Ep. 58 Fostering Understanding and Support in the Bipolar Journey with Sandhya Nagabhushan (Accepting new clients in TX, MD, VA, DC)

When personal experiences blend with professional skills, understanding gets richer. Sandhya Sharma from Enlightenment Therapy Services LLC is here with me, Marta Hamilton, to talk about bipolar disorder in a clear and caring way.

Sandhya's background in holistic therapy and EMDR therapy helps her connect deeply with people. She draws from her own family's struggles with mental illness, especially within the Indian American community. Our talk goes beyond just medical talk. We're here to give you a kind perspective on how resilient and creative people with bipolar disorder can be.

Living with bipolar disorder is like sailing in rough seas, but Sandhya helps us find a smoother path. We talk about spotting triggers like changes in sleep and stress, and how therapy and medicine can help. Sandhya also explains cool therapies like EMDR and mindfulness, and why having supportive people around is crucial. We even dip into the science of epigenetics to understand how it plays a role in bipolar disorder. And for family members trying to help, we share tips on being supportive, especially during manic episodes.

We end our chat by focusing on making schools and workplaces better for people with bipolar disorder. We talk about how it affects relationships and why talking openly and getting therapy together can help. We hope to see a future where we talk about mental health just as easily as physical health, and where there's less stigma around it. If you want to connect with Sandhya and her team at Enlightenment Therapy Services, check out the details in the show notes below. They offer telehealth services in Texas, Maryland, D.C., and Virginia.

https://www.enlightenmenttherapyservices.com/

Transcript

Marta Hamilton: 0:06

Welcome wellness seekers to this week's episode on the Telewellness Hub podcast. I'm Marta Hamilton, your host, and today's guest is Sandhya Sharma from Enlightenment Therapy Services LLC. Sandhya Sharma is a licensed professional counselor with an extensive experience in providing holistic therapy. She is not only a certified substance abuse specialist, but also holds certifications. Professional counselor with an extensive experience in providing holistic therapy, she is not only a certified substance abuse specialist, but also holds certifications in eye movement, desensitization and reprocessing, also known as EMDR therapy. Over the years, sandhya has contributed significantly to the field of counseling through her work with local universities, addressing issues such as sexual assault, stalking, dating violence and trauma, and also has a really extensive background in bipolar disorder, depression and anxiety.

Marta Hamilton: 0:56

So welcome. Thank you so much for joining us today. Thank you so much for having me. It's a pleasure to be here. I'm so excited to talk with you today. Prior to recording, we talked a little bit about your experience and specialization in bipolar disorder and this is our first episode kind of featuring and diving into that and and taking away preconceptions about it and just understanding it better. Before we dive into that, I'm curious if you could please share with us a little bit about why you do the wellness work that you do.

Enlightenment Therapy Services: 1:28

Yes. So, speaking a little bit about holistic medicine and practice, I really believe that the work that we do as mental health counselors, it incorporates the holistic approach. So mind, body, spirit work is a lot of what I do. But really what got me into the field?

Enlightenment Therapy Services: 1:45

You know I have family members that have been afflicted with mental illness, as I'm sure many of us can relate to. And you know, very early on I learned there was a lot of barriers to seeking treatment and in general, being an Indian American born and raised in this country and having family members afflicted with mental illness, there was just not a lot of education or language or narrative or rhetoric around understanding what mental health issues are. And having a family member that was afflicted with bipolar disorder, it really started to raise awareness that one it's manageable, you can be highly functioning with bipolar disorder. This family member I'm thinking of and many patients that I have live very highly functioning lives. So, speaking a little bit about to the misconception piece, you know this particular family member was struggling with mental health issues and bipolar disorder and there was just not a lot of access to treatment and there was a lot of miseducation, misinformation.

Enlightenment Therapy Services: 2:42

So that's really what got me inspired to seeking mental health services and then I did my undergrad in psychology and I got my certification in addictions work, worked at a shelter in undergrad for survivors of stopping rape, assault and so forth. So that's been a big pioneer in what got me into this field and, of course, ever since then it just it took off. I went to grad school and I got my certification in EMDR, which is eye movement, desensitization, reprocessing, do trauma informed therapy, love the work that I do and I love inspiring others and trying to heal each patient one at a time.

Marta Hamilton: 3:17

Well, I that's why I just love this podcast. Honestly. It's just become such an amazing way for me to connect with colleagues who, like you, are just truly transforming lives and bringing healing into this earth, and so I'm always so honored that you'd be willing to give some of your time, because I know your time is precious. As clinicians, you know we spend hours at a time with our clients every day and I think it's it's. I'm just so grateful for the opportunity for you to share a little bit about your personal background, your family history and just in terms of cultural approaches and availability, and when it comes to sharing because I think that's something in the BIPOC community that is something that's really relevant to talk about that sometimes there could be stigma that exists within culture or lack of access to resources or understanding. So I really appreciate you sharing that kind of personal experience and also what's led you here Before we dive in, because we talked about the misconceptions right a little bit, or misunderstandings the misconceptions right A little bit, or misunderstandings.

Marta Hamilton: 4:28

I often hear people say things like you know, we talked about this before recording like the winner is so bipolar and we almost can minimize the effects of a diagnosis such as bipolar disorder. For those listening and don't have all the training and experience that you have, could you give us just kind of an overview of what bipolar disorder is?

Enlightenment Therapy Services: 4:49

Sure. So bipolar disorder is a mood disorder. As mental health clinicians we diagnose different types of mental health issues and bipolar disorder is a mood disorder marked by manias and depressions and there could be some reiteration of high manias in there. But basically it's a swing in an uproot of. High energy levels increase the symptoms I can just name for mania that would help. So increased pressure to speak, high energy levels, feeling on top of the world, grandiose thinking, reckless spending sprees could be one of the things. Stinking, reckless spending sprees could be one of the things. Sexual promiscuity could be one of the factors. So just kind of this feeling of like I'm on top of the world and I'm invincible, that can get into the grandiose stinking. So those are some of the manic symptoms and it has to happen for at least a week straight to be considered a full manic episode. So that's what we use to diagnose manic mania in a patient that has bipolar one. The onset of symptoms usually come about in adolescence. The latest research is saying 18 year old but we see it at 16 in adolescence and sometimes it's misdiagnosed with borderline or other comorbidities because until you get a full psychological assessment or get with a mental health counselor that can do the assessment. You really don't know. The presenting symptoms could just also look like a normal 16-year-old, with having interpersonal difficulties, or hormones are increasing around that time. So that's kind of the distinction between the manias. Now the depressions can look a little bit like you're low mood, trouble getting out of bed, trouble with concentrating, psychosomatic symptoms, feeling lethargic. But typically with bipolar one they tussle with the manias more they do with the depressions. Now there's another criteria of bipolar disorder and I'm trying not to get too clinical here, but it's bipolar two and that's where we cycle with the depressions. We cycle with the depressions and you can hit a hypomanic state which looks like a little bit of elevated mood, maybe did less desire for sleep, functioning at a normal rate, with just three hours or four hours of sleep, and they're very highly functioning patients. I want to say that too.

Enlightenment Therapy Services: 7:01

Some celebrities out there I think we romanticize bipolar disorder a lot and speaking to the BIPOC communities and so forth, you know we romanticize bipolar disorder with celebrities. You know Selena Gomez is very open about her bipolar disorder. Kanye West is very open about his bipolar disorder. But I think there's an element of romanticizing it in social media and in just basically in TV and music and everything too, we romanticize it and then the normal everyday population kind of dismisses it and says things like the comment that you made oh, she's so bipolar, she's so all over the place, the weather is so up and down. Do we really have a true understanding of what bipolar disorder is and what it looks like, and how do we treat it? How do we manage those symptoms? How do we manage the manias? How do we manage the depressions? So that's, that's kind of the summary of what bipolar one looks like yeah, no, I appreciate you sharing that because it is.

Marta Hamilton: 7:53

You know, even in the in the world of therapy and as a clinician myself I'm also an LPC there there can be a lot of. It can be a difficult disorder to diagnose. It can be so, like you mentioned, there could be other things that mimic the symptoms. The age of onset could start early on, but it could look like, you know, let's say it's 16, 18, but it could show up as other interpersonal difficulties. So what does that look like in terms of, like timing of treatment and and like differentiating? And yeah, just for someone who's like, do I have bipolar disorder? I mean, what? What could they look at? Great question.

Enlightenment Therapy Services: 8:34

So the first thing I would say if someone's struggling with an underlying mood disorder is see a clinician, see a therapist, get a proper assessment done because, like you said, the onset of the symptoms can come at 16, but it could look very much different in one person than it does in another person. Um, I work with young adults, children, adolescents, really all populations of different identities that struggle with bipolar disorder and you know it's it's it's tricky because it presents with so many different co-occurring disorders. A lot of the times there's a misconception about BPD. People get BPD and are mislabeled bipolar and so forth. But we know about bipolar. Usually with bipolar disorder it's managed with medication and therapy With borderline and I don't want to get too much into the borderline. There's plenty of education and resources on that because we're focusing on we're bipolar. But so many adolescents and young adults get misdiagnosed with borderline because they have this up and down very intense personalities and sometimes they're mislabeled. Yeah, I.

Marta Hamilton: 9:36

I think bringing up the medication part is so key because, like you mentioned, the first step of being able to go to trained mental health clinician who can navigate and then get treatment options is huge and you mentioned that it could be very manageable. Do you mind sharing a little bit about what you've seen with patients in terms of managing like the road to managing their symptoms and and what you see as like how their life has changed once they're able to?

Enlightenment Therapy Services: 10:07

Absolutely so. Managing bipolar disorder it looks a lot like seeing a therapist consistently and seeing a psychiatrist for medication management. But then we also have concrete tools that we use, things like mood journals where you document how many hours of sleep you're getting a night, assessing if your symptoms on a daily basis. Do you have a little more anxiety today? Do you have a little more depression today? So keeping a nice rigorous mood journal helps the therapist whenever we're working on treating a patient with bipolar disorder, and along with that is the psychiatrist who's going to help with medication management. But really there should be continuity of care between the psychiatrist and the therapist. But to your point, how does the patient evolve with bipolar disorder? So they get the assessment, they get the diagnosis and they're sitting with this. Wow, now what?

Enlightenment Therapy Services: 10:53

It reminds me of my first 16-year-old patient that, diagnosed with bipolar. Her parents kept thinking it was just a mood, she was going through a stage or something. It turns out she was actually struggling with a mood disorder, bipolar one, which is classified in the DSM, as you know, can be considered an SMI diagnosis, a severely mentally ill diagnosis, up there with schizophrenia. But that language can get a little jarring or a little off-putting, Not to say there's anything wrong with any of those diagnoses. Everyone can live a functional, highly functional life. But through this particular patient she was diagnosed and then we did a lot of her discovering herself and looking at patterns of her mood.

Enlightenment Therapy Services: 11:32

What are the triggers? So sleep and stress are the harbingers of bipolar disorder. If you're not getting enough sleep, if you're having a stressful life event, major life changes in your life, college transition, divorce, what have you it's most likely going to prompt? It could prompt a bipolar one mania episode. So she's gone through some manias and she's gone through many different depressions, but what really happened was she got to a space where she's managing it really well. She goes to see her therapist, she takes her medication and she journals, she does mindfulness-based stress reduction techniques. She also does a lot of EMDR because a lot of it is trauma that's rooted at bipolar as well. There's trauma related to it sometimes, and I should say with epigenetics, with bipolar disorder, because since we're talking about it sorry, I get really passionate about about it.

Marta Hamilton: 12:21

No, I love it. I love learning. I'm sitting here with my notebook, so I'm just jotting things down too. Thank you so epigenetics.

Enlightenment Therapy Services: 12:27

bipolar one and bipolar disorders have to be considered under the umbrella term of epigenetics. Which that means is you can have the environment and you can have the genetics. So you may have a pre-genetic disposition to have bipolar, but the environment doesn't induce it. So you may have a pre-genetic disposition to have bipolar but the environment doesn't induce it. Similarly, you may have a trauma, early attachment or a trauma like an unstable upbringing in your childhood, but not have the pre-genetic disposition, and then you then still get bipolar. So it's epigenetic care. It's both facets Okay.

Marta Hamilton: 13:00

No, that's really helpful to know, because something I was curious about too, because you mentioned lifestyle being so important when it comes to sleep, for example, and stress how can someone best support a loved one, for example, who is trying to help them with their sleep and stress especially and maybe this will be part two like if they're in a manic state and they may not realize because of that kind of the grandiose thinking or maybe larger than life, like I'm fine, nothing's wrong, I'm I. Maybe. I've seen sometimes it being turned into the people who are bringing up the attention of you know, maybe there's something going on, it being turned into like they're the problem and not being able to always recognize To your point of being called the identified patient is often what happens when there's a family member that's struggling with the mental health diagnoses and having bipolar one.

Enlightenment Therapy Services: 13:58

Often they're not aware that they're coming, that they're having these symptoms. It feels great to be manic For some people. It feels great until the irritability and the recklessness starts kicking in and that's when it can get dangerous. But if a family member is seeing a loved one struggling with bipolar one or other mood disorders that they need help with, I would say use language that's very empowering, that's soft, remind them of a stage where they were able to get through this same situation before. Try to let the patient kind of express themselves and get their feelings out, because a lot of the times a person just needs to be validated and heard. So while everyone is in crisis mode and trying to fix this patient, sometimes she doesn't need to be fixed. She needs to get through this mood shift in her mood.

Enlightenment Therapy Services: 14:44

And you know I'm thinking of the patient that I have right now that went through a manic episode and she was very resilient. That's the thing about these people that have mental health diagnoses they're extremely resilient. You know her parents and her family men to solution focus mode, trying to get her psychiatrist, her therapist, myself, everyone on board, and we kind of sat back and we said, look, we'll adjust the medication, we'll continue to give her support she needs in therapy. And then she continued to progress, she got better and now she's back to her highly functioning state, which I should note about the highly functioning part Only 30% of people are not able to maintain a work or school.

Enlightenment Therapy Services: 15:23

So while it can get really debilitating, you can also be very highly functioning. So hypomania is highly functioning. You can study for a long time, for hours at a time. You feel goal-oriented, you feel pressured speaking, you feel like again, it's goal oriented. So you are highly functioning at times. So that's also the myth of bipolar. You know we label it as it like it has the stigma to it, but people with bipolar disorder have extreme high creativity because that part of the brain gets overdeveloped, while the other part of the brain, the cognitive part of the brain, you know, the prefrontal cortex, the executive functioning, that kind of stuff goes out the window when they're in a mania. So that's what elicits them to make some reckless decisions or some poor judgment choices.

Marta Hamilton: 16:09

Oh, wow, okay, that makes sense in terms of kind of the judgment aspect and being able to plan out the consequences in that aspect, kind of is that what the medication would help?

Enlightenment Therapy Services: 16:19

with yes, and I should note that medication is only as helpful as the patients taking it as prescribed and taking it every day.

Enlightenment Therapy Services: 16:28

So, in terms of treatment options, medications come in varying degrees either and I'm not a medical of medicine where you can get an injection once a month because patients, when they start getting manic, they feel so good, martha, that they don't want to take their medicine. You have a six year old girl or 20 year old man who feels good, they're getting more things done, they're getting more accomplished, until it starts blurring in that slippery slope where it gets dangerous or at least impairs their judgment and their thinking, and that's when you could. There's treatment options like getting an injection once a month. You go to a clinic and you can get an injection. You can also take psychotropic medications orally in conjunction with therapy. I want to be clear to say that that medication is can treat the symptoms, but therapy is what's going to treat the under rooting coping skills and being able to recognize when triggers are happening and then come into your therapist and planning for those situations.

Marta Hamilton: 17:29

How can loved ones support themselves, educate themselves to help empower their loved ones who have the bipolar diagnoses?

Enlightenment Therapy Services: 17:39

I would say read about it. Schedule family sessions with the patient and their family, Learn more about recognizing the symptoms, educating themselves by reading more about it, talking to the therapist, talking to the providers, but also just learning from the patient itself, from their experiencing what they're experiencing, their triggers, their coping skills, the way they manage it. I think it's important for family members to support their loved ones that are struggling, but also giving them the space to recognize that they have their own coping skills too. Even when they're in a mania, they can sometimes recognize that this is what we need to do at the moment to kind of crisis in our being, and that looks like a lot of like DBT skills. So dialectical behavioral therapy, working on emotional regulation, piece distress tolerance, piece crisis intervention, things like that.

Marta Hamilton: 18:32

You mentioned. You know that age of onset, looking somewhere around 18, and also major life transition, sometimes triggering the mania, something like going to college, and I'm thinking how that really lines up at age 18, going to college as a major life change, maybe graduating college or different moving, I would imagine. So are there any accommodations that a student can request for bipolar disorder and in the university setting? Just with your experience working with universities, Absolutely Great question.

Enlightenment Therapy Services: 19:09

So you know, at every university they all have a mental health counseling department where they can seek. As a student or even an employee at the university, you can access quality care. These are licensed, they have been set, are at your counseling center. If anyone is struggling forget even bipolar If anyone's struggling with just not feeling like they're not feeling like they're there, they're acting like their normal self, see your counselors on campus. They're there to help you and if it's something that needs a specialty to see someone with a more special care, they will refer out to therapists outside of the campus. So, um, a lot of the work I did in my interpersonal stalking, the the mentor advocate position role I did at George Mason when I was a the advocate. There a lot of people were struggling with mental health issues but we're just not getting the access to quality care and I feel like that's I.

Marta Hamilton: 20:01

I almost feel like we need to have another episode to talk about that stopping component, because you worked with the victims of stopping right. Correct, correct.

Enlightenment Therapy Services: 20:10

Yes, yes, yes. I would love to do a follow-up on just that topic as well.

Marta Hamilton: 20:18

Yes, because I think that's an important thing to talk about as well. Just when we think about mental health and wellness and the big picture of holistic wellness and I know your background just looking really holistically at individuals and with therapy, I think I really appreciate you providing that feedback. When it comes to looking at bipolar disorder and ways to get support in college, what about in the workplace? Because you mentioned only about 30%. It affects them where they can't work. What about in these temporary phases? I think because of stigma or maybe misunderstandings people might not want to share. So how do you navigate that?

Enlightenment Therapy Services: 20:57

Yes, so many patients online actually tussle with this idea. What, how do you navigate that? Yes, so many patients online actually tussle with this idea every day. Who do I disclose to there's so much miseducation and misunderstanding about bipolar disorder and this is something I want to disclose in the workplace. It is a documented disability. You can document and receive accommodations for your disability. So I think we need to get away from the shame is the biggest thing is the shame of having any mental health diagnoses. We live in a world where now the younger generations, if I'm okay to say it, are very forward speaking with their mental health awareness. They're very like. Okay, I have my one hour session with my therapist. You know it's becoming more normalized. So I'm hoping we can get that space with other of these mental health conditions like bipolar disorder too, because so many people are needing the help or needing access to quality care and just not getting it because of the stigma. No, you're so right.

Marta Hamilton: 21:51

I've also have noticed that and I've talked with colleagues about the younger generation being able to speak more openly and hopefully they can lead the way and we can learn. Older generations can learn from their examples when it comes to sharing and being open and when it comes to mental health.

Enlightenment Therapy Services: 22:06

Yeah, absolutely, and in the workplace it's really up to the person if they want to disclose their diagnoses. But there's things, people, people. There's like counseling sessions you can receive at work if you feel like you're having a mood disorder shift, and I've had many patients that can get FMLA paperwork or things like that if they need a time off from work. But for the most part there's always access to mental health services. If you utilize it at work, there should be access to mental health services.

Marta Hamilton: 22:39

What about my last question? I know we're coming close on time. I have so many more questions, but when it comes to bipolar disorder and spouses or partners and navigating that we talked a little bit about in the education field or college, and then the workplace, what about in partnerships? Yeah, any insight for us regarding that?

Enlightenment Therapy Services: 23:05

So a lot of the patients that I see in couples counseling where one patient has bipolar and the other person may have a mental health condition or may not and is managing it, typically what we see with the bipolar patient is there's a pursuer and a voider. So what I mean by that is the patient with bipolar disorder tends to often seek validation or acceptance and love from the partner who from their intimate partner, their romantic partner, and then the person who doesn't have the mental health condition often tries to be as supportive but may not have the language or understanding around it. So I would often suggest, like when there's not a crisis, when the patient is not in a mania or not in a significant depression, to talk and normalize what it looks like to have bipolar disorder. What are the symptoms? How can the partner be best supportive? So when these triggers happen, this is the things we can do to kind of manage those triggers, to talk you down from getting too revved up in a mania.

Enlightenment Therapy Services: 24:07

So symptoms that a partner should look for is if they're talking too fast, if they have like a surge of interest in something and they're really goal oriented, if they're sleeping less, if their stress at work is picking up and they started to see some fluctuations in mood. The person, the partner, really needs to be understanding, compassionate and has to be educated on how to help the patient, but also has to know when to pull back the reins and say okay, this is something a mental health provider needs to help you with. I'm not your therapist, I'm not your psychiatrist and we don't want to evolve into a codependent relationship, right? That's another thing that happens right With anyone, not just with pre-existing mental health conditions is recognizing the love and support you can get from your romantic partner or family members and so forth. Recognizing where the coping skills need to come internally, from your internal locus of control.

Marta Hamilton: 25:00

No, absolutely. I'm so appreciative of you sharing just ways that people can advocate for mental health awareness. I think the work that you're doing is amazing and I love that you bring up couples. Therapy is also an option. It's not just an individual treatment for the person with bipolar or mood disorder that it there's always the option for for couples therapy as well, and I'm hopeful that those listening are also touched by this conversation. Just with statistics showing that one in four Americans meet criteria for mental health diagnosis, so surely this impacts someone. If it's not you, it's someone you you know or love and, um, hopefully this helps. This is helpful information. How can people get in touch with you? What's the best way to connect with you?

Enlightenment Therapy Services: 25:50

Thank you so much for asking. So I'm a private practice I own. I'm enlightenment therapy services. Um, my uh phone number and my email address is the best way to contact me. I'm Enlightenment Therapy Services. My phone number and my email address is the best way to contact me. I'm not huge on social media I need to be better at it, but I will start doing more with social media but my phone and email is the best way to contact me and I'm sure we'll put that material out there.

Marta Hamilton: 26:10

Yes, I will make sure it's in the show notes. Absolutely, and something I meant to mention too is that you are licensed in Texas, maryland D to is that you are licensed in Texas, maryland, dc and Virginia so, and you're available through telehealth for clients living in all those areas.

Enlightenment Therapy Services: 26:26

As long as I'm licensed with a patient list, then I can see them through telemedicine visits. That's wonderful.

Marta Hamilton: 26:31

Okay. So yeah, I'll make sure to include that in the in the show notes as well. So yeah, thank you so much for being a part of our wellness journey today. Thank you so much.