# Therapy for bipolar disorder: what it adds, what it involves and how to choose > Medication is a must, but it is not the whole story. What psychological therapy adds in bipolar disorder, which approaches work and how to choose a professional. *https://mypsicotest.com/en/blog/therapy-for-bipolar-disorder/ · Published: 2026-10-21 · 9 min read · MyPsicoTest team* You were diagnosed a few months ago. Your psychiatrist has adjusted your medication and, at last, you have been stable for weeks. But you still have questions that do not always fit into those appointments: how to tell if another episode is coming, what to do about sleep, how to talk about it with your partner, or what to do with the guilt about what happened during your last high. That is what **therapy for bipolar disorder** is for. It does not replace medication, but psychological therapy is the other pillar of treatment and it has good studies behind it. This guide explains when to see a psychologist, which therapies work, what therapy looks like from the inside, how long it takes, whether it works online and how to choose a professional. ## When to see a psychologist for bipolar disorder According to the [NHS](https://www.nhs.uk/mental-health/conditions/bipolar-disorder/), **bipolar disorder** is a mental health condition with extreme mood changes: highs (mania or hypomania) and lows (depression) that usually last a few days or weeks, with stable periods in between that can last weeks, months or years. The World Health Organization estimates that 36 million people worldwide had it in 2023 and points out that it increases the risk of suicide. The order matters. Diagnosis is made by a psychiatrist, who also prescribes medication, and the NHS warns that it can take time because the symptoms are similar to those of other conditions. After that, NICE, the body that issues clinical guidance in England, recommends offering a psychological intervention designed for bipolar disorder in two situations: to prevent relapse and when some symptoms persist between episodes. It also recommends one for bipolar depression. It is worth booking an appointment with a psychologist if: - You have recently been diagnosed and want to understand what is happening and how to manage it. - You have had relapses even though you take your medication. - Between episodes you still have low mood, anxiety or sleep problems. - Bipolar depression is what weighs on you most. - The condition has left its mark on your relationship, your family, your work or your finances. - You find it hard to keep regular hours, or alcohol and other substances are tangled up with your episodes. If you do not have a diagnosis yet and wonder whether your ups and downs are something more, the MyPsicoTest [Bipolar Disorder Test](https://mypsicotest.com/en/bipolar-disorder-test/) goes through, in 16 questions, the periods of euphoria, irritability, little sleep or low mood you may have had over your life. It does not diagnose, but it helps you put what you have been through in order before an appointment. If your mood changes last hours rather than days, [Sudden mood swings: why they happen and when they are something more](https://mypsicotest.com/en/blog/sudden-mood-swings/) will guide you better, and if they are milder ups and downs that keep coming back over years, see [Cyclothymia: what it is, symptoms and how it differs from bipolar disorder](https://mypsicotest.com/en/blog/cyclothymia-symptoms/). If thoughts of harming yourself appear during a low, do not wait: call the **024 line** in Spain (free, confidential, around the clock), **112**, or your local emergency number. And with mania or severe depression, or if there is a risk to you or to others, NICE calls for an urgent mental health assessment, not a psychology appointment. ## Which treatment works for bipolar disorder Treatment combines two parts: **medication** to stabilise mood, prescribed and monitored by a psychiatrist, and **psychological therapy**. That is how the NHS sums it up, mentioning cognitive behavioural therapy, and the WHO, which lists psychoeducation, strengthening social functioning and medicines. NICE asks for the psychological intervention to be structured, delivered individually, in a group or with the family, and to follow an evidence-based manual. If you live with your family or are in close contact with them, it also recommends a family intervention. The evidence that it works is solid. In Barcelona, the team led by Colom and Vieta at the Bipolar Disorders Programme of the Hospital Clínic compared 21 sessions of **group psychoeducation** with 21 unstructured group meetings in 120 stable patients who were already on medication. Psychoeducation reduced relapses and hospital admissions. In a [five-year follow-up published in the *British Journal of Psychiatry*](https://pubmed.ncbi.nlm.nih.gov/19252157/), the psychoeducation group had had an average of 3.86 relapses compared with 8.37, and 154 days of acute illness compared with 586. A [meta-analysis by Miklowitz and colleagues](https://pubmed.ncbi.nlm.nih.gov/33052390/) in *JAMA Psychiatry*, covering 39 trials and 3,863 participants, confirmed that manual-based therapies added to medication were associated with fewer relapses than control treatments. Psychoeducation with guided practice of illness management skills worked better in a group or family format than in individual sessions, and cognitive behavioural therapy helped stabilise depressive symptoms. The authors urge caution because the studies were very different from one another. ![Group of people sitting in a circle during a group therapy session, as in group psychoeducation for bipolar disorder](https://mypsicotest.com/assets/img/blog-psicoeducacion-grupo-trastorno-bipolar-1200.webp) ### What therapy for bipolar disorder looks like from the inside NICE sets out what an intervention to prevent relapse should include, and the programmes with evidence behind them share these elements: 1. **Understanding the condition:** what it is, how it shows up in your case and what role medication and habits play. 2. **Tracking your mood, sleep and energy**, to see patterns before they turn into an episode. 3. **Spotting your warning signs.** Everyone has their own: sleeping less without feeling tired, talking more or spending more than usual before a high; losing interest or avoiding people before a low. Colom's team found that psychoeducation prevented relapses even in patients who took their medication exactly as prescribed, and suggested that its effect rests on three legs: regular habits, spotting those signs early so you can act quickly, and sticking with treatment. 4. **Looking after your rhythms:** regular times for sleep, meals and activity. In a trial by Frank and colleagues of 175 people with bipolar I disorder, interpersonal and social rhythm therapy lengthened the time without new episodes, and those who made their routines more regular had fewer relapses. 5. **Preparing a plan** for when the signs appear: who to tell, what to do and what to avoid. 6. **Working on depression and on what the last episode left behind:** guilt, shame, conflict, debts or the feeling of having lost control. 7. **Involving your family**, if you want to, so they can recognise the signs and know how to help without becoming a watchdog. ### What about medication? Medication is decided and adjusted by a psychiatrist; the psychologist does not prescribe it. NICE recommends lithium as the first-line long-term treatment, explains that it is the most effective at preventing relapse and asks for regular blood tests to check its levels. The NHS stresses not stopping medication without medical advice even if you feel better, and talking to your doctor if you are pregnant or planning a pregnancy, because some medicines are not safe in pregnancy. Therapy helps you live with treatment, not replace it. ## How long therapy for bipolar disorder takes It depends on where you are and what you want to work on. The Hospital Clínic psychoeducation programme had 21 weekly group sessions, close to six months, and its effects were still noticeable five years later. For bipolar depression, NICE suggests that once symptoms have eased, continuing psychological treatment for a further three to six months should be considered and then reviewed. Because bipolar disorder cannot be cured but can be managed, it makes sense to plan therapy in stages: a more intensive phase at first and less frequent check-ins once you are stable. ## Does online therapy work for bipolar disorder? Here the evidence is still limited. A review from the same Bipolar Disorders Programme at the Hospital Clínic, by Hidalgo-Mazzei and colleagues, looked at 12 projects offering psychological interventions over the internet and concluded that there was not enough evidence to draw firm conclusions about their efficacy, although people stuck with them and completed them well. Later, a trial of 304 adults found that an online psychoeducation programme, MoodSwings 2.0, reduced depressive symptoms somewhat compared with a support forum. Video sessions with a psychologist are a different thing: they make it possible to keep treatment going without travelling, especially in stable phases. What they do not replace is urgent, in-person care during mania or severe depression. If you have never had therapy by video call, [Online psychologist: how to choose well and what to expect from video-call therapy](https://mypsicotest.com/en/blog/online-psychologist-how-to-choose/) may help. ## How to choose a psychologist for bipolar disorder These checks help you get it right: - **Registration as a health professional.** This comes first. - **Training and experience in bipolar disorder.** NICE specifically asks for this from therapists who treat bipolar depression. - **A structured approach:** psychoeducation, cognitive behavioural therapy, family therapy or social rhythm therapy, with clear goals. - **Coordination with your psychiatrist.** Treatment is a team effort. - **A relapse prevention plan** worked out with you and written down. - **The option of involving your family or partner**, if you wish. - **Flexibility:** online sessions in stable phases and in-person ones when needed. ## A psychologist for bipolar disorder At MyPsicoTest we recommend [Xènia Capel Salcedo](https://psicologaigualada.es/en/therapist-psychologist-igualada/), a licensed clinical psychologist (COPC 14982) with a master's degree in Clinical Psychology and Psychotherapy. She sees clients in Igualada and Sant Sadurní d'Anoia and also through [online therapy](https://psicologaigualada.es/en/online-therapy-online-therapist/), and on her blog she has written an article about bipolar disorder. In it she explains that treatment is always combined, with medication prescribed by a psychiatrist and psychotherapy, and that her role is the psychological part: she works in coordination with each client's psychiatrist, using psychoeducation, cognitive behavioural therapy and emotional regulation techniques tailored to each case, and keeps EMDR for people carrying trauma, always in stable phases. She offers online therapy for stable phases or remote follow-up. She works from an integrative, evidence-based approach: on her website she explains that she uses tools from cognitive behavioural therapy, EMDR, systemic therapy and person-centred therapy. Sessions are available in English, Spanish or Catalan, and the first contact is a free, no-commitment information consultation. She herself points out that in a serious crisis or psychiatric emergency, immediate in-person care is what is needed. ## Frequently asked questions ### What does a psychologist do in bipolar disorder? They complement medication with psychoeducation, cognitive behavioural therapy, family therapy or social rhythm therapy. They help you understand the condition, track your mood and sleep, spot the signs of relapse and have a plan to act in time. ### Psychiatrist or psychologist for bipolar disorder? Both. The psychiatrist makes the diagnosis and prescribes medication; the psychologist works on the psychological side. NICE recommends offering a psychological intervention to prevent relapse in addition to medication. ### Which therapy works best for bipolar disorder? Structured therapies added to medication are associated with fewer relapses, according to a meta-analysis of 39 trials. Psychoeducation with skills practice worked better in a group or family format than in individual sessions, and cognitive behavioural therapy helped with depressive symptoms. ### Does psychoeducation really work? Yes. In the Hospital Clínic trial in Barcelona, 21 sessions of group psychoeducation reduced relapses and hospital admissions, and five years later that group had had fewer than half as many relapses as the other. ### Can I stop my medication if I am in therapy? Not without talking to your psychiatrist. The NHS warns that you should not stop it even if you feel better, unless your doctor tells you to. Therapy complements medication; it does not replace it. ### Does online therapy work for bipolar disorder? It can, especially in stable phases, to keep follow-up going. The evidence on internet programmes is still limited, and mania or severe depression calls for urgent, in-person care. ### Can bipolar disorder be cured? It cannot be cured, but it can be managed. The NHS explains that treatment helps you manage it and that there are usually stable periods without symptoms that can last weeks, months or years.