by Andrea Vassilev
Chair of DBSA California Education Committee
I adored my peer support group. I loved seeing the same friendly faces every week, connecting with them through shared experience and helping to foster hope and well-being. I was a leader, a trainer and, briefly, the CEO of our charity chapter.
But eventually, I had to stop attending and facilitating. I had referred too many of my clients to the group — and me showing up would have created a massive conflict of interest and dual relationship. No one wants to see their therapist in a peer support setting.
The irony of my situation is that my work as a peer support leader is what led to me beginning my journey in a doctoral program in clinical psychology. I found such joy and success in those early peer meetings that I wanted to make it my life’s work.
I’ve succeeded at this, becoming an active member of groups such as the International Society for Bipolar Disorders and presenting at national and international conferences. I have developed and deployed an original program to address self-stigma in bipolar disorder. But five years later, working as a therapist under my supervisor, I’m still fleshing out the nuances of inhabiting both sides of this space: peer and clinician.
Being a Peer and a Clinician Is a Balancing Act
As a peer, I have 25 years of lived experience with bipolar disorder. As a clinician, I have a thorough comprehension of the causes, correlates and treatments for this mental health condition. As a peer, I write, speak, and share regularly about my own experiences. As a clinician, I often keep that under wraps. I can be both — but sometimes, it’s hard to be both at the same time.
I continue to grapple with the tension between the two: how to be taken seriously in both realms without seeming like a traitor or phony to the other. My Instagram profile is a study in contrasts: I share both clinical knowledge and coping skills alongside stories of my own struggles and survival. It’s a bit of a unicorn, but it’s the truth of my situation.
Lived Experience Has Taught Me How to Be a Better Provider
My experience with mental illness is what makes me an effective clinician to treat it. As someone with both personal and professional intimacy with the disorder, I have a unique understanding of what the condition is, how it feels, how to align with my clients and what they need to hear or experience to live their best lives.
It’s impossible to convey the painful realities of bipolar disorder to someone who hasn’t experienced it. A clinician who understands the use of medication through textbooks won’t necessarily be sympathetic when you want to stop taking it due to side effects. This is along the lines of what therapists call “use of self” and, when done properly, it can be incredibly powerful.
Embracing Strategic Disclosure
I don’t immediately share my diagnosis with new clients. On the contrary, many of my clients don’t even know I have a mental health condition. They don’t have to know my history to reap the benefits of my personal experience with common symptoms such as depression, anxiety, and intrusive thoughts.
As for my clients with bipolar disorder, I don’t necessarily disclose my diagnosis. However, if I choose to share, it typically comes up in the context of talking about stigma. I have found that clients often range from feeling uncomfortable with to ashamed of their diagnosis. They have to swim out of the quagmire of self-stigma before they can start to understand the condition as just one piece of their life’s experience. That’s where a little disclosure can be worth its weight in gold.
Not only is that kind of shared knowledge a boon to the therapeutic relationship (“Wow, you really get what I’m going through!”) but it helps to lessen the power of self-judgment. Seeing others whom you respect (and hopefully my clients respect me a little) survive and thrive with the same condition fosters hope — the same kind of hope one might experience in a peer support group.
That’s not to say that my sessions become peer groups — far from it. I keep my disclosures very basic, usually just my diagnosis. To share more, one of two conditions must be met: either it will be of great benefit to the client to share more specific information or it’s in response to a direct question that, again, I believe it will help to answer.
My ultimate goal and priority is always the well-being of the client. But if a client asks if I’ve ever experienced the same manic symptoms as they have, I’m going to be strategically honest. There’s an inherent disconnect between patient and clinician experiences, and it’s one that I work tirelessly to bridge.
Ultimately, I couldn’t be more grateful for my 25 years of lived experience. They make me the human, and therefore the clinician, I am today.
Andrea Vassilev is a fifth-year doctoral student in clinical psychology and a student therapist specializing in the psychological treatment of bipolar disorder. She is the creator of the original program Overcoming Self-Stigma in Bipolar Disorder (visit www.ossibd.com). She is also a dedicated peer advocate, speaking and writing passionately about her lived experiences and mental health topics. Instagram @andrea.vassilev
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