Carl Z.

Abstract

The generic issue here is supporting this man’s efforts to manage the continual threats to his stability that his bipolar illness presented. By the age of 70, when he arrived at Pathways, he had already organized a rich work life and a rich family life; however, he had periodically jeopardized both by discontinuing his mood-stabilizing medication, as is common with patients having this illness. Outside of those periods, it did not interfere significantly with accomplishing his goals. Thus, his coming to understand his motives for undermining himself was an important issue. Fortunately, he accepted the role of capable family members as first-line observers of his behavior. As was true in different ways for all the other patients presented here, the psychiatrist’s own life experiences turned out to be useful both in establishing an alliance and in providing him some practical advice, when requested. His growing satisfaction with his continuing accomplishments and relationships emboldened him to try some new approaches in crucial situations that might have driven him to relapse in the past.