Area of focus
Emotion regulation and bipolar disorder
For people who understand perfectly well what they should do, but can't reach it once the emotion arrives — and for those living with mood swings that cut across decisions and relationships.
The first conversation is to understand what you need and see whether working together makes sense. No commitment.
When reason can't reach the emotion
There's a familiar gap between knowing and being able. You know that message didn't deserve the reply you gave. You know the reaction was bigger than the event. You even know what would have been better. And still, in the moment, none of it was available.
That isn't a character flaw or a failure of intelligence. It's emotional dysregulation: the emotion rises fast, arrives high and comes down slowly — and while it's high, the range of available responses narrows. It's a way of functioning, and ways of functioning can be trained.
Dialectical Behaviour Therapy
DBT was developed by Marsha Linehan and combines the structure of CBT with explicit skills training in four groups:
- Mindfulness. Noticing what's happening before you're already reacting.
- Distress tolerance. Getting through the peak of an emotion without making the decision you'll regret an hour later.
- Emotion regulation. Identifying, naming and modulating intensity, and working on vulnerability factors like sleep, food and overload.
- Interpersonal effectiveness. Asking, refusing and holding a position without disappearing or exploding.
The word "dialectical" points to a central idea: two apparently opposite things can be true at once. You can be doing the best you can and need to do something different. Acceptance and change don't cancel each other out.
Bipolar disorder: what psychology contributes
Roles matter here. Diagnosis and medication in bipolar disorder are medical responsibilities. Psychotherapy is complementary care, and works on:
- Psychoeducation about the condition, for you and, where it helps, for those close to you
- Routine and sleep regularity, among the most consistent factors in mood stability
- Early identification of warning signs, with an agreed plan for what to do
- Treatment adherence and the relationship with medication
- Repairing the impact episodes leave on work, finances and relationships
- Grieving the life expectations the diagnosis reorganises — a part that's rarely named
Coordinated care. In bipolar disorder, my work assumes psychiatric follow-up running in parallel. If you don't yet have it, arranging that referral is one of the first things we'll organise.
Is DBT only for borderline personality disorder?
That's the context it was developed in, but DBT skills training has since been studied and applied across a range of situations involving emotional dysregulation, including ADHD and mood disorders. The skills are teachable and don't belong to one diagnosis.
Do you diagnose bipolar disorder?
No. Diagnosing bipolar disorder is a physician's role. What I provide is psychological assessment, psychotherapeutic support, and coordinated work alongside the psychiatrist treating you. If someone arrives with suggestive signs and no medical follow-up, my job is to raise it and refer.
Does psychotherapy replace medication in bipolar disorder?
No. In bipolar disorder, medical treatment led by a psychiatrist is the foundation. Psychotherapy is complementary — psychoeducation, routine and sleep regularity, early identification of warning signs, treatment adherence, and managing the impact on life and relationships.
Please read before booking. Sessions are provided from Brazil by a psychologist registered with the Brazilian Federal Council of Psychology (CRP 03/22210), and are governed by Brazilian professional regulation and law. This is not a licensed health service in any U.S. state or other jurisdiction, and it does not replace care from a provider licensed where you live. Booking a session means agreeing to this arrangement, which is also set out in the service agreement.
Next step
A conversation before you decide
You don't need to arrive with the problem explained, or know the name of what you're feeling. Send a message describing it in your own words, and I'll explain how the work would go from there.
Want a feel for her work first? Follow on Instagram @sabrinasteele.