While it is possible to reach Self-Mastery alone in a cave, having family and friends around can make the journey much easier, not to mention more enjoyable. The Family and Friends Assessments help them to be more effective members of our team.

Most people might expect a Family and Friends Assessment to be about how they see the bipolar person. Although this assessment does include a small amount of such observations, it is mostly about what the family and friends need to understand about their own role. The questions are geared toward helping them to look at family dynamics, their own issues, relationship skills, and strengths. The goal is to find opportunities for growth that are all around us in our daily lives.

The questions and answers below are examples of the form filled out by a family member who has developed strong skills and understanding. Please do not look at them as the “correct” answers, but as a guide to help you to better understand the process.

Frank is a 59 year old father of three sons and has been married for 39 years. His wife, Jeanette (author of the Living Situation Assessment example), has ultra rapid cycling bipolar disorder. He has strived to be as supportive as possible which is why she asked him to be a key part of her health care team. He has made a point of becoming educated about his wife’s condition to the point of flying across the country with her to take a Bipolar in Order Workshop in San Francisco.

Family dynamics and Home Environment:

Please explain your understanding of bipolar and depression.Bipolar affects a person causing mood swings of both highs and lows. Some people have a cycle every couple of years. Others more often. Some people multiple times in a week.Describe briefly how well or adversely you are responding to your friend/family member.We try to keep communication open. I find my observations are a key element in distinguishing my wife’s mood. If I notice something seems off in her behavior I ask her about it. On most occasions it opens the door to discussion.There may be several adjectives or phrases that you could think of to describe your home environment: harmony, zen, walking on eggshells, war zone, not my place, beautiful, the only peace I have, etc. Describe how the home environment feels to you.Our home is a warm, cozy, loving environment. I consider it a safe haven and oasis.What do you think the home environment is like for your friend/family member?I think my wife feels it is safe and an oasis.What things can you do to improve the environment so that it is better for everyone?I think I need to be patient, keep the noise level down and maintain a good daily routine.

Your Issues:

Please describe any of your own mental conditions that are contributing negatively to the situation.I don’t have a mental diagnosis. I sometimes lack patience.Describe any treatment or support that you are getting.I went to a therapist to help me understand my wife’s diagnosis as well as attended classes from NAMI and a Bipolar in Order Workshop.Do you take any medication, drugs or alcohol? Does it help or hinder your family relationships?Occasionally I’ll have a glass of wine before bed. It helps relax me before bed so I have a good night’s rest.What fears do you have for your friend/family member?I fear coming home someday and finding my wife has hurt herself.What fears do you have for yourself?I don’t have any fears for myself.What observations do you have that indicate that your friend/family member is not coping well with a mental condition?On occasion I notice a glassy look in my wife’s eyes or a slightly swollen look to her face.List the behaviors or observations about yourself that indicate that you are not coping well with your friend/family member’s mental condition.I’ll feel a tightness in my chest, a difficult time swallowing and short tempered.What issues about behavior or mental states do you disagree on?I can’t think of any. When we disagree, we have an open discussion. In the past, we’ve taken a couple of issues up for discussion together with my wife’s psychiatrist or therapist.In order of priority, what do you think needs to be addressed?Maintaining a four legged stool: taking medication as needed, using coping skills, socialization and spirituality.

Relationship Issues:

What skills do you practice to maintain the health of your relationships?Making an effort to schedule and do enjoyable activities together. keeping open communication is a key in our relationship. Humor can also help.What processes do you follow or have in place to repair relationships when there has been an argument or a crisis?There needs to be a cool-down period for both parties. Then we ask each other if we can then go forward to reconcile and discuss the root of the problem. Then the healing process begins.Describe how you calm yourself and re-establish a sense of peace before repairing your family relationships.I take some deep breaths, sometimes going out to exercise, allow a time buffer to cool down to allow for clearer thinking.What gestures or communications do you use to demonstrate forgiveness or support?With my wife, we hug, I’ll say “things are going to be okay”.What new skills have you learned to more effectively deal with your present family conditions?I have become educated about bipolar. That has been a big help. I go to the psychiatrist with my wife and I now know the right questions to ask concerning medications and her adverse reactions.Describe the different situations that create an intense reaction or cause an argument with your friend/family member.I find it difficult to accept when, on occasion, my wife is not motivated to do certain things.Describe a response or reaction on your part that is likely to escalate the intensity and make it harder for him/her to calm down.Getting caught up with my emotions and forgetting our rules for open discussion.Describe a response or reaction from you that is more likely to calm the situation.Hugging my wife and keeping discussion open.What agreements would you like to have in place to calm an intense situation?Give ourselves 30 minutes of cool-down quiet time. When we both agree we can talk calmly, we come together to discuss the issue.What would you tell a friend or family member in asking to postpone a discussion, for a short time, until you feel more capable of remaining calm?I would tell them it’s a great idea. It would give us time to get a grasp on our emotions and calm down.Describe ways in which you monitor too closely, call into question your friend/family member’s judgement, or treat him/her as incapable or disabled.On occasion, due to my concern for my wife’s well being, I become a helicopter husband, I observe her too closely.How do you respond when your loved one pushes back against these kinds of behaviors?I realize I’ve messed up and apologize.How could you become more supportive?I continue to look for new information to educate myself. Other than that, I feel I’m doing all that I can. I let go and let God.How would your friend/family member like to be treated when they are in crisis?Give her some space & solitude.What do you say when you are seriously concerned about something?I ask her to sit down with me to discuss it.How you would like to be treated in similar situations?The same. Ask me to sit down and discuss it.

Strengths:

What assets or strengths does your friend/family member have that you admire?Great writing skills - she journals, determination to succeed. She feels that failure is not an option.What assets or strengths do you possess?I’m committed, loyal, cheerful, loving and want to see her succeedWhat would indicate positive change or growth in your friend/family member?She understands herself better than ever before. She continues to expand and renew her coping skills.Describe in what way you see your friend/family member as open to change and growth.She continues to help herself by expanding her skills, accepting changes in medication when needed, and she found a new therapist who challenges her.Describe in what way you demonstrate that you are open to your own need for change and growth?I keep an open mind, accept new information given to me, everything is open for discussion.

Early on in the Family and Friends Assessment, Frank demonstrates he has done his homework. He's not only put time and effort into learning about bipolar, but time into learning about his wife, as well. The third and fourth questions ask about the home environment and both Frank and Jeanette use the word oasis. It's not wrong that he uses the same word, it merely shows they have worked together as a team.

Another example demonstrating their efforts are the similar answers regarding the need to have some sort of cool down period before a situation escalates. With such an agreement, they can come back together to settle the issue calmly and in a better frame of mind. We can also tell he and she have communicated with his answer to the assessment question “What gestures or communications do you use to demonstrate forgiveness or support?” He says he gives her a hug and says “Things are going to be okay.” Frank and Jeanette have clear understanding of the best actions to take.

When asked, “Describe ways in which you monitor too closely, call into question your friend/family member's judgement or treat him/or as incapable or disabled,” Frank answered that occasionally he becomes a “helicopter husband.” He attempts to define that phrase by saying he observes her too closely. Each team needs to determine exactly what they consider to be “helicopter monitoring”. Remembering there is no right or wrong answer we will use our gracious Mr. and Mrs. Doe again to give us an example. John may ask multiple times during the day if Jane has taken her medications leaving Jane feeling he's being bossy and overbearing. On the reverse side, John may comment that he noticed Jane apparently didn't sleep very much the night before. Jane's reaction is accusatory suggesting that he's spying on her. Concessions need to be made on both sides. John can agree to only ask once a day about her meds. Jane may accept that John is merely making morning conversation and not jotting down every little thing she does to send off to the doctor (or whoever). In order to determine what is not “helicopter monitoring” each side needs to find the middle ground where the bipolar person doesn't feel over scrutinized, over criticized and pushed into a box; and the family/friend doesn't feel unhelpful or uncaring.

Again, as we read Frank and Jeanette's answers to the assessment questions, we tend to look that them and think that they are The Gold Standard and therefore should be our own goals. Frank and Jeanette's answers are merely the correct answers for them. While it is obvious they have spent much time and effort to get to this point, thus demonstrating their hard work, there is nothing to say that had they taken such an assessment many years ago that Frank's answers would have been quite different and reflect a great deal of frustration.

For example, were John Doe to answer the first question “Please explain your understanding of bipolar and depression.” He could very well have said, “I don't know anything about it. It all is so confusing.” For John Doe that would be the right answer for him since he is being honest and open. When John Doe answers the question about the home environment he may think it's a good and comfortable space which contrasts greatly with Jane Doe's perception of the home closing in on her.

When John Doe is asked to describe the different situations that create an intense reaction or cause an argument with your wife he may just say, “I don't have a clue. It's like she's happy and then without warning it's a war zone. She refuses to tell me what happened and I just don't know what's going on.” Again, it is the correct answer for John Doe.

When answering assessment questions, pride and embarrassment have to go on the shelf. Any truthful, honest, heartfelt answers given on these assessments are Gold Standard answers. They are correct for each individual person and team. The point of the assessments is to find out what work needs to be done and how to successfully adapt and grow in a way that is beneficial for that person, family and team.

NOTE: By sharing and discussing these questions, perhaps with the help of a professional, this process will begin an open dialog about how each member of the family can support the others in a non-blaming, respectful manner. It leads to a much deeper understanding of what is going on in the family dynamic and how to improve the situation so healing and wellness can begin. As you grow both separately and together, it is important to know there will be setbacks and there will be bad days. The important thing is to stay committed to helping and supporting each other.

This form should be used every 3 months to measure progress.