Holding Down a Job—With Bipolar

I have a 23-year-old bipolar daughter who seems incapable of holding a job. She has had 16 jobs to date and has been fired from all of them. Is there anything I can do to help?

There may be many reasons why your daughter could be having trouble holding a job, and a diagnosis of bipolar disorder might give us a clue as to how to help her. Just like unipolar depression, bipolar disorder brings emotional and practical problems to overcome. I presume that she is currently under some professional care for medication, which stabilizes the emotional swings to a functional degree. Let's help her weave together a philosophy about bipolar depression that allows her to weather the emotional storms with minimal stress to herself.

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Many people with bipolar disorder hold down jobs—although they may suffer emotionally. Some also work very hard to monitor their thoughts and moods. People with bipolar use a type of thinking known as overgeneralization. Overgeneralizations are ideas that propound a form of thinking that is absolute and unrelenting—ideas that are fixed in either an overly negative, or overly grandiose direction. Thus, the person with bipolar may experience two distinct moods—very up or very down. This kind of thinking: "Poor me, I'm always left behind," or, "No one cares for me, therefore I'm worthless" keeps your daughter vulnerable, wounded, and hurt. It is hard to buck up against the onslaught of these negative ideas.

Appropriate medication and psychotherapy are a key part of treatment. And while the physiology of BPD requires stabilization, so do some of the over-generalizing thoughts that accompany episodes of upset. These include:

  • "This is too hard—I have no control."
  • "Poor me—I can't stand this unfairness."
  • "It's easier for me to escape then to stay and work this out."
  • "I need relief now—and if I don't see a way out there is none."
  • "I need constant reassurance of caring from others."
  • "Not feeling understood is intolerable."

Other triggers for episodes are seasonal changes, sleep disruption, and interpersonal conflict. As we seek to control the physiology—we also seek to control the psychology, the beliefs about her own self, others, the world, and the future.

A good approach would focus on managing your daughter's ideational triggers. By getting her to recognize the external and internal triggers for her upset, we can then focus on some goals:

  1. Accepting her condition of having an illness—and not to blame herself for having bipolar disorder. Having this emotional condition is largely chemical and physiological, with a cognitive component. She is not responsible for having this illness, but she is responsible for taking care of herself and treating it.
  2. Learn what helps her feel better—and to look forward to it, whether it be music, a movie, getting together with a trusted friend.
  3. Practice the coping statements that would counteract the overgeneralized ideation mentioned earlier. For example, she could practice reminding herself that although this is hard, she has weathered it before, and can learn to tolerate it better.

As her emotions stabilize with a combination of medication and good cognitive restructuring, her chances of enjoying her life more and more (and holding down a good job) improve dramatically.

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