Q: I am a job coach, I help get jobs for disabled people and help train them. I have had several clients who have bipolar disorder. They do not seem to be able to keep jobs no matter what field we put them in. Many of them are great workers but getting them to come on time (if at all) is a big deal. Is there a way to work with these people that would make them successful? It is frustrating to know that they can do the job and they love the job and the people they work with, but they cannot keep the job because of not showing up on time or not calling in when they’re going to miss work. Please let me know if you have any ideas that can help us help them.
MaryAnn Cheney, Job Coach
A: In terms of working with clients on these types of problems, the task is to break it down into more specific concerns. While we can say broadly that individuals with bipolar disorder have trouble with time management—that doesn’t help us solve the problem for any one individual, Sitting with the client and identifying the more exact nature of the problem is the first step, so you can develop an individualized plan for addressing specific issues.
Start with the assumption that the client is not getting there on time because they can’t, rather than because they won’t. Next, try to break down the problem into much smaller issues so you can address the skill set deficits and solve the problems from a smaller, more manageable standpoint.
For example, does the person have trouble remembering to set the alarm, hearing the alarm when it rings, or getting up upon hearing the alarm? Does the person run into delays when showering and getting dressed? Is transportation a major issue? Does the person have other demands in the morning or conflict with another person prior to work? Is there a problem with medications—either not taking them or perhaps a side effect that makes the person less able to wake up in the morning?
Once you can break it down, you can start to address one issue at a time—with your client actively involved in developing possible solutions. If you try to tackle too many issues at once it won’t work, so focus on one issue at a time.
Remember: Changes, when they come, will be incremental—small changes at first. You and your client are working to solve problems that are occurring because of skill set deficits, so always consider skill set deficits when formulating your solutions to the problem.
For example if we’re talking about waking up when the alarm rings, what may be getting in the way might include medication hangover, general fatigue, and lack of mental and/or physical energy. One solution could be to work toward a very gradual process of waking up. Your client could try to set the alarm earlier and hit the Snooze button one or two times before waking up. If your client’s medications were suspected of causing some morning fatigue, your client may consider consulting with his or her doctor to determine if the times that the medications are taken could be adjusted.
It is also important to remember that as long as you are talking and working on solving the problem, you are still in the game with the client. The first solutions you develop may not work or may be effective only to a certain degree. Achieving an effective solution is a dynamic process and may require a good deal of tweaking along the way. Remain persistent and provide your client with plenty of encouragement.
Firstly, please do not assume everyone with bipolar disorder is late for work or cannot keep a job. How many people without this “label” do exactly the same thing as stated in your article? Many, no doubt. I have a job and I’m in a long term, stable relationship. Yes, I have bipolar disorder. I have been diagnosed as “quote” – “rapid cycling, treatment resistant bipolar II disorder”. I’ve survived 16 treatments of ECT. I’ve also survived a suicide attempt and I’ve come back and proved that I’m a survivor.
Your comments irritated me. I do not like the quote “these people”. We are trying to abolish the stigma of mental illness and these quotes by you are not helping. Maybe Australia is more advanced in this area. We are treated equally and do not walk around with a label on our foreheads.
Thank you for sharing. I’ve been diagnosed 2007. Come from a generation of duo diagnosis. I was infuriated even by family members. I say and believe that even professionals with 30 plus years under their belt will never get those as much as others who actually lived the lives with specific and or multiple challenges. Self care, nutrition ( especially that it’s a chemical imbalance, etc) Grateful to have a loved who cares enough to study in depth and to know we’re all great workers, …
Diagnosed Bipolar II , ADHD. Previous PTSD , childhood lost, instability, generational ancestors substances, alcohol.
Clean whole food eating, adequate sleep, support group of only related peoples sharing our experiences , strength and hope
I also am extremely irritated by the comments that were made about “these people”.They have to live each and every day trying to overcome the stigma that most people place on them while most of them are productive members of society. As the mother of a young adult that was diagnosed more than five years ago as a rapid cycling Bipolar I while she was still in high school , yes there were days that she had difficulty getting up due to medication side effects. But that was overcome by taking them earlier in the evening. Five years later she has just finished her bachelor’s degree as a Registered Nurse. There have been good times and some really really bad times but our faith has always shown us the way. Most days she is fully functional and most people around her don’t know that she is bipolar as she also does not feel the need to walk around with a label on her chest. But if anyone asks or talks about it she is open about it. I also wonder if the fact that we live in Canada has any thing to do with the fact that people seem more tolerant of this disease maybe because we have universal health care and there are fewer cases left untreated.
The recent discussion has brought up some of the most delicate and difficult issues related to bipolar disorder and mental illness overall. Without a doubt any individual who is diagnosed with bipolar disorder will be different from the next and the problems faced by one person won’t necessarily be the problems faced by another. I think that the goal of working with someone who has bipolar – as a clinician or friend or family member – is to keep this in mind and to not make any assumptions about the problems this person faces. My point may not have been clear in my previous post – but I agree with Minnie and Marilyn – that the goal in the work is to explore specific difficulties – not to make assumptions about the problems someone is having.
The great news is that so many individuals with bipolar disorder have overcome many problems and are doing beautifully! Having bipolar disorder does not mean that someone will not be able to function – thinking this way is prejudiced and uninformed. However, bipolar disorder often creates some difficulties in life that need to be addressed. Every human has areas of challenge that they work on problem solving and changing. People with bipolar are no different in that respect – but the areas of difficulty for a person with bipolar disorder are often big hurdles that take careful strategies and creative ideas to get past. Just as stigma and prejudice about bipolar disorder are dangerous it can also be dangerous to ignore a problem that needs to be solved. Eliminating stigma is critical in this world – and yes the US is probably lagging behind in this area. No arguments from me there. But eliminating stigma is not the same as not identifying problems and digging in to solve them. Eliminating stigma includes accepting these problems as just part of life – part of any given individual’s needs – rather than labeling these problems as “weakness” or “craziness.”
Thank you Dr. Fink for being very thorough. Thank you for reminding us that each individual are a unique as to what tools will work for them. Constantly working with Nutritionists who understands. Daily self care , self check. What works for one may not work for next . What works for me today may not work for me tomorrow and or ever again. It’s a constant Learning. I am encouraged when both recipients and their loved ones show true love by willing to take the time to learn and educate themselves.
Maternal grandma ” diagnosed in generation with less research and study ” needed more support from both professionals ( at the time lacked knowledge, education, research) , raised 8 children, amazing loving woman.
Mom, her daughter, duo diagnosed bipolar, schizophrenia
Myself Bipolar II with parallel Bipolar I and PTSD , And ADHD
Before being diagnosed from my first doctor Nitritionist was very important to discuss eating clean whole foods greens, no / little sugar, white, processed no oily no fried…. being we’re dealing with chemical imbalance. Making natural food(s) our medicine., exercise, active, Then as necessary supplements and then utilizing medication as necessary. Remembering it’s “a part ” of us / a person” and that an individual is not a part of it.
I don’t think that MaryAnn meant any harm by using the phrase “these people.” I can see how someone could be offended by it, but I hope it does not eclipse the fact that MaryAnn is a job coach who is sincerely trying to assist her clients who have bipolar disorder return to fulfilling jobs. I applaud her for seeking advice and trying to make a difference. We all occasionally have a slip of the tongue that offends somebody. Let’s forgive the slip and celebrate the fact that MaryAnn is trying to improve the lives of her clients.
MaryAnn,
I am a 30 yr old bipolar female, and prior to being diagnosed with bipolar i was an extremely successful executive, the one problem i had was my timing and that seemed to be a recurring issue throughout my career. Just before i was diagnosed, i was very lucky to have a boss who not only took the issue seriously but actually helped me understand my problem. What i discovered, and what you may find is 80% of people who are late to work are actually perfectionists. Perfectionists, naturally create a vision or a goal and it becomes more important to them to achieve that than to adhere to a scheduled work timing. What happens is they get carried away and focus on getting the goal/vision ahcieved and get sidetracked, you may find with ppl having the bipolar disorder that they are more prone to getting sidetracked. Plus the fact that everyone is generally slower when they wake up, so something that would take you 3 mins in the evening, will take you 6 mins in the morning…and so you have to do as much as possible the nigt before, and create a morning routine and talk yourself into dropping all other irrelevant tasks and actually getting to work on time.
Once, i was diagnosed with bipolar i started being late again after having been punctual for a year, it was mainly because of the heavy medication that i was on that literary makes its impossible to wake up and face the world. But like someone earlier said, the earlier you take the medicine the easier it is to wake up, one of the key things i found in helping me recover from a relapse, is routine…getting into a routine is extremely theraputic and helps us get by until we feel normal again.
Dana brings up a number of problem solving strategies that she has used to address some challenges that were specific to her situation. Perfectionism – sometimes like an obsessive or compulsive pattern – is an often overlooked cause of lateness for many people with bipolar disorder. Dana mentioned strategies such as developing routines and allowing more time in the mornings – which have been helpful to her and will likely help others. There is also the notion of “talking yourself out” of the perfectionism – and working on staying focused on the priority task of getting to work on time, rather than the task of doing something else to perfection. This can sometimes be a symptom that requires more specific types of therapy – anxiety reduction or other cognitive behavioral techniques – that can assist those who find that talking themselves out of it isn’t enough.
Another problem solving strategy – a general one that can be a starting point for almost all problems – is getting help from someone. Dana says that her boss helped her identify some of the specific patterns that were getting in the way of getting to work on time. If you are struggling with trying to find a solution to a problem – a good starting point is often – “ask for help.”
Sharing these strategies helps others who are looking for ways to solve their specific problems. While the same strategies won’t work for everyone – they can be a starting point or a springboard for solutions that are more individualized to another person’s needs.
Thanks so much for the information that everyone has given me. I would like to let you all know that I have not labeled my clients. I work with people with all kinds of mental and physical disabilities. I am the only one at the job site that knows what disability they have. We do not let the employer know unless it is a disability that needs special attention while they are at work. I have worked with other clients that are Bi-Polar and have not had this problem. That is why I used the term “these people”, not these bi-polar people but these specific clients that can’t seem to get to work on time. We work swing and graveyards shifts so it is not having to get up early. Dana makes more sense to me when I think about the clients that I am trying to find a way to help them be successful on their jobs. When they are at work they do a good job and catch on really quick. They do seem to be perfectionists. One client was a stocker at a commissary, his section was always so clean and straight. He had to have everything just perfect, that was another problem he had because that slowed him down. The boss expected them to put so many cases up in a certain amount of time. He was so frustrated because his speed was not getting better. Now just getting him to put, getting to work on time as his first priority. As a job coach I can not go to their home and make sure they get ready and out the door. Maybe a quick call to them to see how the night before went and get them excited for that night.
Joe, thank you so much. I do not want to offend anyone! I have a daughter that was diagnosed with diabetes when she was 6, she is 29 now. It is not easy to watch your child go through life with different hurdles they have to go through.
Minnie and Marilyn I am sorry I offended you, that was not my intent. I knew that their were people that live with this on a daily basis that could give me some advise so that I will be able to help my clients now and the ones that I will have in the future.
If there is anything else that I should know about Bi-Polar that would help me with my clients I would appreciate it. All I know is what you all have told me.
I’m in my early 50s now, and was well into my third “career” before I was diagnosed. Each of them lasted about a decade or so – from freelance tech on sound and lights to establishing a graphic design/marketing firm and now I program live cultural presentations with musicians, video artists and poets that are presented to 10,000 a day who’ve bought tickets to be there…
I think that before I was diagnosed, I was attracted to, found acceptance and was successful in environments where one had to be able to think quickly and creatively, deal with all kinds of people and it was generally expected one would work at odd hours and a wide variety of things.
I would suggest to prospective employers that the working conditions may need to be tailored to some degree to fit the particular strengths, challenges and ongoing changes of the employee (bipolar or not, really). Given the trends in recent years towards contracting out, tele-commuting, virtual corporations, etc this can even be a bonus.
Add to this the enhanced levels of creativity, sensitivity etc that often come wrapped in the bipolar package, so to speak, any number of companies could sorely use a lot more of these traits than they often seem to have, or encourage.
At the same time, if I was expected to show up everyday from 9 to 5 not because there was anything special to do or not do but just because “it’s the way we do things” or to show I was a “team player” I wouldn’t last a week.
After a decade in my trade, I know for a fact that I work longer, harder than 90% of the people in my field. The projects I work together with artists and tech crews to develop and present are risky, exciting and influential…
…but I can’t stand being bored.
I also can’t stand stupid rituals that are all about “appearances” and/or the illusion of control, and that really have little to do with the quality, the quantity or even the rate at which work gets done.
So perhaps one of the questions to find a nice way to ask employers might be something along the lines of “do you want someone who will do exactly (and only) what you tell them to do including being at their desk, dressed in a presentable fashion at 9am…
or does this job need someone … special?”
because in my experience, for people who are bipolar, thinking inside the box is the hard part…
literally and figuratively.
for what it’s worth,
d
I think several good points have been raised that bear on my experience with timeliness and workplace issues.
Medication is a serious consideration. I know my hardest period of time was the year after I was first diagnosed and taking medication. The side effects, rashes, dulling, sleepiness…all made mornings problematic. Embarassing, but true, I also had problems with lithium and diahrrea, I was late to work a number of times due to stops.
The job coach’s frustration is one that many employers experience with otherwise high performing employees. And the perception of unreliability that some form as a result can be cery destructive for someone who is already struggling.
Even had it not been for all of the other serious side effects and the complete lack of any positive medication effect on my symptoms, the morning grogginess issue would probably been enough on its own to cause me to stop medication. And, these cheery statements that it goes away over time as your body adjusts are largely the stuff of fantasy, at least in my experience.
The point about perfectionism and distractability is also right on.
In my case, I realized I was late in some situations at times when I was feeling most withdrawn or too easily overstimulated by the company of others. It wasn’t anxiety in the classic sense, but I think a very sensible reaction to noticing that I was hypersensitive at that moment. For me, this has been the hardest cause of the behavior to address when it occurs. In fact, I find it is a lot easier to avoid a hypomanic episode if I LISTEN to my reactions and find a quieter environment that day. Fortunately, I can do this as a programmer, as I often work from remote, or if on site, can withdraw to a server room for relative quiet. It isn’t perfect though. the days this happens when there is a mandatory meeting…I’m sunk. It is just painful.
Dugg made some interesting remarks, many of which I think apply to me. One of the positive things about me and my skill set is that I do find solutions to problems others have trouble coming up with, this is why I get paid. The downside of this is that I too have trouble staying in the box, and remaining patient with corporate culture. It generates difficulties from time to time. Often, my employers choose to overlook my bluntness and impatience. I try to help them by not expressing it any more than I can help. But I think if I were less good at what I do, I’d be gone in a heartbeat…and even with that, I’ve pushed the limit on more than one occasion.
So, attitudinally, when it comes to timeliness, one of my efforts is to appreciate that my employers have a very conventional view of a work day that is often unrelated to the actual needs of the work. I do my best to conform, but mostly I remind myself that I do not want to be a prima donna or ‘special’. I’ve worked with those sorts (without any declared diagnosis from the medical establishment) and they are truly not the sort of person I want to be. This works somewhat.
But I’m afraid I will never really be sincere in my acceptance of illogical scheduling guidelines that exist only for form’s sake. Fortunately, this level of sincerity is a perfection, and I remind myself that this form of perfection is not required of me.
It is a lot of work.
Lastly, sleep patterns. I have the same difficulty I think many BP do. Sleep meds and mood stabilizers didn’t help, and I sure wish they would have. I am one of the ones that wants to sleep, desperately. I seem to have missed out on the godlike feelings and lack of a need to sleep. What I learned is that my rythyms just aren’t typical. My solution was to try to make the most of the deficit, so my work is such that I am productive at odd hours and this is good news for people that need things fixed or done while the rest of the business world sleeps! It also helps in the point I was making before, employers are more understanding if you start at 10 or 11, if they know you were up and working while they were comfy in bed.
So finding a schedule or a job that meshes with the deficit or turns it into an advantage is a positive thing.
On an ironic note, the one thing I found that helps most with keeping sleep stable and close to normalish hours…acupuncture. And, it was a side effect! I went originally to address some pain from a damaged nerve in my arm from a fall last year (fixing a roof). The Lyrica offered by my psychiatrist/neurologist was not a good choice for me. It did definitely help the pain, but it made me goofier than a cartoon. The nerve pain wasn’t going to go away short term so I needed somethign that would help that didn’t leave me higher than a kite. I was reluctant to try acupuncture and didn’t have much in the way of expectations from it. As it turns out, it did help the pain a little, but I found a dramatic difference in my sleep pattern afterwards. I don’t know if its a placebo or a fluke. I frankly don’t care at this point. This has been working reasonably well for about 6 months so I plan to stick with it.
And my quality of sleep has improved too, which is really more important for me than WHEN I sleep. I find it easier to tolerate things, calmer, better all around. I have reserves I don’t normally have.
Which in a pecular way, makes it easier for me to be on time? Strange perhaps, but I feel it is so.
To wrap up, if you are coaching, cause and effect have their place; but the most effective strategies may have to do with finding ways to adapt better to a schedule. Something has to bend. A compromise must be reached, but that doesn’t mean it always has to come with the BP person adapting to the norm. Either help the client find ways to make their deficit more acceptable, or places where their deficit is an asset.
My clients have, on occasion, hailed me as a welcome sight at 1 in the afternoon. Of course, that was because they had email in their inbox dated from 4 am telling them their application would be available to them when they came in at 7. They then spent the morning reviewing and testing it. And the afternoon was a good time to talk about impressions and next steps.
I was right on time. 🙂
As a recently diagnosed bipolar individual , your article made a lot of
sense to me. I have struggled with tardiness for as long as I can remember. I am currently 49 yrs old
and I need to change this habit.
I found this article most helpful – thank you .