A relative of mine, recently diagnosed with bipolar disorder, has been displaying disorganized thinking, exercising poor judgment without knowing it, overstepping boundaries, with hyper-religiosity. She does not see these things, but her loved ones do. I want to let her know our observations so she can get the right help. How do I gently tell her this without upsetting or alienating her?

These conversations can certainly be challenging. Despite what you see on television, dramatic confrontations or “interventions” are often not at all helpful. It’s usually best to start with a calm and non-confrontational one-on-one conversation. Some general advice about how to make those conversations more effective:

Pick the right time. You may feel the most urgent need to have this conversation right after something upsetting has happened, like an argument or confrontation. But those can be the most difficult times for people to feel safe and understood. Try to pick a calmer time when things are going relatively well—when you are feeling more connected or in agreement about things. It’s natural to want to fix the roof when it’s raining, but it’s safer and easier when the sun is out.

Describe, rather than label. Try to express your concern about specific things you notice without using diagnostic labels (like “manic”) or inflammatory terms (like “out of control”). Instead, try using “I” statements to describe what you see: “I notice that you’re talking faster than usual” OR “I notice that you’re only sleeping a few hours at night.” If you use any labels, be sure to allow that you might be wrong: “Last time you were talking fast like this, it turned out that you were getting manic. Could that be happening again?”

Find common ground. Is something happening that both of you can identify as a problem? You may be most concerned about your relative’s over-spending, but she may care most about not being able to sleep. Try to understand what she is most bothered by, even if it is not your highest priority.

Avoid threats and “I told you so.”  If you are upset or frightened, it’s natural to want to say things like “If you don’t get help, then (fill in terrible disaster of your choice)!” The only thing less helpful is to say, “Didn’t I tell you this would happen if you didn’t get help?” If your relative is not seeing some problems that you are seeing, then fear or humiliation will not make it easier for her to see them.

Offer to help. Instead of saying, “You’d better get in to see your doctor right away!” it’s usually more helpful to say something like “How could I help you to check in with your doctor?” Offering and asking often works better than telling.

About the Doc

About the Doc

Greg Simon, MD, MPH, is a psychiatrist and researcher at  Kaiser Permanente Washington Health Research Institute in Seattle. His research focuses on improving the quality and availability of mental health services for people living with mood disorders, and he has a specific interest in activating consumers to expect and demand more effective mental health care.