensuring that distance does not become a barrier to treatment. Additionally, providing him with direct referrals, and even scheduling his intake appointments can be an added layer of security knowing that he is already linked up with appropriate treatment providers.

Example for John:

  • Medication management with Dr. X, at the [insert name of practice]
  • Outpatient counseling and therapy services with Clinician X at [insert practice or facility]
  • Continued engagement in bipolar disorder support group
  • Continued engagement in family counseling services

Final Thoughts On Creating a Treatment Plan for Bipolar Disorder

A well-structured bipolar treatment plan is crucial for managing the complexities of bipolar disorder. It can provide both the clinician and the client with a roadmap for stabilizing mood swings, preventing relapses, and improving overall quality of life. Effective treatment plans typically combine medication, therapy, lifestyle changes, and support systems to address both manic and depressive episodes. By adhering to a comprehensive treatment plan, individuals can achieve better mood regulation, enhanced functioning, and a more stable and fulfilling life.

TherapyByPro is a valuable resource for mental health professionals that offers various mental health therapy worksheets that can be incorporated into your sessions. Examples of worksheets that may be helpful with clients who are living with bipolar disorder include:

TherapyByPro is an online mental health directory that connects mental health pros with clients in need. If you’re a mental health professional, you can Join our community and add your practice listing here. We have assessments, practice forms, and worksheet templates mental health professionals can use to streamline their practice. View all of our mental health worksheets here.

Resources:

Kayla Loibl, MA, LMHC
Author: Kayla Loibl, MA, LMHC

Kayla is a Mental Health Counselor who earned her degree from Niagara University in Lewiston, New York. She has provided psychotherapy in a residential treatment program and an outpatient addiction treatment facility in New York as well as an inpatient addiction rehab in Ontario, Canada. She has experience working with individuals living with a variety of mental health concerns including depression, anxiety, bipolar disorder, borderline personality disorder, and trauma.

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