I am a registered nurse and have just realized the adverse effect my variances in energy and mood have had on my career. My family doctor sent me to a psychiatrist, who now won't see me because I owe her money and currently am unable to pay, even though I have insurance. I need alternatives in therapy, and direction. I am not now nor have I ever been suicidal. I have had one partial hospitalization, but was not diagnosed with Bipolar at that time.

Help, I want to turn my marriage around.

ANSWER: It is not your moods alone that cause disturbances in your relationships and achieving your goals. It is the behavior you engage in that damages your relationships and thwarts your personal goals. We all must learn how to nurture ourselves, and regulate our self-esteem. We learn patterns of behavior in childhood, including how to respond to our moods. Though medication may help adjust neurochemical imbalances, it will not help you learn new behavioral patterns or build deeper internal stability!

You are gaining insight and objectivity into the effect of your actions on others. And you are confronting the self sabotaging patterns of your behavior on your career. This newfound awareness means that you are ready to develop a psychotherapeutic relationship that can help you learn the internal soothing needed to allow you to change the ways you behave towards others that are self-destructive. You should not be on medication alone, without psychotherapy. The medication can help stabilize chemical imbalances, but you need a concurrent therapeutic relationship with a professional therapist with whom you can develop trust to further reflect and amplify your recent and valuable insights. You are on the edge of new growth. But you cannot do it alone!

Find a professional counselor you can trust. A licensed social worker, psychologist or other professionally licensed counselor (such as marriage and family in the state of California) who is trained in early childhood development and family systems would be a good choice. Interview them regarding their experience with depression, including bipolar disorder. Choose an experienced counselor who can address family and individual issues as they emerge. And one you feel to be a good "fit" for your personality. Couples' counseling will also be needed to help reinforce therapeutic goals at some point. Find a counselor who can refer you to a psychiatrist who is willing to consult regarding medication. To a large degree, psychiatrists are trained in pharmacology, but may lack the in-depth psychological training to reprogram behavior in a proactive and thorough manner necessary to turn around family patterns and relationships. Relatively few psychiatrists are trained in family systems theory, but may be quite knowledgeable about useful psychopharmacological interventions. Be sure the psychiatrist you choose supports psychotherapy. With the use of medication which can stabilize your neurochemical influences on moods, you may be in a position to quiet the noise inside, so that you can focus upon the behavioral changes you want to make in your therapy.

Through concerted effort, your situation can change. One example of such turnaround took place in my practice with a wife and her husband of 12 years. The husband expressed hopelessness over a long-standing but emotionally excruciating couples' pattern. He experienced deep pain when his wife used name calling to influence him during arguments. He had come from a family where no such words were ever exchanged, no matter how angry family members became with each other. She came from a family that commonly swore and used name calling whenever anger flared. She came to realize that his need for rules around conflict needed to include abstaining from calling names, as the effect on him was deeply damaging. But she could not simply change her behavior! Through individual psychotherapy she had been able to change this destructive behavior towards her children but had been unable to suppress this programming in the heat of discussions with her spouse.

It was ingrained in her neurological "wiring" that whenever anger coursed through her veins, expletives were released from her mouth! It was OK with Mom and Dad, so why not in her own marriage? Though she intellectually knew that she did not want to continue this behavior with her husband, she found it impossible to control when she was in a desperately angry and depressed mood.

Several attempts were made towards allowing her to reach out to her husband when she felt this desperation, rather than push away and isolate. With consistent effort, she was able to build strategies, such as taking a walk when she felt explosive, in order to clam down, reach out for help when she became calm, and notes on the refrigerator to remind her of the steps she could take to curtail destructive behavior and build in constructive discussion. She gradually learned to tolerate differences without exploding. And was able to clarify and express her needs much more effectively in the couples' relationship.

Relearning deeply ingrained behavior takes time and love. You need support to explore and then work through mood induced behavior that is destructive and self-sabotaging. Use the loving relationships you have to help you turn this dragon around. It is bigger than you, and you will need help to do so. But do not despair, you can make progress with the valuable insights you have already found. Our behavior is conditioned through our emotions. The only way to recondition ourselves is through this same emotional sphere. Healing relationships can help you turn this energy around. But like learning to ride a bicycle, you will have to fall down before you gradually achieve the automatic and unconscious control you desire.

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