Humanistic Therapy  for Young Adults Diagnosed with Bipolar 1 Disorder

Introduction

As noted in the Diagnostic and Statistical Manual of Mental Disorders 5-TR Edition (5^th ed., Text Rev.; American Psychological Association [APA], 2022), bipolar disorder is diagnosed on a continuum ranging from cyclothymia to bipolar 1 disorder. Bipolar 1 disorder is a form of bipolar illness characterized by the manifestation of a manic episode that can co-occur with psychotic features. The recommended course of treatment is pharmacotherapy with psychoeducation (Geddes & Miklowitz, 2013).

Research on young adults with bipolar disorder 1 has focused primarily on age of onset, prevalence, and associated risk factors (Birmaher et al., 2020; Desai Boström et al., 2024; Vieta et al., 2018). Nothing has been written in recent years describing the unique and complex features associated with treating an initial manic-induced psychosis during this vulnerable time in development. This paper examines the humanistic treatment of young adults diagnosed with bipolar 1 disorder as an adjunct to pharmacotherapy.

A Humanistic Approach

One of the goals of humanistic therapy is to establish a collaborative working relationship between the client and the therapist (Guigno et al., 2017). For the humanistic therapist, the goal is to enter into and explore the subjective experience of the manic episode, how the client interprets it, and to identify and resolve the residual affective states that may have contributed to the episode and which have long colored the client’s foundational sense of self.

The author’s work with young bipolar adults suggests that the experience of mania with psychosis is an intimate and highly vulnerable life event that, even when resolved, can be difficult to integrate within one’s psychological system. The experience of a manic-induced psychosis represents a complete loss of self that may result in an intrapsychic terror fueled further by psychiatric hospitalization (Lu et al., 2017).

Upon initial approach, the still fragile young adult may be highly guarded and mistrustful of caregivers and treatment providers who insist that they accept the treatment plan. They may report feeling talked at by those unaware of the trauma associated with experiencing a psychosis. By engaging in a collaborative relationship, the humanistic therapist has the opportunity to maneuver safely into this vulnerable space, connect and create trust, emotionally stabilize and restore linearity of thought, facilitate self-agency, and allow for the reconstitution of oneself. Overly focusing on medication and symptom management, at this vulnerable time, may negate the individual’s buy-in to treatment and result in conflict with providers and family members. This may perpetuate further episodes of psychosis that require further hospitalizations.  

Lived-Experiential-Flow

So how does the psychotherapist navigate into and arrive at such vulnerable material when working with the young adults diagnosed with bipolar 1 disorder? Pica’s educative-experiential (EE) model (2025, September) discussed the establishment of a lived-experiential-flow between client and therapist. This flow is defined as a reciprocally lived or collaborative-based interaction between client and therapist from which therapeutic interventions are both framed and implemented. Implicit in the flow is a felt energy that activates and promotes movement into vulnerable affective material that may otherwise be more readily defended against. 

Activation into a lived-session flow makes for peak moments of clarity in a manner similar to that described by Csikszentmihalyi (1990). Absorbed in a moment of deep personal meaning, the client can more easily assimilate what they are processing without their normative defenses at work. This is important to consider with young adults diagnosed with bipolar 1 disorder, as they may enter treatment with a certain level of resistance or guardedness.

Establishment of the flow can make psychotherapy more tolerable for the client by making them feel part of the process. It has the potential to facilitate an openness to pharmacotherapy, education, and suggestions that run counter to a developmental window in which some young adults stay up late playing video games or interacting on social media and may socialize through substance use.

How Do We Create This Lived-Experiential-Flow?

Though a more thorough discussion of this topic is beyond the scope of this paper, the following suggestions should be considered to promote a lived-experiential-flow.

First, the therapist enters with a suspension and/or bracketing of presuppositions to enter cleanly into the client’s lived perceptual experience (see Giorgi, 1985). This creates a safe experiential space to allow for and hold the generation of powerful affects that may arise within the context of the therapeutic relationship.

Second, the therapist makes use of the technique known as clean language (Sullivan, 2009). This emphasis on words can promote an affective deepening into more vulnerable material that may be otherwise be difficult to access.

Third, the therapist makes natural use of humor. Humor has the power to connect and facilitate the psychotherapeutic process (Panichelli et al., 2018; Sarink & Garcia-Montes, 2023) but only when the therapist knows the client enough to introduce it in a manner that does not threaten or offend the client.

Fourth, the therapist introduces experiential exercises that are naturally implemented and engaged in concurrently by the client and the therapist. For example, the therapist might introduce a form of spatial referencing, progressive muscle relaxation, or breathing exercises in which they collaboratively engage. This has the potential to create energy, connection, and movement into more vulnerable affective material or perhaps evoke a mind/body connection with regard to feeling vulnerable and serve as a mode the client can use to manage when feeling vulnerable.

Fifth, the therapist makes use of relatable references. This creates another form of connection, particularly when humorous and/or of personal significance. For instance, the author worked with a college wrestler facing a seemingly insurmountable interpersonal conflict. The author noted, “It sounds like you’re trying to wrestle Triple H”.  The client laughed, which resulted in discussing his preoccupation with needing to feel validated, significant, understood, and accepted.

A final approach pertains to therapeutic disclosure. While therapists vary on the use of disclosure, when used in a timely and appropriate manner, it has the potential to foster an intimacy that can facilitate the lived-experiential flow (Wood, 2025).

Treatment Considerations

Bipolar 1 disorder in young adults can be difficult to treat. Stabilization may take time, even on medication, and may not be achieved during a relatively brief hospital stay. Resistance may remain high in the face of social, emotional, financial, occupational, and/or academic consequences that the young adult may perceive as embarrassing or stigmatizing. There is also the influence of caregivers who may be perceived as pushing an agenda, which can elicit further resistance toward accepting the diagnosis and treatment.

Young adults diagnosed with bipolar 1 disorder may make use of certain defense mechanisms in the form of denial, projection, and rationalization (Mrozowicz-Wronska, 2023). This may be in response to immense feelings of shame and embarrassment that, if not sufficiently defended against, could evoke a breakdown of the self. Coming to terms with posting they were an angel of God or a light worker here to shift the Earth’s vibrational frequencies can be a hard pill to swallow. Therapeutic feedback should be given as perspective or suggestive as a means to sustain engagement and avoid unhelpful power struggles and abrupt termination of treatment.

Given these considerations, a humanistic approach might prove a viable adjunct to pharmacotherapy and psychoeducation by talking with and not at the client, entering into the lived perceptual experience of the manic episode, working through the psychotic terror of psychosis, appreciating the existential crisis that precipitated the event, deepening affective processing, restoring self-agency, accepting the diagnosis, and committing to treatment.

Case Example

Consider the case of C as a means of integrating the above-mentioned concepts into treatment. C experienced his first manic episode (with a prior history of teenage depression) following a series of disappointments at college. He began isolating and smoking cannabis daily. He became convinced he was an apostle of Christ meant to heal his peers and lead the university to greatness. He approached a professor in a confrontational manner about ideas that would save the poor and propel him to become a billionaire via an AI matrix he developed. He next went to his pastor, who contacted his parents. He was taken home and hospitalized for one week.

C came to therapy three weeks after the initial episode. He was placed on an antipsychotic and mood stabilizer but was still relatively tangential in his thinking. He was sensitive about maintaining his psychological space. He projected his vulnerabilities onto his mother preferring to focus on her faults than his mental fragility.

C’s delusional process began to resolve under a higher dose of antipsychotic medication. However, it made him drowsy, and he refused to comply unless the dose was decreased to a more acceptable level.

A lived-experiential flow was created by bracketing presuppositions about his situation and letting him take the lead in telling his story (whether reality-based or not), argue against the diagnosis, and share aspects of his delusional thought on his terms. Gently, the author questioned some of his logic but never challenged it with respect to the purpose the delusions were serving him. Time was spent with his mother to educate and normalize his resistance. She was reminded that her young adult son was still living in a certain degree of terror.

Clean language was used to deepen movement into the lived-experiential-flow and process what happened at college. He discussed feeling overloaded by the media, which triggered what he referred to as “brain confusion”. Humor, sports-related analogies , and personally meaningful references were used to strengthen rapport and connect with the C’s lived experience. Eventually, he revealed he did not believe that he was adequate enough to make it in a difficult and expensive world.

Over time, C became curious about the biological basis of bipolar disorder, the problem with cannabis use as it relates to bipolar disorder, buying into structure, and avoiding material contributing to his “brain confusion”. In his case, it was the Bible and artificial intelligence. He collaboratively agreed to stop reading the Bible and working on his AI matrix, while acute symptoms were being stabilized.

C explored his grandiosity as a defense against profound feelings of inadequacy that colored his foundational sense of self. He explained he always knew he was different and described himself as an insecure and self-conscious boy.  He explored his overly anxious attachment style that had evolved early in his development and left him unsure of himself.

Despite developing an openness to treatment, C resisted acknowledging the shame associated with his episode as it pertained to friends and school. He insisted he had nothing to be ashamed of; yet he was avoiding his peers and contacting his professors. This delicate matter was addressed at his pace until he eventually discussed his shame-based reluctance about responding to a friend from school who reached out to him.

Eight months into treatment, C had developed a structured routine. He quit using cannabis, and his thoughts impressed as generally linear and without an active delusional process. He began to reclaim his self-agency and reconstitute himself as a person of significance.

Through collaborative engagement, C was able to lower his defenses and take in therapeutic feedback. At times, he insisted on existential debate, perhaps as a way to maintain his sense of agency. Sometimes, his thoughts became loose and tangential, but he was more quickly aware of it. He was more open to explore his “brain confusion” as a delusional process. At other times, he insisted that maybe he was not ever delusional. The author allowed him to express himself on the matter only to remind him that whatever the case, there was a “disruption in his thinking” and that he should continue to follow the course of treatment, which he did.  

Overall, C was able to maintain a commitment to his treatment. He was consistently reminded that his voice and independence were the most important aspects of his care and would always be respected by the therapist. This consideration of his personhood played perhaps the most pivotal role in keeping him actively invested in treatment.

Concluding Remarks

This paper introduced a humanistic psychotherapy model as an adjunct for treating young adults diagnosed with bipolar 1 disorder. The humanistic approach makes intuitive sense given the fragile nature of the young adult who just experienced the terror of psychosis and may feel completely vulnerable and exposed to others. Recommended forms of treatment such as pharmacotherapy and psychoeducation may be met with resistance, particularly following the initial manic episode. This may be due to caregivers and providers speaking outside the client’s lived perceptual experience at the time and what they need in a residual state of trauma. In a vulnerable and fragile mindset, they may respond by using defense mechanisms that minimize their behaviors and shift the blame onto others.

The need to protect what is left of their dignity may cause these individuals to refuse their diagnoses and invest fully in the recommended course of treatment. Unless they are able to safely process the event in a manner that is psychologically tolerable, speaks to their sense of personal significance, and helps begin to reconstitute their sense of self, treatment may remain stuck at a standstill. Or worse, the client may decompensate into further manic episodes resulting in hospitalization. This is why a collaborative humanistic engagement and connection plays such a pivotal role in treatment. As shown via the case example, the collaboratively engaged C examined, took part in, put words to, and consolidated his lived-experience of mania in a manner that spoke to him as a person of significance and moved toward a process of stabilization and recovery.